Infections: Prevention and Current Treatments

Summer 2007 CSANews Issue 63  |  Posted date : Aug 07, 2007.Back to list

Last week, my new grandson had to be admitted to the hospital with a serious infection. He’s only four weeks old and was premature – still under six pounds. Infections, including colds, ear infections, bronchitis and flu, seem routine with children and adults, but in infants and the elderly, immune systems are weaker and contracting an infection can be a serious matter. Although cancer and heart and vascular disease are more prevalent as we age, we are also at increased risk for certain infections. This article provides you with important information about how you can reduce that risk, as well as some tips on early intervention to treat them.

Malaria and HIV are the world leaders in serious infections. In Africa, where malaria and HIV thrive, it is estimated that there are more than a million people who die from malaria each year and most of these are children under the age of five. HIV has accounted for millions of deaths. It is estimated that there are more than 50,000 people living with HIV infection in Canada. Fortunately, most of us are not at risk for these serious infections.

The Importance of Immunization
Living in North America, where immunization and public health measures have largely controlled these major infections, we are still exposed to organisms which can cause serious disease or death. Many are preventable and through judicious decisions, we can reduce the likelihood of contracting many of these conditions. After years of mass immunization, childhood infections such as measles, mumps, chicken pox, rubella (German measles) and polio have been minimized. Nevertheless, as has been evidenced by the recent outbreaks of mumps, constant maintenance of immunization is important in reducing the risk of major epidemics. As adults, the major immunizations requiring our attention are the annual flu shot, as well as our booster for polio and tetanus about every 10 years. For those with impaired immune systems or lung function such as COPD and emphysema, particular immunization against pneumococcus, hepatitis and other organisms may be indicated. It is recommended that all those over the age of 65 receive annual immunization for influenza. Older adults, especially those with other medical conditions such as lung disease and diabetes, are more susceptible to complications and simple flu can become a life-threatening condition. In addition, getting this annual protection helps us reduce the risks of prevalence and spread of the infection to others.

Preventing the Common Cold
The common cold, although usually not a serious threat to our health, can often be prevented through simple hygiene measures. The virus is usually spread through close contact with an infected person, either by inhaling droplets from a sneeze or cough, or touching, such as in shaking hands. The SARS outbreak taught us about the importance of washing our hands frequently and using alcohol-based products to help sterilize our hands. Hospitals still encourage this practice for all visitors who enter the hospital, as well as frequent use by hospital staff. We should all purchase and use one of these recommended products daily. Separate hand towels and utensils and dishes are recommended. Treatment of the common cold for most of us includes rest, taking plenty of fluids and keeping our rooms humidified in the winter, along with using over-the-counter cold preparations to alleviate our symptoms. Those with certain underlying conditions such as asthma, lung disease, immuno-suppressed individuals, patients with heart valve abnormalities and diabetics should seek early medical advice, and many will be placed on antibiotics to prevent secondary bacterial infections.

The Threat of Pandemics
From time to time, the threat of a pandemic arises. History has shown that sometimes, a more potent and pervasive infectious epidemic occurs across a large region or worldwide and recently, there has been much speculation that we are imminently due for another outbreak. The pandemic of 1918-19, the Spanish Flu, resulted in the deaths of more than 40 million individuals worldwide. Children and young adults were especially vulnerable. In our lifetime, there was the Asian Flu of 1957-58 and the Hong Kong Flu of 1968-69. Then in 2003, the rapid spread of the SARS organism appeared to be a new pandemic until effectively brought under control by extensive public health measures worldwide. In each case, there was no prediction as to the timing or intensity of such an outbreak and no immunization was available. Most experts predict that another pandemic is bound to happen. When and to what extent is unknown. The current Avian Flu affecting poultry has been contracted directly by some individuals who have had close contact with infected birds and more than half of the reported cases (mainly in the Middle East) have died; however, the virus has not yet changed or mutated, allowing for easy spread among humans. Governments and public health agencies here and abroad are developing strategy plans to minimize the risk and spread, including public education, stockpiling of Tamiflu – one of the only drugs known to have some effect in reducing severity – and escalated research into the development of vaccines. For our part, our main objective will be to severely restrict our contact with other individuals during the course of such an outbreak and to take special precautions such as masks and skin hygiene when it is necessary to be in public.

The Flu
Influenza occurs to varying degrees each winter. A flu shot each fall usually protects us from getting the illness altogether, or at least decreases the infection's intensity and duration. This illness is usually characterized by sore throat, congestion, fever, aching and cough and may last for more than a few days. Unless there are pre-existing conditions, treatment is usually symptomatic, as with a cold; however, if symptoms persist or worsen – especially with fever and chest congestion – antibiotics and even hospitalization may be necessary.

Pneumonia often begins with an upper respiratory infection such as a cold or influenza. In individuals with certain health conditions, especially pre-existing lung conditions, there are certain organisms such as pneumococcus for which there are now immunizations. Ask your doctor if you should receive this added protection. Otherwise, serious cases of pneumonia are usually treated in hospital and often require intravenous antibiotic.

Skin Infections
Skin infections, although usually mild and treated with topical antibiotic, are occasionally serious and life-threatening and may require urgent and aggressive hospital treatment. Diabetics in particular are always advised to pay close attention to skin hygiene as infections are more likely to occur, especially on the lower limbs and feet. Treatment must be early and aggressive in order to reduce the risk of complications. We’ve all heard of the serious condition called “flesh-eating disease.” This condition, medically termed necrotizing fasciitis, is caused by a bacterium – streptococcus group A. Characterized by the sudden development of a reddened area of skin associated with discomfort and tenderness, the infection requires emergency care which usually involves immediate surgery and intravenous antibiotic. With early diagnosis and treatment, the condition is curable. If intervention is delayed, a limb may be lost or death can ensue. Any such symptoms and signs must be seen by a physician immediately!

Hospital-acquired Infections
Hospital-acquired infections present an increasing threat to our health. As many as one-third of hospital patients may be on antibiotics at any one time, making them more vulnerable to certain organisms. Bacteria are becoming more resistant to antibiotics and certain organisms have begun to thrive, especially within the hospital setting. These threats to one’s health are exposed to many individuals who are ill, elderly and institutionalized, putting them at greater risk. We have all read about the outbreak of one of these conditions, initially in certain Quebec hospitals but increasingly prevalent in Ontario and other provinces. C. difficile (clostridium difficile) is an opportunistic bacterium which causes severe diarrhea and damage to the intestinal lining in such persons and can often be fatal. Treatment is often ineffective and symptoms can be long-lasting and severe, especially in weakened and elderly patients. Hospitals are increasing their infection controls and patients are being discharged as quickly as possible in order to reduce the risk of contracting this infection.

The other hospital infection threat is an organism called MRSA (methacillin resistant staphylococcus aureus). This bacterium is resistant to most of the current antibiotics and accordingly, poses a serious threat to those who contract it. Again, seriously ill hospitalized patients are most vulnerable, however, recent spread to the community has been documented. Management of the condition and efforts to reduce the incidence are much the same as with c. difficile. For our part, living a healthy lifestyle and avoiding any unnecessary hospitalization are all that we can do.

Shingles (herpes zoster) is an eruption of blisters on the skin on one side of the body only, caused by the same virus that causes chicken pox. The initial symptoms include tingling or burning in one particular area of the body, most often the trunk. After a few days to a week, blisters – similar in appearance to chicken pox – appear in the affected area. Pain, itching and extreme sensitivity of the area is common. The earlier the diagnosis, the more likely the infection can be effectively treated with certain antiviral drugs, which may reduce the symptoms and lessen the course of the infection. See your doctor early if you suspect this infection, especially if you had chicken pox as a child. Shingles is not normally contagious, except to a child who has never had chicken pox or been immunized. A serious and debilitating complication is a neuralgia pain that can persist in the area of the affected nerve root for years.

Infections and pandemics have posed a major risk to mankind throughout the ages. Many precautions, immunization programs and drug therapies have now eradicated these threats. Nevertheless, new and previously unknown organisms will appear. There are important measures that we can all take to avoid many of them. Keep abreast of preventive measures and seek medical attention early if you suspect an infection.