CHAPTER 8 Microbiological Diseases: Non-Respiratory Infectious Diseases

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. CHAPTER 9Respiratory-Related MicrobiologicalDiseases

23. Introduction Respiratory system Serves as host for infectious diseases, although contains many layers of defense Warm, moist atmosphere facilitating microbacterial growth Site for constant inhalation of environmental particles 9-3

24. Upper Respiratory Infections • Includes • Sinusitis • Pharyngitis • Epiglottitis • Croup 9-4

25. Description Inflammation of hollow sinuses in nasal cavity Viral or bacterial Signs/Symptoms (S/S) (not limited to): nasal stuffiness and discharge; pain/pressure in face; if bacterial, yellow or green nasal discharge Diagnostic Observe for ten days to determine if self-limiting or if treatment required (Continues) Sinusitis 9-5

26. Treatment Oral decongestants Topical decongestants Nasal steroids Analgesics Antibiotics Sinusitis 9-6

27. Description Inflammation of pharynx and surrounding lymphatic tissue Viral or bacterial S/S (not limited to): sore throat; dysphagia; fever; white, mucosal patches Treatment: usually self-limiting; if bacterial, antibiotics Severe complications, if untreated Pharyngitis 9-7

28. Description Acute airway obstruction (airway emergency) Prevalent in children 2–6 years of age Abrupt onset (usually due to haemophilis influenzae Type B) Symptoms (4 Ds): distress (respiratory), drooling, dysphasia, dysphonia Treatment Maintain airway Antibiotic therapy Epiglottitis 9-8

29. Description Infection of laryngeal area, prevalent in children younger than 3 years of age Usually viral S/S: barking cough, stridor, may be afebrile Treatment: air humidification, administration of oxygen, nebulized epinephrine or corticosteroids Croup 9-9

30. Lower Respiratory Infections • Includes • Acute bronchitis • Acute bronchiolitis • Pneumonia • Tuberculosis 9-10

31. Description Affects bronchi; common in winter months Usually viral and may be self-limiting S/S: may progress from nonspecific symptoms (e.g., headache, sore throat) to thick bronchial secretions with productive cough; bilateral rhonchi and coarse crackles Treatment: symptomatic treatment, antibiotics (if bronchitis due to pertussis) Acute Bronchitis 9-11

32. Bronchiolitis Description Affects bronchioles, especially in infants 2–10 months of age; often in winter–spring months S/S (not limited to): restlessness, mild fever, noisy upper airway breathing, tachypnea Most common cause: RSV Treatment: antivirals, aerosolized drug using special nebulizer equipment (hood or mist tent) 9-12

33. Pneumonia • Many types • Community-acquired pneumonia • Atypical pneumonia • Viral pneumonia • Tracheobronchitis • HCAP, VAP, HAP • Aspiration pneumonia • Pneumocystis jiroveci (Continues) 9-13

34. Pneumonia Description Causes: virus, bacteria, fungus, drugs or chemicals S/S (not limited to): leukocytosis, fever, rhonchi, dullness of percussion at site Diagnostic: chest x-ray and cultures of sputum and blood Assess respiratory function to determine need for hospitalization 9-14

35. CAP Description of infection is determined by prevalent pathogens, not geographical location Usual cause: Streptococcus pneumoniae Treatment Determined by such guidelines as local resistance patterns, clinical condition, chest x-ray results Recommended treatments are frequently updated Community-Acquired Pneumonia 9-15

36. Atypical Pneumonia • Description • Cause: organisms not detectable by gram stain, nor growth on standard cultural media • Organisms do not respond to antibiotics used to treat pneumonia • Often due to Mycoplasma pneumoniae, Legionella, Chlamydophila pneumoniae • Treatment • Empiric therapy 9-16

37. Viral Pneumonia Description • Determined by molecular diagnostic methods, such as polymerase chain reaction (PCR) test • Must rule out bacterial cause • Bacteria and virus can coinfect • If bacterial, treat with antibiotics 9-17

38. Tracheobronchitis • Pneumonia-like infection caused by mechanical ventilation • S/S: fever, new/increased sputum production • Diagnostic: sputum sample from endotracheal tube for gram stain and culture • Treatment • Antibiotics (determined by local antibiotic susceptibility patterns) 9-18

39. HCAP, VAP, HAP • Health care–associated (HCAP), ventilator- associated (VAP), hospital-acquired (HAP) • Pneumonia related to exposure to/frequent contact with health care settings • Preventive measures: decrease aspiration by patients; prevent cross-contamination; disinfection/sterilization of respiratory devices; vaccines against certain infections; education of hospital staff and patients 9-19

40. Aspiration Pneumonia • Two types • Chemical • Exposure to stomach acid • Treatment: symptomatic therapy allowing lungs to heal • Bacterial • Due to aspiration of oropharyngeal organisms, or aerosol inhalation • Treatment: empiric antibiotic therapy 9-20

41. Pneumocystis jiroveci (Carinii) • Description • Due to defects in cell-mediated immunity (e.g., complications of HIV; organ or bone marrow transplantation; medications) • S/S (not limited to): asymptomatic (or) fever, cough, tachypnea, dyspnea • Diagnostic: ABGs • Treatment: specific IV or parenteral medications 9-21

42. Tuberculosis • Airborne, chronic disease due to Mycobacterium tuberculosis • Latent: inhaled droplet is encapsulated • Active: inhaled droplet (bacilli) escapes • S/S: asymptomatic (or) weight loss, fever, night sweats, bloody sputum • Diagnostic: Mantoux or PPD, testing of sputum specimen, chest x-ray (Continues) 9-22

43. Tuberculosis • Treatment • If latent • Preventive treatment (isoniazid 6–12 months) • If active • Medication regimen 6–24 months • Directly observed treatment (DOT) may be required due to noncompliance 9-23

44. Bioterrorism • Pulmonary irritants • Chlorine, phosgene • Biochemical reactions of irritants cause laryngospasm and pulmonary edema • Anthrax • Transmission: skin contact, inhalation • If inhaled, spores are transported to lymph system, germinate and produce toxins • Treatment: antibiotics (Continues) 9-24

45. Bioterrorism • Plague • Potential bioweapon, contagious • Transmission: close contact, aerosol • Treatment • If systemic: parenteral antibiotic therapy • Prophylaxis (post-exposure): oral antibiotics • Vaccine no longer available; discontinued in 1999 9-25

46. Avian Influenza (H5N1) • Carried in intestines of wild birds; transmitted to domestic birds, including poultry (cause of human exposure) • May be transmitted through touching contaminated surfaces • S/S noted after a 2- to 5-day incubation period include (not limited to) fever, cough, rhinorrhea, diarrhea, abdominal pain (Continues) 9-26

47. Avian Influenza (H5N1) • Symptoms may progress to acute respiratory distress syndrome • Treatment • Prophylaxis and supportive treatment • Antiviral medications • Includes treatment of anyone living with infected patient 9-27

48. Summary • Clinical presentation, diagnosis, treatment of respiratory system infections • Upper respiratory infections • Lower respiratory infections • Bioterrorism • Avian influenza (Continues) 9-28

49. Summary • Many upper respiratory tract infections due to viruses • Treating viral infections with antibiotics promotes bacterial resistance • Refer to text/tables for in-depth information 9-29