Chapter 18: Infectious Diseases infecting the Skin and Eyes

Disease

Causative Organism(s) Propionibacterium acnes

Most Common Mode(s) of Transmission Endogenous

Virulence Factors Lipase, inflammatory mediator, other enzymes

Culture/ Diagnosis Based on clinical picture Routinely based on clinical signs, when necessary, culture and Gram stain, coagulase and catalase tests, multitest systems, PCR

Prevention

Treatment Antibiotics(topical or oral), isotretinoin

Distinguishing Features n/a

Acne

n/a

Staphylococcus aureus

Direct Contact, indirect contact

Exfoliative toxin A, coagulase, other enzymes

Hygiene practices

Topical Mupirocin, oral cephalexin

Seen more often in older children, adults

Impetigo Streptokinase, plasminogenbinding ability, hyaluronidase, M protein Same with impetigo S. aureus Same with impetigo S. pyrogenes n/a Mode(s) of Transmission Virulence Factors

Streptococcus pyrogenes

Seen more often in newborns; may have some involvement in all impetigo (preceding S. aureus in staphylococcal impetigo) n/a

S. aureus Cellulitis Streptococcus pyrogenes Other bacteria or fungi Disease Causative Organism(s) Parenteral implantation

Based on clinical signs

n/a

Oral or IV antibiotic (caphalexin); surgery sometimes necessary Aggressive treatment with (see Cellulitis tr.s) Treatment Immediate systemic antibiotics (cloxacillin or cephalexin)

n/a n/a Prevention

n/a More common in immunocompressed Distinguishing Features Split in skin occurs within epidermis

Culture/ Diagnosis Histological sections; culture performed but false (-) common because toxins alone are sufficient for

Scalded Skin Syndrome

S. aureus

Direct contact, droplet contact

Exfoliative toxins A and B

Eliminate carriers in contact with neonates

disease Clostridium perfringens, other species Vehicle (soil), endogenous transfer from skin, GI tract, reproductive tract Droplet contact, inhalation of aerosolized lesion fluid Alpha toxin, other exotoxins, enzymes, gas formation Gram stain, CT scans (abdominal infections), X ray, clinical picture Clean wounds, debride dead tissue Live attenuated vaccine; vaccine to prevent reactivation of latent virus (shingles) Live virus vaccine (vaccinia virus) Penicillin & Clindamycin, surcgical removal, oxygen therapy

Gas gangrene

n/a

Chickenpox

Human herpesvirus 3 (varicella- zoster virus)

Ability to fuse cells, ability to remain latent in ganglia

Based largely on clinical appearance

None in uncomplicated cases; acyclovir for high risk

Smallpox

Variola virus

Droplet contact, indirect contact

Ability to dampen, avoid immune response Syncytium formation,ability to suppress CMI In fetuses: inhibition of mitosis,apoptosis, and damage to vascular endothelium Virulence Factors

n/a No antivirals; Vit A, antibiotics for secondary bacterial infections

No fever prodrome; lesions are superficial; in centripetal distribution (more in center of the body) Fever precedes rash, lesions are deep and in centrifugal distribution Starts on head, spreads to whole body, lasts over a week Milder red rash, lasts approximately 3 days Distinguishing Features Slapped- face rash first, spreads to limbs and trunk, tends to be confluent rather than distinct bumps High fever precedes rash stagerash not always present

Measles (Rubeola)

Measles virus

Droplet contact

ELISA for IgM, acute/ convalescent IgG

Live attenuated vaccine (MMR)

Rubella

Rubella virus

Acute IgM, acute/ convalescent IgG

n/a

Disease

Causative Organism(s)

Mode(s) of Transmission

Culture/ Diagnosis

Prevention

Treatment

Fifth Disease

Parvovirus B19

Droplet contact, direct contact

n/a

Usually diagnosed clinically

n/a

n/a

Roseola

Human herpesvirus 6 or 7

Ability to remain latent

n/a

n/a

Streptococcus pyrogenes (lysogenized)

Droplet contact, direct contact

Erythrogenic toxin

Examination of skin lesions, throat culture (beta- hemolytic on blood agar, sensitive to bacitracin, rapid antigen tests)

Hygiene practices

Penicillin, cephalexin in penicillin- allergic

Sandpaper feel to affected ski; severe sore throat

Warts

Human papillomaviruses

Direct contact, autoinoculation, indirect contact Direct contact, including sexual contact, autoinoculation

n/a

Clinical diagnosis, also histology, microscopy, PCR

Avoid contact

Home treatment, cryosurgery (virus not eliminated) Usually none but mechanical removal can be performed Sodium stibogluconate Ciprofloxacin, doxycycline, levofloxacin Treatment Topical tolnaftate, itraconazole, terbinafine, miconazole, thiabendazine Topical antifungals Topical and oral antibiotics Broad- spectrum topical antibiotic, often ciprofloxacin

n/a

Molluscum contagiosum

Molluscum contagiosum viruses

n/a

n/a

Leishmaniasis

Leishmania spp.

Biological vector

Multiplication with macrophages Endospore formation; capsule, lethal & edema factor Virulence Factors Ability to degrade keratin, invoke hypersensitivity

Cutaneous Anthrax Disease

Bacillus anthracis Causative Organism(s) Trichophyton, Microsporum, Epidermophyton

Direct contact with endospores Mode(s) of Transmission Direct and indirect contact, vehicle (soil) Endogenous normal biota Vertical

Culture of protozoa, microscopic visualization Culture on blood agar; serology, PCR performed by CDC Culture/ Diagnosis Microscopic examination, KOH staining, culture Usually clinical, KOH can be used Gram stain and culture

Avoiding sand fly Avoid contact; vaccine available but not widely used Prevention

Mucocutaneous and systemic forms Can be fatal Distinguishing Features

Cutaneous Infections Superficial Infections (Tinea versicolor) Neonatal conjunctivitis Bacterial conjunctivitis

Avoid contact

n/a

Malassezia furfur Chlamydia trachomatis or Neisseria gonorrhoea S. pyrogenes, S pneumonia, Staphylococcus aureus,

n/a

n/a Screen mothers, apply antibiotic or silver nitrate to newborn eyes Hygiene

n/a In babies < 28 days old Mucopurulent discharge

n/a

Direct, indirect contact

n/a

Clinical diagnosis

Haemophilus influenza, Moraxella and also N. gonorrhea, C. trachomatis Viral conjunctivitis Adenoviruses and others n/a Detection of inclusion bodies in stained preparations Hygiene, vector control, prompt treatment of initial infection None, although antibiotics often given because type of infection not distinguished Azithromycin or topical erythromycin Serous (clear) discharge

Trachoma

C. trachomatis serovars A- C

Indirect contact, mechanical vector

Intracellular growth

n/a

Disease

Causative Organism(s) Herpes simplex virus Miscellaneous microorganisms

Keratitis

Mode(s) of Transmission Reactivation of latent virus, although primary infections can occur in the eye Often traumatic introduction (parenteral)

Virulence Factors Latency

Culture/ Diagnosis Usually clinical diagnosis; viral culture or PCR if needed Various Skin snips: small piece of skin in NaCl soln examined under microscope and microfilariae counted

Prevention

Treatment Topical trifluridine and/or oral acyclovir Specific antimicrobials

Distinguishing Features n/a

n/a

Various

n/a

n/a

River blindness

Wolbachia plus Onchocerca volvulus

Biological vector

Induction of inflammatory response

Avoiding black fly

Ivermectin

Worms often visible in eye

Summing Up Microorganism Gram positive bacteria Disease Acne Impetigo, cellulitis, scalded skin syndrome Impetigo, cellulitis Gas gangrene Cutaneous anthrax

Gram negative bacteria DNA Viruses RNA Viruses Fungi Protozoa Helminths

Neonatal conjunctivitis Neonatal conjunctivitis, trachoma River blindness Chickenpox, smallpox, fifth disease, roseola, warts, molluscum contagiosum, keratitis Measles, rubella Ringworm, superficial mycosis Leishmaniasis River blindness

Chapter 19: Infectious Diseases Affecting the Nervous System Disease Causative Organism(s) Mode(s) of Transmission Virulence Factors Capsule, endotoxin, IgA protease Capsule, induction of apoptosis, hemolysin and hydrogen peroxide production Capsule Culture/ Diagnosis Gram stain/ culture of CSF, blood, rapid antigenic tests Prevention Conjugated vaccine; rifampin or tetracycline used to protect contacts Two vaccines: Prevnar (children), and Pneumovax (adults) Hib vaccine Cooking food, avoiding unpasteurized dairy products Treatment Distinguishing Features Petechiae, meningococcemia

Neisseria meningitidis

Droplet contact

Penicillin G or Cefotaxime

Streptococcus pneumoniae

Droplet contact

Gram stain/ culture of CSF

Cefotaxime check for resistance (add vancomycin in that case) Cefotaxime Ampicillin, trimethoprimsulfamethoxazole

Serious, acute, most common meningitis in adults

Meningitis

Haemophilus influenzae

Droplet contact

Culture on chocolate agar Cold enrichment, rapid methods Negative staining, biochemical tests, DNA probes Identification of spherules, cultivation on

Listeria monocytogenes

Vehicle (food)

Intracellular growth

Serious, acute, less common since vaccine became available Asymptomatic in healthy adults, meningitis in neonates, elderly and immunocompromised Acute or chronic, most common in AIDS patients Almost exlusively in endemic regions

Cryptococcus neoformans

Vehicle (air, dust, soil)

Capsule, melanin production Granuloma (spherule) formation

n/a

Amphotericin B and fluconazole

Coccidioides immitis

Vehicle (air, dust, soil)

Avoiding airborne spores

Amphotericin B or oral or IV itraconazole

Sabourauds agar Initially, absence of bacteria/fungi/ protozoa, followed by viral culture or antigen tests Culture/ Diagnosis Culture mothers genital tract on blood agar; CSF culture of neonate CSF Gram stain/culture Cold enrichment, rapid methods Examination of CSF; brain imaging Examination of CSF; brain imaging Usually none unless specific virus identified and specific antiviral exists)

Viruses

Droplet contact

Lytic infection of host cells

n/a

Generally milder than bacterial or fungal

Disease

Causative Organism(s) Streptococcus agalactiae

Mode(s) of Transmission Vertical (during birth) Vertical (during birth) Vertical Vehicle (exposure while swimming in water) Direct contact

Virulence Factors Capsule

Prevention Culture and treatment of mother Cooking food, avoiding unpasteurized dairy products Avoid warm fresh water

Treatment Penicillin G plus aminoglycosides Cefotaxime plus aminoglycoside Ampicillin, trimethoprimsulfamethoxazole Amphotericin B; mostly ineffective Surgical excision of granulomas; Ketoconazole may help

Distinguishing Features Most common; positive culture of mother confirms diagnosis Suspected if infant is premature Suspected if infant is premature

Neonatal Meningitis

Escherichia coli, strain K1 Listeria monocytogenes Primary Amoebic Meningoencephalitis Naegleria fowleri Granulomatous Amoebic Meningoencephalitis Acanthamoeba Arboviruses (viruses causing WEE, EEE, California encephalitis, SLE, West Nile encephalitis) Herpes simplex 1 or 2 JC virus

Intracellular growth

Invasiveness

Meningoencephalitis

Invasiveness

Vector (arthropod bites)

Attachment, fusion, invasion capabilities

History, rapid serological tests

Insect control, vaccines for WEE and EEE available

None

History of exposure to insect important

Meningitis

Vertical or reactivation of latent infection ? Ubiquitous

Clinical presentation, PCR, Ab tests, growth of virus in cell culture PCR of cerebrospinal

Maternal screening for HSV None

Acyclovir Zidovudine or other antivirals

In infants, disseminated disease present; rare between 30 and 50 years In severely immunocompromised,

fluid Immunologic reaction to other viral infections Sequelae of measles, other viral infections and occasionally, vaccination Mode(s) of Transmission Vehicle (meat) or fecal-oral Persistence of measles virus CJD= direct/parenteral contact with infected tissue; or inherited vCJD= vehicle (meat, parenteral) Parenteral (bite trauma), droplet contact History of viral infection or vaccination Steroids, antiinflammatory agents

especially AIDS History of virus/vaccine exposure critical

Disease

Causative Organism(s) Toxoplasma gondii Subacute sclerosing panencephalitis

Virulence Factors Intracellular growth Cell fusion, evasion of immune system

Culture/ Diagnosis Serological detection of IgM EEGs

Prevention Personal hygiene, food hygiene None

Treatment Pyrimethamine and/or sulfadiazine None

Distinguishing Features Subacute, slower development of disease History of measles

Subacute Encephalitis Prions

Avoidance of host immune response

Biopsy

Avoiding tissue

None

Long incubation period; fast progression once it begins

Rabies

Rabies virus

Envelope glycoprotein

RT-PCR of saliva; Ab detection of serum or CSF; skin biopsy

HDCV inactivated vaccine Live attenuated (developing world) or inactivated vaccine (developed world) Tetanus toxoid immunization Food hygiene; toxoid immunization available for

Postexposure passive and active immunization

n/a

Poliomyelitis

Poliovirus

Fecal-oral, vehicle

Attachment mechanisms

Viral culture, serology

None, palliative, supportive

Tetanus

Clostridium tetani

Parenteral, direct contact Vehicle (foodborne toxin, airborne organism);

Tetanospasm exotoxin

Symptomatic

Combination of passive antitoxin and tetanus toxoid active immunization, supportive Antitoxin, supportive care

n/a

Botulism

Clostridium botulinum

Botulinum exotoxin

Culture of organism; demonstration of toxin

n/a

direct contact (wound); parenteral (injection) African Sleeping Sickness Trypanosoma brucei subspecies gambiense or rhodesiense Vector, vertical Immune evasion by antigen shifting Microscopic examination of blood, CSF

laboratory professionals Suramin or pentamidine (early), melarsoprol (late)

Vector control

Chapter 20: Infectious Diseases Affecting the Cardiovascular and lymphatic systems Most Common Mode(s) of Transmission Parenteral

Disease

Causative Organism(s) Staphylococcus aureus

Virulence Factors

Culture/ Diagnosis

Prevention

Treatment Penicillin, or vancomycin plus aminoglycoside; surgery may be necessary Penicillin, or vancomycin plus aminoglycoside; surgery may be necessary Broad-spectrum antibiotic until identification and susceptibilities tested Streptomycin or gentamicin

Distinguishing Features Acute onset, high fatality rate

Acute Endocarditis

Attachment

Blood culture

Aseptic surgery, injections Prophylactic antibiotics before invasive procedures

Subacute Endocarditis

Alpha-hemolytic streptococci

Endogenous transfer of normal biota to bloodstream Parenteral, endogenous transfer Vector, biological; also droplet contact (pneumonic) and direct contact with body fluids Vector, biological; also direct contact with body fluids from infected animal; airborne Vector, biological

Attachment

Blood culture

Slower onset

Septicemia

Bacteria or fungi

Cell wall or membrane components Capsule, Yop system, plasminogen activator

Blood culture

Plague

Yersinia pestis

Culture or Gram stain of blood or bubo aspirate Culture dangerous to lab workers and not reliable; serology most often used ELISA for Ab, PCR

Flea and or animal control; vaccine available for high-risk individuals Live attenuated vaccine for highrisk individuals

Tularemia

Francisella tularensis

Intracellular growth

Gentamicin or streptomycin Doxycycline and/or amoxicillin (34 weeks), also

Lyme Disease

Borrelia burgdorferi

Antigenic shifting, adhesins

Tick avoidance

cephalosporins and penicillin Epstein-Barr virus (EBV) Infectious Mononucleosis Cytomegalovirus (CMV) Direct, indirect contact, parenteral Direct, indirect contact, parenteral, vertical Latency, ability to incorporate into host DNA Differential blood count, Monospot test for heterophile antibody, specific ELISA Virus isolation and growth, ELISA or PCR tests Most common in teens

Supportive

Latency, ability to fuse cells

Vaccine in trials

Only for immunosuppressed patients, not usually for mononucleosis

More common in adults, dangerous to fetus

Hemmorhagic Fever Most Common Mode(s) of Transmission Biological vector Biological vector Direct contact, body fluids Droplet contact (aerosolized rodent excretions), direct contact with infected fluids

Disease Yellow fever Dengue Fever Ebola and/or Marburg

Causative Organism(s) Yellow fever virus Dengue fever virus Ebola virus, Marburg virus

Virulence Factors Disruption of clotting factors Disruption of clotting factors Disruption of clotting factors

Culture/ Diagnosis ELISA, PCR Rise in IgM titers PCR, viral culture (conducted at CDC)

Prevention Live attenuated vaccine available Live attenuated vaccine being tested

Treatment Supportive Supportive Supportive

Distinguishing Features Accompanied by jaundice Breakbone fever so named due to severe pain Massive hemorrhage; rash sometimes present Chest pain, deafness as longterm sequelae

Lassa Fever

Lassa fever virus

Disruption of clotting factors

ELISA

Avoiding rats, safe food storage

Ribavirin

Nonhemmorhagic Fever Most Common Mode(s) of Transmission Direct contact, airborne, parenteral (needlesticks)

Disease

Causative Organism(s) Brucella abortus or B. suis

Virulence Factors Intracellular growth; avoidance of destruction by phagocytes

Culture/ Diagnosis Gram stain of biopsy material

Prevention Animal control, pasteurization of milk

Treatment Doxycycline plus (gentamicin or streptomycin)

Distinguishing Features Undulating fever, muscle aches

Brucellosis

Q fever

Coxiella burnetii

Airborne, direct contact,

Endosporelike structure

Serological tests for antibody Biopsy of lymph nodes plus Gram staining; ELISA (performed by CDC) ELISA (performed by CDC) PCR, indirect antibody test Fluorescent antibody, PCR

Vaccine for highrisk population

Doxycycline

Airborne route of transmission, variable disease presentation History of cat bite or scratch; fever not always present Endocarditis common, 5-day fever Seasonal occurrence (AprilOct.) Most common in east and southeast United States

Cat-Scratch Disease

Bartonella henselae

food-borne

Endotoxin

Clean wound sites

Azithromycin

Trench Fever Ehrlichioses Rocky Mountain Spotted Fever

Bartonella quintana Ehrlichia species Rickettsia rickettsii

Parenteral (cat scratch or bite) Biological vector (lice) Biological vector (tick)

Endotoxin Induces apoptosis in cells lining blood vessels

Avoid lice Avoid lice Avoid lice

Doxycycline or erythromycin Doxycycline Doxycycline

Disease

Causative Organism(s) Plasmodium falciparum, P. vivax, P. ovale, P. malariae

Most Common Mode(s) of Transmission Biological vector (mosquito), vertical

Virulence Factors Multiple life stages; multiple antigenic types, ability to scavenge glucose, GPI, cytoadherence Triple exotoxin, capsule Attachment, syncytia formation, reverse transcriptase, high mutation rate Induction of malignant state

Culture/ Diagnosis

Prevention Mosquito control; use of bed nets; no vaccine yet available; prophylactic antiprotozoal agents Vaccine for highrisk population, postexposure antibiotic prophylaxis Avoidance of contact with infected sex partner, contaminated blood, breast milk

Treatment Chloroquine, mefloquine, artemisinin, Fansidar, quinine, or proguanil Doxycycline, ciprofloxacin, penicillin HAART (reverse transcriptase inhibitors plus protease inhibitors), Fuzeon, nonnucleoside RT inhibitors Antineoplastic drugs, interferon alpha

Distinguishing Features

Malaria

Blood smear; serological methods

Anthrax

Bacillus anthracis

Vehicle (air, soil) indirect contact (animal hides), vehicle (food) Direct contact (sexual), parenteral (blood-borne), vertical (perinatal and via breast milk) Unclear bloodborne transmission implicated

Culture, direct fluorescent antibody tests Initial screening for antibody followed by Western blot confirmation of antibody Differential blood count followed by histological examination of

HIV Infection and AIDS

Human immunodeficiency virus 1 or 2

Adult T-Cell Leukemia

HTLV-I

Hairy-Cell Leukemia

(Possibly) HTLV-II

Unclear bloodborne transmission implicated

Induction of malignant state

excised lymph node tissue Differential blood count followed by histological examination of excised lymph node tissue

Antineoplastic drugs, interferon alpha

Chapter 21: Infectious disease affecting the respiratory system

Disease

Causative Organism(s) Approximately 200 viruses

Most Common Mode(s) of Transmission Indirect contact, droplet contact

Virulence Factors Attachment proteins; most symptoms induced by host response

Culture/ Diagnosis

Prevention

Treatment

Distinguishing Features

Rhinitis

Not necessary Culture not usually performed; diagnosis based on clinical presentation, occasionally X rays or other imaging technique used Same

Hygiene practices

For symptoms only

Various bacteria, often mixed infection Sinusitis

Endogenous (opportunism)

Broad-spectrum antibiotics

Much more common than fungal

Various fungi

Introduction by trauma or opportunistic Overgrowrth Endogenous (may follow upper respiratory tract infection by S. pneumoniae or other microorganisms) Endogenous (follows upper respiratory tract infection)

Streptococcus pneumoniae Otitis Media

Capsule, hemolysin

Usually relies on clinical symptoms and failure to resolve within 72 hours

Pneumococcal conjugate vaccine (heptavalent)

Physical removal of fungus; in severe cases antifungals used Wait for resolution; if needed, amoxicillin (are high rates of resistance) or amoxicillin clavalanate or cefuroxine Same as for S. pneumoniae

Suspect in immunocompromised patients

Haemophilus influenzae

Capsule, fimbriae

Same

Hib vaccine

Other bacteria

Endogenous

Same

None

Wait for resolution; if needed, a broadspectrum antibiotic (azithromycin) might be used in absence of etiologic diagnosis

Suspect if fully vaccinated against other two

Disease

Causative Organism(s) Streptococcus pyogenes

Most Common Mode(s) of Transmission Droplet or direct contact

Virulence Factors LTA, M protein, hyaluronic acid capsule, SLS and SLO, superantigens

Culture/ Diagnosis Beta-hemolytic on blood agar, sensitive to bacitracin, rapid antigen tests Goal is to rule out S. pyogenes, further diagnosis usually not performed Tellurite medium gray/black colonies, club-shaped morphology on Gram stain; treatment begun before definitive identification Grown on B-G, charcoal, or potatoglycerol agar; diagnosis can be made on symptoms Direct antigen testing Viral culture (310 days) or rapid antigen-based or PCR tests

Prevention

Treatment Penicillin, cephalexin in penicillin-allergic Symptom relief only

Distinguishing Features Generally more severe than viral pharyngitis Hoarseness frequently accompanies viral pharyngitis

Hygiene practices

Pharyngitis Viruses All forms of contact Droplet contact, direct contact or indirect contact with contaminated fomites

Hygiene practices

Diphtheria

Corynebacterium diphtheriae

Exotoxin: diphtheria toxin

Diphtheria toxoid vaccine (part of DTaP)

Antitoxin plus penicillin or erythromycin

Pertussis (Whooping Cough)

Bordetella pertussis Respiratory syncytial virus (RSV) Influenza A, B, and C viruses

Droplet contact

FHA (adhesion), pertussis toxin and tracheal cytotoxin, endotoxin Syncytia formation Glycoprotein spikes, overall ability to change genetically

RSV Disease

Droplet and indirect contact Droplet contact, direct contact, some indirect contact

Influenza

Acellular vaccine (DTaP), erythromycin or trimethoprimsulfamethoxazole for contacts Passive antibody in high-risk children Killed injected vaccine or inhaled live attenuated vaccinetaken annually

Mainly supportive; erythromycin to decrease communicability Ribavirin in severe cases Amantadine, rimantadine, zanamivir, or oseltamivir

Disease

Causative Organism(s)

Most Common Mode(s) of Transmission

Virulence Factors

Culture/ Diagnosis

Prevention

Treatment Isoniazid, rifampin, and pyrazinamide ethambutol or streptomycin for varying lengths of time (always lengthy); if resistant, two other drugs added to regimen Azithromycin or clarithromycin plus one additional antibiotic Cefotaxime, ceftriaxone, ketek; much resistance Fluoroquinolone, azithromycin, clarithromycin Recommended not to treat in most cases, doxycycline or macrolides may be used if necessary Supportive

Distinguishing Features

Mycobacterium tuberculosis Tuberculosis

Vehicle (airborne)

Lipids in wall, ability to stimulate strong cell-mediated immunity (CMI)

Rapid methods plus culture; initial tests are skin testing and chest X ray

Avoiding airborne M. tuberculosis, BCG vaccine in other countries

Responsible for nearly all TB except for HIV

Mycobacterium avium complex Streptococcus pneumoniae

Vehicle (airborne) Droplet contact or endogenous transfer Vehicle (water droplets)

Positive blood culture Gram stain often diagnostic, alphahemolytic on blood agar Requires selective charcoal yeast extract agar; serology unreliable

Capsule

Rifabutin or azithromycin given to AIDS patients at risk Pneumococcal polysaccharide vaccine (23valent)

Suspect this in HIVpositive patients Patient usually severely ill Mild pneumonias in healthy people; can be severe in elderly or immunocompromised Usually mild; walking pneumonia

Legionella species

Mycoplasma pneumoniae Pneumonia Hantavirus SARS-associated coronavirus Histoplasma capsulatum Pneumocystis jiroveci

Droplet contact

Adhesins

Rule out other etiologic agents

No vaccine, no permanent immunity Avoid mouse habitats and droppings Avoid contaminated soil/ bat, bird droppings Antibiotics given to AIDS patients to prevent this

Vehicle airborne virus emitted from rodents Droplet, direct contact Vehicle inhalation of contaminated soil Droplet contact

Ability to induce inflammatory response ? Survival in phagocytes

Serology (IgM), PCR identification of antigen in tissue Rule out other agents, serology, PCR Usually serological (rising Ab titers) Immunofluorescence

Rapid onset; high mortality rate Rapid onset Many infections asymptomatic Vast majority occur in AIDS patients

Supportive Amphotericin B and/or itraconazole Trimethoprimsulfamethoxazole

Nosocomial Pneumonia

Gram-negative and gram-positive bacteria from upper respiratory tract or stomach

Endogenous (aspiration)

Culture of lung fluids

Elevating patients head, preoperative education, care of respiratory equipment

Broad-spectrum antibiotics

Chapter 22: Infectious diseases affecting the GIT

Disease Dental Caries

Causative Organism(s) Streptococcus mutans, Streptococcus sobrinus, others Polymicrobial community including some or all of: Tannerella forsythus, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, others? Polymicrobial community (Treponema vincentii, Prevotella intermedia, Fusobacterium species) Mumps virus (genus Paramyxovirus)

Most Common Mode(s) of Transmission Direct contact

Virulence Factors Adhesion, acid production

Culture/ Diagnosis -

Prevention Oral hygiene, fluoride supplementation

Treatment Removal of diseased tooth material Removal of plaque and calculus, gum reconstruction, tetracycline

Distinguishing Features

Periodontitis

Induction of inflammation

Oral hygiene

Necrotizing Ulcerative Gingivitis and Periodontitis Mumps

Inflammation Clinical, fluorescent Ag tests, ELISA for Ab

Oral hygiene

Debridement of damaged tissue, metronidazole, clindamycin Supportive Antibiotics plus acid suppressors (clarithromycin or metronidazole plus omeprazole or bismuth subsalicylate)

Droplet contact

Spike-induced syncytium formation

MMR live attenuated vaccine

Gastritis and Gastric Ulcers

Helicobacter pylori

Adhesions, urease

ELISA, endoscopy

None

Disease: Acute Diarrhea:

Causative Organism(s)

Most Common Mode(s) of Transmission Vehicle (food, beverage), fecaloral

Virulence Factors Adhesins, endotoxin Endotoxin, enterotoxin, shiga toxins in some strains Shiga toxins; proteins for attachment, secretion, effacement Various: proteins for attachment, secretion, effacement; heat-labile and/or heatstable exotoxins; invasiveness Adhesins, exotoxin, induction of autoimmunity

Culture/ Diagnosis Stool culture, not usually necessary Stool culture; antigen testing for shiga toxin Stool culture, antigen testing for shiga toxin

Prevention Food hygiene and personal hygiene Food hygiene and personal hygiene Avoid live E. coli (cook meat and clean vegetables)

Treatment Rehydration; no antibiotic for uncomplicated disease TMP-SMZ, rehydration Antibiotics contraindicate d, supportive measures

Fever Present

Blood in Stool

Salmonella

Usually

Sometimes

Distinguis hing Features Often associated with chickens, reptiles Very low ID50

Shigella

Fecal-oral

Often

Often

Shiga-toxinproducing E. coli O157:H7 (EHEC)

Vehicle (food, beverage), fecaloral

Often

Usually

Hemolytic uremic syndrome

Bacterial Causes

Other E. coli (non-shiga-toxinproducing)

Vehicle, fecal-oral

Stool culture not usually necessary in absence of blood, fever

Food and personal hygiene

Rehydration

Sometimes

Sometimes

EIEC, ETEC, EPEC

Campylobacter

Vehicle (food, water), fecal-oral

Stool culture not usually necessary; dark-field microscopy Coldenrichment stool culture Stool culture, PCR, ELISA demonstrati

Food and personal hygiene

Yersinia

Vehicle (food, water), fecal-oral, indirect contact Endogenous (normal biota)

Intracellular growth

Food and personal hygiene

Clostridium difficile

Enterotoxins A and B

Rehydration, erythromycin in severe cases (antibiotic resistance rising) None in most cases, doxycycline or TMP-SMZ for bacteremia Withdrawal of antibiotic, in severe cases metronidazole

Usually

No

GuillainBarr syndrome

Usually

Occasionall y Not usually; mucus

Severe abdominal pain Antibioticassociated diarrhea

Sometimes

Vibrio cholerae

Vehicle (water and some foods), fecal-oral

Cholera toxin (CT)

Cryptosporidium Nonbacterial causes Rotavirus Other Viruses Staphylococcus aureus exotoxin

Vehicle (water, food), fecal-oral Fecal-oral, vehicle, fomite Fecal-oral, vehicle

Intracellular growth Heat-stable exotoxin

on of toxins in stool Clinical diagnosis, microscopic techniques, serological detection of antitoxin Acid-fast staining, ruling out bacteria Usually not performed Usually not performed Usually based on epidemiologi cal evidence Microscopic analysis of food or stool Detection of toxin in stool

or vancomycin Rehydration, in severe cases tetracycline, TMP-SMZ None, paromomycin used sometimes Rehydration Rehydration

Water hygiene

No

prominent

Rice-water stools

Water treatment, proper food handling Oral live virus vaccine Hygiene

Often Often Sometimes

Not usually No No

Resistant to chlorine disinfection Severe in babies

Acute Diarrhea with Vomiting (Food Poisoning)

Bacillus cereus Clostridium perfringens

Vehicle (food)

Heat-stable toxin, heatlabile toxin Heat-labile toxin

Proper food handling

None

Not Usually

No

Suspect in foods with high salt or sugar content Two forms: emetic and diarrheal Acute abdominal pain

Disease

Causative Organism(s) Enteroaggregative E. coli (EAEC)

Most Common Mode(s) of Transmission Vehicle (food, water), fecal-oral

Virulence Factors ?

Culture/ Diagnosis Difficult to distinguish from other E. coli Stool examination, PCR Stool examination, ELISA

Prevention

Treatment None, or ciprofloxacin

Fever Present No

Blood in Stool Sometimes , mucus also

? Washing, cooking food, personal hygiene Water hygiene, personal hygiene

Distinguis hing Features Chronic in the malnourish ed Frequently occurs in backpacker s, campers

Chronic Diarrhea

Cyclospora cayetanensis

Fecal-oral, vehicle

Invasiveness

TMP-SMZ

Usually

No No, mucus present (greasy and

Giardia lamblia

Vehicle, fecaloral, direct and indirect contact

Attachment to intestines alters mucosa

Quinacrine, metronidazole

Not usually

malodorou s) Entamoeba histolytica Lytic enzymes, induction of apoptosis, invasiveness Stool examination, ELISA, serology Water hygiene, personal hygiene Iodoquinol plus metronidazole or chloroquine, Flagyl Chronic in the malnourish ed

Vehicle, fecal-oral

Yes

Yes

Disease

Causative Organism(s) Hepatitis A or E virus

Most Common Mode(s) of Transmission Fecal-oral, vehicle Parenteral (blood contact), direct contact (especially sexual), vertical Parenteral (blood contact), vertical

Virulence Factors

Culture/ Diagnosis

Prevention Hepatitis A vaccine or combined HAV/HBV vaccine HBV recombinant vac

Treatment

Long term consequences

Incubation Period

IgM serology

Immune globulin

None

27 weeks

Hepatitis

Hepatitis B virus

Latency

Serology (ELISA, radioimmuno assay)

Interferon, nucleoside analogs (Pegylated) interferon with or without ribavirin

Chronic infection, liver cancer, death Chronic infection and liver disease very common; cancer, death

16 months

Hepatitis C virus

Core protein suppresses immune function?

Serology

28 weeks

Disease

Causative Organism(s) Trichuris trichiura (whipworm) Enterobius vermicularis (pinworm) Taenia solium (pork tapeworm) Diphyllobothrium

Most Common Mode(s) of Transmission Cycle A: vehicle (soil)/fecal-oral Cycle A: vehicle (food, water), fomites, selfinoculation Cycle C: vehicle (pork) also fecal-oral Cycle C: vehicle

Virulence Factors Burrowing and invasiveness

Culture/ Diagnosis Blood count, serology, egg or worm detection Adhesive tape method Blood count, , serology, egg or worm detection Blood count,

Prevention Hygiene, sanitation Hygiene Cook meat, avoid pig feces Cook meat

Treatment Mebendazole Piperazine, pyrantel Praziquantel, Niclosamide Praziquantel,

Distinguishing Features Humans sole host Common in United States Tapeworm; intermediate host is pigs Large tapeworm;

Intestinal Distress

Vitamin B12

latum (fish tapeworm) Hymenolepis nana and H. diminuta Ascaris lumbricoides (intestinal roundworm) Intestinal Distress plus Migratory Symptoms Necator americanus and Ancylostoma duodenale (hookworms) Strongyloides stercoralis (threadworm) Opisthorchis sinensis, Clonorchis sinensis Fasciola hepatica

(seafood) Cycle C: vehicle (ingesting insects)also fecal-oral Cycle A: vehicle (soil/fecal-oral), fomites, selfinoculation Cycle B: vehicle (soil), fomite Cycle B: vehicle (soil), fomite Cycle D: vehicle (fish or crustaceans) Cycle D: vehicle (water and water plants) Cycle D: vehicle (contaminated water)

usage

serology, egg or worm detection Blood count, serology, egg or worm detection Hygienic environment

Niclosamide

anemia Most common tapeworm infection Roundworm; 1 billion persons infected Penetrates skin, serious intestinal symptoms Penetrates skin, severe for immunocompromised Live in bile duct Live in liver and gallbladder Penetrates skin, lodges in blood vessels of intestine, damages liver Brain and heart involvement can be fatal

Praziquantel

Induction of hypersensitivity, adult worm migration, and abdominal obstruction

Hygiene Blood count, serology, egg or worm detection

Alebendazole

Sanitation

Alebendazole Invermectin or thiabendazole Praziquantel Triclabendazole

Sanitation Cook food, sanitation of water Sanitation of water Avoiding contaminated vehicles

Liver and Intestinal Disease

Blood count, serology, egg or worm detection Identification of eggs in feces, scarring of intestines detected by endoscopy Serology combined with clinical picture; muscle biopsy

Liver Disease

Schistosoma mansoni, S. japonicum

Antigenic cloaking

Praziquantel

Muscle and Neurological Symptoms

Trichinella species

Vehicle (food)

Cook meat

Mebendazole and steroids

Chapter 23: Infectious Diseases Affecting the Genitourinary tract

Disease

Causative Organism(s)

Most Common Mode(s) of Transmission

Virulence Factors

Culture/ Diagnosis Often bacterial infection diagnosed on basis of increased white cells in urinalysis; if culture performed, bacteria may or may not be identified to species level

Prevention

Treatment

Distinguishing Features

Escherichia coli Urinary Tract Infections (Cystitis, Pyelonephritis) Staphylococcus saprophyticus Proteus mirabilis

Endogenous transfer from GI tract (opportunism)

Adhesins, motility

Vaccine may be available soon; hygiene practices

Cephalosporin

Opportunism

Urease enzyme, leads to kidney stone formation Slide agglutination test of patients blood for antibodies

Hygiene practices Hygiene practices Strain-specific vaccine available to limited populations; avoiding contaminated vehicles Avoiding contaminated vehicles

Ampicillin, amoxicillin, trimethoprimsulfamethoxazole Ampicillin or cephalosporins Kidney stones and severe pain may ensue

Opportunism

Leptospirosis

Leptospira interrogans

Vehicle contaminated soil or water

Adhesins? Invasion proteins?

Doxycycline and amoxicillin

Urinary Schistosomiasis

Schistosoma haematobium

Vehicle (contaminated water)

Antigenic cloaking, induction of granulomatous response

Identification of eggs in urine

Praziquantel

Disease

Causative Organism(s) Candida albicans

Most Common Mode(s) of Transmission Opportunism

Virulence Factors

Culture/ Diagnosis Wet prep or Gram stain Visual exam of vagina, or clue cells seen in Pap smear or other smear Protozoa seen on Pap smear or Gram stain Digital rectal exam to examine prostate; culture of urine or semen

Prevention

Treatment Topical or oral azole drugs, some over-the-counter drugs Metronidazole or clindamycin

Distinguishing Features White curdlike discharge

Vaginitis/ Vaginosis

Mixed infection, usually including Gardnerella Trichomonas vaginalis

Opportunism?

Discharge may have fishy smell Discharge may be greenish Pain in genital area and/or back, difficulty urinating

Direct contact (STD) Endogenous transfer from GI tract; otherwise unknown

Barrier use during intercourse

Metronidazole

Prostatitis

GI tract biota

Various

None

Antibiotics, muscle relaxers, alpha blockers

Genital Discharge Diseases (in Addition to Vaginitis/Vaginosis) Disease Gonorrhea Effects on fetus: Eye infections, blindness Neisseria gonorrhoeae Causative Organism(s) Most Common Mode(s) of Transmission Virulence Factors Fimbrial adhesions, antigenic variation, IgA protease, membrane blebs/endotoxin Intracellular growth resulting in avoiding immune system and cytokine release, unusual cell wall preventing phagolysosome fusion Culture/ Diagnosis Gram stain in males, rapid tests (PCR, ELISA) for females, culture on ThayerMartin agar Avoid contact; condom use PCR or ELISA, can be followed by cell culture Azithromycin, doxycycline and follow-up to check for reinfection More commonly asymptomatic than gonorrhea Prevention Treatment Many strains resistant to various antibiotics; local and current guidelines must be consulted Distinguishing Features Rare complications include arthritis, meningitis, endocarditis

Direct contact (STD), vertical Chlamydia Effects of Fetus: Eye infections, pneumonia Chlamydia trachomatis

Disease: Genital Ulcer Diseases

Causative Organism(s)

Most Common Mode(s) of Transmission

Virulence Factors

Culture/ Diagnosis Direct tests (immunofluorescence, dark-field microscopy), blood tests for treponemal and nontreponemal antibodies, PCR Culture from lesion

Prevention Antibiotic treatment of all possible contacts, avoiding contact Avoiding contact Avoiding contact, antivirals can reduce recurrences

Treatment

Distinguishing Features

Effects on Fetus

Syphilis

Treponema pallidum

Direct contact and vertical

Lipoproteins

Penicillin G

Three stages of disease plus latent period, possibly fatal

Congenital syphilis

Chancroid

Haemophilus ducreyi

Direct contact (vertical transmission not documented) Direct contact, vertical

Hemolysin (exotoxin)

Azithromycin, ceftriaxone

No systemic effects Ranges from asymptomatic to frequent recurrences

None

Herpes

Herpes simplex 1 and 2

Latency

Clinical presentation, PCR, Ab tests, growth of virus in cell culture

Acyclovir and derivatives

Blindness, disseminated herpes infection

Disease: Wart Disease

Causative Organism(s)

Most Common Mode(s) of Transmission Direct contact (STD)also autoinoculation, indirect contact Direct contact (STD), also indirect and autoinoculation

Virulence Factors Oncogenes (in the case of malignant types of HPV)

Culture/ Diagnosis

Prevention Vaccine available; avoid direct contact; prevent cancer by screening cervix Avoid direct contact

Treatment Warts or precancerous tissue can be removed; virus not treatable Warts can be removed; virus not treatable

Distinguishing Features Infection may or may not result in warts; infection may result in malignancy Wartlike growths are only known consequence of infection

Effects on Fetus May cause laryngeal warts

HPV

Human papillomaviruses Poxvirus, sometimes called the molluscum contagiosum virus (MCV)

PCR tests for certain HPV types

Molluscum Contagiosum

Clinical diagnosis

Disease Group B Streptococcus Colonization

Causative Organism(s) Group B Streptococcus

Most Common Mode(s) of Transmission Vertical

Culture/ Diagnosis Culture of mothers genital tract

Prevention

Treatment

Treat mother with penicillin/ ampicillin