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Diseases of Cardiovacular and Lymphatic Systems

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Title: Diseases of Cardiovacular and Lymphatic Systems


1
Diseases of Cardiovacular and Lymphatic Systems
2
Rheumatic Fever
  • Caused by Streptcoccus pyogenes
  • Generally starts out as sore throat caused by
    Strep. bug
  • Signs and symptoms
  • First expressed as a period of arthritis and
    fever
  • Subcutaneous nodules at joints often accompany
    this stage
  • 50 afffected, experience inflammation of heart
    probably due to misdirected immune reaction
    against infection
  • Causes damage to heart valves

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  • Treatment
  • Treatment of rheumatic fever involves a dual
    approach antibiotics to rid your body of
    streptococcal infection and prevent recurrences,
    and other medications to ease the symptoms of the
    disease.
  • To eliminate any remaining strep bacteria once
    you have rheumatic fever, your doctor may
    prescribe penicillin or another antibiotic.
    Usually, you'll then need to be on some kind
    suppressive schedule of antibiotics for several
    to many years to prevent second attacks of
    rheumatic fever.

5
Tularemia
  • Francisella tularensis, the organism that causes
    tularemia, is one of the most infectious
    pathogenic bacteria known, requiring inoculation
    or inhalation of as few as 10 organisms to cause
    disease. It is considered to be a dangerous
    potential biological weapon because of its
    extreme infectivity, ease of dissemination, and
    substantial capacity to cause illness and death.
  • Francisella tularensis is a hardy non-spore
    forming organism that is capable of surviving for
    weeks at low temperatures in water, moist soil,
    hay, straw or decaying animal carcasses.

6
  • Tularemia is a zoonosis. Natural reservoirs
    include small mammals such as voles, mice, water
    rats, squirrels, rabbits and hares. Naturally
    acquired human infection occurs through a variety
    of mechanisms such as bites of infected
    arthropods handling infectious animal tissues or
    fluids direct contact or ingestion of
    contaminated water, food, or soil and inhalation
    of infective aerosols. F. tularensis is so
    infective that examining an open culture plate
    can cause infection.
  • Humans can contract tularemia in the following
    ways
  • direct contact with an infected animal or carcass
    via broken skin
  • the bite of an infected flea or tick
  • ingesting infected meat (rare)

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  • Symptoms   
  • red spot on the skin, enlarging to an ulcer
  • enlarged lymph nodes of groin or armpits
  • headache
  • muscle pains
  • possible conjunctivitis
  • shortness of breath
  • fever
  • chills
  • sweating
  • weight loss
  • joint stiffness

9
  • Treatment   
  • The goal of treatment is to eliminate the
    infection with antibiotic therapy. Streptomycin
    and tetracycline are commonly used in this
    infection.
  • Tularemia is fatal in about 5 of untreated cases
    and in less than 1 with treatment.
  • Complications   
  • meningitis
  • pneumonia
  • pericarditis

10
Anthrax
  • Anthrax is an infectious disease caused by the
    spore-forming bacteria called Bacillus anthracis.
  • Infection in humans most often involves the skin
    (cutaneous anthrax), the gastrointestinal tract,
    or the lungs (inhalation anthrax).
  • Cutaneous anthrax is an infection of the skin
    with anthrax.
  • The disease occurs after the bacteria contact
    skin cuts or abrasions.
  • Usually within two weeks, an itchy skin lesion
    develops (similar to an insect bite).
  • This lesion may later blister and then break
    down, resulting in a black ulcer which is
    frequently painless. The skin lesion is usually
    surrounded by significant swelling.
  • Sometimes painful lymph nodes may develop. A scab
    is often formed which then dries and falls off
    within two weeks.
  • In 20 of UN-treated individuals, the infection
    may spread through the bloodstream and become
    fatal. However, in most individuals who receive
    appropriate treatment, death from cutaneous
    anthrax is extremely rare.

11
  • Inhalation anthrax develops when anthrax spores
    enter the lungs.
  • A person may have spores in the nasal passages
    (which indicates exposure), but that doesn't mean
    they will get the disease. In fact, antibiotic
    therapy following known or suspected exposure can
    help prevent the disease.
  • In order for a person to develop the actual
    disease, the spores must germinate -- a process
    which may take several days, or even up to 60
    days to occur.
  • The spores move to the lymph nodes, and once they
    germinate, lead to the release of several toxic
    substances (toxins).
  • This results in hemorrhage, swelling, and tissue
    death. The main form of inhalation anthrax
    includes hemorrhagic infection of the lymph nodes
    in the chest (hemorrhagic mediastinitis).
  • Up to half of affected individuals may also have
    a hemorrhagic meningitis.

12
  • There are usually two stages of inhalation
    anthrax
  • the first stage can last from hours to a few days
    and is similar to a flu-like illness with fever,
    headache, cough, shortness of breath, and chest
    pain.
  • The second stage often develops suddenly and is
    notable for shortness of breath, fever, and
    shock. This second stage is highly fatal in up to
    90 of individuals because of the build-up of
    toxins.

13
  • Symptoms   
  • Cutaneous anthrax papule, blister, ulcer with
    black scar with extensive surrounding swelling
  • Inhalation anthrax Initial stage -- fever,
    malaise, headache, cough, shortness of breath,
    and chest pain Second stage -- fever, severe
    shortness of breath, and shock

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  • Treatment   
  • The mainstay of treatment is early antibiotic
    therapy. Several antibiotics are effective,
    including penicillin, doxycycline, and
    ciprofloxacin (Cipro).
  • If an outbreak of anthrax is suspected, the
    antibiotic of choice is ciprofloxacin, until it
    is known whether the anthrax strain is resistant
    to any of the other usual antibiotics.
  • Because spores may take up to 60 days to
    germinate, the length of treatment is usually 60
    days.
  • For inhalation anthrax, people with known or
    suspected exposure would be given oral
    antibiotics (pills).
  • If a person develops symptoms of the disease or
    has a positive test for the disease itself (not
    just a test for "exposure"), antibiotics would be
    given intravenously (IV) for 14 days, then orally
    for the rest of the 60 days.
  • Cutaneous anthrax is treated with oral
    antibiotics (pills).

16
  • The prognosis of cutaneous anthrax treated with
    antibiotics is excellent. However, in the absence
    of antibiotics, up to 20 of individuals may die
    as anthrax may spread into the bloodstream.
  • The prognosis of inhalation anthrax once it
    reaches the second stage is poor, even with
    antibiotic therapy. Up to 90 of cases in the
    second stage are fatal.

17
Cat-scratch Disease
  • Cat scratch disease is an infectious illness
    caused by the bacteria Bartonella, believed to be
    transmitted by cat scratches, bites, or exposure
    to cat saliva.
  • More than 40,000 cases occur annually in the US
  • Symptoms   
  • A history of contact with a cat
  • Common
  • Papule or pustule at site of injury
    (inoculation), usually the first sign
  • Swelling of the lymph nodes (adenopathy) occurs
    in the area near where the skin was infected
    (bitten, scratched, etc.)

18
  • Fever in approximately one third of patients
  • Fatigue
  • Malaise
  • Headache
  • Treatment   
  • Generally, cat scratch disease is not serious.
    Treatment, other than reassurance, is not usually
    recommended. However, in severe cases treatment
    with antibiotics can be helpful.

19
Plague
  • Plague is transmitted among rodents and to humans
    by flea bite or ingestion of the feces of fleas.
    It can also be transmitted human to human when a
    plague victim develops pneumonia and spreads
    infected droplets by coughing. An epidemic may be
    started this way.

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  • Symptoms  
  • Sudden onset of high fever
  • Chills
  • General discomfort, uneasiness, or ill feeling
    (malaise)
  • Muscular pains
  • Severe headache
  • Smooth, oval, reddened, painful swellings of
    swollen lymph glands called buboes in the groin,
    armpits, neck, or elsewhere in the body. Pain may
    occur in the area before the swelling the most
    common area is in the groin
  • Seizures

22
  • Treatment   
  • Immediate treatment with antibiotics such as
    streptomycin, chloramphenicol, or tetracycline is
    indicated.
  • Oxygen, intravenous fluids, and respiratory
    support are additional treatments.
  • Patients with pneumonic plague are strictly
    isolated from other patients.
  • People who have had contact with anyone infected
    by pneumonic plague are observed closely and are
    given antibiotics as a preventive measure.
  • Prognosis   
  • Half of bubonic plague victims die if not
    treated, and almost all victims of pneumonic
    plague die if not treated. Treatment reduces the
    death rate to 5

23
Typhus
  • Typhus is a rickettsial disease caused by one of
    two organisms, Rickettsia prowazekii (epidemic
    typhus and Brill disease) and Rickettsia typhi
    (murine or endemic typhus). Epidemic typhus and
    Brill disease are uncommon in the United States.
  • Murine typhus occurs in the southeastern and
    southern states. There are less than 100 cases
    per year. Murine typhus is a milder form and is
    seldom fatal (less than 2).
  • It is frequently seen in the summer and fall and
    typically lasts two to three weeks. Risk factors
    for murine typhus include exposure to rat fleas
    or rat feces, or exposure to other animals (such
    as cats, opossums, raccoons, skunks, and rats).
  • Epidemic typhus occurs in poor hygienic
    conditions (which is why it is sometimes called
    "jail fever"), usually when the temperature is
    cold. It is spread by lice. Although very rare in
    the United States, it has sometimes been spread
    by the lice and fleas of flying squirrels.

24
  • SYMPTOMS OF MURINE TYPHUS
  • headache
  • backache
  • arthralgia
  • fever, extremely high (105 to 106 degrees
    Fahrenheit) and may last up to two weeks
  • rash that begins on the trunk and spreads
    peripherally (The rash is made up of dull red
    macules that may become slightly papular after
    the initial appearance may last only a few
    hours.)
  • nausea and vomiting in most patients
  • hacking, dry cough
  • abdominal pain

25
  • SYMPTOMS OF EPIDEMIC TYPHUS
  • severe headache
  • fever, high (104 degrees Fahrenheit)
  • cough in 70 of patients
  • arthralgia and myalgia, (muscle pain) severe
  • chills
  • falling blood pressure
  • stupor
  • delirium
  • rash that begins on chest and spreads to rest of
    trunk and extremities, but not to palms and soles
  • early rash is faint and rose colored and fades
    with pressure (Later the lesions become dull,
    red, and do not fade. People with severe typhus
    may also develop petechiae.)
  • lights appear very bright, and exposure to light
    may hurt the eyes

26
  • Treatment   
  • The goal of treatment is to eliminate the
    infection and to treat the symptoms with
    antibiotics (such as tetracycline, doxycycline,
    or chloramphenicol). For epidemic typhus,
    intravenous fluids and oxygen may be necessary to
    help stabilize the patient.
  • Prognosis   
  • Without treatment death may occur in 10 to 60 of
    patients with epidemic typhus. Patients over the
    age of 60 have the highest risk of death. With
    timely antibiotic therapy, the affected person is
    expected to recover completely.
  • Less than 2 of untreated patients with murine
    typhus may die, and appropriate antibiotic
    therapy will cure virtually all patients.

27
Rocky Mountain Spotted Fever
  • An infectious disease caused by Rickettsia
    rickettsii transmitted to humans by the bite of
    ticks.
  • Symptoms   
  • fever
  • chills
  • incubation period of 2 to 14 days
  • severe headache
  • muscle pain
  • mental confusion
  • rash, first appearing on wrists and ankles, then
    spreading to most of the body, usually starts a
    few days after fever starts up to 20 of people
    do not get a rash

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  • Treatment   
  • The objective of treatment is careful removal of
    the tick from the skin and antibiotics to
    eliminate the infection. Doxycycline or
    tetracycline are frequently used. Chloramphenicol
    may be used in pregnant women.
  • Prognosis   
  • Treatment usually cures the infection.
    Complications are rare but can include paralysis,
    hearing loss, and nerve damage. The death rate is
    5 to 7 and usually reflects a delay in seeking
    treatment.

30
Gangrene
  • A severe form of gangrene (tissue death) usually
    caused by Clostridium perfringens (see also
    necrotizing subcutaneous infection). It can also
    be from Group A Streptococcus. Staphlococcus
    aureus and Vibrio vulnificus can also cause
    similar infections.
  • Gas gangrene occurs as a result of infection by
    Clostridium bacteria that, under anaerobic (low
    oxygen) conditions, produce toxins that cause the
    tissue death and associated symptoms.

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  • Gas gangrene generally occurs at the site of
    trauma or a recent surgical wound.
  • Symptoms   
  • moderate to severe pain around a skin injury
  • progressive swelling around a skin injury
  • moderate to high fever
  • skin color initially pale, later dusky
    progressing to dark red or purple
  • vesicle (blister) formation, coalescent (combine
    into large blisters)
  • blisters filled with brown-red fluid
  • drainage from the tissues, foul-smelling
    brown-red or bloody fluid (serosanguineous
    discharge)
  • increased heart rate (tachycardia)
  • sweating
  • subcutaneous emphysema (air under the skin)

33
  • Treatment   
  • Prompt surgical removal of dead, damaged, and
    infected tissue (debridement) is necessary.
    Amputation of an arm or leg may be indicated to
    control the spread of infection.
  • Antibiotics, preferably penicillin-type, should
    be given. Initially, this is given intravenously
    (through a vein). Analgesics may be required to
    control pain. Hyperbaric oxygen has been tried
    with varying degrees of success.
  • Prognosis   
  • Gas gangrene is progressive and often lethal.
    Immediate medical attention is required.

34
Lyme Disease
  • Borrelia burgdorferi
  • Transmitted by bite of tick
  • One of the most common tickborne diseases in the
    US
  • Field mice most important reservoir
  • Prevalent in atlantic ticks

35
  • Symptoms
  • Bull's-eye rash at site of bite
  • Flulike symptoms appear on couple of weeks as
    rash fades
  • During 2nd phase, irregular hearbeat
  • Neurological symp.
  • Facial paralysis
  • Meningitis,
  • Encephalitis

36
  • Early treatment with antibiotics seem to be
    effective
  • Lyme arthritis resolves in most patients within a
    few weeks or months following antibiotic therapy,
    although it can take years to disappear
    completely in some people.
  • If the disease has persisted long enough,
    however, it may irreversibly damage the structure
    of the joints. Following treatment for Lyme
    disease, some people still have muscle achiness,
    neurologic symptoms such as problems with memory
    and concentration, and persistent fatigue.
    NIH-sponsored researchers are conducting studies
    to determine the cause of these symptoms and how
    to best treat them.

37
Chagas Disease
  • Chagas disease is caused by Trypanosoma cruzi, a
    parasite related to the African trypanosome that
    causes sleeping sickness. It is spread by reduvid
    bugs and is one of the major health problems in
    South America, where 20 million people are
    infected. Due to immigration, approximately
    500,000 people in the United States are believed
    to be infected.

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  • Chagas disease has two phases -- acute and
    chronic.
  • The acute phase may have no symptoms or have very
    mild symptoms.
  • Symptoms of the acute phase include swelling and
    reddening at the site of infection (where the
    blood-sucking insect caused the initial
    infection).
  • This may be followed by swelling of one eye.
  • Lymph nodes that drain the area of the insect
    bite may become swollen.
  • As the parasite spreads from the bite site, the
    patient develops fever, malaise, and generalized
    swelling of the lymph nodes.
  • The liver and spleen may become enlarged.
  • The disease goes into remission after the acute
    phase and may become chronic with no further
    symptoms for many years.
  • When symptoms finally develop, they appear as
    cardiac disease (cardiomyopathy) and digestive
    abnormalities.

40
  • Patients may develop congestive heart failure.
    Swallowing difficulties may be the first symptom
    of digestive disturbances and may lead to
    malnutrition. Patients who have parasitic
    infection of the colon may experience abdominal
    pain and constipation. Death is usually caused by
    heart disease.

41
  • Symptoms   
  • history of exposure in an area where Chagas
    disease is known to occur
  • swollen red area at site of previous insect bite
  • enlarged lymph nodes
  • swelling of one eye
  • fever
  • irregular heartbeat (arrhythmia)
  • rapid heartbeat (tachycardia)
  • swallowing difficulties

42
  • Treatment   
  • The acute phase should be treated. Benznidazole
    has been shown to be effective. Experimental
    treatment may include nifurtimox. Treating the
    chronic phase with antibiotics is not helpful.
    Instead, the symptoms of heart and intestinal
    disease should be treated.
  • Prognosis   
  • Approximately 30 of infected and untreated
    people will develop chronic or symptomatic Chagas
    disease. It may take more than twenty years from
    the time of the original infection to develop
    heart or digestive problems.
  • Abnormal heart rhythms (arrythmias, ventricular
    tachycardia) may cause sudden death. Once
    congestive heart failure develops, death usually
    occurs within several years.

43
Leishmaniasis
  • Leishmania are tiny protozoa. Their parasitic
    life cycle includes the sandfly and an
    appropriate host. Humans are one of those hosts.
    Leishmania infection can cause skin disease
    (called cutaneous leishmaniasis). It can affect
    the mucous membranes with a wide range of
    appearance, most frequently ulcers. It may cause
    skin lesions that resemble those of other
    diseases including cutaneous tuberculosis,
    syphilis, leprosy, skin cancer (basal cell
    carcinoma), and fungus infections.

44
  • Leishmania can also cause systemic disease
    (visceral leishmaniasis) with fatal
    complications.
  • When introduced into the body by the bite of a
    sandfly, the parasite migrates to the bone
    marrow, spleen, and lymph nodes.
  • Systemic infection in children usually begins
    suddenly with vomiting, diarrhea, fever, and
    cough.
  • In adults, fever for 2 weeks to 2 months is
    accompanied by nonspecific symptoms such as
    fatigue, weakness, and loss of appetite.
  • Weakness increases as the disease progresses. The
    skin may become grayish, dark, dry and flaky.
  • The parasites damage the immune system by
    decreasing the numbers of disease-fighting cells
    so death usually results from complications such
    as other infections rather than from the disease
    itself.
  • Death often occurs within 2 years.

45
  • Symptoms   
  • history of exposure to the bite of sandflies
  • history in being in an area known for
    leishmaniasis
  • Systemic illness (visceral leishmaniasis)
  • fever, persistent, long duration (weeks), may
    cycle irregularly
  • night sweats
  • fatigue
  • weakness
  • appetite loss (anorexia)
  • weight loss

46
  • abdominal discomfort, vague
  • vomiting (children)
  • diarrhea (children)
  • cough (children)
  • skin, scaly
  • skin, gray, dark, ashen
  • hair, thinning

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  • Skin disease (cutaneous leishmaniasis)
  • Symptoms on the skin include
  • macule or papule, erythematous
  • skin ulcer, forms at site of original lesion
  • ulcer heals very slowly over a matter of months
  • smaller lesions may form around the ulcer
    (satellite lesions)

49
  • Treatment   
  • Antimony-containing compounds are the principal
    medications used to treat leishmaniasis. These
    include
  • meglumine antimonate
  • sodium stibogluconate
  • Other drugs that may be used include
  • pentamidine
  • amphotericin B
  • Miltefosine

50
  • Plastic surgery may be required to correct
    disfigurement by destructive facial lesions
    (mucocutaneous leishmaniasis). Removal of the
    spleen (splenectomy) may be required in
    drug-resistant cases (visceral leishmaniasis).

51
Schistosomiasis
  • Causes and risks   
  • Schistosoma infections are contracted through
    contact with contaminated water. The parasite in
    its infective stages is called a cercaria. It
    swims freely in open bodies of water.
  • On contact with humans, the parasite burrows into
    the skin, matures into another larval stage
    (schistosomula), then migrates to the lungs and
    liver (where it matures into the adult form).
  • The adult worm then migrates to the anatomic area
    of its preference, depending on which species is
    involved. Likely areas include the bladder,
    rectum, intestines, liver, portal venous system,
    spleen, and lungs.
  • Schistosomiasis is not usually found in the
    United States. However, it is prevalent in many
    tropical or subtropical areas, and it is a common
    illness thought to affect more than 200 million
    people.

52
  • Symptoms   
  • Symptoms vary with the species of worm and the
    phase of infection.
  • Initial invasion of the skin may cause itching
    and a rash (swimmer's itch).
  • Heavy infestation may cause fever, chills, lymph
    node enlargement, and liver and spleen
    enlargement.
  • Urinary symptoms may include frequency, painful
    urination (dysuria), and blood in urine
    (hematuria).
  • Intestinal symptoms include abdominal pain and
    diarrhea (which may be bloody).

53
  • Treatment   
  • Praziquantel
  • With acute infection, corticosteroids may be
    given
  • Prognosis   
  • Treatment before significant damage or severe
    complications usually produces good results.
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