SARS ( Severe Acute Respiratory

Syndrome)

is a serious ;life threatening viral infection

caused by a previously unrecognized virus
from the coronaviridae family
It was first reported in China in
November 2002, with over 8300
cases and 812 deaths reported by the
beginning of July 2003.
Earliest case: Guangdong Province,
China in November 2002
Global outbreak: March 12, 2003
First case in the Philippines:
April 11, 2003
Particles are irregularly-shaped, ~60-220nm in diameter, with an outer envelope
bearing distinctive, 'club-shaped' peplomers. This 'crown-like' appearance (Latin,
corona) gives the family its name.

Most coronavirus occurs in the epithelial cells

*occasionally, it grows in the liver,kidneys, heart or eyes may
be infected, as well as other cell types such as macrophages.
Mode of transmission
The primary mode of transmission appears to be
direct mucous membrane (eye, nose, and mouth)
Contact with infectious respiratory droplets or
exposure to fomites.
Contamination of inanimate materials or objects by
infectious respiratory secretions or body fluids
(saliva, tears, urine and stools) have been found to
contain the virus.
Virus found in stool of SARS victims
*could live up to 4 days
*virus can live for months and years
when temp is below freezing
~fever greater than 100.4 degrees F
(38.0 degrees C)
~Difficulty in breathing.
~Influenza-like symptoms:
*Muscle aches, Cough, headache,
loss of appetite, malaise, myalgia
~Gastrointestinal symptoms
:Vomiting – 14%, Diarrhea – 27%,
abdominal pain- 13%
Less common symptoms

Dizziness
Productive cough (sputum)
Sore throat
Runny nose
Nausea and vomiting
Diarrhea
Risk Factors
Household contact with a probable
case of SARS.
Increasing age
Presence of co-morbidities
 Chest X-ray
Blood chemistries
          *CRP and CPK are
sometimes elevated.
          *LDH levels are often
elevated.
         
ELISA ( enzyme-linked immunosorbent assay
Immunofluorescence Assay
PCR ( Polymerase Chain Reaction)
Treatment is symptomatic and
supportive and includes maintenance of
a patent airway and adequate nutrition.
Antipyretics
Antiviral drug - Ribavirin
Supplemental oxygen and ventilatory
support.
 Respiratory Failure
Heart Failure

Liver Failure
Consult your doctor promptly if you develop
respiratory symptoms such as fever, joint pain,
dizziness, rigors, cough, sore throat and runny
nose.
Build up good immunity.
Maintain good personal hygiene.
Wear mask if you develop runny nose, sore throat
and cough.
Wear protective mask in public areas, classrooms,
computer rooms, and public transports.
Keep hands clean and wash hands
properly.
Respiratory secretions should be
considered infectious, which means no
sharing of food, drink, or utensils.
minimizing travel to locations where
there is an uncontrolled outbreak
Meningococcal septicemia
Meningococcal blood poisoning;
Meningococcal bacteremia
There may be few symptoms at
first. Some may include:

Anxiety
Fever
Irritability
Spotty red or purple rash (petechiae)
Additional symptoms may
include:

Headache
Muscle and joint pain
Nausea
Vomiting
Later symptoms may include:

Changing level of consciousness

Ill appearance
Large areas of bleeding under the skin (
purpura)
Shock
Blood tests will be done to rule out other
infections and help confirm meningococcemia.
Such tests may include:
Blood culture
Complete blood count with differential
Clotting studies (PT, PTT)
Other tests that may be done include:
Lumbar puncture to obtain spinal fluid sample for
CSF culture
Skin biopsy and gram stain
Urinalysis
Treatments may include:

Antibiotics given through a vein (IV)

Breathing support
Clotting factors or platelet replacement -- if
bleeding disorders develop
Fluids through a vein (IV)
Medications to treat blood pressure problems
Wound care for areas of skin with blood clots
The condition is most life threatening in
those who have:

Disseminated intravascular coagulopathy

(DIC)
Kidney failure
Profound shock
Arthritis
Blood clotting that leads to the loss of the arms
or legs
Disseminated intravascular coagulopathy (DIC)
Inflammation of blood vessels in the skin
(cutaneous vasculitis)
Irreversible shock
Pericarditis
Profound shock
Severe damage to adrenal glands that can lead
to low blood pressure
Influenza A(H1N1) virus was
previously known as swine flu.
Because most of the scientist
thought that it came from infected
pigs. Influenza A(H1N1) is caused
by a novel virus that resulted from
the reassortment of 4 viruses from
pigs, human and birds
Influenza A virus strains are
categorized according to two proteins
found on the surface of the virus:
hemagglutinin (H) and neuraminidase
(N). All influenza A viruses contain
hemagglutinin and neuraminidase.
Signs and Symptoms:

Fever
Cough
Headache
Muscle pain
Joint pain
Sore throat
Runny nose
Vomiting (sometimes)
Diarrhea (sometimes)
Mode of Transmission:
The virus is spread from
person-to-person
Can be passed to other
people by exposure to
infected droplets
expelled by coughing or
sneezing that can be
inhaled, or that can
contaminate hands or
surfaces.
Influenza A (H1N1) is
not transmitted by
eating thoroughly
cooked pork
Medications:

Oseltamivirr or zanamivir are the

recommended drugs to treat and
or prevent infection with this
virus
How can we prevent the spread of the
virus?

1. Observe proper personal hygiene:

Cover  your  nose and mouth when
coughing or  sneezing
Wash hands regularly with soap and water,
at least for 20 seconds (or use alcohol-
based hand sanitizers) especially after
handling patients and specimen, before and
after eating, after using the toilet and as
necessary.
Avoid touching your eyes, nose or mouth.
Germs spread this way.
2.  Increase your body’s resistance
• Have at least  8 hours of  sleep
• Be physically active
• Manage your stress
• Drink plenty of fluids
• Eat  nutritious food, especially fruits
and vegetables
3. Social distancing.
• Avoid crowded places.
• Avoid close contact with sick
people.
• Stay home if you are sick until
you are free from symptoms to
prevent the spread of the virus.
High risk for complications

Pregnant women
Children less than 5 years old 
Persons aged 65 or older (the risk of
infection in this group appears to be lower
than for other age-groups, but once
people of this age become ill they are at
increased risk of complications)
Children and adolescents (age 6 months
to 18 years) who are receiving long-term
aspirin therapy and who might be at risk
for experiencing Reye syndrome after
influenza virus infection
 Anthrax is an infection caused by
BACILLUS ANTHRACIS that occurs
primarily in herbivores.
Aerosolized spores of B.
ANTHRACIS have the potential for
use in biological warfare or
bioterrorism.
Human cases are classified as:

Agricultural Cases
Industrial Cases
Mode of transmission

Direct transmission
Indirect Transmission
Airborne Transmission
 Cutaneous Anthrax

The incubation period ranges from

nine hours to two weeks (2-7 days).
Two to three days after the entrance
of the microorganism, a small papule
or macule appears.
On the 4th day a ring of vesicles
develops around the papule. Vesicular
fluid may exude.
Marked edema starts to develop.
Unless there is secondary
infection, there is no pus and the
lesion is not painful, although
painful lymph adenitis may
occur in the inguinal area.
On the 5th to 7th day, the original
papules ulcerate to form the
characteristics eschar.
Edema extends to some distance
from the lesion.
Clinical symptoms maybe severe
if the lesion is located in the
face, neck or chest.
In more severe forms, clinical
findings are high fever, toxemia,
regional painful
lymphadenopathy, and
extensive edema. Shock and
death may also ensue.
 Inhalational Anthrax
Presenting symptoms resemble those of
severe viral respiratory diseases.
After one to three days of acute phase,
increasing fever, dyspnea, stridor, hypoxia
and hypotension occur usually leading to
death within 24 hours.
Clinical findings showed that the organisms
are directly deposited into the alveoli or into
the alveolar duct producing hemorrhagic
necrosis of the nodes associated with
hemorrhagic mediastinitis.
Gastrointestinal Anthrax

Results from ingestion of

inadequately-cooked meat
from animals with anthrax.
Primary infection is initiated in the
intestines where lesions are formed
accompanied by hemorrhagic
lymphadenitis.
Symptoms include fever, nausea,
vomiting, abdominal pain, bloody
diarrhea, and sometimes rapidly
developing ascitis.
Approximately 95 percent of human
cases of anthrax are the cutaneous
form and five percent are
inhalational form. Gastrointestinal
anthrax is very rare. B. anthracis
bacteremia occurs in almost all cases
of anthrax and progresses to fatal
outcome.
Parenteral Penicillin G – 2 million
units every six hours, until edema
subsides with subsequent
administration of oral penicillin to
complete seven to ten-day-course.
Patients who are sensitive to penicillin
can be treated with erythromycin,
tetracycline, or chloramphenicol.
 Careful history taking
Thorough physical
examination
Skin care, psychological and
emotional support.