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Diseases of Cardiovacular and Lymphatic Systems

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1 Diseases of Cardiovacular and Lymphatic Systems

2 Sepsis Septicemia, 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

3 Sepsis

4 Sepsis 50% of all cases of sepsis are caused by gram negative rods
other etiologies include: CNS Staphylococcus aureus Enterococcus sp Fungi (yeast) The numbers of sepsis are predicted to increase: larger numbers of immunocompromised patients more frequent use of invasive procedures or devices greater availability of life-sustaining technology higher infection rates of antibiotic resistant bacteria increase 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 the most common cause of death. The term systemic inflammatory response syndrome (SIRS)was developed to imply a clinical response from a non-specific etiology. SIRS is defined as two or more of the following: temperature above 38 C or below 36 C heart rate above 90 beats/minute respiratory rate above 20/minute P CO2 less than 32 mm Hg white blood count above 12M or below 4M cells/mm3 presence of more than 10% immature neutrophils

6 Gas 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. Staphlyococcus aureus and Vibrio vulnificus can also cause similar infections. Gas gangrene occurs as a result of infection by Clostridium bacteria. Under anaerobic (low oxygen) conditions, produce toxins that cause the tissue death and associated symptoms.

7 Gas Gangrene 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)

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 treatment Prognosis    Gas gangrene is progressive and often lethal. Immediate medical attention is required.

9 Plague Yersina 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 human to human when a plague victim develops pneumonia and spreads infected droplets by coughing. An epidemic may be started this way.

11 Plague Symptoms Sudden onset of high fever Chills
   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

12 Plague 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.

13 Plague 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%

14 Art Appreciation

15 Art Appreciation

16 Lyme Disease Borrelia 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 Disease Borrelia 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 Disease The 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 cefuroxime axetil. Patients with certain neurological or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin. Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely. A few patients, particularly those diagnosed with later stages of disease, may have persistent or recurrent symptoms. Scientists have concluded that longer courses of antibiotic treatment are not beneficial. Longer courses of antibiotics have been linked to serious complications, including death.

20 Brucellosis Brucellosis 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 Brucellosis In 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 Brucellosis Mainly 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 Brucella organisms in samples of blood or bone marrow. Also, blood tests can be done to detect antibodies against the bacteria. If this method is used, two blood samples should be collected 2 weeks apart.

24 Brucellosis Treatment 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 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.

26 Tularemia 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.

27 Tularemia 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, deer fly, or tick ingesting infected meat (rare)

28 Tularemia Sx red spot on the skin, enlarging to an ulcer
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

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    meningitis pneumonia pericarditis

30 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

31 Cat-Scratch Disease Symptoms A history of contact with a cat
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.) Fever in approximately one third of patients Fatigue Malaise Headache

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 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).

34 Typhus 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.

35 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

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 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

38 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.

39 Chagas Disease 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 Chagas Disease 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 Chagas Disease Sx    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 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 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 Leishmaniasis 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 abdominal discomfort, vague vomiting (children) diarrhea (children) cough (children) skin, scaly skin, gray, dark, ashen hair, thinning

45 Leishmaniasis 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)

46 Leishmaniasis 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 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).

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 given Prognosis    Treatment before significant damage or severe complications usually produces good results.

50 Toxoplasmosis Toxoplasmosis 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 Toxoplasmosis Toxoplasmosis 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 Toxoplasmosis Cats 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 feces Accidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's feces that contain Toxoplasma Accidental 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. People can be infected by: Accidental ingestion of oocysts after cleaning a cat's litter box when the cat has shed Toxoplasma in its feces Accidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's feces that contain Toxoplasma Accidental 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 Toxoplasmosis Most 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 Toxoplasmosis Persons 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.


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