CHAPTER 8 Microbiological Diseases: Non-Respiratory Infectious Diseases

2. CHAPTER 8Microbiological Diseases:Non-Respiratory Infectious Diseases 8-2

3. Introduction This chapter includes a discussion of infectious diseases of systems of the body (except respiratory system) Includes Diseases Symptoms Diagnostic procedures Treatments 8-3

4. Meningitis Inflammation of meninges (viral or bacterial) Signs/Symptoms (S/S): fever, nuchal rigidity, fatigue, headache, decline in mental status Diagnostics: blood culture, lumbar puncture, gram stain, CSF culture Transmission: respiratory droplets Treatment: antibiotics (if bacterial) (Continues) Infectious Diseases of Head and Neck 8-4

5. Encephalitis Inflammation of brain tissue S/S: fatigue, headache, abnormal brain function, seizures, paralysis, abnormal movements Diagnostic: lumbar puncture Treatment: acyclovir Prognosis: death (if untreated) (Continues) Infectious Diseases of Head and Neck 8-5

6. Otitis media Inflammation of middle ear S/S: irritability, ear tugging, decreased energy and appetite, fever, vomiting Treatment Antibiotics/topical steroids/analgesics/NSAIDs Myringotomy No ASA due to possibility of Reye syndrome (Continues) Infectious Diseases of Head and Neck 8-6

7. Parotitis Infection of parotid gland S/S: localized redness, swelling, firmness, and pain; difficulty swallowing; high fever; chills Treatment Antibiotics Infectious Diseases of Head and Neck 8-7

8. Conjunctivitis Inflammation of sclera Acute: noninfectious (allergies) Bacterial: usually contagious Viral: contagious, often preceded by URI Treatment Bacterial: topical antibiotics Viral: antihistamines/decongestants (Continues) Infections of the Eye 8-8

9. Keratitis Inflammation of cornea Due to: viruses, bacteria, parasites, fungi Can cause blindness; refer to ophthalmologist immediately Diagnostic: culture Treatment: antibiotics if bacterial (medication is compounded by pharmacist, since not commercially available), antivirals if due to Herpes simplex Infections of the Eye 8-9

10. Cardiovascular Infections Endocarditis Infection in one or more heart valves S/S: dyspnea; fever; edema of legs/feet; petechiae/lesions of skin, hair, nails Diagnostic: echocardiogram Treatment Valve replacement IV antimicrobials Prognosis: death if not properly treated 8-10

11. Catheter-Related Bloodstream Infections (CRBIs) Types of catheters (based on infusion site) Central (subclavian, internal jugular, femoral) S/S: localized redness and purulent drainage, fever, hypotension, change in mentation Diagnostic: culture from catheter and from a peripheral vein Treatment: antimicrobials, removal of catheter Peripheral (arms/hands), rarely infected 8-11

12. Cellulitis Infection of lower dermis/fat tissue S/S: flat, red area on skin; difficult to distinguish border; possible drainage Slow development Risk factors: non-intact skin; chronic edema of extremities Treatment Antibiotics (Continues) Infectious Diseases of Skin and Soft Tissues 8-12

13. Infectious Diseases of Skin and Soft Tissues • Erysipelas • Infection of upper dermis and lymphatics of skin • S/S: redness with swelling of tissue above level of skin, fever, chills • Abrupt onset • Treatment • Antibiotics (Continues) 8-13

14. Infectious Diseases of Skin and Soft Tissues • Necrotizing skin and soft tissue infections (including necrotizing fasciitis) • Serious, rapid destruction of skin/fascia • Anaerobic or aerobic • S/S: edematous, fluid-filled blisters at site; fever; tachycardia; hypotension; confusion; decreased urine output • Treatment • Debridement, antibiotics 8-14

15. Intra-Abdominal Infections • Appendicitis • S/S: abdominal pain, radiating from navel to right lower abdomen; nausea; vomiting; loss of appetite • Treatment • Surgery • Antibiotics, if required (Continues) 8-15

16. Intra-Abdominal Infections • Acute cholecystitis • Presence of stone blocking bile flow • S/S: fever, right upper abdominal pain radiating to back or right shoulder, nausea; vomiting; lack of appetite, onset of pain one hour after eating fatty meal • Diagnostic: gallbladder ultrasound • Treatment: surgery, antibiotics, if required (Continues) 8-16

17. Intra-Abdominal Infections • Diverticulitis • Inflammation of diverticula • Rupture can cause localized abscess, diffuse peritonitis (or death if not treated) • S/S: pain in left lower abdomen, nausea, vomiting, constipation or diarrhea • Treatment • Antibiotics (Continues) 8-17

18. Intra-Abdominal Infections • Clostridium difficile colitis • Mild to severe and/or life-threatening • Usual history of antibiotic therapy 10 weeks prior to onset of symptoms • S/S: diarrhea, abdominal pain with cramping, low-grade fever, leukocytosis • Diagnostic: symptoms, history of antibiotics • Treatment: contact isolation, combination therapy (Continues) 8-18

19. Intra-Abdominal Infections • Infectious diarrhea • Associated with consumption of contaminated food, travel, or exposure to pets • S/S: abdominal cramps, diarrhea that might be bloody • Treatment: self-limiting, replacement fluids • Source: usually food, not water • Prevention: handwashing, cautious food and beverage consumption 8-19

20. Genitourinary Tract Infections • Sexually transmitted diseases • Preventable with safe sex practices • Chlamydia • Incubation period 7–21 days • Males: asymptomatic (or) painful urination, mucoid discharge from penis • Females: cervicitis, urethritis, salpingitis, endometritis, PID • Treatment: doxycycline or azithromycin (Continues) 8-20

21. Genitourinary Tract Infections • Sexually transmitted diseases • Gonorrhea • Asymptomatic (or) urogenital, pharyngeal and rectal infections (males and females) • Conjunctivitis (young children and adults) • Coinfection with chlamydia is common • Treatment: ceftriaxone, cefixime, azithromycin (Continues) 8-21

22. Genitourinary Tract Infections • Herpes simplex 1 or 2 • Type 2 usually causes genital herpes • S/S: asymptomatic (or) blisters around rectum/genitals • Outbreaks may recur since viruses cannot be eliminated from the body • Treatment • Antivirals (Continues) 8-22

23. Genitourinary Tract Infections • Human immunodeficiency virus (HIV) • If untreated, progresses to AIDS • Risk factors: STD, injection drug use, receiving blood products, needle stick of health care workers • S/S: similar to common cold • Treatment • Antiretrovirals • Lack of treatment leads to opportunistic infections 8-23

24. Bone and Joint Infections • Osteomyelitis • Infection in one or more bones of the body • S/S: localized pain, redness, warmth and edema at site; fever; chills • Treatment • Debridement • Antibiotics • Surgery to remove necrotic bone (Continues) 8-24

25. Bone and Joint Infections • Septic arthritis • Infection in one or more joints of the body • Risk factors: diabetes, steroid use, surgery or trauma to joint, rheumatoid arthritis, IV drug use, advanced age • S/S: painful, swollen joint; warmth at site; fever with chills; pain with movement of joint • Treatment • Antibiotics 8-25

26. Summary • Clinical presentation, diagnosis, treatment of common non-respiratory infections • Infectious diseases of the head and neck • Infections of the eye • Cardiovascular infections • Infectious diseases of the skin and soft tissues • Intra-abdominal infections • Genitourinary tract infections • Bone and joint infections 8-26

27. Summary • Treatment • Empiric therapy if required • Appropriate anti-infective when microbe is targeted • Refer to text/tables for expanded information related to diseases, treatments 8-27