hiv, hepatitis, and other blood-borne pathogens

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CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 34 HIV, Hepatitis, and Other Blood-Borne Pathogens

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34. HIV, Hepatitis, and Other Blood-Borne Pathogens. Learning Outcomes. 34.1Describe ways in which blood-borne pathogens can be transmitted. 34.2Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection. - PowerPoint PPT Presentation

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Page 1: HIV, Hepatitis, and Other Blood-Borne Pathogens

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

34HIV, Hepatitis, and Other Blood-Borne

Pathogens

Page 2: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-2

Learning Outcomes

34.1 Describe ways in which blood-borne pathogens can be transmitted.

34.2 Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection.

34.3 Describe the symptoms of hepatitis and AIDS.

34.4 List and describe the blood tests used to diagnose HIV infection.

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34-3

Learning Outcomes (cont.)

34.5 Identify chronic disorders often found in patients who have AIDS.

34.6 Compare and contrast drugs used to treat AIDS/HIV infection.

34.7 Describe the symptoms of infection by other common blood-borne pathogens.

Page 4: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-4

Learning Outcomes (cont.)

34.8 Describe the steps involved in reporting a communicable disease.

34.9 Explain how to educate patients about minimizing the risks of transmitting blood-borne infections to others.

34.10Describe special issues you may encounter when dealing with patients who have terminal illnesses.

Page 5: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-5

Introduction • Chapter 34 expands on OSHA Blood-

Borne Pathogen Standard– How to reduce your risk of exposure

• HIV, hepatitis, and other blood-borne infections – Reporting guidelines– Educating patients

• Issues associated with terminal illnesses such as AIDS

Page 6: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Transmission of Blood-Borne Pathogens

• Blood-borne pathogens are disease-causing microorganisms carried in the host’s blood.

• Transmission occurs from one host to another through contact with infected – Blood – Tissue – Body fluids – Mucous membranes

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34-7

Transmission (cont.)

– Cerebrospinal fluid

– Synovial fluid

– Pleural fluid

– Peritoneal fluid

– Pericardial fluid

– Amniotic fluid

Identified by the Centers for Disease Control and Prevention (CDC)

Transmission agents for blood-borne diseases Blood Blood products Human tissue Semen Vaginal secretions Saliva from dental

procedures

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34-8

Transmission (cont.)

• Transmission agent only if there is visible blood

– Feces

– Nasal secretions

– Perspiration

– Sputum

– Tears

– Urine

– Vomitus

– Saliva

Page 9: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-9

Transmission (cont.)

• Blood-borne pathogens may be introduced into a new host by– Needlesticks – Cuts or abrasions– Any body opening– Transfusion of infected

blood

Page 10: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-10

People at Increased Risk

• Anyone who comes in contact with substances that may harbor the pathogens– Health-care professionals– Law enforcement officers– Mortuary or morgue attendants– Firefighters– Medical equipment service technicians– Barbers and cosmetologists

Page 11: HIV, Hepatitis, and Other Blood-Borne Pathogens

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People at Increased Risk (cont.)

• Pathogens– Hepatitis B virus (HBV)

– Hepatitis C virus (HCV)

– HIV AIDS

Page 12: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Research

• Incidence of many infectious diseases– Reported to state health

departments

• Information then sent to CDC– Trends in spread – Identify control tactics– Allocate resources

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Apply Your Knowledge

ANSWER: Transmission occurs from one host to another through contact with infected blood, tissue, body fluids, and mucous membranes.

How are blood-borne pathogens transmitted from host to host?

Good Answer!

Page 14: HIV, Hepatitis, and Other Blood-Borne Pathogens

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34-14

Universal Precautions

• The most effective means of preventing the spread of HIV, hepatitis, and other blood-borne pathogens is to avoid contamination

• Universal Precautions are required by OSHA

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Universal Precautions

• For medical offices, includes all– Body fluids– Secretions– Excretions– Moist body surfaces

• Assume every patient is contaminated

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Apply Your Knowledge

ANSWER: In medical offices, Universal Precautions apply to body fluids, secretions, excretions, and moist body surfaces. Assume every patient is contaminated and use Universal Precautions with everyone.

In a medical office, to what items do Universal Precautions apply, and with which patients should you practice these precautions?

Right!

Page 17: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Disease Profiles

• Keep up-to-date so you can

– Identify symptoms that may indicate that a patient has a blood-borne disease

– Identify habits of your patients that increase risk of spreading the disease

– Educate patients to limit risks of contracting disease

Page 18: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Hepatitis

• Viral infection of the liver that can lead to cirrhosis and death

– Hepatitis A – spread by fecal-oral route

– Hepatitis B – blood-borne disease that spreads by contact with contaminated blood or body fluids or sexual contact

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Hepatitis (cont.)

– Hepatitis C (non-A/non-B)• Spread through contact with contaminated

blood or body fluids and sexual contact• No cure • Many people are carriers• Flu-like symptoms, if any • Damages liver; causing cirrhosis, liver

failure, and cancer

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Hepatitis (cont.)

– Hepatitis D (delta agent hepatitis)• Occurs only in people that are infected with HBV • May mimic symptoms of hepatitis B, but more

severe• Associated with liver cancer

– Hepatitis E • Caused by hepatitis E virus (HEV)• Transmitted by fecal – oral route

Page 21: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Hepatitis (cont.)

• Risk factors – same for HBV and HCV

– Occupation that requires exposure to blood and body fluids

– High-risk sexual activity

– IV drug use

– Hemophilia

– Travel to areas with high incidence

– Blood transfusions prior to screen

– Hemodialysis

– Living with partner with hepatitis B or hepatitis C

– Multiple sexual partners

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Hepatitis (cont.)

• Risk in medical community– HIV

• Approximately 0.5% from a single needlestick

– Hepatitis B • 6% to 33% from single needlestick

The primary risk factor for HBV and HCV infection is occupational exposure to the virus.

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Hepatitis (cont.)

• Infection progression– Acute illness lasts about 16 weeks

– Prodromal stage – general malaise, maybe nausea or vomiting, or no symptoms

– Icteric, or jaundice, stage – yellowing of the skin, eyes, and mucous membranes

• Appears 5 – 10 days after initial infection

– Convalescent (after acute stages) – can last 2 to 3 weeks

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Hepatitis (cont.)

• Symptoms– Jaundice– Decreased appetite– Fatigue– Nausea and vomiting– Joint pain/tenderness– Stomach pain– General malaise

• Diagnosis– Investigation of

• Risk factors

• Exposure incidents

– Blood tests• Antigen-antibody

systems

• Determine stage of disease

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34-25

Hepatitis (cont.)

• Preventive measures– Avoid contact with contaminated substances

– Use Universal Precautions with all patients

– Vaccination is available to prevent HBV infections

• Will not protect you from other strains of hepatitis• CDC recommends routine vaccination for

everyone

– HBIG for postexposure inoculation

Page 26: HIV, Hepatitis, and Other Blood-Borne Pathogens

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AIDS/HIV Infection

• Virus that infects and destroys components of the immune system

• HIV infection develops into AIDS

• Pathogen destroys – Helper T cells – white blood cells that are a

key component of immune system– Neurons, causing demyelination

• Patients develop opportunistic infections

Page 27: HIV, Hepatitis, and Other Blood-Borne Pathogens

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AIDS/HIV Infection (cont.)

• Risk factors

– Unprotected sexual activity

– Sharing needles used by IV drug users

– Passes from mother to fetus during pregnancy or to infant during delivery or breastfeeding

• Incubation period of 8 to 15 years

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AIDS/HIV Infection (cont.)

• Risk in medical community– Percutaneous exposure – exposure through

a puncture wound or needlestick

– Mucocutaneous exposure – exposure through a mucous membrane

Page 29: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Progression of AIDS/HIV

• Three main stages

• Initial infection – Can occur years before symptoms appear– Virus enters cell and makes copies– Helper T cells die– Immune system responds

• Cleans the blood supply of the virus• Virus enters an inactive phase

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Progression of AIDS/HIV (cont.)

• Incubation period– Virus genetic material incorporated into the

genetic material of the helper T cells– HIV becomes active again and continues to

attack and kill helper T cells

– Virus trapped in lymph system

– As helper T cells decrease, patients are more prone to opportunistic infections

– Incubation period can be 8 to 15 years

Page 31: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Progression of AIDS/HIV (cont.)

• Full-blown AIDS

– 200 or fewer helper T cells/mL blood indicates full-blown AIDS

– Opportunistic infections and neurological deterioration

Page 32: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Diagnosis of AIDS/HIV• Enzyme-linked immunosorbent assay (ELISA)

– Confirms presence of antibodies in response to HIV– 85% accurate – cross-reactivity with other viruses

• Western Blot Test or immunofluorescent antibody (IFA) – Confirms positive ELISA test – Specific to individual viruses

• Accurate diagnosis – ELISA plus one of the other two

• Home tests available – may give false results

Page 33: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Symptoms of AIDS/HIV

• Systemic

• Respiratory

• Oral – hairy leukoplakia

• Gastrointestinal

• Peripheral nervous system

• Skin-related

• Kaposi’s sarcoma

Page 34: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Prevention of AIDS/HIV

• Sexual contact– Use protection – Avoid multiple partners– Use condoms correctly

• IV drug users– Avoid sharing or

reusing needles

• Medical procedures– Universal Precautions– Wash hands

• Education– Dangers of HIV/AIDS– How HIV/AIDS is

spread and not spread– Preventive measures

Page 35: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Apply Your Knowledge

Which statements are true and which are false?

____ Risk factors are the same for HBV and HCV.

___ Hepatitis A is spread via contaminated blood or body fluids.

____ Helper T cells are red blood cells and are a key component of immune system.

____ Percutaneous exposure occurs through a puncture wound or needlestick.

ANSWER:

F

T

T

FHepatitis A is spread by the fecal-oral route.

Helper T cells are white blood cells.

Right!

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Patient Profile

• No one is immune to AIDS• 2005: 40.3 million men, women, and children

were HIV-infected worldwide.• People infected

– Homosexual males (rate decreasing)– Young people in large metropolitan areas– IV drug users– Women

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Chronic Disorders of the AIDS Patient

• Impaired immune system permits opportunistic infections– Pneumocystis carinii pneumonia

• Protozoal infection• Occurs in 75% of AIDS patients

– Kaposi’s sarcoma• Aggressive malignancy

– Non-Hodgkin’s lymphoma• Second most common malignancy associated with

HIV infection

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Chronic Disorders (cont.)

– Tuberculosis• Often drug-resistant • Mantoux skin test often negative in AIDS patients

– Anergic reaction – no response to any substances injected as a skin test

– Mycobacterium avium complex (MAC) infections

• 97% of nontuberculous bacterial infections

– Meningitis• Can lead to AIDS dementia complex

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Chronic Disorders (cont.)

– Candidiasis • Oral – thrush• Vaginal – females

– Herpes simplex • Infections caused by HSV can be mild to life-threatening

– Herpes zoster• Virus that causes chickenpox becomes dormant• Returns as herpes zoster, or shingles• Lesions last longer in immunocompromised patients –

patients with impaired or weakened immune systems

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Treating Opportunistic Infections

• Drug side effects problematic

• Patients develop– Allergies to treatment – Intolerance to medications

• Pathogens become resistant to treatments

• Treatments may conflict with other treatments

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Testing Regulations

• CDC does not require mandatory HIV testing for health-care workers

• Health-care workers’ chances of being infected by a patient are greater than a patient being infected by a health-care worker

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Drug Treatments

• Drugs– Slow reproduction of

virus, no current cure – List of FDA approved

drugs – Table 21-2

• Treatment goals– Increase the time

between infection and symptomatic disease

– Improve quality of life– Reduce transmission

• To uninfected• Maternal-infant

– Reduce HIV-related deaths

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Drug Treatments (cont.)

• Treatment guidelines– Panel of Clinical Practices for Treatment of

HIV Infections• Initial and follow-up testing• Drug resistance testing• HAART – combination of drug treatment

• Initiating therapy– Decision made by patient and physician– AIDS diagnosis or CD4 T cell count is <

200cells/mm3

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Drug Treatments (cont.)

• Delayed treatment– Benefits

• Postponement of drug-related adverse affects• Delayed development of drug resistance• Preserving treatment options

– Risks• Irreversible immune system damage• Increased risk of transmission of disease

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Drug Treatments (cont.)

• Early treatment– Benefits

• Suppression of viral replication (preserves immune function)

• Reduction in chance of transmission

• Helps patient live symptom-free longer

– Disadvantages• Drug toxicity

• Drug resistance

• Adverse effects on quality of life

• Loss of treatment options

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Drug Treatments (cont.)

• Treating complications– Must also treat

opportunistic infections– Patients more prone to

• Bacterial infections• Protozoal infections• Viral infections• Fungal infections• Malignancies

• Continuing research– Global issue– Keep informed of new

treatments and prevention methods

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Apply Your Knowledge

Identify where these opportunistic infections affect the body.

1. Herpes simplex

2. Pneumocystis carinii

3. Kaposi’s sarcoma

4. Tuberculosis

5. Meningitis

6. Oral candidiasis

ANSWER:

mouth, lips, genitalia

lungs

arms, legs, chest, neck, face, conjunctiva, palate

lungs

brain

mouth, tongue

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Other Blood-Borne Infections• Cytomegalovirus

– Antibodies found in 80% of adults

• Erythema infectiosum– Parvovirus B19– Fifth disease

• Human T-cell lymphotropic virus– HTLV-1– Appears in IV drug users,

among others

• Listeriosis– Caused by bacteria Listeria

monocytogenes– Fever, shock, rash, and

aches

All are problematic for people with impaired immune systems.

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Other Blood-Borne Infections (cont.)

• Malaria– Parasite enters

bloodstream through mosquito’s bite

– Cyclical symptoms

• Syphilis– Caused by spirochete

Treponema pallidum– Three stages– Difficult to identify and

treat in HIV-positive persons

• Toxoplasmosis– Caused by

Toxoplasma gondii in cat feces

Page 50: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Apply Your Knowledge

Which blood-borne pathogen is found in 80% of adults and rarely causes noticeable symptoms?

ANSWER: Cytomegalovirus (CMV)

Good Job!

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Reporting Guidelines

• Requirements for reporting HIV infections and AIDS determined by state

• Follow state and employer’s guidelines for reporting

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Reporting Guidelines (cont.)

• State health department report forms– Different for each disease– Information needed

• Disease identification• Patient identification• Infection history• Information about reporting institution

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Apply Your Knowledge

ANSWER: Information needed includes: Disease identification Patient identification Infection history Information about reporting institution

What information is generally needed when making a report of an infectious disease?

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Patient Education

• An effective means of

preventing disease transmission

• Assess the patient’s understanding of the risk for infection

• Provide information about preventions and treatments

Page 55: HIV, Hepatitis, and Other Blood-Borne Pathogens

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Patient Education (cont.)

• Clinical drug trials– Recognized research protocols designed to

• Evaluate the efficacy or safety of drugs• Produce scientifically valid results

– Information on trials available from www.ClinicalTrial.gov

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Patients with Special Concerns

• Teenagers– Dangers of HIV and AIDS

– Establish trust and provide facts

• Patients about to be discharged– Patient must understand the importance of

• Returning for follow-up

• Reporting any adverse reactions

• Watching for signs and symptoms that need to be reported

• Multicultural concerns– High-risk groups based on CDC reports

– Written information available in appropriate language

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Apply Your Knowledge

What guidance could you give a patient with AIDS or hepatitis who requests more information about the disease?

ANSWER: Suggest that the patient contact government agencies such as the CDC or the Consumer Information Center by mail or on the Internet. In addition, there may be local support groups and resource organizations available in your area.

Impressive!

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Special Issues with Terminal Illness

• Terminal – fatal • Reactions will vary• Help by

– Supporting and accepting patient regardless of reaction

– Encouraging patient to express feelings– Communicating respect through nonverbal

communication– Meeting reasonable needs and demands– Providing referrals to hospices

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Apply Your Knowledge

Mr. Andrews recently learned his HIV status has progressed to AIDS. When he comes into the office for an appointment, his mood swings from anger to crying. What should you do to help him?

ANSWER: You should show support and acceptance of Mr. Andrews regardless of his reactions, encourage him to express feelings, and show respect for him. If his demands are reasonable, attempt to meet them. At this time, you should not refer him to a hospice because there may still be treatment options available.

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In Summary34.1 Blood-borne pathogens can be transmitted by

exposure to blood and body fluids, including blood products, human tissue, semen, vaginal secretions, saliva from dental procedures, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid.

34.2 Strict adherence to Universal Precautions by treating all individuals as if they are potentially infected with blood-borne pathogens is essential in preventing the spread of infection. Protecting oneself from exposure through the use of appropriate personal protective equipment is the best way to prevent the spread of infection.

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In Summary (cont.)

34.3 The general symptoms of hepatitis include jaundice, diminished appetite, fatigue, nausea, vomiting, joint pain or tenderness, stomach pain, and general malaise. The initial symptoms of AIDS are usually severe flu-like symptoms followed later by systemic (weight loss, fatigue, night sweats), respiratory, oral, gastrointestinal, nervous system, and skin complaints.

34.4 The tests used to diagnose HIV infection include the Rapid test, enzyme-linked immunosorbent assay (ELISA) test, Western blot, and immunofluorescent antibody (IFA) test.

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In Summary (cont.)

34.5 AIDS/HIV patients develop chronic disorders including Pneumocystis carinii pneumonia (PCP), Kaposi’s sarcoma, non-Hodgkin’s lymphoma (NHL), tuberculosis, Mycobacterium avium complex (MAC), meningitis, oral and vaginal candidiasis, herpes simplex, and herpes zoster.

34.6 FDA-approved pharmaceutical agents used in the treatment of HIV/AIDS are divided into four classes; fusion inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs).

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In Summary (cont.)

34.7 Several other common blood-borne pathogens are of importance especially to patients who are immunocompromised. It is important that the medical assistant be able to recognize the symptoms of these infections, which include cytomegalovirus (CMV), erythema infectiosum (fifth disease), human T-cell lymphotrophic virus (HTLV-1), listeriosis, malaria, syphilis, and toxoplasmosis.

34.8 The steps involved in reporting a communicable disease include obtaining the correct form, filling in the appropriate blanks on the form, and submitting the form to the physician prior to mailing it to the appropriate agency.

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In Summary (cont.)

34.9 Medical assistants can assess patients’ understanding of their risk for infection, the measures patients must take to eradicate an infection, the potential dangers posed by treatments, and the methods for controlling an infection’s spread.

34.10Patients will have a variety of reactions to the news that they are dying. Some become angry, some will deny that they are dying, and some will get depressed.

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Thought is an infection. In the case of certain thoughts, it becomes an epidemic.

~ Wallace Stevens

End of Chapter 34