Treat infectious Disease and Immunologic Symptoms



In this lesson several infectious diseases and immunologic symptoms will be reviewed.  The ability to differentiate between reportable and non-reportable diseases/symptoms is essential.  As a soldier medic, you will be expected to assess, treat, and report a given disease, if indicated.  


Review Concepts Associated with Infectious Diseases

Public health principles relative to infectious diseases

(1)        All humans are susceptible to infectious disease

(2)        Individuals display varying susceptibilities to infection

(3)        When dealing with infectious diseases, the soldier medic must consider the needs of the casualty, potential consequence on public health and his own health protection

(4)        The soldier medic should think of the consequences of the patients’ contact with family members, roommates and friends


Infectious agents

(1)        Bacteria- unicellular microorganisms

(2)        Viruses- submicroscopic organism. Able to replicate only in a living cell

(3)        Fungi- spore bearing plants

(4)        Rickettsia- microorganisms, which combine qualities of bacteria and viruses

(5)        Helminths (worms)- various invertebrates, having round or flattened bodies


Terminology of the immune system

(1)        Antibodies- a protein produced by lymphocytes in response to infectious agents

(2)        Antigen- A substance which causes the formation of an antibody

(3)        Epitope- a specific site where an antibody binds.  May be numerous epitopes on one antigen

(4)        Leukocytes- White blood cells

(a)        Five types:

(i)         Lymphocytes

*           T cells - Divide rapidly when exposed to antigen.  May assist in destroying foreign protein

*           B cells - circulate in immature form, activated when exposed to antigen

(ii)        Monocytes

*           Ingest dead or damaged cells via phagocytosis (absorption of foreign bodies in the bloodstream)

*           Provide immunological defenses against infectious organisms

(iii)       Neutrophils

*           Essential for phagocytosis

(iv)       Basophils

*           Increased number during healing phase and inflammation

*           Immediate immune response to external antigens

(v)        Eosinophils

*           Increase numbers in certain diseases, especially infections by helminths and allergies


Host defense mechanisms

(1)        Nonspecific immune system defenses

(a)        Skin

(i)         Effectively bars invading microorganisms

(ii)        Some exceptions occur, as with human papillomavirus (causative agent of warts) which can invade normal skin

            (iii)       Normal dermal flora - alteration of this flora can lead to overgrowth of inherently pathogenic microorganisms

(b)        Respiratory system

(i)         Inhaled microorganisms must penetrate the filter system of the upper airways and tracheobroncial tree

(ii)        Coughing also helps remove organisms

(iii)       Smoking greatly impairs effectiveness

(iv)       These defense mechanisms can be overcome by large numbers of organisms or by compromised effectiveness resulting from air pollutants

(c)        Inflammatory response

(i)         Directs immune system components to injury or infection sites and is manifested by increased blood supply and vascular permeability

(ii)        Microorganisms are engulfed by phagocytic cells in an attempt to contain the infection

(2)        Specific immune system defenses

(a)        Humoral immunity

(i)         Component of the immune system involving antibodies

(ii)        Recognizes antigens associated with microorganisms or foreign substances

(iii)       Recognition is coupled with ability to initiate appropriate actions against these microorganisms or foreign substances

(b)        Cell-mediated immunity

(i)         Phagocytic and/or cytotoxic cells play major role

(ii)        Antibody plays minor role

(iii)       Macrophages and neutrophils important in combating bacteria

(iv)       T cells essential to elimination of virus-infected cells




General Assessment of Suspected Infectious or Communicable Disease

Primary assessment

(1)        Ensure open airway

(2)        Assess breathing

(3)        Assess circulation


Secondary assessment (specific to infectious disease)

(1)        History of present illness

(2)        Past medical history

(a)        Chronic infections, inflammation

(b)        Medications

(c)        Medical and surgical history

 (3)       Detailed history and physical

(a)        Vital signs

(b)        Assess skin

(i)         Temperature

(ii)        Turgor (hydration)

(iii)       Color (jaundice)

(iv)       Abnormal lesions

(c)        Assess Head, Ears, Eyes, Neck, and Throat (HEENT)

(d)        Assess neck

(i)         Lymphadenopathy - localized or generalized enlargement of lymph nodes or lymph vessels

(ii)        Rigidity

(e)        Assess for abnormal breath sounds

(f)         Assess abdomen

(i)         Tenderness

(ii)        Rebound

(iii)       Guarding or organomegaly

(g)        Assess extremities for edema, pain and joint range of motion (ROM)


Assess and Treat Eye, Ear, Nose, Throat, and Respiratory Complaints


Conjunctivitis (pink eye)

(1)        Infection of the membrane lining the eyelids (conjunctiva)

(2)        Signs and Symptoms- may be unilateral or bilateral

(a)        Pruritus

(b)        Burning

(c)        Itching

(d)        Swelling

(e)        Excessive purulent discharge or tearing

(f)         Redness

(3)        Provide medical care

(a)        Perform visual acuity before any treatment is initiated

(b)        Ensure eye is not injured and no foreign body is present

(c)        Administer ophthalmic ointments or solutions for conjunctivitis as ordered by MD/PA

(d)        Use universal precautions gloves), conjunctivitis is very contagious


            Pharyngitis (sore throat)

(1)        The majority of sore throat complaints are viral in origin, not bacterial

(2)        Most common bacteria causing pharyngitis is group A Beta hemolytic streptococcus

(3)        Signs and symptoms

(a)        Often difficult to clinically differentiate between viral and bacterial infections

(b)        Patients with a bacterial (strep) infection may present with:

(i)         Sudden on set of sore throat

(ii)        Painful swallowing

(iii)       Chills and fever

(iv)       Headache, nausea, vomiting and abdominal pain are common associated symptoms

(c)        Physical examination of patients with strep throat reveals

(i)         Foul smelling breath

(ii)        Beefy red throat

(iii)       Tonsillar exudate

(iv)       Enlarged, tender anterior cervical lymph nodes. There is no posterior cervical adenopathy.

(v)        Patient may have petechiae on the palate and strawberry tongue

(d)        Patient with a viral pharyngitis usually present with a more vesicular and petechial pattern on the soft palate and tonsils and no exudate

(e)        Throat culture remains the most effective method for diagnosis

(4)        Provide medical care

(a)        Symptomatic treatment

(i)         Gargling with warm salt water

(ii)        Drinking warm liquids

(iii)       Rest

(iv)       Consider IV hydration in patients who are unable to tolerate oral fluids or who become dehydrated

(b)        Antibiotics

(i)         Drug of choice for strep throat is penicillin. Ampicillin or amoxicillin may also be used.

(ii)        May also consider cephalosporin

(iii)       Erythromycin is drug of choice for patients allergic to penicillin

(iv)       Oral medications usually administered for 10 days even though pain from sore throat may resolve in 24-48 hours

(v)        Refer to MD/PA for appropriate therapy

(c)        Untreated strep throat (group A B – hemolytic streptococcus) is associated with significant sequela in the form of acute rheumatic fever or acute glomerulonephritis. Because of this, early diagnosis and treatment of strep throat is essential.

(d)        Prevent spread

(i)         Handwash

(ii)        Avoid using same utensils or drinking from same container

(iii)       Avoid close contact

(e)        Infectious mononucleosis

(i)         Acute viral infection is primarily caused by an Epstein-Barr virus (EBV).  Infrequent causes are Cytomegalovirus (CMV) and Human Immunodeficiency Virus (HIV)

(ii)        Humans are the sole source, with transmission by close contact.  Incubation period is 3-7 weeks.

(iii)       Assessment findings

*           High fever

*           Swollen lymph glands

*           Sore throat

*           Fatigue

*           Persistent headache

*           Acute phase lasts 1-3 weeks, with complete recovery expected in 6-8 weeks

*           Most serious complication is splenic rupture due to an enlarged spleen, combined with physical activity.  Limited activity during the acute phase is required.  All soldiers must be assessed by an MD/PA for suspected mono cases.

(iv)       Provide care

*           Uncomplicated acute infectious mononucleosis usually only requires supportive therapy

*           Consider Tylenol for fever and pain

*           Warm salt water gargles for sore throat

*           Patient should get ample bed rest.  Isolation is unnecessary because EBV shedding continues after the acute illness

*           Recovery occurs in a few weeks; however, some people take months to regain former level of energy



(1)        Viral infection of the respiratory tract

(2)        Flu vaccine is available annually.  Influenza is self-limited in healthy individuals, but its potentially severe consequences must be stressed to elderly or chronically ill patients to ensure their annual vaccination.

(3)        Assessment findings

(a)        Fever- may be high (up to 103 degrees)- rapid onset and may last 3-5 days

(b)        Cough- usually nonproductive.  If a secondary bacterial infection occurs, cough turns productive with purulent sputum

(c)        Headache

(d)        Muscle aches- may to tender to palpation

(e)        Shortness of breath

(f)         Chills

(g)        Sweating

(h)        Fatigue

(i)         Nausea and vomiting

(j)         Joint stiffness and aches

(k)        Nausea, vomiting

(4)        Provide medical care

(a)        Because influenza is a viral infection, antibiotics are not helpful

(b)        Bed rest

(c)        Provide analgesics for muscles aches

(d)        Provide oral or intravenous fluids

(e)        Symptoms may last 7 - 10 days

(f)         Notify MD/PA if:

(i)         Symptoms increase

(ii)        Fever is present

(iii)       Unable to keep food or fluids down



(1)        Sudden, forceful release of air from the lungs

(a)        Helps clear material

(b)        May produce and expel mucus and/or pus - productive cough

(c)        Minor irritations in throat can start cough reflex though normal mucus is only material expelled - dry cough

(2)        Common causes include:

(a)        Smoking

(b)        Common cold or flu

(c)        Allergies

(d)        Bacterial infection

(e)        Viral infection

(f)         Asthma

(g)        Emphysema

(3)        Assessment Findings

(a)        Shortness of breath requires immediate evaluation.

(b)        Productive or nonproductive cough - Productive may be rusty/blood-streaked,  yellow-green or yellow sputum

(c)        Elevated temperature

(d)        Chest may be clear to auscultation or have abnormal breath sounds (wheezing, rhonchi or crackles)

(4)        Provide medical care

(a)        Increase air humidity, if available

(b)        Inform patient to drink extra fluids

                        (c)        Consider an expectorant to help liquefy secretions

(d)        Consider a decongestant if cough is accompanied by runny nose

(e)        Consider antihistamines if caused by allergy or sinus infection

(f)         Dry tickling coughs can be relieved by lozenges

(5)        Notify MD/PA if:

(a)        Violent cough begins suddenly or high-pitched sound (stridor)

(b)        Produce blood

(c)        Shortness of breath and/or difficulty breathing

(d)        Abnormal breath sounds are heard on auscultation

(e)        Fever or abdominal swelling

(f)         Unintentional weight loss

(g)        Thick, foul-smelling, rusty, or greenish mucous

(h)        Lasts more than 10 days



(1)        Inflammation of lungs caused by an infection           

(2)        Prevention

(a)        Vaccination (flu, pneumovax) may be helpful in preventing some types of pneumonia

(b)        Coughing and deep breathing



(1)        Inflammation of the bronchi

(2)        Prevention

(a)        Early recognition

(b)        Treat small airway disease

(c)        Smoking cessation


Viral Upper Respiratory Infection (Common Cold)

(1)        Contagious viral infection of the upper respiratory tract.  Transmission may occur through air droplets (sneezing) or lack of handwashing

(2)        Assessment Findings (usually minimal)

(a)        Runny nose

(b)        Nasal congestion

(c)        Sneezing

(d)        Sore throat

(e)        Cough

(f)         Muscle aches

(g)        Headache

(h)        Low grade fever (100 F or lower)

(3)        Provide medical care

(a)        Consider antihistamine and/or decongestant for nasal congestion

(b)        Consider Tylenol for minor aches and pains

(c)        Patient should get able bed rest

(d)        Instruct patient to drink plenty of fluids

(e)        Patient should return to MTF if:

(i)         Develop temperature greater than 101F

(ii)        Develop a productive cough

(iii)       Symptoms do not begin to improve within the next 2-3 days


Assess and Treat Gastrointestinal (GI) Complaints

(1)        Nausea is the sensation leading to the urge to vomit

(2)        Vomit is to force the contents of the stomach up through the esophagus and out of the mouth

(3)        A common cause is a viral infection.  Assessment findings include:

(a)        Presence of absence of abdominal pain

(b)        Description of emesis

(c)        Fever

(4)        Provide care

(a)        Instruct patient to drink clear fluids for 24 hours.  Solids should be increased as tolerated.

(b)        Patient should get bed rest

(c)        Instruct patient to return to MTF if:

(i)         Blood is in vomitus

(ii)        Increasing abdominal pain

(iii)       Nausea/vomiting persists for greater than 24 hours



(1)        Frequent passage of unformed, watery stool

(2)        Infectious diarrheal disease can be grouped:

(a)        Viruses

(b)        Bacteria

(c)        Parasites

(d)        Funguses

(3)        Assessment findings include:

(a)        Abdominal cramps

(b)        Fever

(4)        Provide care

(a)        Observe good hygiene.  Wash hands frequently.     

(b)        Consider Imodium (only if non bloody) or Pepto-Bismol

(i)         May be given to the patient for the symptomatic control of diarrhea

(ii)        Best treatment is NOT to interfere with the mechanical cleansing of the GI tract

(c)        If diarrhea is not controlled in 24-48 hours with normal medications, refer patient to MD/PA for assessment



(1)        Inflammation of stomach and intestines due to bacterial or viral infection

(2)        Modes of transmission

(a)        Fecal-oral

(b)        Ingestion of infected food or non-potable water

(3)        Susceptibility and resistance

(a)        Travelers into endemic areas are more susceptible

(b)        Populations in disaster areas, where water supplies are contaminated, are susceptible

(c)        Native populations in endemic areas are generally resistant

(4)        Assessment findings include:

(a)        Nausea/Vomiting

(b)        Diarrhea

(c)        Fever

(d)        Abdominal pain and cramping

(e)        Diarrhea

(f)         Heartburn

(5)        Provide care

(a)        Antibiotic therapy is usually not indicated

(b)        Consider antidiarrheal medications, though not generally given because they may prolong infectious process

(c)        Clear liquid diet



Assess and Treat a Fever, Headache, and Sinus Symptoms


            Fever is a common presenting symptom, accounting from 2-6 percent of adults presenting to hospital emergency rooms and clinics.

(1)        Fever can be due to:

(a)        Infection: all causes, whether bacterial, viral or parasitic

(b)        Trauma

(c)        Immunologic: serum sickness or acute inflammatory arthritis

(d)        Drug induced

(e)        Vascular disorders: acute myocardial infarction, pulmonary emboli

(2)        Acute bacterial infection requires a timely diagnosis and treatment.  The initial approach to evaluating a patient with an acute fever is detecting a treatable infection or excluding a bacterial infection with reasonable certainty.

(3)        Fever above 100 F must be evaluated by an MD/PA

(4)        Provide care

(a)        Administer Tylenol or Motrin.  The use of aspirin should not be used due to bleeding problems

(b)        If fever is uncontrolled, seek methods of cooling patient.  Such as cooling mats, tepid baths or showers.



 (1)       Meningitis- an infection of the meninges (the membranes surrounding the brain)

(a)        Causes:

(i)         Bacterial

(ii)        Viral

(iii)       Fungal

(c)        Signs and Symptoms

(i)         Headache, sudden onset, severe, usually occipital

(ii)        Fever

(iii)       Chills

(iv)       Photophobia

(v)        Neck stiffness or nuchal rigidity (more pronounced on flexion)

(vi)       Petechial rash - Bacterial

(vii)      Altered mental status

(viii)      Nausea and vomiting

(d)        Provide medical care

(i)         Protective measures should include BSI with surgical masks applied to casualties displaying suggestive signs/ symptoms

(ii)        Meningitis is a medical emergency.  Delay in treatment will result in death.  Notify MD/PA immediately and evacuate

(iii)       Initiate IV

(iv)       Perform serial neurological examinations


(1)        Disorder involving infection and/or inflammation of one or more of the paranasal sinuses.  The maxillary sinuses are the most frequently affected.  Factors predisposing to sinusitis are upper respiratory infection, smoking, allergies and nasal polyps.

(2)        Assessment findings include:

(a)        Headache

(b)        Purulent nasal discharge

(c)        Cough

(d)        Pain in the sinus area with palpation or percussion

(e)        Facial pain

(f)         Pain may also be referred to the teeth.  Patients may complain of a "toothache“.

(3)        Provide medical care

(a)        Administer analgesics to relieve pain

(b)        Administer saline or decongestant nasal sprays to increase drainage

(c)        Consider an expectorant/mucolytic to thin secretions and promote drainage

(d)        Antibiotic therapy is indicated for 10-21 days.  Antibiotic choice is based on duration of symptoms and the individual patient

(e)        Refer patient to MD/PA for suspected sinus infections


Assess and Treat Hepatitis
Viral Hepatitis-

Management of viral hepatitis has been through major changes, therefore knowledge of the various types is important.  At least 7 major viruses have been identified and cause the majority of disease

(1)        Hepatitis A- inflammation of liver caused by hepatitis A virus

(a)        Seen worldwide and is a food and water-borne disease

(b)        Spread by fecal-oral contact

(2)        Signs and symptoms

(a)        Symptoms are similar to flu

(i)         Fever

(ii)        Weakness

(b)        Jaundice of skin and eyes - liver is not able to filter bilirubin from blood

(c)        Darkening of urine

(d)        Clay colored stools

(e)        Nausea and vomiting

(3)        Provide care

(a)        Treatment is primarily supportive

(b)        Rest should be recommended during acute phases

(c)        Patient should avoid alcohol and substances toxic to liver

(d)        Full recovery usually  within 1 month

(e)        Patient education should be given advising avoidance of unbottled drinking water, ice, shellfish or unpeeled fruits and vegetables in endemic areas

(f)         Hepatitis A vaccine is available prior to deployment to endemic areas

(4)        Hepatitis B and Hepatitis C- inflammation of the liver caused by a Hepatitis B virus or Hepatitis C virus

(a)        Transmission is parenteral, with the virus found in body fluids such as blood, semen and saliva

(b)        Sexual transmission is common 

(c)        IV drug usage is also and important mode for transmission

(5)        Assessment findings

(a)        Jaundice

(b)        Fatigue

(c)        Nausea and vomiting

(d)        Low grade fever

(e)        Pale or clay color

(f)         Abnormal urine color/dark urine

(g)        Abdominal pain and enlarged liver

(h)        In Hepatitis C, many patients are asymptomatic

(6)        Provide care

(a)        Treatment is primarily supportive.  Interferon is used with some success in Hepatitis B and C patients.

(b)        Bedrest and occasionally hospitalization during the acute phase is necessary

(c)        Patient should avoid alcohol and substances toxic to liver

(d)        Patient should be informed of preventative measures

(i)         Hepatitis B vaccination series

(ii)        Condoms if sexually active

(iii)       Test for HIV

(7)        Hepatitis D

(a)        Hepatitis D occurs only in association with Hepatitis B infection.  Mode of transmission is similar to Hepatitis B

(b)        May increase severity of disease associated with Hepatitis B

(c)        Treatment is same as for hepatitis B

(8)        Hepatitis E

(a)        Hepatitis E is a food and water-borne disease

(b)        Associated with epidemics where there is fecally contaminated water

(c)        Treatment and travel precautions are identical to Hepatitis A

(9)        Hepatitis G- has recently been identified is patients with Hepatitis that was not Hepatitis C

(a)        Liver disease has not been proven

(b)        Signs and symptoms have not yet been characterized


Assess for Human Immunodeficiency Virus (HIV)


A viral infection-

Caused by the human immunodeficiency virus (HIV) that gradually destroys the immune system.  Although the virus has been found in all body fluids, only blood, semen and vaginal secretions have been implicated in transmission.  There are three known routes of transmission:

(1)        Sexual transmission (anal, oral or vaginal)

(2)        Blood or blood products (transfusions, infected needles)

(3)        Perinatal transmission (in utero, at delivery or through breastfeeding)


History of HIV

(1)        Initial case definition was established by CDC in 1982

(2)        In 1987 and 1993, case definitions were expanded to include additional illnesses


Body systems affected and potential secondary complications - generally related to opportunistic infections that arise as immune system compromise develops

(1)        Nervous system - toxoplasmosis of CNS

(2)        Immune system - major site of compromise

(3)        Respiratory system - pneumocystis carinii pneumonia

(4)        Integumentary system - Kaposi's sarcoma


Health care workers -

(1)                    At risk increased when:

(a)        The exposure involves a large quantity of blood

(b)        Needle or instrument stick needle size, type (hollow bore versus suture), and depth of penetration

(c)        The exposure to a patient with a terminal HIV related illness, possibly reflecting a higher viral load in the late course of AIDS

(d)        Universal precautions not adhered to

(2)        Risk needs to be understood in terms of how the exposure occurred, and what factors were involved

(3)        Potential may appear to be high, but the probability may actually be quite low


Assessment findings- Asymptomatic HIV Infection

(1)        Asymptomatic HIV patients must have had no previous signs or symptoms attributable to HIV infection

(2)        History may be suggestive of an acute mononucleosis or flulike syndrome in the past

(3)        Physical examination of asymptomatic HIV patient is completely normal

(4)        Diagnosis is made with laboratory evidence only


Assessment Findings-

Early Symptomatic HIV Infection

(1)        With disease progression, CD4 lymphocyte counts decrease.  There is an increased risk of opportunistic infections

(2)        Signs and symptoms associated with early HIV disease are frequently nonspecific

(a)        Fever                           (h)        Chronic cough

(b)        Sore throat                  (i)         Shortness of breath

(c)        Fatigue                        (j)         Oral lesions, ulcers

(d)        Myalgia                        (k)        Chronic diarrhea

(e)        Weight loss                 (l)         Skin rashes

(f)         Night sweats

(g)        Lymphadenopathy

(3)        Diagnosis is made with laboratory evidence and presence of one or more opportunistic infections:

(a)        Oral candidiasis

(b)        Generalized wasting

(c)        Generalized lymphadenopathy

(d)        Hepatosplenomegaly

(e)        Severe herpes zoster in a previously healthy person

(f)         Pneumocystis carinii pneumonia


Assessment Findings-

Late Symptomatic HIV Infection

(1)        Progressive destruction of CD4 cells by the HIV virus places the patient at risk for opportunistic infections, routine infections and malignancies

(2)        Symptoms depend on reactivation of previous illness or exposure to new infections.  Commonly seen are:

(a)        Chronic headaches

(b)        Seizures

(c)        Chronic diarrhea

(d)        Weight loss leading to wasting

(e)        Chronic fever

(f)         Visual changes leading to blindness


Provide care

(1)        Treatment of HIV is complex and beyond the scope of the handout

(2)        Isolation is unnecessary, ineffective and unjustified

(3)        Observe BSI when treating an HIV patient

(4)        Psychosocial evaluation of the patient is indicated because of the high incidence of family dysfunction, depression and suicide associated with HIV infection

(5)        Sexual partner notification by Preventive Medicine is essential to prevent transmission

(6)        Consistent use of latex condoms, preferably with nonoxynol-9, a spermicide is recommended to prevent sexual transmission of HIV. Petroleum based lubricants should be avoided because they increase the risk of condom rupture



Assess and Treat for Lyme Disease
An acute inflammatory disease-

Caused by the spirochete Borrelia burgdorferi Transmitted by the bite of a deer tick.


Assessment findings-

(1)        An early localized stage with a painless skin lesion at the site of the bite, called erythema migrans (EM), and a flu-like syndrome with malaise, myalgia

(2)        EM starts off as a red, flat, round rash which spreads out; the outer border remains bright red, with the center becoming clear, blue, or even necrose and turn black

(3)        Incubation period until EM - 3 to 32 days post tick exposure

(4)        Fever and headache

(5)        Inflammation in the knees and other large joints in systemic infection


Patient management and control measures

(1)        The 91W Medic who works, or treats/ transports casualties in a wilderness environment, should be vigilant to the presence of ticks on themselves and their casualties

(2)        There is no evidence of natural transmission from person-to-person

(3)        Tetracycline is the drug of choice given 500mg four times a day for 10-30 days

(4)        Consider anti-inflammatory medications to relieve joint stiffness



Identify Viral Diseases of Childhood

(1)        A highly contagious, usually mild childhood disease caused by the Herpes varicella-zoster virus.

(2)        Assessment findings

(a)        Begins with:

(i)         Mild respiratory symptoms

(ii)        Malaise

(iii)       Low-grade fever

(b)        Rash begins as small red spots that become raised blisters on a red base.  These fluid-filled vesicles eventually collapse and dry into scabs

(c)        Intense itching

(3)        Provide care

(a)        Do NOT give aspirin due to association with Varicella and Reye's syndrome.

(b)        Isolation of patient from medical offices, emergency departments, and public places until all lesions are crusted and dry

(c)        Consider antiviral drugs exist that shortens the duration of symptoms and pain in the older patient

(d)        Soldier medics who have not had chickenpox should inquire with their chain of command about receiving the chickenpox vaccine

(e)        VZIG (Varicella Zoster immune globulin) is recommended for pregnant women with a substantial exposure (household contact, close indoor contact > 1 hour, or prolonged direct face-to-face contact with infected person) to chickenpox with no history of previous exposure to chickenpox



(1)        An acute, contagious viral disease that causes painful enlargement of the salivary or parotid glands

(2)        Assessment findings

(a)        Fever

(b)        Swelling

(c)        Tenderness of salivary glands, especially parotid

(d)        Sore throat

(3)        Provide care

(a)        There is no specific treatment for mumps.  Measles, Mumps, Rubella (MMR) immunization should be considered.

(b)        Symptoms may be relieved by:

(i)         Ice or heat to affected neck area

(ii)        Acetaminophen for pain relief

(iii)       Warm salt water gargles

(iv)       Soft foods

(v)        Extra fluids


Rubella (German Measles)

(1)        A contagious viral infection with mild symptoms associated with a rash

(2)        Assessment findings

(a)        A rash that spreads from forehead to face to torso to extremities, and lasts 3 days,

(b)        Serious complications, such as encephalitis, which may occur in measles, do not occur in Rubella

(c)        Younger females sometimes develop a self-limiting arthritis

(d)        Cloudy cornea

(e)        Low grade fever

(f)         Inflammation of the eyes

(3)        Provide medical care

(a)        Consider MMR immunization

(b)        There is no treatment- supportive care primarily

(c)        Acetaminophen can be given to reduce fever



Measles (rubeola, red measles)

(1)        Highly contagious viral illness

(2)        Assessment findings

(a)        Conjunctivitis

(b)        Swelling of the eyelids

(c)        Photophobia

(d)        High fevers to 105 degrees

(e)        Hacking cough

(f)         Malaise

(g)        Rash

(3)        Provide care

(a)        Immunization

(i)         Effective immunization should be instituted for every person, and is available for combination with other vaccines and/ or toxoids (MMR)

(ii)        Immunization in children is believed to confer 99% immunogenicity

(b)        There is no specific treatment.  Symptomatic care:

(i)         Bed rest

(ii)        Acetaminophen

(iii)               Humidified air


Pertussis (Whooping cough)

(1)        A highly contagious bacterial disease that affects the respiratory system and produces spasms of coughing that usually end in a high-pitched crowing inspiration (whooping sound)

(2)        Assessment findings

(a)        Cough

(b)        Crowing or high-pitched inspiratory whoop

(c)        Expulsion of clear mucous

(d)        Vomiting

(3)        Provide care

(a)        Erythromycin is given 500mg four times a day for 10 days

(b)        Consider oxygen with high humidity

(c)        Intravenous fluids may be indicated if coughing is severe enough to prevent adequate oral fluid intake



Reporting an Exposure to an Infectious/ Communicable Disease

What constitutes an exposure?

The following should be considered an exposure incident:

(1)        Eye

(2)        Mouth

(3)        Other mucous membranes

(4)        Non-intact skin

(5)        Parenteral contact with blood

(6)        Blood products

(7)        Other potentially infectious materials


Why it is important to report?

(1)        Permits immediate medical follow up, permitting identification of infection and immediate intervention

(2)        Enables the Designated Officer (DO) to evaluate the circumstances surrounding the incident and implement engineering or procedural changes to avoid a future exposure

(3)        Facilitates follow up testing of the source individual if permission for testing can be obtained

(a)        Under provisions of the Ryan White Act, the exposed employee has the right to request the infection status of the source casualty from the casualty's health care provider, but neither the agency nor the employee can force testing of the source individual

(b)        Employers must, and should as part of an effective Exposure Control Plan, tell the employee what to do if an exposure incident occurs


Preventing disease transmission

(1)        Notify supervisor for proper disposition

(a)        If you have diarrhea

(b)        If you have a draining wound or any type of wet lesions; wait until lesions are crusted and dry

(c)        If you are jaundiced

(d)        If you have been told you have mononucleosis/hepatitis

(e)        If you have not been treated with a medication and/ or shampoo for lice and scabies

(f)         Until you have been taking antibiotics for at least 24 hours for a step throat

(g)        Observe BSI

(i)  Always wear gloves

(ii) If chance of splash, wear protective eyewear or face shield

(iii) If large volumes of blood are possibility, wear a gown

(iv) When contacting a possible TB casualty, wear appropriate particulate mask

(h)        Patients with coughs, headaches, general weakness, recent weight loss, stiff necks, high fevers, and taking medications suggestive of an infectious process are tip-offs in history taking, with experience, the list will get longer for you

(i)         If after a call with lice, scabies, ticks or other insect vectors

(i)         Spray the stretcher and casualty compartment with an insecticide, then wipe off/ mop up insecticide residue

(ii)        Bag the linen separately, and ensure that it not be taken home; bottom line is that it needs to be washed separately

(iii)       Report any infectious exposure to the designated officer/ manager of your agency identified as such

(2)        Effective hand washing, to include the webs of the hands

(3)        The major infectious diseases that 91W Medic personnel should have in-depth knowledge of for purposes of regulatory compliance

(a)        HIV

(b)        Hepatitis

(c)        Tuberculosis

(d)        Sexually transmitted diseases

            (4)        Understand the concept of occupational risk

(1)        Appreciate that infectious agent mode of entry, virulence, dose, and host resistance factors combine to define risk, or potential for infection

(2)        Just because there is risk, doesn't mean that you will become infected

(3)        Not all infectious diseases are communicable and do not always pose risks to family members

(4)        Risk and potential does not necessarily equate to probability; HIV is a good example - risks for infection may appear to be high, but the probability of occupational exposure is very low (0.2-0.44%)


Medical and legal aspects of reporting and recording an exposure

(1)        Out-of-hospital personnel deal with very few infectious disease emergencies, but must be vigilant about consequences to themselves, as well as their casualties and coworkers, based on daily, often unknown exposures to infectious agents

(2)        Universal/ standard precautions for soldier medics are superseded by body substance isolation guidelines, based upon the premise that all body fluids, in any situation, may be infectious

(3)        Contact Preventive Medicine for any questions concerning infectious diseases and reporting protocols




In this lesson, a variety of infectious disease and immunologic symptoms were presented.  As a soldier medic, you must be capable of taken the appropriate measures to provide care and keep yourself safe.  An understanding of infectious disease and immunologic symptoms is essential.