Infectious Diseases - PowerPoint PPT Presentation

Loading...

PPT – Infectious Diseases PowerPoint presentation | free to download - id: 3b4eb6-M2NkN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Infectious Diseases

Description:

Infectious Diseases 2008 Pathogenic E. coil ETEC (-toxigenic) Traveler s diarrhea Contaminated food/H2O Toxins cause diarrhea LT cAMP, ST cGMP EPEC ... – PowerPoint PPT presentation

Number of Views:418
Avg rating:3.0/5.0
Slides: 70
Provided by: utcom2011W
Learn more at: http://utcom2011.wikispaces.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Infectious Diseases


1
Infectious Diseases
  • 2008

2
Sepsis
  • SIRS systemic response
  • Temp gt38C (lt36C)
  • HR gt90bpm, RR gt20bpm (PaCO2lt32mmHg)
  • WBC gt12k or gt10 bands
  • Sepsis SIRS Infection
  • Severe Sepsis Sepsis Organ Dysfunction
  • Septic Shock Sepsis Hypotension
  • PIRO severity staging
  • TLR 4 LPS (Gm-)
  • TLR 2 PGN, LTA (Gm)
  • Fever, inflammation, DIC, ARDS, azotemia,
    olyguria, cellulitis, purpura, GI bleeding,
    jaundice
  • Procalcitonin diagnostic?
  • Tx ATB, supportive, Activated Protein C (Xigris)

3
Fever / Hyperthermia
  • Fever
  • Hyperthermia
  • Hypothalamic setpoint shifted up by PGE2
    stimulating EP-3
  • Pyogenic cytokines
  • Pneumonia, drugs, PE, DVT, C. difficile, fungal
    infection, MI, NG tubes, IV catheters
  • Hypothalamic setpoint unchanged
  • Does not respond to NSAIDS
  • Heat stroke, hyperthyroidism, atropine, ecstasy,
    malignant hyperthermia, serotonin syndrome

4
Bioterrorism
  • Anthrax (Cutaneous)
  • Bacillus antracis
  • Botulism (Inhalation)
  • Bacillus antracis
  • Direct contact with spores
  • Jet black lesions (eschars) on skin within 7-10d
  • Incubation 1d
  • Tx Cipro or Doxy q 60d
  • Vaccine attenuated Ag
  • Inhaled spores, no person-to-person transmission
  • Incubation 1w to 2 months
  • Mediastinal widening, pleural effusion,
    infiltrates
  • Initial symptoms improve, abrupt onset of
    fever/ARDS, shock/death within 24-36h
  • Tx Penicillin or Cipro/Doxy

5
Bioterrorism
  • Anthrax (GI)
  • Bacillus antracis
  • Botulism
  • Clostridium botulinum
  • Ingested spores, no person-to-person transmission
  • N/V, severe abd pain, bloody diarrhea, possibly
    mediastinal widening, rebound tenderness, ascites
  • Incubation 1-7d
  • Tx Penicillin or Cipro/Doxy
  • Most poisonous toxin on earth
  • Not contagious, spread by aerosol/food
  • 12-72 h incubation
  • N/V, diff see, swallow, speak
  • Muscle weakness/paralysis

6
Bioterrorism
  • Cholera
  • Vibrio cholerae
  • Glanders
  • Burkholderia mallei
  • Rice-water diarrhea, dehydration, shock
  • Incubation 12h-5d
  • Food/water spread
  • Affects horses, mules, donkeys
  • Enters cut skin, mucous membranes, inhalation

7
Bioterrorism
  • Plague
  • Yrsinia pestis
  • Q Fever
  • Coxiella burnetii
  • Black Death, infected fleas
  • Bubonic 1-10 cm buboes on skin w/ edema,
    flu-like symptoms w/ abd pain
  • Septicemic - secondary septicemia, thromboses in
    acral v. leading to necrosis
  • Penumonic acute fulminant symptoms, nearly 100
    mortality rate
  • Tx Streptomycin or Doxycycline
  • Nonspecific febrile syndrome, pneumonia
  • Hepatitis, endocarditis, granulomatous
    complications
  • Tx Doxycycline 14-21d

8
Bioterrorism
  • Smallpox
  • Variola major
  • Tularemia
  • Francisella tularensis
  • Officially eradicated
  • Incubation 10-14d
  • High fever, HA, backache, vomiting, rash on
    palm/sole
  • Highly contagious
  • No tx, vaccine within 3-5d
  • One of most infectious bacteria in world
  • Tick/insect bites
  • Incubation 10-14d
  • Fever, chills, HA, cough, lethargy, skin ulcers,
    lymph-adenopahty

9
Bioterrorism
  • GB
  • Sarin
  • VX
  • Binary weapon two non-lethal reagents mix to
    form sarin gas
  • Inhibit ACHe, phosphonate esters, light brown oil
  • If mild dim vision, salivation, chest tightness
  • Tx Atropine and 2PAMCl
  • 1000x more toxic than GB
  • Persists in soil for 6d
  • Binary weapon
  • Inhibits ACHe, phosphonate esters, light brown
    oil
  • If severe stop breathing, paralysis, seizures,
    LOC

10
Bioterrorism
  • Ricin
  • Waste leftover from processing castor beans
  • V/D, dehydration, hypotension, hallucinations,
    seizures, hematuria, multiple organ dysfunction
  • No tx available

11
Bioterrorism
  • Needs Immediate Treatment, Suspect
  • Respiratory Symptoms
  • Acute Cyanide
  • Also nerve agents, mustard, lewisite, phosgene,
    SEB
  • Delayed Anthrax, Plague, Tularemia
  • Also Q Fever, SEB, ricin, mustard, lewisite,
    phosgene
  • Neurological Symptoms
  • Acute Nerve agents
  • Also cyanide
  • Delayed Botulism
  • Also VEE-CNS

12
Bioterrorism
  • Active Research
  • Algeria
  • Egypt
  • India
  • Iran
  • Israel
  • N. Korea
  • Pakistan
  • Syria
  • Taiwan
  • Secretly Developing
  • China
  • Russia
  • Former Programs
  • Canada
  • France
  • Germany
  • Japan
  • S. Africa
  • UK, US

13
Immunocompromised
  • Deficiencies in
  • Complement
  • IG/B-Cell
  • Phagocyte
  • T-cell
  • Clues
  • Recurrent Neisseria inf
  • Recurrent pneumonia
  • Severe presentation
  • Pneumocystis jiroveci
  • Burkholderia cepacia
  • Non-TB Mycobacteria
  • Aspergillus

14
Complement Deficiency
  • Hereditary angioedema
  • C1 inhibitor deficiency
  • Overactive complement
  • Minor stressors trigger attacks
  • C5-9 Deficiency
  • MAC lysis defect
  • Neisseria bacteremia
  • DAF and CD59
  • Paroxymal nocturnal hemoglobinuria
  • C1, C3, C4 deficiency
  • Recurrent pyogenic sinus and respiratory
    infection
  • C1q deficiency
  • 90 have SLE

15
Ig/B-Cell Deficiency
  • (Brutons) X-Linked Agammaglobulinema
  • Btk defect, no B-cells, Ig
  • Multiple pyogenic infections
  • No live vaccines!
  • Tx IvIg
  • Hyper IgM Syndrome
  • X-linked, normal B-cell
  • Low Ig but high IgM
  • Pneumocystis infections
  • T-cells lack CD40L
  • CVID
  • Low Ig, normal B-cell
  • Recurrent sinus, respiratory infections
  • Chronic infections with Giardia, Campylobacter
  • Tx ATB, IVIg
  • IgA deficiency
  • Associated with CVID
  • Compensated by others
  • Secondary Ig deficiencies
  • Multiple myeloma, leukemia, skin burns

16
Neutrophil Deficiency
  • Neutropenia
  • Causes
  • Blacks have lower counts
  • Chemotherapy patients
  • Post-infection, sepsis
  • Sulfa-drugs, ß-lactams
  • Infections
  • Mucositis
  • Ecthyma gangrenosum
  • Disseminated candidiasis
  • Aspergillosis
  • Hereditary Cyclic N.
  • AD, ELA2 mutation
  • Predictable cycles
  • Aphtous stomatitis
  • Tx G-CSF, steroids
  • Chediak-Higashi Syndrome
  • AR, LYST mutation
  • Giant lysosomes, ineffective granulopoiesis
  • Oculocutaneous albinism

17
Neutrophil Deficiency
  • Jobs Syndrome
  • Hyper IgE, impaired chemotaxis
  • STAT3 gene mutation
  • Facies, scoliosis, skin abscesses, sinusitis
  • Myeloperoxidase (MPO)
  • Makes pus green
  • Converts H2O2 to HOCl
  • Deficiency impairs this
  • CGD
  • Defective NADPH oxidase, no respiratory burst, no
    killing
  • Infections with catalase positive organisms
  • NBT test

18
Spleen Deficiency
  • Splenectomy
  • Trauma, ITP, Hairy cell leukemia, abscess
  • Hyposplenism
  • Autoimmune (Graves, Hashimoto, SLE)
  • Neoplasia (Hodgkin, CML, Sezary)
  • Amyloidosis
  • Alcoholism, elderly, Crohns, Sickle cell
  • Decrease in circulating activated B-cells (75)
  • Risk of thalassemia gt hodgkins gt sphero-cytosis gt
    ITP gt sepsis
  • Infections
  • S. Pneumoniae (mostly)
  • Haemophilus, GNR, Neisseria (less common)

19
T-Cell Deficiency
  • DiGeorges
  • Deletion 22q11.2
  • No T-cells, hypocalcemia, velocardiofacial
    defects
  • SCID
  • Combined B/T-cell deficiency, lymphopenia,
    hypogammaglobulinemia
  • ADA, PNP, RAG1/2, Jak3 gene deficiencies
  • CD4 T-cell Deficiency
  • HIV, lt300 CD4/mL
  • Wiskott-Aldrich
  • WASP protein
  • Pyogenic infections, purpura, eczema
  • High IgA, IgE, low IgM
  • Infections
  • Mycobacteria, norcardia, legionella,
    cryptococcus, histoplasma, pneumocystis,
    herpesvirus, cryptosporidium, toxoplasma

20
Food Safety
  • Milk pasteurization 72C for 15s or 63C for 30m
  • Botulism spores kill with high heat acidic
  • Preservatives weak acids, nitrites, sulfites,
    spices
  • Radiation ?-irradiation for spices, meats
  • Survival Cold Listeria Chlorine Giardia,
    Cryptosporidum cysts Anything home processed
  • Outbreaks Listeria (microwaved hot dogs),
    Cyclospora (raspberries), Salmonella, ETEC

21
TuberculosisMycobacterium tuberculosis, bovis,
africanum
  • Acid-fast, aerobic non-motile bacillus, reduce
    nitrates, produce niacin, slow growing
  • BACTEC blood culture, DAT tests using PCR
  • PPD (Mantoux) is killed tuberculin, positive if
    gt15 mm, indicates prior infection (LTBI), need
    CXR
  • Risks (normal) 1st year 3-4, lifetime
    5-15(HIV infected) 1st year 40, 10 every
    year
  • Tx test susceptibility, give multiple drugsINH
    RIF ETH ( PZA), INH prophylaxis,
    hepatotoxicity

22
TuberculosisMycobacterium tuberculosis, bovis,
africanum
  • Infected aerosolized droplets, milk (M. bovis),
    replicates in middle/lower lobes alveolar space,
    Rasmussens aneurysm (pulmonary a.), pleural
    effusion, sputum with PMNs
  • Spread to hilar lymph nodes in macrophages
  • Reactivate in upper lobes, cavities form
  • Can disseminate through blood (military TB), skin
    lesions, HA, abd pain, osteomyelitis

23
LeprosyMycobacterium leprae
  • Lepromatous Leprosy
  • Tuberculoid Leprosy
  • Poor TH1 response
  • Large of bacteria in tissue
  • Infectious, non self-limiting
  • Tx rifampicin (monthly)and dapsone (daily) -
    FREE
  • Thickened peripheral nerves
  • Loss of sensation, lesions, peripheral nerve
    damage, hair loss, disfigurement
  • Strong TH1 response
  • Small of bacteria
  • Self-limiting
  • Form granulomas

24
AIDSHIV infection
  • Lenti- retrovirus, persistent viremia, infects
    T-cells and macrophages (CD4 CCR5/CXCR4)
  • CD4 gt500 asymptomatic, 200-500 increased thrush,
    shingles, lt200 opportunistic infections, lt50 MAI,
    CMVCD4 drops 10/month on average
  • Transmitted by breast milk (acute), blood,
    semenRisk blood 95, pregnancy 20-33, MSM 10,
    needlestick 1 in 300 (1 in 2400 with therapy)
    Acute infection mono-like w/ rash, ulcers, and
    w/o tonsil hypertrophy and exudate.

25
AIDSHIV infection
  • Presents with unexplained anemia, leukopenia,
    recurrent pneumococcal pneumonias, Kaposis
    sarcoma, thrush, wasting, STD, fever
  • Screen ELISA, Confirm Western Blot, Viral Load
    PCR, Severity CD4 Count
  • HAART Treatment NRTI (AZT, 3TC), NNRTI
    (nevirapine, efavirenz), protease inhibitors
    (ritonavir, nelfinavir)
  • Opportunistic Infections CMV, MAC, PCP,
    Toxoplasmosis, Cryptococcosis, Candida, PML

26
GonorrheaNeisseria gonorrhoeae
  • Gm- diplococci
  • Infect columnar/cuboidal epi, PMN response,
    pharynx, anorectal, conjunctivitis
  • Spread via sex and perinatally
  • Dysuria w/o frequency or urgency, pain,
    discharge, cervicitis (PID complication)
  • Dx by culturing swab for diplococci
  • Tx with Ceftriaxone IM/cefixime PO

27
ChlamydiaC. trachomatis, psittaci, pneumoniae
  • Intracellular membrane-bound inclusions
  • Dx with culture, DFA (MicroTrak), ELISA, annual
    screen sexually active women lt25 yo
  • Tx Azithromycin x 1 or Doxycycline bid x 7d,
    abstinence x 7d after treatment

28
ChlamydiaC. trachomatis, psittaci, pneumoniae
  • LGV (STD)
  • Urethritis
  • Endemic in Africa/SE Asia/ India/S. America
  • Painless ulcer (heals) to lymphadenopathy (scars)
    to ulceration of genetalia
  • Tx Doxycycline po bid x 21d
  • NGU
  • 7-14d incubation
  • Dysuria, scant discharge
  • Complications
  • PID, ectopic pregnancy
  • Reiters syndrome (arthritis)

29
Trichomonas Vaginalis
  • Flagellated motile protozoa
  • Yellow, purulent, frothy, foul-smelling vaginal
    discharge, itch, dysuria, lower abd pain
  • Tx Metronidazole (ok in pregnancy)

30
Bacterial VaginosisGardnerella or Mobiluncus
  • Mild to moderate thin, gray, adherent vaginal
    discharge with odor, itch
  • Clue cells (squamous cells stippled with
    bacteria)
  • Whiff test (fishy smell in KOH)
  • Tx Flagyl/Clindamycin (Metronidazole in
    pregnant women)

31
Herpes SimplexHSV-1/2
  • Vesicular lesions, grouped, painful ulcers
  • Incubation 6 days, primary disease lasts 3wks
  • Recurrence in 90 of patients
  • Dx by Tzanck smear (Wright stain) showing
    multinucleated giant cells
  • Tx Acyclovir

32
SyphilisTreponema pallidum
  • 1 - localized painless chancres (ulcerated,
    non-tender, hard, smooth clean base)
  • 2 (25 untreated) 3-6 wks after chancre,
    generalized rash on palms/soles, condylomata lata
    (flat warts), minimally pruritic
  • Latency High Ab titers, 30 progress to 3
  • 3 - gummas (granulomatous lesions)neurosyphili
    s general paresis (insanity),tabes dorsalis
    (demyelination of posterior columns - sensation),
    Argyll Robertson pupil (non-reactive to light),
    gun-barrel sight

33
SyphilisTreponema pallidum
  • Congenital affects muscle, skin, bones saber
    shins, saddle nose, Hutchinsons teeth
  • Dx non-specific VDRL, RPR (negative in 1, 3),
    specific FTA-ABS test (confirmatory)
  • Tx (1, 2) Benzathine Penicillin G IM x
    1(late latent) Benzathine PCN G q week x
    3(neurosyphilis) IV PCN G q 4h

34
ChancroidH. ducreyi
  • Painful ulcer/ragged edges, painful inguinal
    lymphadenopathy
  • Often associated with HIV infection
  • Incubation 4-7d
  • Tx Azithromycin x 1 or Ceftriaxone IM x 1

35
DonovanosisKlebsiella granulomatis
  • Painless destructive ulcers
  • No lymphadenopathy
  • Tx Doxycycline (aminoglycoside)

36
TORCH Syndrome
  • Mother asymtomatic but baby has small size,
    hepatosplenomegaly, rash (thrombocytopenia), CNS
    defects (encephalitis, seizures), jaundice
  • Toxoplasma
  • Other (syphilis, HIV)
  • Rubella
  • CMV
  • HSV

37
TORCH Syndrome
  • Toxoplasmosis
  • Other (syphilis)
  • Detect IgG for previous infection, positive
    immunity
  • If not immune monitor for IgM (acute), avoid
    undercooked meat, garden soil, wash fruits and
    vegetables, handwashing
  • Treat infected infants aggressively
  • Test all pregnant mothers
  • If positive, treat monther with penicillin, if
    allergic to PCN then desensitize
  • Infected babies commonly show bone lesions,
    screen CSF for neurosyphilis

38
TORCH Syndrome
  • Other (HIV)
  • Rubella
  • Reduce transmission by
  • Anti-HIV therapy (zidovudine) during pregnancy
    and at birth
  • Give infant antiretroviral therapy for 16 weeks
  • Cesarean delivery
  • No breast feeding
  • Vaccinate mother
  • Highest risk when mother infected in 1st
    trimester, no risk after 16 weeks
  • Infected infant has patent ductus arteriosus

39
TORCH Syndrome
  • CMV
  • HSV
  • Dangerous if mother not immune before pregnancy
  • If mother not immune, 40 transmission
  • 15 infected infants have neurological symptoms
    (hearing loss, MR)
  • Education, handwashing, no vaccine
  • Perinatal infection by reactivated herpes lesions
  • Reduce transmission by Cesarean section
  • Can treat mother with acyclovir around birth time
    to reduce transmission
  • Treat infected infants with antiviral therapy

40
Other Congenital
  • GBS
  • Perinatal infection (50), anogenital screening
  • Concern in newborn (meningitis), infant (sepsis)
  • VSV
  • Primary infection during pregnancy very serious,
    especially during first 20 weeks (later is mild)
  • VZV Ig given within 96h of exposure, no vaccine
  • Fetal infection results in short limbs, skin
    scars, CNS
  • B19
  • Most maternal infections do not lead to fetal
    infection
  • Infant symptoms death, anemia w/ blueberry rash

41
Endocarditis
  • Infection of the endocardial surface or valves
  • Surface disrupted, platelets/fibrin deposit on
    exposed collagen forming sterile thrombus,
    transient bacteremia infect sterile thrombus on
    low pressure side (Venturi effect), thrombus
    grows, Ab cannot clear infection
  • Once established, require ATB to cure
  • Two types, native or prosthetic valve endoc.

42
Endocarditis
  • NVE
  • PVE
  • Native Valve Endocarditis
  • Viridans strep most common (followed by S.
    aureus, Strep, Entero)
  • If culture negative, can be HACEK, intracellular
    pathogens, fungi
  • Prosthetic Valve Endocarditis
  • Coagulase negative Staph most common in early PVE
  • Late PVE similar to NVE but coag neg staph still
    common
  • Platelets still deposit
  • Infection of surgical site leads to ring abscess

43
Endocarditis
  • Fever murmur, persistent bacteremia
  • Insidious onset of non-specific symptoms
  • History of heart disease, dental work
  • Small red lesions on palms/soles, Janeway are
    non-tender, Oslers is tender
  • Roth spots retinal hemorrhage w/ central pallor
  • Splinter hemorrhages under nails
  • Anemia, elevated ESR, TEE echo

44
Endocarditis
  • Dx Duke microbes on valve OR 2 major OR1
    major 3 minor OR 5 minor
  • Tx IV Bactericidal for gt4 weeks(Viridans) IV
    PCN aminoglycoside(Culture-neg) IV
    Ceftriaxone(MRSA) Vancomycin Gentamycin
    Rifampin(Entero) Ampicillin Gentamycin(Fungi)
    Amphotericin B SURGERY(2 embolic event)
    SURGERY
  • Prophylaxis Amoxicillin

45
Respiratory Diseases
  • Rhinitis
  • Influenza
  • Rhinovirus, parainfluenza, RSV, coronavirus,
    others
  • Rhinorrhea, little cellular damage, self-limiting
  • Symptoms peak days 3-4, persist 1-2 weeks
  • Late August to early spring, unrelated to temp
  • Leading infectious cause of death in US
  • Type A shifts HN antigens easily, B less so
  • Vaccine 2 A strains, 1 B
  • Amantadine resistance is prevalent

46
Respiratory Diseases
  • Typical Pneumonia
  • Streptococcus pneumoniae
  • Atypical Pneumonia
  • Mycoplasma pneumoniae
  • Rusty sputum, unilobar
  • Aspirated into alveolar space, fills with fluid
    and PMN, then fills with blood (2-3d), then fill
    with fibrin, then resolve w/o scarring
  • Asplenic, sickle-cell, agammaglobulinemia at risk
  • Vaccine has 23 serotypes
  • Dry cough, myringitis
  • Inhaled, attaches to respiratory cell, bronchitis
    infiltrated by plasma cells, lasts 2-6 wks
  • Similar to Chlamydophila
  • Unusual over age 40
  • IgM cold agglutinins

47
Respiratory Diseases
  • Aspiration Pneumonia
  • Chronic, foul sputum
  • Polymicrobial anaerobic, microaerophilic
    aspirated into lung
  • Alcoholics, seizures, tracheoesophageal fistula
    are risk factors
  • Tx Clindamycin PO x 3wks

48
Acute Bacterial Meningitis
  • S. pneumoniae
  • vaccine covers most types
  • N. meningitidis
  • B cause half infections
  • vaccine does not have B
  • H. influenzae
  • type b vaccine
  • L. monocytogenes
  • neonates elderly
  • lt4w GBS, lt18y H.flu, 18-50y S.pneu, gt50y L.mono
  • Stiff neck, Kernigs sign (leg extension resisted
    when supine), Brudzinskis sign (neck flex causes
    hip flex)
  • Dx CNS leukocytosis, positive culture
  • Tx Ceftriaxone (Vanco if community acquired)
    (ampicillin if immuno-compromised)
    Dexamethasone

49
Acute Viral Meningitis
  • Enterovirus
  • Kids gt 2 wks old
  • Summer months
  • Hand-foot-mouth disease, herpangina
  • HSV-2
  • Aseptic meningitis
  • Genital warts
  • HIV
  • Aseptic meningitis
  • Mucosal to viremia to BBB crossing to
    subarachnoid space to CSF to inflammation
  • Dx LP lt1000, mostly lymphocytes
  • Tx (enterov) nothing(HSV-2) acyclovir(HIV)
    HAART

50
Chronic Meningitis
  • Fungal
  • CSF glucose normal, protein gt60, WBC lt500
  • Tuberculosis
  • CSF protein gtgt100
  • AFB smear, culture
  • Chronic symptoms with gradual neurologic decline
  • Dx history, PE, LP
  • Tx most likely diagnosis

51
Intracranial Abscess
  • Frontal sinus, teethTemporal ear, jaw,
    sinusCerebellum ear, jaw
  • Strep, GNR, Bacteroides, S. aureus, Fusobacter
  • MCA blood, lung, heart
  • Staph, Strep, Fusobacter, Actinomyces, Anaerobes
  • Beneath wound
  • Clostridium, Staph, Strep
  • Neurologic deficit
  • 1-3d early cerebritis4-9d late
    cerebritis10-13d early capsulegt14d late
    capsule
  • Dx MRI/CT c contrast
  • Tx Surgical drainage, manage ICP,
    cultureMetronidazole ceph naf/vanco

52
Viral Encephalitis
  • Non-treatable
  • EEEV, WEEV, VEEV, St. Louis Encephalitis, West
    Nile, Polio, Rabies, HIV, Measles
  • Treatable
  • HSV-1/2, VZV
  • Altered mental status, decrease LOC, seizures
  • Enter brain via blood, retrograde transport,
    exposed CN-I
  • Dx EEG, MRI, LP/PCR
  • Tx Acyclovir if treatable

53
Subdural Empyema
  • Bacteriology
  • Strep, Staph,S. pneumoniae,H.
    influenzae,anerobes, GNR
  • Usually polymicrobial
  • Inflammatory Source
  • 50-80 frontal/ethmoid
  • 10-20 mastoid/AOM
  • 5 hematogenous
  • Altered mental status, focal neuro signs,
    seizures, like rapidly expanding mass lesion
  • Reach via emissary vessels or osteomyelitis
  • Dx MRI
  • Tx Burr holes, craniotomy, manage
    ICPMetronidazole Ceftriaxone Naf/Vanco

54
Epidural Abscess
  • Intracranial
  • Spinal
  • Intracranial epidural abscess spills over into
    subdural space
  • 81 associated with subdural empyema, similar
    bacteriology, diagnositic, treatment
  • Mainly S. aureus (60-90)
  • Abscess covers 4-5 vertebra but can extend entire
    length
  • Focal pain, radiculopathy, increasing paralysis
  • Bacteria enter space by osteomyelitis or
    hematogenous
  • Dx MRI, myelogram
  • Tx Surgical drainageMetro 3rd gen ceph Vanco

55
Nosocomial Precautions
  • Standard gloves, do not recap needles
  • Infectious blood, CSF, amniotic/vaginal fluid,
    semen
  • Low Risk saliva, sputum, urine, feces
  • Surgery double glove, cover shoes, (face shield)
  • Contact gown (gloves)
  • VRE, MRSA, C. difficile
  • Droplet surgical mask
  • Influenza, Mumps, Meningococcal Meningitis
  • Airborne N-95 mask (particles lt5 microns)
  • TB, Chicken Pox

56
Nosocomial Risks and Numbers
  • Accidental contaminated needlestick
  • 1300 HIV (therapy decrease risk 8-fold)
  • 130 Hepatitis C
  • 13 Hepatitis B (without therapy)
  • Bacterial drug resistance
  • 63 S. aureus in hospitals are MRSA (2007)
  • 80 E. faecium in this area are VRE
  • Bacteruria occurs in 100 of patients with
    indwelling urinary catheters after 30 days

57
UTIs
  • We prevent UTIs by emptying bladder, valves,
    normal flora distally, lack glucose,
    Tamm-Horsfall protein (prevent E. coli
    attachment)
  • Lower UTI vs Upper UTI
  • Lower UTI is the lower poles and the bladder,
    upper UTI is the upper poles and the kidneys
  • Uncomplicated vs Complicated
  • Uncomplicated is adult female who Is not pregnant
    with normal urinary tract anatomy/fxn
  • E. coli most common cause of UTIs

58
UTIs
  • Lower UTI
  • Upper UTI
  • Cystitis
  • Dysuria, frequency, urgency
  • Pyuria tested by urine dipstick
  • Hematuria, bacteruria
  • Uncomplicated tx Cipro x 3d
  • Complicated tx Cipro x 7-14d
  • Urethritis
  • Usually due to STD
  • Prostatitis
  • Avoid rectal exam if acute
  • Acute tx TMP-SMX x 14d
  • Chronic difficult to treat
  • Fever common symptom
  • Pyelonephritis
  • 85 E. coli, 15 entero
  • Dysuria, frequency, urgency
  • Fever, CVA/flank tenderness, N/V
  • urosepsis appear septic
  • Tx ampi aminoglycoside x 14d
  • Renal Abscess
  • Rare complication in DM
  • Can be caused by S. aureus
  • Dx CT/Ultrasound
  • Tx anti-staph PCN, cephalosporin

59
Other UTIs
  • Catheter-related UTI
  • Pregnancy
  • Most common nosocomial infection
  • Indwelling Foley cath
  • Mostly by E. coli, Proteus, Pseudomonas,
    Enterococci
  • Can lead to urosepsis
  • Tx change the catheterbroad spectrum ATB x 3-5d
  • 5 develop asymptomatic bacteruria
  • Screened at 1st visit and 28th week (or 16th week
    once)
  • Associated with premature labor, stillbirth, low
    infant birth weights
  • Tx amoxicillin, TMP-SMX, cephalosporin to
    eradicate

60
CellulitisStaph. aureus Strep. pyogenes
  • Source anterior nares
  • Virulence hemolytic toxin and leukocidin
  • Source nasopharynx
  • Virulence M-protein and hyaluronidase
  • Entry by infected oil gland, puncture, bite,
    rash
  • High risk poor lymph drainage, blood supply,
    neutropenia, hypogammaglobulinemia
  • Tx elevate extremity, local heat, ATB
  • Variants
  • Impetigo confined to dermis with crusting
  • Erysipelas rapidly spreads, raised borders
  • Furuncles local abscesses from infected
    gland
  • Carbuncle several connected furuncles

61
Skin and Soft Tissue Diseases
  • Synergistic Gangrene
  • Toxin-Cased Skin Inflammation
  • Clostridium perfringens is synergistic with GNR,
    S. aureus causing cellulitis
  • Necrosis of blood vessels, gangrene of
    subcutaneous tissue, spreads rapidly
  • Tx Surgical removal
  • Toxic Shock Syndrome
  • Staphylcoccus protein
  • Desquamation of skin of hands, feet, tongue
  • Hypotension, organ failure
  • Scarlet Fever
  • Streptococcus toxin
  • Diffuse red rash
  • Scalded-skin syndrome
  • Staphylococcal toxin
  • Dehydration, infection

62
Skin and Soft Tissue Infections
  • Anthrax
  • Pasteurella Multocida
  • Bacillus anthracis, a soil bacterium
  • Marked edema, necrosis surrounding black ulcer
  • 20 fatal if untreated
  • Common in underdevelopd world
  • Gm- coccobacillus
  • Cat bites
  • Pain/swelling at bite can spread to joints and
    bone
  • Tx opening bite, cleaning, PCN

63
Skin and Soft Tissue Infections
  • Lymphocutaneous Granulomas
  • Lyme Disease
  • Mycobacterium manium or Sporothrix schenckii
  • Painful papule can ulcerate, spread along
    lymphatics
  • M. marinum exposure to fresh/brackish water
  • S. schenckii exposure to plants (rose thorns,
    hay)
  • Tx (fungus) Itraconazole(bac)
    rifampinethambutol
  • Borrelia burgdorferi
  • Deer tick bite, expanding disc of redness
    clearing in center (bulls-eye), lethargy, fever,
    can progress to arthritis and CNS symptoms
  • Tx PCN, tetracycline

64
GI Infections
  • Transmission Feces, Food, Fluids, Fingers,
    Fomites, Fornication, Flies
  • Lactose (CSEEK) Citrobacter, Serratia, E. coli,
    Enterobacter, Kleb
  • Lactose- (invas) Salmonella, Shigella, Yersinia
  • Lactose- (opportunistic) Proteus
  • Non-motile Gm- rod Shigella, Kleb, Yersinia

65
Vibrios
  • Vibrio cholerae
  • Cholera toxin increase cAMP results in water
    loss and dehydration
  • Rice water diarrhea, no fever, no inflammation
  • Halophilic, Gulf Coast
  • Spread via contaminated food/water
  • Vibrio parahemolyticus
  • Improperly cooked seafood, oysters
  • GI year-round, wound infections and septicemia in
    summer
  • Vibrio vulnificus
  • Very virulent
  • Eating oysters can cause sepsis

66
Pathogenic E. coil
  • ETEC (-toxigenic)
  • Travelers diarrhea
  • Contaminated food/H2O
  • Toxins cause diarrhea
  • LT ?cAMP, ST ?cGMP
  • EPEC (-pathgenic)
  • Infant diarrhea
  • Effacing of microvilli, increased signal transd.
  • Oral/fecal, hands, foods
  • EHEC (-hemorrhagic)
  • Bloody diarrhea
  • Fever, HUS (hemolytic anemia, oliguric RF,
    thrombocytopenia)
  • E. coli O157H7
  • Shiga-like toxin, Stx
  • Burgers, apple juice
  • Do not give ATB
  • EAEC (-adhesive)

67
Invasive Enteric Pathogens
  • Shigella
  • S. dysenteriae (developing countries, shiga toxin
    stops protein synthesis), sonnei (US), flexneri,
    boydii
  • Resistant to acid
  • 70 lt15 yo kids
  • Invade colon, multiply intracellularly
  • Salmonella
  • S. typhi (humans), choleraesuis (pigs),
    typhimurium (US)
  • Typhoid fever
  • Bacteria invade and divide in macrophages
  • Carrier in gallbladder
  • Tx (typhi) ampicillin, cefriaxone, bactrim

68
Invasive Enteric Pathogens
  • Yersinia
  • Y. enterocolitica and pseudotuberculosis
  • Resist phagocytosis
  • Blood transfusion disease (grow at 4C)
  • Belgian chocolates
  • Mimic appendicitis
  • Tx Cipro, TMP-SMX, third gen ceph
  • Camphylobacter
  • Small Gm- commas
  • C. jejuni (most common US gastroenteritis,
    poultry, unpasteurized milk, water)C. fetus
    (spread to blood)C. upsaliensis (uncommon)
  • Damage jejunum mucosa, ulceration, self-limited
  • Guillan-Barre sequale

69
Helicobacter
  • H. pylori
  • Spiral Gm- rods
  • Corkscrew motility
  • Urease production
  • Peptic/duodenal ulcers, gastritis, carcinoma,
    MALT lymphoma
  • Fecal-oral transmission
  • Dx ELISA, urease breath test, silver stain,
    biopsy
  • Tx proton pump inhibitor tetra metro bismuth
  • H. cinaedi
  • Gastroenteritis, septicemia, proctitis,
    cellulitis, sepsis in ICH
  • Homosexual men
  • Tx amp and/or gent
  • H. fennelliae
  • Gastroenteritis, septicemia, proctitis
  • Homosexual men
  • Tx amp and/or gent
About PowerShow.com