1,440 Matching Annotations
  1. Apr 2017
    1. Brucella can gain entry into the human body through breaks in the skin, mucous membranes, conjunctivae, and respiratory and gastrointestinal (GI) tracts.

      Modes of entry

    2. international tourism and migration

      -have you traveled recently? specifically ask about CA, TX, and Mexico

    3. consumption of illegally imported unpasteurized dairy products from Mexico. Approximately 60% of human brucellosis cases in the United States now occur in California and Texas.

      SO INTERESTING. Geographical importance highlighted here

    4. use of milk and meat products

      -do you consumer milk or meat (i.e are you lactose intolerant or vegetarian)?

    5. North American

      -where do you live?

    6. aerobic
    7. localize in the reproductive organs of host animals, causing abortions and sterility

      Information useful for this: -are you a vet/farmer/etc. ? -do you have pets? -are your pets sterile, do you know?

    8. by ingestion through infected food products, direct contact with an infected animal, or inhalation of aerosols

      modes of transmission

    9. zoonotic infection

      -specifically asking if you have pigs or have been exposed to anything pig-related in the near past?

    10. placental fluid

      If yes to pet, did she give birth recently?

    11. has the highest age/sex-related incidence in males in their mid-20s.

      Are you a male in the mid-20s or from 13-40 years of age?

    12. Clinically, identification to the genus level is sufficient to warrant initiation of therapy.

      If diagnosed with any strain within the genus, begin therapy.

    13. B abortus and B suis species

      Two species exist.

    1. High dose of penicillin is the common cure. As an alternative tetracycline & chloramphenicol is used in beta-lactam intolerant patients.
    2. Isolation of Pasteurella multocida bacteria is usually done in sterile location such as the blood, pus or CSF.
    1. The infection is transmitted to humans by animals through direct contact with infected materials like afterbirth or indirectly by ingestion of animal products and by inhalation of airborne agents. Consumption of raw milk and cheese made from raw milk (fresh cheese) is the major source of infection in man. Most of the fresh cheeses are sheep and goat cheese.

      Have you come into contact with these? Do you work with livestock?

    1. Oculoglandular

      Tularemia of the eye

    2. Glandular

      Results in swelling of lymph nodes.

    3. Ulceroglandular

      Most common form of Tularemia that results in an ulcer at the site of infection and swelling of nearby lymph nodes.

    4. This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism.

      Does friend have pneumonic symptoms? this is most severe form

    5. All forms are accompanied by fever, which can be as high as 104 °F

      Does the friend have a fever?

    6. Signs & Symptoms

      Signs and Symptoms of Tularemia

    7. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.
    8. All forms are accompanied by fever, which can be as high as 104 °F.
    9. This can occur when a person is butchering an infected animal and touches his or her eyes
    10. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.
    11. accompanied by swelling of regional lymph glands, usually in the armpit or groin.
    12. A skin ulcer appears at the site where the bacteria entered the body
    13. All forms are accompanied by fever

      Did you have a fever recently?

    1. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin.

      Does friend have any allergies to antibiotics? Specifically any of these antibiotics?

    2. likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. 

      Has friend been in an environment in which they may have been exposed to ticks or deer flies?

    3. For this reason, it is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. 

      asking about mode of transmission necessary for diagnosing this

    4. Blood tests and cultures can help confirm the diagnosis

      because of difficulty to diagnose, you must culture and run blood tests for the patient to be confirm that the diagnosis is tularemia

    1. 5 days to 5 months after initial exposure to Brucella species

      Ask about traveling history/dairy consumption for at least 6 months, possibly a year?

    2. initial symptoms(https://www.cdc.gov/brucellosis/symptoms/index.html) are non-specific

      Means narrowing down before concluding Bru, need context especially risk of exposure

    1. Streptomycin

      Drug used to treat tularemia

    2. Gentamicin

      Another drug to use, but not as successful as streptomycin

    3. Growth of F. tularensis in culture is the definitive means of confirming the diagnosis of tularemia. Appropriate specimens include swabs or scrapings of skin lesions, lymph node aspirates or biopsies, pharyngeal swabs, sputum specimens, or gastric aspirates, depending on the form of illness.

      Suggest to friend that they get a culture.

    4. Diagnostic testing

      Grow F. tularensis in culture!

    1. The disease is spread through contact with an infected cat (a bite or scratch) or exposure to cat fleas

      Have you been in contact with a cat?

    2. Bump (papule) or blister (pustule) at site of injury (usually the first sign)FatigueFever (in some people)HeadacheLymph node swelling (lymphadenopathy) near the site of the scratch or biteOverall discomfort (malaise)

      Does the patient have any of these symptoms?

    1. This modeof transmissionoccurs whena herd owner buys replacementcattle or domestic bisonthat are infected or have been exposed to infected animals, animal tissues or animal dischargespriortopurchase

      Have you come into contact with any infected animals/animal tissues/animal discharges? (or with anyone who may have come into contact with these)

    1. Highly contagious and potentially fatal, tularemia usually can be treated effectively with specific antibiotics if diagnosed early.

      Must run blood tests and culture as quickly as possible for sake of patient's health

    1. Antibiotics treat serious cases of cat scratch fever

      Treatment

    2. In rare cases, surgery is necessary to remove infected tissues from the eye

      sequelae

    3. an eye infection that produces symptoms similar to pink eye

      sequelae

    4. result in bone damage

      sequelae

    5. causing impaired vision

      sequelae

    6. encephalopathy results in permanent brain damage or death

      sequelae/outcome

    7. indirect fluorescent antibody (IFA) blood test to see if the Bartonella henselae bacteria are present in your body

      diagnosis

    8. enlarged spleen (an organ above your stomach)

      how to diagnos

    9. a bump or blister at the bite or scratch site swollen lymph nodes near the bite or scratch site fatigue headaches a low-grade fever

      Symptoms

    10. 40 percent of cats carry the bacteria at some time in their lives, most commonly when they are kittens

      Cats also get the disease from fleas. Bacteria is common in cats

    11. weakened immune system

      If you have a weaker immune system then people are more susseptable to contract the infection

    12. bite or scratch from an infected cat. You can also get the disease if saliva from an infected cat gets into an open wound on your body or touches the whites of your eyes

      How to contract the disease

    13. Bartonella henselae bacteria

      The bacterial name

    14. people contract it from cats

      Reservoir

    15. bacterial infection

      Cat Scratch disease is a bacterial infection

    16. There are a number of possible complications from cat scratch fever.

      Could be possible examples of Sequelae for Cat Scratch Disease

    1. Tick and deer fly bites

      Ask "Do you have any bug bites?"

    2. Humans can become infected(https://www.cdc.gov/tularemia/transmission/index.html) through several routes, including:

      mode of transmission

    3. antibiotics

      treatment

    4. Skin contact with infected animals

      Ask "Have you been around any animals in nature, a zoo, etc.?"

    5. Tick and deer fly bites Skin contact with infected animals Ingestion of contaminated water Inhalation of contaminated aerosols or agricultural dusts Laboratory exposure

      Mode of transmission

    6. Francisella tularensis

      The bacteria that causes Tularemia

    7. Tick and deer fly bites Skin contact with infected animals Ingestion of contaminated water Inhalation of contaminated aerosols or agricultural dusts Laboratory exposure

      examples of mode of transmission

    8. Tick and deer fly bites Skin contact with infected animals Ingestion of contaminated water Inhalation of contaminated aerosols or agricultural dusts Laboratory exposure

      Risk Factors

    9. Francisella tularensis

      bacteria that causes Tularemia

    10. Tularemia is a disease of animals and humans caused by the bacterium Francisella tularensis.
    1. People who hunt animals may also be at risk

      Have you been hunting recently?

    2. Infected mothers who are breast-feeding may transmit the infection to their infants

      -is the friend a woman/has she given given birth recently? important to know for baby's safety and well-being

    3. meat-packing employees

      -are you a meat-packer?

    4. Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals.

      Do you work in a slaughterhouse, meat-packing facility, or a veterinarian and could have been exposed to an infected animal?

    5. slaughterhouse workers meat-packing plant employees veterinarians

      Do you do any of these jobs for a living? --basically ask what their exposure to dairy animals and dairy products are in as many ways as possible

    6. eating or drinking unpasteurized/raw dairy products.

      "did you eat unpasteurized/raw dairy products?"

    1. typically appearing within 24 hours following a bite

      Ask about the onset of the symptoms from last contact with animal.

    2. humans is often associated with an animal bite, scratch, or lick

      Can ask about animal contact.

    3. gram-negative

      we can stain the bacteria with a swab of the infected area

    4. cellulitis, abscesses, tenosynovitis, osteomyelitis, and septic arthritis. [1] The latter two are particularly common following cat bites because of their small, sharp, penetrative teeth

      Ask if they have any of these signs/symptoms. This can narrow down if they recieved the agent via a cat.

    1. thoroughly cleaned and debrided

      Was wound cleaned after bite/scratch?

    2. Animals do not have to be ill to pass the bacterium to humans, as they can carry the organism without showing symptoms.

      Has pt been bitten or scratched by an animal, even if animal has not appeared ill?

    3. develop into a serious soft tissue infection, and can also be complicated by abscesses, septic arthritis and osteomyelitis. Pasteurella spp can also cause meningitis, ocular infections, and respiratory infections, usually in patients with underlying pulmonary disease.

      What are the pt's signs and symptoms? Obvious skin differences near location of bite/scratch? Difficulty moving near injury? Neck pain? Difficulty breathing?

    4. P. multocida is found worldwide

      Location of pt and/or animal may not be telling for a pasteurella infection

    5. caused by infection with bacteria of the Pasteurella genus

      Bacterial infection - consider types of antibiotics that would be effective

    6. zoonotic disease

      Contracted from animals

      "Were you bitten or scratched by an animal recently?"

    7. Pasteurellosis is a zoonotic disease. It is caused by infection with bacteria of the Pasteurella genus
    8. antimicrobials usually chosen empirically for bite wounds
    9. soft tissue infection

      Do you have an infection?

    10. hickens, turkeys, cattle, swine, cats, dogs and rodents

      Have you come into contact with pigs, cows, cats, dogs or rodents?

    11. animal bites, scratches or licks. Animals do not have to be ill to pass the bacterium to humans, as they can carry the organism without showing symptoms
    12. meningitis, ocular infections, and respiratory infections, usually in patients with underlying pulmonary disease.

      Do you have underlying pulmonary disease?

    13. local wound infection

      Any animal bites or scratches lately?

    14. Human infections are usually contracted following exposure to domestic pets such as cats and dogs

      Do you have a dog or cat?

    15. avian cholera
    16. Animal bites

      Were you bitten by an animal recently? What type?

    17. Animal bites
    1. Tularemia is more common in the months of May through September. Bites from infected ticks or deer flies usually occur in the summer months, but illness due to animal handling and hunting can occur at any time of the year

      More cases in summer when people are more likely to be outside farming, cutting hay, working outdoors, etc.

    2. usually occur in the summer months

      More common in summer months

    3. Tularemia is more common in males, possibly because of a greater likelihood of exposure through hunting and landscaping. Tularemia occurs in persons of all ages, but is most common in children.

      Mostly affects male, more specifically children. Due to more exposure.

    4. most common in the south central United States, the Pacific Northwest, and parts of Massachusetts

      Most cases located in central US.

    1. malaise

      "a general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify" (Google)

    2. Initial symptoms can include:

      What are the symptoms and how many from this list does the patient have?

    3. Some signs and symptoms may persist for longer periods of time

      Duration of symptoms? Severity of symptoms? Can help determine when it's onset

    4. longer periods of time

      Q: What counts as "longer periods of time?"

    5. Initial symptoms can include:

      What symptoms have you experienced? (do they match up with this list) How long have you been experiencing these symptoms?

    1. wild hogs (feral swine) elk bison caribou moose

      Have they been in areas where this would be common (if they haven't participated themselves)?

    1. General symptoms of brucellosis are often vague and similar to the flu. They may include: Fever (the most common symptom, with high "spikes" that usually occur in the afternoon) Back pain Body-wide aches and pains Poor appetite and weight loss Headache Night sweats Weakness Abdominal pain Cough

      Do you have any flu-like symptoms and how bad have those symptoms been? Have you had vomiting or diarrhea?

    1. Even in patients with CNS involvement, however, recovery without neurologic sequelae within weeks to months can be expected. Death caused by CSD in patients who are immunocompetent is extremely rare.
    2. Complete recovery without sequelae occurs in nearly all patients.
    3. Patients can become confused and disoriented, and their condition can deteriorate to coma.

      Sign

    4. In general, lymph nodes become enlarged in the 1-2 weeks after exposure.

      Sign

    5. In most patients, the disease resolves spontaneously within 2-4 months.

      Not a fatal disease for most patients

    6. Bartonella henselae,

      This is the bacteria that causes catscratch disease

    1. Laboratory tests and a short course of antibiotics

      Bacterial! Harmful to unborn children, therefore need to provide prophylaxis if this is possible/likely

    2. Prompt diagnosis and treatment of brucellosis during pregnancy can be lifesaving for the fetus

      outcome requires more aggressive treatment for fetuses

    1. respiratory tract and cause sinusitis and ear infections, and more severe symptoms including pneumonia or lung abscesses in those with underlying pulmonary disease, however this is rare. Other uncommon presentations of P. multocida infection include septicaemia (blood poisoning), eye infections, meningitis and gastrointestinal problems

      Serious complications spread to signs and symptoms in the respiratory tract, blood, meninges, etc.

    2. Exposure to aerosols, bites or scratches involving animals or injuries from objects contaminated with body fluids from animals require immediate first aid and medical attention

      Less likely, but infection can also occur from contact with infected animal bodily fluid, such as contact with infected object

    3. seek medical attention as soon as possible

      How long ago did the injury/infection occur?

    4. abscesses, cellulitis (an area of spreading inflammation) and joint infections

      Most common complications stay near the site of infection

    5. abscesses, cellulitis (an area of spreading inflammation) and joint infections

      What does the wound look like in the pt?

    6. local wound infection

      Typical presentation

    7. persons with a weakened immune system are at higher risk

      Does the pt have a weakened immune symptom?

    1. more likely to occur in children younger than 5 years and people with weakened immune systems.

      Does the friend have a weakened immune system?

    2. Later, the person's lymph nodes closest to the original scratch or bite can become swollen, tender, or painful.

      Do they have swollen areas/bumps, especially near a bite/scratch?

    3. About three to 14 days after the skin is broken, a mild infection can occur at the site of the scratch or bite.

      Did they recently have a skin infection where they may have gotten bitten/scratched?

    4. Cat-scratch disease (CSD) is a bacterial infection spread by cats.

      Have they been in physical contact (bitten, licked, etc.) with a cat?

    1. papule or pustule

      Papule: "solid elevation of skin with no visible fluid" (Wikipedia) Major Symptoms: -Fever -Enlarged Lymph Nodes -Papule

    1. infected include sheep, cattle, goats, pigs, and dogs, among others.

      Have you had any contact with any of these animals?

    1. The genus Pasteurella is a member of the Pasteurellaceae family, which includes a large and diverse group of Gram-negative Gammaproteobacteria, whose members are not only human or animal commensals and/or opportunistic pathogens but also outright pathogens
    2. Most likely due to routine prompt prophylactic treatment of animal bite wounds with antibiotics, pasteurellosis is still a relatively uncommon cause of mortality in humans (37, 38), even though deaths due to pasteurellosis have increased in recent years in the United States (Fig. 1). Nevertheless, pasteurellosis is often associated with significant morbidity due to complications resulting from animal bite or scratch wounds or from respiratory exposure

      @SCUMedMicroS17

    3. conventional methods for detection and diagnosis of infection with Pasteurella (pasteurellosis) relied on observation of the bacterium by microscopy using staining and/or isolation by in vitro culturing on selective media, followed by phenotypic and/or serological characterization
    1. y unknowingly consume unpasteurized dairy products.

      Be skeptical if they have traveled to these areas but report not consuming dairy products - may not realize they have consumed products

    2. Unpasteurized cheeses (sometimes called "village cheeses

      Have you consumed dairy products outside/from outside of the US recently? (how long ago?)

    1. The first sign of this infection is a blister or a small bump that develops several days after the scratch or bite and may resemble a bug bite. This blister or bump is called an inoculation lesion (a wound at the site where the bacteria enter the body). Lesions are most commonly found on the arms and hands, head, or scalp and usually are not painful.

      Has the friend noticed any unusual lumps or blisters on their body, specifically the armpit region?

    2. n the United States, most cases happen in the fall and winter and usually affect kids, probably because they're more likely to play with cats and be bitten or scratched

      Is the friend our age? Also have they been exposed to a cat recently and have they come into physical contact with said cat?

    1. inhaling dust or aerosols contaminated with F. tularensis bacteria.

      Mode of Transmission

    2. rabbits, muskrats, prairie dogs and other rodents.

      Reservoir

    3. dog tick (Dermacentor variabilis), the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Deer flies (Chrysops spp.)

      Reservoirs

    4. enter the human body through the skin, eyes, mouth, or lungs

      Portal of Entry

    1. Page 138 has a lot of important info about symptoms. Warmth, swelling, sensitivity. Most from cat bites

    Tags

    Annotators

    1. slaughterhouse workers meat-packing employees veterinarians laboratory workers

      Do you work with/around animals or animal remains?

    1. lthough brucellosis can be found worldwide, it is more common in countries that do not have effective public health and domestic animal health programs.

      Have you traveled to any of these countries recently? (In the past year, 6 months, etc.?)

    1. The overall mortality rate was 31%

      Yikes :(

    2. In 5/13 cases a recent animal-derived trauma could be found. In the other cases the source of the infecting organism was thought to be endogenous (from patients’ own pharyngeal commensal flora) or secondary to contact with secretions of a pet animal.

      Contact with animals?

    3. All the patients had an underlying disease (77 % had cirrhosis) and 2 were receiving chemotherapy for hematologic malignancy.

      Did the patient have any illnesses before this?

    1. causing major organs to fail. Pneumonia is common after inhalation but may also occur when the organism spreads throughout the body.

      symptoms and future cause

    2. fever, fatigue, aches and headache. Swollen lymph nodes

      look for these symptoms in patient

    3. Tularemia may be spread through inhalation of dried animal matter, eating undercooked game, skinning or dressing killed animals, or drinking water contaminated with animal carcasses.

      Ask if they have eaten wild game or hunted wild game recently.

    1. Related Disorders

      Tularemia can be hard to differentiate from cat-scratch disease. May also present like the plague.

    1. Nature of the exposure
    2. Francisella tularensis is highly infectious when grown in culture, and laboratory-acquired infections have been documented.
    1. Tularemia bacteria enter the body through the mucous membranes the skin, the lungs, or the digestive system. There are seven different forms of the disease:

      Seven different forms of the disease --> based on how it is contracted and the symptoms it causes.

    2. How Do People Contract Rabbit Fever?

      Get Tularemia through contact with infected animals. Not contagious from one human to another.

    1. Use insect repellents containing 20% to 30% DEET (N,N-diethyl-meta-toluamide), picaridin or IR3535. EPA provides information on the proper use of repellents.

      can ask if working outside/camping/etc without using insect repellent

    1. usually confirm a diagnosis of brucellosis by testing a sample of blood or bone marrow for the brucella bacteria or by testing blood for antibodies to the bacteria
    1. undulant fever is often used to describe this disease because the fever rises and falls in waves.
    1. Transmission by aerosol, fecal-oral, and contact with infected secretions (including venereal transmission) has been reported. 

      Exposure to animals?

    1. and not just through person-to-person contact --

      Includes zoonotic transmission

    2. Some scientists argue that it's equally important to analyze primary cases -- the person or animal that first brings a bacterium or virus into a population.

      In order to analyze primary cases, it's important to not stop at assuming that "patient zero" is the definite beginning and cause of a symptom. Scientists have to question the "patient zero" idea because diseases most likely have multiple beginnings.

    3. some people are more capable of spreading it than others
    4. MERS

      "Middle East respiratory syndrome coronavirus is a viral respiratory illness that was first reported in Saudi Arabia, in 2012. Symptoms are those of a severe, acute, respiratory illness, similar to pneumonia. All known cases so far have been linked to travel or residence in and around the Arabian Peninsula...There is currently no vaccine or cure for MERS-CoV, and so far it has been fatal in around 36 percent of cases. As coronaviruses tend to mutate, there are concerns that MERS could become a pandemic."(Nichols, Medical News Today).

      http://www.medicalnewstoday.com/articles/262538.php

      "

    5. unsafe burial practices, which involve washing and preparing the body of the deceased, apparently contributed to the infection of many people who were participating in this cultural practice

      Highlights the value of understanding other cultures/values in medicine. In 2014, the president of Liberia ordered that all Ebola victims were to be cremated rather than buried (The Guardian). Even though this was ordered, many people still continued to have secret burials out of respect of their loved ones and traditions. Across various countries in Africa, people had to change their cultural practices or risk spreading Ebola further (Maxmen, National Geographic).<br> References: https://www.theguardian.com/world/2014/oct/24/ebola-cremation-ruling-secret-burials-liberia

      http://news.nationalgeographic.com/2015/01/150130-ebola-virus-outbreak-epidemic-sierra-leone-funerals/

    6. A reassortant is the virus that emerges when the genetic material from two or more other viruses infecting a single human or animal host mix together.

      Reassortant: A hybrid virus from two or more viruses that mix their genetic material

    7. In the film, a fictional deadly virus sweeps the world after migrating from a dead pig to a chef that handles it.

      I watched the film after reading this article, it definitely made me more aware of the surfaces I was touching and the amount of times I touched my face during the day.

    8. In less than four months, about 4,000 cases and 550 deaths from SARS could be traced to Liu's stay in Hong Kong.

      To me, how quickly the virus spreads highlights how many people come into contact with the same surfaces!

    9. super-shedders

      Super Spreaders: Spred the virus throughout the population Super Shedders: Spread variations of the virus throughout the population

    10. incorrect impression about how the disease emerges in the first place and, on the other hand, insinuate that somebody should be blamed for this outbreak, when that's not really appropriate,"

      Gaetan Dugas was vilified for being identified as patient zero in the spread of HIV and AIDS. While it is useful to know the origins of a disease in order to figure out how it spreads, the point of index cases is not to place blame. With multiple routes of disease transmission and entry, some people are just more susceptible to illness from the bacteria and viruses on the surfaces people come in contact with.

    11. "patient zero" lives on, and continues to create confusion and curiosity about how disease spreads.

      Patient zero does not exist and is not real. People associate patient zero with being the person where the disease originates as a host. Index case is the correct term to use. It is the first case with the disease that can be identified and traced back to.

    12. pigs are 'mixing vessels,'

      Pigs are susceptible to both avian and human flu viruses, making them especially effective mixing vessels

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702078/

    13. In less than four months, about 4,000 cases and 550 deaths from SARS could be traced to Liu's stay in Hong Kong.

      The CDC states that in the 2003 outbreak, there were a total of 8,098 cases of SARS, with 774 deaths. 8 of these cases were in the United States.

      https://www.cdc.gov/sars/about/fs-sars.html#outbreak

    14. no longer needs the animal reservoir
    15. a total of 856 cases of human infections with H5N1 viruses worldwide have been documented, and there have been 452 deaths

      Nearly a 53% fatality rate from H5N1!

    16. Jacqueline Howard,

      The author has had many appearances on popular news sites such as CNN, the HuffPost, and MSNBC (https://jacqueline-howard.com/biography/). She works as a writer and "on-air talent" through these media sources (https://jacqueline-howard.com/biography/). She received a bachelor's degree in Communications studies from the University of Michigan-Ann Arbor and a master's degree in journalism from the University of Southern California’s Annenberg School for Communication & Journalism (https://jacqueline-howard.com/biography/).

    17. super-spreader or whether she was also a super-shedder or possibly both

      In some cases, wouldn't it be difficult to tell if an individual who spreads a disease is a super-spreader or a super-shedder?

    18. Nonetheless, it's important scientifically and for people and public health to understand index cases so that we know how diseases are coming into a community and how to stop their spread."
    19. "It could mean nothing, but it can also mean the absolute beginning."
    20. 60% of all existing human infectious diseases are zoonotic
    21. diseases that are spread from animals are called zoonotic.
    22. bat species

      Bats have been associated with numerous viruses including Ebola, Marburg, Rabies, to list a few of the most infamous examples. This has been claimed to be due to the high internal temperatures of bats. If viruses are able to survive a inside a bat, with temperatures reaching as high as 40C, then they will most likely survive a human fever (https://www.cdc.gov/features/bats/).

    23. super-shedders

      The way I understand it, super-spreaders directly infect a large number of other hosts, while super shedders simply release a large amount of infectious material. So these terms are not mutually exclusive.

    24. super-shedders,

      Super Shedders v Spreaders Nature article differentiates the two terms, super spreading more based on opportunity to spread disease, while shedding is more based on quantity of infectious units/organisms they may spread.

    25. cleared Dugas' name and provided strong evidence that the virus emerged in the United States from a pre-existing Caribbean epidemic in or around 1970.

      "evidence" refers to a comparison of the genetic makeup of the HIV strains from the Caribbean and the United States. Examining the genome from the various strains and the genome of Dugas' strain, showed that he was likely not the index case in the U.S..

    26. consciously

      Very important concept --these "patient zeros" are not doing it on purpose. We, as a society, need to take an observational stance on patient zeros rather than a judgmental one. That being said, I agree with Kaileen --the scariest terrorism of all is biological! There is definitely a terrifying potential to harm purposefully.

    27. we sort of want to make tight stories about things,

      Similar to the phenomenon of patternicity

    28. earliest documented case

      index case

    29. naming a patient zero

      Similarly to what Mikayla argues in her annotation above, how ethical is it to make patient zero label public? One one hand, it is important to alert populations of areas of epidemic, but on the other revealing the personal identity of someone is placing the blame solely on them. With globalization, we are all spreading diseases to other countries and putting each other at risk --someone should not bear the brunt of our globalized world's medical consequences.