2 SepsisSepticemia, bacteremia, “bacteria in the blood” 500M cases in United States/annum 25% mortality rate 10% of patients with sepsis die of underlying disease or comorbidity 13th leading cause of death in the United States Cost 5-10 billion in annual healthcare expenditures
4 Sepsis 50% of all cases of sepsis are caused by gram negative rods other etiologies include:CNSStaphylococcus aureusEnterococcus spFungi (yeast)The numbers of sepsis are predicted toincrease:larger numbers of immunocompromised patientsmore frequent use of invasive procedures or devicesgreater availability of life-sustaining technologyhigher infection rates of antibiotic resistant bacteriaincrease proportion of patients at the extremes of age
5 Bacterial Sepsis Among hospitalized in non-coronary intensive care units, sepsis has been reported to be themost common cause of death.The term systemic inflammatory responsesyndrome (SIRS)was developed to imply aclinical response from a non-specific etiology.SIRS is defined as two or more of the following:temperature above 38 C or below 36 Cheart rate above 90 beats/minuterespiratory rate above 20/minute P CO2 less than 32 mm Hgwhite blood count above 12M or below 4M cells/mm3presence of more than 10% immature neutrophils
6 Gas Gangrene A severe form of gangrene (tissue death) usually caused by Clostridiumperfringens (see also necrotizingsubcutaneous infection). It can also befrom Group A Streptococcus.Staphlyococcus aureus and Vibriovulnificus can also cause similarinfections.Gas gangrene occurs as a result ofinfection by Clostridium bacteria.Under anaerobic (low oxygen)conditions, produce toxins that causethe tissue death and associatedsymptoms.
7 Gas Gangrene Gas gangrene generally occurs at the site of trauma or a recentsurgical wound.Symptoms moderate to severe pain around a skin injuryprogressive swelling around a skin injurymoderate to high feverskin color initially pale, later dusky progressing to dark red or purpleVesicle (blister) formation, coalescent (combine into large blisters)blisters filled with brown-red fluiddrainage from the tissues, foul- smelling brown-red or bloody fluid (serosanguineous discharge)increased heart rate (tachycardia)sweatingsubcutaneous emphysema (air under the skin)
8 Gas Gangrene Treatment Prognosis 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.Hyperbaric treatmentPrognosis Gas gangrene is progressive and often lethal. Immediate medical attention is required.
9 PlagueYersina pestis is the causative agent. Three clinical manifestations: Pneumonic Septicemic Bubonic In early stages of bubonic there is fever, delirium, and swelling of lymph nodes. Septicemia develops and cause hemorragic blackened lesion therefore black death
10 Plague Plague is transmitted among rodents and to humans by flea bite or ingestion of the feces of fleas.It can also be transmitted humanto human when a plague victimdevelops pneumonia and spreadsinfected droplets by coughing.An epidemic may be started thisway.
11 Plague Symptoms Sudden onset of high fever Chills Sudden onset of high feverChillsGeneral discomfort, uneasiness, or ill feeling (malaise)Muscular painsSevere headacheSmooth, 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 groinSeizures
12 PlagueTreatment 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.
13 PlaguePrognosis 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%
16 Lyme DiseaseBorrelia burgdorferi is a species of Gram negative bacteria of the spirochete class of the genus Borrelia. B. burgdorferi is predominant in North America, but also exists in Europe, and is the agent of Lyme disease. It is a zoonotic, vector-borne disease transmitted by ticks and is named after the researcher Willy Burgdorfer who first isolated the bacterium in B. burgdorferi is one of the few pathogenic bacteria that can survive without iron, having replaced all of its iron-sulfur cluster enzymes with enzymes that use manganese, thus avoiding the problem many pathogenic bacteria face in acquiring iron.
17 Lyme DiseaseBorrelia burgdorferi infections have been linked to non-Hodgkin lymphomas. Lyme disease is diagnosed based on symptoms, objective physical findings (such as erythema migrans, facial palsy, or arthritis), and a history of possible exposure to ticks. Validated laboratory tests can be very helpful but are not generally recommended when a patient has erythema migrans.
18 Lyme DiseaseThe Lyme disease bacterium, Borrelia burgdorferi, normally lives in mice, squirrels and other small animals. It is transmitted among these animals and to humans through the bites of certain species of ticks. In the northeastern and north-central United States, the black-legged tick (or deer tick, Ixodes scapularis) transmits Lyme disease.
19 Lyme Disease Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroximeaxetil. Patients with certain neurological orcardiac forms of illness may require intravenoustreatment with drugs such as ceftriaxone orpenicillin.Patients treated with antibiotics in the early stagesof the infection usually recover rapidly andcompletely.A few patients, particularly those diagnosed withlater stages of disease, may have persistent orrecurrent symptoms.Scientists have concluded that longer courses ofantibiotic treatment are not beneficial.Longer courses of antibiotics have been linked toserious complications, including death.
20 BrucellosisBrucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates. Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria.
21 BrucellosisIn humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Also known as undulating fever (higher at night), muscle aches, enlarged spleen and lymph nodes Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.
22 BrucellosisMainly an infection of livestock. Human cases are reported as: 60% butchers, meat packers 30% ranchers and hunters 10% people who consume unpasteurized dairy products
23 Brucellosis Brucellosis is diagnosed in a laboratory by finding Brucellaorganisms in samples ofblood or bone marrow.Also, blood tests can be done todetect antibodies against thebacteria.If this method is used, two bloodsamples should be collected 2 weeksapart.
24 BrucellosisTreatment can be difficult. Doctors can prescribe effective antibiotics. Usually, doxycycline and rifampin are used in combination for 6 weeks to prevent reoccuring infection. Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Mortality is low (<2%), and is usually associated with endocarditis.
25 Tularemia Francisella tularensis, the organism that causes tularemia, is one of themost infectious pathogenicbacteria known, requiringinoculation or inhalation of as fewas 10 organisms to cause disease.It is considered to be a dangerouspotential biological weapon because ofits extreme infectivity, ease ofdissemination, and substantial capacityto cause illness and death.Francisella tularensis is a hardy non-spore forming organism that is capableof surviving for weeks at lowtemperatures in water, moist soil, hay,straw or decaying animal carcasses.
26 Tularemia Tularemia is a zoonosis. Natural reservoirs include small mammals such as voles,mice, water rats, squirrels, rabbits andhares.Naturally acquired human infection occursthrough a variety of mechanisms such as:bites of infected arthropods; handlinginfectious animal tissues or fluids; directcontact or ingestion of contaminatedwater, food, or soil; and inhalation ofinfective aerosols.
27 TularemiaF. 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 skinthe bite of an infected flea, deer fly, or tickingesting infected meat (rare)
28 Tularemia Sx red spot on the skin, enlarging to an ulcer red spot on the skin, enlarging to an ulcerenlarged lymph nodes of groin or armpitsheadachemuscle painspossible conjunctivitisshortness of breathfeverchillssweatingweight lossjoint stiffness
29 Tularemia Tx Complications 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 meningitispneumoniapericarditis
30 Cat-Scratch DiseaseCat 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
31 Cat-Scratch Disease Symptoms A history of contact with a cat Papule or pustule at site of injury (inoculation), usually the first signSwelling of the lymph nodes (adenopathy) occurs in the area near where the skin was infected (bitten, scratched, etc.)Fever in approximately one third of patientsFatigueMalaiseHeadache
32 Cat-Scratch Disease 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.
33 TyphusTyphus 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).
34 TyphusEpidemic 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.
35 Symptoms Of Epidemic Typhus severe headachefever, high (104 degrees Fahrenheit)cough in 70% of patientsarthralgia and myalgia, (muscle pain) severechillsfalling blood pressurestupordeliriumrash that begins on chest and spreads to rest of trunk and extremities, but not to palms and solesearly 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
36 Typhus Treatment Treatment Prognosis 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.
37 Rocky Mountain Spotted Fever An infectious disease causedby Rickettsia rickettsiitransmitted to humans by thebite of ticks.Symptoms feverchillsincubation period of 2 to 14 dayssevere headachemuscle painmental confusionrash, 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
38 Chagas DiseaseChagas 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.
39 Chagas DiseaseChagas 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 Chagas Disease Patients may develop congestive heart failure. Swallowing difficulties maybe the first symptom ofdigestive disturbances andmay lead to malnutrition.Patients who have parasiticinfection of the colon mayexperience abdominal pain andconstipation. Death is usuallycaused by heart disease.
41 Chagas Disease Sxhistory of exposure in an area where Chagas disease is known to occurswollen red area at site of previous insect biteenlarged lymph nodesswelling of one eyefeverirregular heartbeat (arrhythmia)rapid heartbeat (tachycardia)swallowing difficulties
42 Chagas Disease Treatment Prognosis 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 LeishmaniasisLeishmania 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 Leishmaniasis Symptoms history of exposure to the bite of sandflies history in being in an area known for leishmaniasisSystemic illness (visceral leishmaniasis)fever, persistent, long duration (weeks), may cycle irregularlynight sweatsfatigueweaknessappetite loss (anorexia)weight lossabdominal discomfort, vaguevomiting (children)diarrhea (children)cough (children)skin, scalyskin, gray, dark, ashenhair, thinning
45 LeishmaniasisSkin disease (cutaneous leishmaniasis) Symptoms on the skin include:macule or papule, erythematousskin ulcer, forms at site of original lesionulcer heals very slowly over a matter of monthssmaller lesions may form around the ulcer (satellite lesions)
46 Leishmaniasis Treatment Antimony-containing compounds are the principal medications used to treat leishmaniasis. These include:meglumine antimonatesodium stibogluconateOther drugs that may be used include:pentamidineamphotericin BMiltefosinePlastic 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).
47 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.
48 Schistosomiasis 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).
49 Schistosomiasis Treatment Prognosis Praziquantel With acute infection, corticosteroids may be givenPrognosis Treatment before significant damage or severe complications usually produces good results.
50 ToxoplasmosisToxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. In the United States it is estimated that 22.5% of the population 12 years and older have been infected with Toxoplasma. In various places throughout the world, it has been shown that up to 95% of some populations have been infected with Toxoplasma. Infection is often highest in areas of the world that have hot, humid climates and lower altitudes.
51 ToxoplasmosisToxoplasmosis is not passed from person-to-person, except in instances of mother-to-child (congenital) transmission and blood transfusion or organ transplantation. People typically become infected by three principal routes of transmission.
52 Toxoplasmosis Foodborne transmission The tissue form of the parasite (a microscopic cyst consisting of bradyzoites) can be transmitted to humans by food. People become infected by:Eating undercooked, contaminated meat (especially pork, lamb, and venison)Accidental ingestion of undercooked, contaminated meat after handling it and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin)Eating food that was contaminated by knives, utensils, cutting boards, or other foods that had contact with raw, contaminated meat
53 ToxoplasmosisCats play an important role in the spread of toxoplasmosis. They become infected by eating infected rodents, birds, or other small animals. The parasite is then passed in the cat's feces in an oocyst form, which is microscopic.Kittens and cats can shed millions of oocysts in their feces for as long as 3 weeks after infection. Mature cats are less likely to shed Toxoplasma if they have been previously infected. A Toxoplasma-infected cat that is shedding the parasite in its feces contaminates the litter box. If the cat is allowed outside, it can contaminate the soil or water in the environment as well.People can accidentally swallow the oocyst form of the parasite. People can be infected by:Accidental ingestion of oocysts after cleaning a cat's litter box when the cat has shed Toxoplasma in its fecesAccidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's feces that contain ToxoplasmaAccidental ingestion of oocysts in contaminated soil (e.g., not washing hands after gardening or eating unwashed fruits or vegetables from a garden)Drinking water contaminated with the Toxoplasma parasite
54 Toxoplasmosis People can accidentally swallow the oocyst form of the parasite. Peoplecan be infected by:Accidental ingestion of oocysts after cleaning a cat's litter box when the cat has shed Toxoplasma in its fecesAccidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's feces that contain ToxoplasmaAccidental ingestion of oocysts in contaminated soil (e.g., not washing hands after gardening or eating unwashed fruits or vegetables from a garden)Drinking water contaminated with the Toxoplasma parasite
55 ToxoplasmosisMost healthy people recover from toxoplasmosis without treatment. Persons who are ill can be treated with a combination of drugs such as pyrimethamine and sulfadiazine, plus folinic acid. Pregnant women, newborns, and infants can be treated, although the parasite is not eliminated completely. The parasites can remain within tissue cells in a less active phase; their location makes it difficult for the medication to completely eliminate them.
56 ToxoplasmosisPersons with ocular toxoplasmosis are sometimes prescribed medicine to treat active disease by their ophthalmologist. Whether or not medication is recommended depends on the size of the eye lesion, the location, and the characteristics of the lesion (acute active, versus chronic not progressing). Persons with compromised immune systems need to be treated until they have improvement in their condition. For AIDS patients, continuation of medication for the rest of their lives may be necessary, or for as long as they are immunosuppressed.