INFECTION

INFECTION

• The most frequent encountered

pathology

• The leading cause of death from

disease
INFECTION

• We share this world with many

organisms, using us as a source
of energy

• Humans possess diverse

protective mechanisms
DEFINITION

Is a dynamic process involving

- invasion of the body by
pathogenic microorganisms
- reaction of the tissue to their
injury
INFECTION

• The indigenous micro flora

usually does not harm, may be
beneficial
• Infection evolves into overt
disease only when the
equilibrium between host and
microorganisms is upset
INFECTION

• When the host’s resistance is

lowered, the indigenous
microorganisms are capable of
causing disease
• Lowered resistance:
• Malnutrition
• Cancer
• Diabetes mellitus
• Old age
Infection is

as great a problem now

as in the past
THE PENICILLIN

• Discovered by Flemming-1929
• First used-1941
• Still active on streptococcal
infections
INFECTION

• Streptococci are no longer the

captains of death- ab. can
control them
• Staphylococci continue to
cause nosocomial infection
(hospital acquired infection)
• G- bacteria have become a
major problem
NOSOCOMIAL
INFECTIONS
• Hospital acquired infections

• Transmission of pathogens to
previously uninfected patient from a
source in the hospital environment
NOSOCOMIAL
INFECTION
• Some nosocomial infections have an
iatrogenic basis: prolonged use of
vascular or urinary catheters
• Patients may become infected by direct
contact with a carrier or contaminated
objects during hospitalization
SURGICAL INFECTION

• Infection that requires surgical

treatment
• It can be a complication of surgical
treatment
• Postop. wound infection =
nosocomial infection
• Most common surgical pathogens:
staph. strepto. G - bacili
INFECTION

• Pathogenic bacterias have the

capacity to invade and produce
disease
• Infection disease is a biological
accident and a complex
interaction between the
bacterias and the host
INFECTION

• Healthy people that harbor

pathogenic bacteria= carriers
• The healthy carrier = the
principal reservoir of most
diseases
• If the resistance of the host is
low or a big number of bacteria
are introduced- infection
INFECTION
VIRULENCE
• Tissue invading powers of a
specific strain of a pathogen:
• The smallest dose of a bacterial
strain that will produce disease
• A given strain produces the
disease more frequently than
another
HOST DEFENCES

• Primary defenses
• Antibacterial substances in blood,
lymph and interstitial fluid
• Phagocyte cells
• Intact skin and mucous
membranes
• Secondary defenses
• Specific antibodies
LOW HOST RESISTANCE

• DIABETES MELLITUS
• VIRAL INFECTIONS
• MALIGNANT DISEASE
• MALNUTRITION
• CHRONIC ALCOOLISM
CLASSIFICATION

• RELATED TO FINAL OUTCOME

• SELF-LIMITING INFECTION
• SERIOUS INFECTION
• FULMINATING INFECTION
CLASSIFICATION

• RELATED TO OPERATING TIME

• ANTEOP.SURGICAL INFECTION
• OPERATIVE SURGICAL INFECTION
• PREVENTABLE
• NO PREVENTABLE
• POSTOPERATIVE SURG. INF.
DIAGNOSIS
• LOCAL SIGNS
• REDNESS, SWELLING, HEAT, PAIN
• LOSS OF FUNCTION
• GENERAL SIGNS
• FEVER, CHILLS, MALAISE
• WBC- LEUCOCYTOSIS
• GRAM STAIN SMEAR
• BACTERIOLOGICAL CULTURE
• BIOPSY
• BLOOD CULTURE
SURGICAL THERAPY

• LOCAL TREATMENT
• DEBRIDEMENT
• DRAINAGE
• SUPPORTIVE MEASURES
• BED REST
• IMMOBILIZATION
• PAIN KILLERS
• ANTIBIOTICS
ANTIBIOTICS
• Antibiotics should be:
• Used only when necessary
• Discontinued as soon as possible
• Chosen carefully
• Used cost/effectively
• Key pharmalogical parameters:
• Tissue penetration
• Duration of action
• Route of elimination
• Tolerability/interactions
DEFINITIONS FOR
SEPSIS-RELATED
CLINICAL CONDITIONS
DEFINITIONS
SEPSIS-RELATED
• SEPSIS=SIRS resulting from
infection

• SEVERE SEPSIS= sepsis

associated with signs of at
least one acute organ
dysfunction
DEFINITION SEPSIS-
RELATED
• SEPTIC SHOCK= sepsis induced
hypotension persisting despite
adequate fluid resuscitation

• MODS=MULTIPLE ORGAN
DYSFUBCTION SYNDROME
INFECTIONS WITH
STAPHYLOCOCCUS
AUREUS
• BOILS OR FURUNCLES
• STYES
• PARONYCHIA
• CARBUNCLES
• HIDRADENITIS SUPPURATIVA
• OSTEOMYLITIS
• INFECTIONS OF BURNS AND
SURGICAL WOUNDS
STREPTOCOCCUS
PYOGENES INFECTIONS
• SUPPURATIVE
• PHARYNGITIS
• IMPETIGO
• PNEUMONIA
• NON SUPPURATIVE
• RHEUMATIC FEVER
• ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS
ERYSIPELAS

• ERYTHEMATOUS SWELLING OF
THE SKIN DUE TO STREPTO.
PYOGENES
• DIFFUSE CELLULITES
CLOSTRIDIAL
INFECTIONS
• CLOSTRIDIAL WOUND
INFECTION
• CLOSTRIDIAL CELLULITIS
• CLOSTRIDIAL MYONECROSIS
OR GAS GANGRENE
DIAGNOSIS GAS
GANGRENE
• SEVERE SEPSIS
• FEVER, CHILLS
• LOCAL PAIN
• SKIN DISCOLORATION
• BLEBS
• SUBCUTANEOUS CREPITUS
• FOUL SMELLING SECRETIONS
TREATMENT
GAS GANGRENE
• 24 H. DELAY IN THE TREATMENT
MAY BE FATAL
• MULTIPLE LONGITUDINAL
INCISIONS
• AGGRESSIVE DEBRIDEMENT
• DRAINAGE
• ANTIBIOTICS:HIGH DOSES
PENICILLIN, FLAGYL
• HYPERBARIC OXYGENATION
DEFINITIONS

• CELLULITIS
• LYMPHANGITIS
• LYMPHADENITIS
• ABSCESS
• BACTERAEMIA
• SEPTICAEMIA
• PYEMIA
• TOXEMIA
ABSCESS
AXILLARY ABSCESS
BREAST ABSCESS
ABSCESS
BEHIND THE EAR
SKIN ABSCESS
PARONICHIA
ERYSIPELAS
PERIORBITAL ABSCESS
CT SCAN OF THE HEAD
CT SCAN OF THE HEAD
INFECTIONS
GRAM - BACILLI
• Most part are indigenous-
intestinal tract
• Pseudomonas aeruginosa
• Salmonella thyphi
• Enterobacter aerogenes
• Escherichia coli
• Klebsiella pneumoniae
INFECTIONS
G- BACILLI
• GREAT NR. OF PTS. WITH IMPAIRED HOST
DEFENCE
• OVERUSE OF MULTIPLE ANTIBIOTICS
• CORTICOSTEROIDS
• CHEMOTHERAPY
• RADIOTHERAPY
• INDWELLING VENOUS, URETHRAL
CATHETERS
• ENDOTRACHEAL TUBES
• ANY FOREIGN BODY- PORTAL OF ENTRY
PSEUDOMONAS
AERUGINOSA
• AEROBE G- BACILLI
• PRESENT ON SKIN, INTESTIN
• OPPORTUNISTIC PATHOGEN
• HEROIN ADDICTS-
HEMATOGENOUS
PSEUDOMONAL
OSTEOMYELITIS
ESCHERICHIA COLI

• PRESENT IN THE INTESTINAL

FLORA
• MAY PRODUCE:
• meningitis, septicemia,
• endocarditis, appendiceal abscess,
• peritonitis, septic wound, UTI
Klebsiella pneumoniae

• Causes a severe pneumonia

• In debilitated pts.
• Endocarditis, septicemia, UTI,
Cellulitis, myonecrosis
ENTEROBACTER
AEROGENES
• PRESENT IN THE INTESTIN OF
5% OF HEALTHY INDIVIDUALS

• INVOLVED IN THE HOSPITAL-

ACQUIRED SEPSIS
PROTEUS

• INFECTED WOUNDS

• INFECTED BURNS
ACINETOBACTER

• G- AEROBES

• INFECTIONS IN COMPROMISED
PATIENTS
ANAEROBIC BATERIA

• G- BACILLI, - NORMAL FLORA

ON SKIN, MUCOUS
MEMBRANES SURFACES
• ORAL CAVITY 10 / 1 =
ANAEROBE / AEROBE
• PEPTOSTREPTOCOCCI,
FUSOBACTERIA, BACTEROIDES,
CLOSTRIDIA
DIAGNOSIS

• FOUL SMELLING DISCHARGE

• GAS
• NECROTIC TISSUE
• FAILURE TO OBTAIN GROWTH
ON AEROBIC CULTURE
• INTRAABDO. SEPSIS, LUNG
ABSCESS, SOFT TISSUE SEPSIS
TREATMENT

• INCISIONS
• EXCISIONS
• DRAINAGE
• ANTIBIOTICS
BOILS
BOILS
CARBUNCLE
FOLICULITIS
IMPETIGO
GAS GANGRENE
FOOT X RAY- GAS
GANGRENE
GAS GANGRENE