Clinical infectious diseases

Abdominal abscesses

2011-04-29T11:19:00.000-07:00

INTRAABDOMINAL INFECTIONS - VISCERAL ABSCESSES

INTRODUCTION OF ABSCESS

An abscess is a local collection of pus is contained in a cavity. Pus is a mixture of dead and dying inflammatory cells called neutrophils, combined with special fluids proteins secreted by cells trying to kill microbes. Abscess containing dead tissue in the center and is surrounded by a fibrous capsule or case. This cap ensures that the infection can spread to other parts of the body. It may be difficult to treat abscess, because antibiotics also have trouble crossing the layer of fibers. Abscesses can occur anywhere in the body, but only those that occur in the abdomen are discussed in this article. These often contain a mix of bacteria which means they can be more difficult to treat.

The most usual organism involved is the Bacteroides fragilis bacteria, which constitutes a small percentage of the normal intestinal flora. intra-abdominal abscesses often develop secondary to peritonitis, an infection of the serous membrane lining the abdominal organs and the walls.

VISCERAL ABSCESS

Abscesses can also be found on the surface or inside of the digestive organs. Liver abscesses are the most common and about half of all visceral abscesses. These can cause pain in the right upper abdomen. pancreatic abscesses occur late complication of acute pancreatitis. Pancreatitis causes severe abdominal pain radiating center back. Early recognition and treatment of the disorder to prevent abscess formation. And spleen abscesses are rare but can occur if the body is damaged or if the infection in the blood. Patients with immune disorders or sickle cell disease are at higher risk function. Abscesses or near the kidneys are rare, but can lead to the spread of infections of the urinary tract by tract. CT image below shows a large abscess in the liver.

LIVER ABSCESS

Liver abscesses due to bacteria, parasites and fungi organisms. In developed countries, pyogenic abscesses are more common, but amoebas the most common cause worldwide. Usually polymicrobial. Organisms usually of intestinal origin of E. coli and Klebsiella pneumoniae, Bacteroides spp. Anaerobic streptococci and enterococci the most common. Staphylococci and streptococci are more likely if the endocarditis secondary / tooth infection. Fungal (Candida spp. The most common) or opportunistic organisms more likely if the patient's immune response.

Pyogenic liver abscess is secondary iatrogenic liver biopsy or a blocked bile stent. Bacterial endocarditis and dental infections and other causes. No cause in 15%. More common if immunocompromised. 15% of adults with liver abscesses are afflicted with diabetes. Cirrhosis is a strong risk factor. Liver abscess is a complication of umbilical vein catheterization in infants. In children and adolescents are usually compromised immune or trauma. Amebic liver abscess. Transmission is by faecal-oral route. Amoeba invade the intestinal mucosa and can access the portal venous system. E. histolytica causes amoebic colitis and dysentery, but an abscess of the liver is the most common manifestation of extraintestinal infection. Liver abscess may be present without a history of colitis. It may also present for months or years after travel in an endemic area. Affects the right lobe in 80% 0.7

PSOAS ABSCESS

Psoas abscesses can originate from hematogenous seeding or from contiguous spread from an intraabdominal or pelvic or some nearby structures sources foe example S.aureus is more common in hematogenous or from bony route .its a mixed enteric flora just like abdominal source .Patients have complain of reffered pain to the hip or knee ,with fever ,lower abdominal or back pain.

psoas muscle is the large muscle that runs along the spine, which exceeds the pelvis . It helps to bend the hip so the doctor can do tests, if the hip flexion is painful to make this diagnosis. The clinical symptoms of back pain or pain during bending, the hip may help doctors make a diagnosis as soon trigger them to do imaging like CT (explained below) or MK. psoas muscle abscesses occur when the spread of infection in blood or local authorities, abdomen or pelvis. In addition, infections in bones, spinal column (osteomyelitis) can cause psoas abscesses.

SPLENIC ABSCESS

Splenic abscesses usually develop by hematogenous spread of infection (eg due to endocarditis). Abdominal pain or spleen occurs more or less 50% of cases and pain in the upper left quadrant plus or minus 25%. Fever and leukocytosis are common. CXR may show infiltrates or left pleural abscess effusions.Splenic most often causaed by atreptococci, S. aureus is the most common cause. Gram negative bacteria can cause splenic abscesses in patients with urinary tract homes, and Salmonella may be responsible in patients with sickle cell anemia. The diagnosis is often only after the death of the patient, the disease is often fatal if not untreted. Most patients undergo splenomegaly and receive additional antibiotics, but percutaneous drainage has been a success.

PERINEPHRIC AND RENAL ABSCESSES

Over 75% of these abscesses are due to infection and are preceded asceding pyelonephritis.Areas parenchymal abscesses may rupture into the perirenal space. The most important risk factors is the presence of kidney stones that produce a local obstruction of urine flow. Other risk factors include structural abnormalities of the urinary tract, a history of urologic surgery, trauma or diabetes. E. coli. Proteus spp (associated with struvite stones), and Klebsiella spp are the most common etiologic agents.

There is some nonspecific clinical signs include flank pain, abdominal pain and fever.If patients with pyelonephritis diagnosis should be consider ,have persistent fever after 4 or 5 days of treatment, urine culture gives a polymicrobial flora in patients with kidney disease known stone, or fever and pyuria occur in conjunction with a urine culture sterile. Treatment includes drainage and administration of antibiotics active against the organisms recovered. Percutaneous drainage is usually successful.

Gastrointestinal infections

2011-04-29T11:04:00.000-07:00

GASTROINTESTINAL INFECTIONS

In medical terminology " gastrointestinal " refers to the stomach. A gastrointestinal infection that is affecting the stomach or intestines and usually lead to diarrhea. Some infections, such as E. coli and shingles is caused by bacteria. Others, such as Norwalk and Sapporo, are caused by viruses. Giardia is a gastrointestinal infection caused by parasites. Many of these infections are very contagious. An abdominal infection can spread if a person with traces of bacteria on their hands to touch another person or food from another person. Salmonella is a bacterial infection that is transmitted in this way. It is often found in eggs and chicken. If these products are not properly handled or undercooked, people can become sick.

Gastrointestinal infections associated with eating undercooked contaminated meat, usually that goats, sheep and cows. The infection in the intestines usually caused by an overgrowth of certain bacteria or yeasts. gastro-intestinal infection usually causes germs diarrhea.Which are responsible for diarrhea depends on the geographical infected person, their level of sanitation, economic development, and hygiene. Gastrointestinal infections are common in bacteria, Salmonella, Shigella, E. coli, and parasites such as Giardia and Cryptosporidium. The most common symptoms are: abdominal cramps followed by diarrhea, fever, loss of appetite, nausea, vomiting, weight loss, dehydration, mucus or blood in the stool.

Shingella is a gastrointestinal infection caused by bacteria. Shingella usually transmitted through consumption of infected material, such as water. The bacteria can cause dysentery, which is a disease in which the intestine is inflated. Mucus lining the intestinal wall usually start to decompose and can become apparent in the gut. A person may also develop bleeding ulcers as a result of this infection.

The viruses that cause diarrheal diseases, also known as viral gastroenteritis, can pass through a house (or college dorm or anywhere else where many people live together) quickly because they are highly infectious. Luckily, the diarrhea usually goes away by itself within a few days. For teens and healthy adults, viral gastroenteritis is a common problem, but minor. But young children and people with chronic diseases, can lead to dehydration that requires medical attention. Many types of bacteria and parasites can also cause gastrointestinal infections and diarrhea. Most are not serious and disappear after a few days, but others may be very serious.

The incubation period for a gastrointestinal infection can vary depending on the particular germ at the origin. For example, the Shigella incubation period is usually 2-4 days but the period for viral infections ranges from 4-48 hours. Parasitic generally have longer incubation periods, such as Giardia, where the symptoms can take from one to four weeks appears. Then, as the germ and the general health of the person, a diarrheal illness lasting several days or weeks.

Diarrheal infections are very contagious. They can spread from person to person by dirty hands, contaminated food or water and some animals. Most cases are contagious for as long as someone has diarrhea, but some infections can be contagious for longer.

The most effective way to prevent contagious diarrheal infections is to wash your hands frequently. Dirty hands carry germs into your body when you do things like biting your nails or use your hands when you eat. It is important to always wash hands with soap and water after using the toilet and before eating, especially if you know there's a disease going around. Make sure bathroom surfaces are clean can also help prevent infection.

Make sure kitchen counters and cooking utensils are clean, too, especially after they have been in contact with raw meat, eggs and poultry. Avoid eating foods that have been neglected for a few hours, even if it has been reheated, because toxins can survive in food.

If you're traveling or camping, never drink the streams, springs or lakes where the local health authorities have certified the clean water to drink. In some developing countries, you can stick to bottled water and drinks rather than tap water - and watch street vendors to buy food. Pets, especially reptiles, can spread bacteria if not kept separate from the family of European food sectors. Do not clean pet cages or bowls in the sink itself, and the family to prepare meals. And always wash your hands after handling your pet .

Most infections, infections that cause diarrhea infections, especially viral, will disappear without treatment. Relax at home and drink plenty of fluids to avoid dehydration are the best ways to overcome the disease. If you become dehydrated, you may need to go to hospital for intravenous (IV) fluids to replace those lost to diarrhea, vomiting and fever. Most infections caused by gastrointestinal viruses and many bacterial infections without treatment, but someone with a weakened immune system that receives a bacterial disease of the bowel may need to be prescribed antibiotics to prevent infection spread throughout the body.

Travel vaccination requirements

2011-04-29T10:49:00.000-07:00

Required immunizations are prescribed by international regulations for entery into certain areas and recommended vaccinations are advisable

VACCINATIONS OF INFECTIOUS DISEASES AND ADVICE TO TRAVELERS :

VACCINATIONS
Vaccination is one of the greatest achievements of public health of the twentieth century and one of the few cost-effective interventions to prevent infectious diseases.

DEFINITIONS.
Active immunization: the administration of antigen to induction of immune defenses .

Passive immunization: the provision of temporary protection by the injection of exogenous immune substances produced.

Immunizing agents .

vaccine : A attenuated live or killed preparation of microorganisms or portions of antigenic agents used for induction of immunity and for disease prevention.

Toxoid :A bacterial toxin which is modified ,and that has been rendered non toxic to stimulate the antitoxin formation by retaining the capacity .

Immune globulin :Protein fraction which is containing antibody ,derived from human blood plasma , used in immunodeficient persons for maintaining defensive immunity for passive immunization when active immunization is impossible.

Antitoxin : Derived antibody from the animal serum with specific antigens after stimulation ,it can be used for provision of passive immunity to the toxin protein to which it is directed.

VACCINE FOR ROUTINE USE

For the recommended immunization schedule for childhood and adolescence and for adults with certain medical conditions .

ADVICE FOR TRAVELERS

Travellers should be aware of health risks that may be associated with different locations since. Information about specific risks for the country to be published in CDC Health Information for International Travel.

VACCINATION FOR TRAVEL

There are three types of immunizations for travel .

Routine immunizations : It is necessary regardless of travel. Passengers, however, to ensure that their routine immunizations are up to date, because certain diseases (eg, diphtheria, tetanus, polio, measles) are more likely to be acquired outside the United States than ours.

Required immunizations : are prescribed by international regulations for entry into certain areas.

Recommended immmunizations : it is advisable, since they protect against disease, including the acquisition of the traveler is at increased risk.

PREVENTION OF MALARIA AND OTHER INSECT-BORNE DISEASES

Chemoprophylaxis against malaria and other measures can be recommended for travel. In the U.S., it seems that 90% of infections with Plasmodium falciparum among returnees and immigration from Africa and Oceania, the destination will help you determine the particular drug selected (for example. .. on P. falciparum resistant to chloroquine is present) which is preferred by travelers and medical history. In addition, personal protective measures against mosquito bites, especially between ducsk and dawn (e.g .. use insect repellent containing DEET, permethrin-impregnated nets and be projected bedrooms which can prevent malaria and other diseases transmitted by insects (eg dengue) .

PREVENTION OF GASTROINTESTINAL ILLNESS

Diarrhea is the leading cause of illness in travelers. Has the highest incidence in parts of Africa. Central and South America. And South-East Asia. Travelers should eat only thoroughly cooked food hot, peeled or cooked fruit and liquid vegetablesand bottled or boiled. Although self-limited diarrhea to change travel plans, and only 20% and bring the drug itself bed.Travelers treatment.Mild moderate diarrhea can be treated with loperamide and fluid. Moderate or severe diarrhea should be treated during 3 days or a single dose of fluoroquinolones, high resistance to quinolones in Campylobacter Thailand azithromycin is a better choice for the country. Prophylactic subsaicylate bismuth is 60% effective and a single dose of quinolone and very effective distances of lasted: However, preventive care is generally not recommended.

OTHER INFECTIONS

Travelers are at high risk for :
Sexually transmitted diseases can be preventable by using condom .

Schistosomiasis ,it can be preventable by swimming avoidance or fresh water bathing avoidance in lakes ,rivers in endemic areas .

And avoidance of bare foot walking outside for the prevention of Hook worm and Strongyloides infectious diseases.

TRAVEL DURING PREGNANCY

The safest part of pregnancy where the journey is between 18 and 24 weeks. Contraindications for international travel during pregnancy include a history of miscarriage, premature delivery, incompetent cervix, or toxemia, or other general health problems (eg diabetes). Areas of excessive risk-taking (for example .. if i live virus vaccines are needed for the trip, or multi-drug resistant malaria is endemic) should be avoided during pregnancy.

THE HIV - INFECTED TRAVELERS

HIV positive individuals with CD4 + T cells that are normal or > 500 / l microphone does not seem to be at greater risk during the trip. However, people with depression of CD4 + cells should seek advice from a health care traveler before departure, especially when traveling in the developing world. This consultation should include a discussion about the appropriate use of vaccines (for example .. live vaccine against yellow fever is not recommended for people living with HIV), prophylactic medication issues include the systematic denial of entry to persons HIV-positive people in several countries.

PROBLEMS AFTER RETURN FROM TRAVEL

Diarrhea: After traveler's :diarrhea, symptoms may persist due to the continued presence of pathogens (eg Giardia lamblia and Cyclospora cayetanensis ..), or more frequently, due to postinfectious as intolerance or irritable bowel syndrome lectose . A trial of metronidazole for giardiasis, a lactose-free diet, or a trial of high doses of lactulose mucilloid hydrophilic (as well as for constipation) can relieve symptoms.

Fever, malaria should be considered as the first diagnosis, whether a traveler returning from an endemic area of the mouth. viral hepatitis, typhoid fever, enteric bacteria, arbovirus infections, rickettsial infections, and amebic liver are other possibilities.

Skin conditions : pyoderma, sunburn, insect bites, skin ulcers and cutaneous larva migrans skin conditions are common in most returning travelers.

What is peritonitis ?

2011-04-29T09:58:00.000-07:00

INTRAABDOMINAL INFECTIONS

PRIMARY ( SPONTANEOUS ) BACTERIAL PERITONITIS ( PBP )

Spontaneous bacterial peritonitis (SBP) is to develop peritonitis (infection of the abdominal cavity), although there is no obvious source of infection.It occurs almost exclusively in cases of portal hypertension of people (more of Increased portal vein pressure ), usually a result of cirrhosis of the liver and liver.It may also occur in nephrotic syndrome patients.

Primary bacterial peritonitis is seen as the result of a combination of factors associated with cirrhosis and ascites, and prolonged bacteremia secondary to compromised host defenses, maneuvers intrahepatic blood colonized, and the defective bactericidal activity in the ascites fluid. Contrary to previous theories, transmucosal migration of bacteria in the intestine of ascites is no longer considered to play an important role in the etiology of SBP. With regard to the compromised host defenses, patients with chronic liver disease often have severe acute deficiency of the complement and possibly a system malfunction of neutrophils and the reticuloendothelial system.

ETIOLOGIES

Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.

SIGN AND SYMPTOMS

Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic encephalopathy could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.

MORTALITY / MORBIDITY

The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.

DIAGNOSIS

The diagnosis of Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from the cavity of abdomen . If the fluid contains bacteria or a big amount of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.

TREATMENT

Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.

PREVENTION

Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time.

SECONDARY PERITONITIS

Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

CLINICAL FEATURES

Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .

DIAGNOSIS AND TREATMENT

Studies marked leukocytosis with a left shift to find the source of peritonitis are the main treatment. Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.

PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS

Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter removal scheme should be considered if the patient does not improve within 48 hours ....... read more

Peritonitis

2011-04-29T09:52:00.000-07:00

Micro-organism enter the sterile abdominal cavity and cause peritonitis if this infection goes untreated patient survives abscesses

INTRAABDOMINAL INFECTIONS

The intraperitoneal infection, usually due to normal anatomic barrier is broken. This disorder can occur when the appendix, diverticulum, wound or ulcer ruptures, when the intestinal wall is impaired ischemia, tumor or infection (for example, in inflammatory bowel disease ), or adjacent to inflammatory processes, such as pancreatitis or inflammatory pelvic disease in which the enzyme (in the previous case), or bodies (in this case) can leak into the abdominal cavity.

Regardless incitement case, when the inflammation develops and bodies are often contained within the intestines or other body normally sterile peritoneal space, a predictable series of events takes place. intra-abdominal infections occur in two stages: peritonitis and if the patient survives this stage, and Treat an abscess formation. types of micro-organism every phase of infection are responsible for the pathogenesis of the disease.

Most intra-abdominal infections arise from a source in the gastrointestinal tract. They are usually caused by enteric aerobic and anaerobic. The management usually involves an invasive procedure to control the source of infection and antimicrobial therapy against pathogenic microorganisms. In a small number of highly selected patients, these infections can be treated without due process of final source code control.

Antimicrobial therapy is tailored to each patient, with narrow spectrum agents used to treat community infections intra-abdominal and wider spectrum of agents used for nosocomial infections. In general, these infections are associated with significant morbidity and mortality, especially among high-risk patients have impaired host defenses.

PERITONITIS

Peritonitis Inflammation of the peritoneum, a thin line membrane covering the abdomen and internal organs. The inflammation caused by bacterial or fungal infections in this film. There are two different types of peritonitis. Primary peritonitis due to the spread of infection from blood and lymph to the peritoneum. This type of peritonitis rare - less than 1% of all peritonitis is a priority. The most common type of peritonitis-called secondary peritonitis, caused by infection of the peritoneum should be in the stomach or biliary tract. In both cases of peritonitis are very serious and can be fatal if not treated quickly....... read more

Primary ( Spontaneous ) bacterial peritonitis
Secondary peritonitis

Peritonitis in patients undergoing chronic ambulatory peritoneal dialysis

Abdominal infections

2011-04-29T09:08:00.000-07:00

INTRAABDOMINAL INFECTIONS -INTRAPERITONEAL ABSCESSES

Untreated peritonitis can form abscesses as an extension of the infection process and as an attempt by the host's defenses to contain the infection.Most of the abscesses can originate from colonic sources.Abscesses can occur anywhere in the abdomen and retroperitoneum. They mainly follow the operations, injuries or conditions involving abdominal infection and inflammation, especially when there is a perforation or peritonitis. Symptoms include malaise, fever and abdominal pain. The CT diagnosis. The treatment is drainage, either surgical or percutaneous. Antibiotics are auxiliary.

CAUSES

Intra-abdominal abscesses can be classified as

INTRAPERITONEAL
RETRO-PERITONEAL OR VISCERAL

INTRAABDOMINAL ABSCESSES. Many intra-abdominal abscess developing after perforation of a hollow organ or cancer of the colon. Others develop from the spread of infection or inflammation caused by conditions such as appendicitis, diverticulitis, Crohn's disease, pancreatitis, pelvic inflammatory disease or condition that causes generalized peritonitis. abdominal surgery, particularly those affecting the gastrointestinal tract or bile is another important risk factor: The peritoneum can become contaminated during or after surgery to events such as anastomotic leakage. lacerations and bruises abdominal injuries, especially liver, pancreas, spleen and intestine, abscesses can develop, whether treated or not functioning properly.

Transmitted infecting organisms generally reflect the normal intestinal flora and a complex mixture of aerobic and anaerobic bacteria. The most common strains of aerobic gram-negative bacilli (e.g. Escherichia coli and Klebsiella) and anaerobic (Bacteroides fragilis in particular). undrained abscess can spread to adjacent structures, damage to the vessels surrounding the passage (due to bleeding or thrombosis), will rupture the peritoneum, or bowel or a skin fistula. sub-diaphragmatic abscess may extend to the thoracic cavity, resulting in empyema, lung abscess or pneumonia. abdominal abscess may track down the thigh or perirectal Fossa. splenic abscess is a rare cause of persistent bacterial endocarditis that persists despite appropriate antimicrobial therapy.

CLINICAL PRESENTATION

Wide range of presenting complaints , the patients may have general malaise and anorexia or weight loss, other people present in critically ill septic shock with acute abdomen. visceral abscesses do not develop gastrointestinal perforation after local disease (diverticulitis, etc), trauma or surgery, secondary peritonitis subsequently becomes walled by adhesions, inflammatory bowel loops or mesentery omentum abscess and other intra-abdominal abdominal viscera also can develop after primary peritonitis (spontaneous bacterial peritonitis). Sx: fever, pain, nausea, vomiting, anorexia. Physical examination: local pain, perhaps a palpable mass, post-operative evaluation of abscess confused by painkillers and pain in the incision, with more than half is within 10 days of the initial operation. Laboratry: elevated white blood cell count, the yield of direct aspiration of Gram-positive, anti-culture, positive blood cultures ~ 25% depending on the site.

DIAGNOSTIC INVESTIGATIONS

CT SCAN is more useful. Ultra Sound and Nuclear Magnetic Resonance (MRI )from time to time ,is not used to guide the drainage. CT or ultrsound guided percutaneous or surgical drainage to be considered in all cases to confirm the diagnosis, microbiological evaluation, and therapy. Indium gallium is rarely necessary for diagnosis with the advent of these new imaging modalities.

TREATMENT

MEDICAL TREATMENT

Antibiotic therapy requires parenteral administration of empirical antibiotics. Start treatment before the abscess drainage, and be careful when all signs of systemic sepsis is resolved. As the abscess fluid generally includes both aerobic and anaerobic organisms early empirical therapy directed against both microbes. This can be achieved by antibiotic treatment or combination therapy with broad spectrum, a management representative. Special treatment, then guided by the results of cultures, retrieved from a boil. Patients who are immunosuppressed, yeast fungi species can be an important pathogenic role, and amphotericin B therapy may be indicated.

DRAINAGE

The drainage of pus is mandatory and is the first line of defense against infections gradually. Percutaneous catheter drainage guided by CT became the standard treatment for most intra-abdominal abscesses. It can be difficult to avoid laparotomy, requires anesthesia, eliminates the possibility of wound complications of open surgery, and may reduce the length of hospitalization. It also avoids the possibility of contamination of other areas in the peritoneal cavity. CT-guided drainage of the abscess cavity delimited and can provide secure access for percutaneous drainage. When performed by experienced hands, but also avoids the risk of injury to adjacent organs or blood vessels.

After surgical drainage, clinical improvement should occur in 48-72 hours. The lack of improvement in this period, the second term of the CT review additional abscesses. surgical drainage should be compulsory, if the remaining liquid can be removed with irrigation catheter manipulation, merger or other investments.

SURGICAL INTERVENTION

The surgical procedure can also be intended to persist with the content of abscesses, such as hematoma, infection, fungal infection or pancreatic abscesses. Surgical drainage is an option if the skin is dry or fails if the collections are not susceptible to drainage catheter. surgical approach can be either open or laparoscopic drainage (laparotomy) drainage. transperitoneal approach is safer to open a prudent use of preoperative antibiotics. Although contamination of otherwise non-infected sites is an important concern, this complication is particularly reduced if the organizations involved are sensitive to selected drugs. transabdominal examination of the abdomen and allows for full cleaning of fibrin. It also allows full bowel movement to identify and remove all synchronized with the abscesses, which occur in more than 23% of patients.

Improved clinical outcomes in three days after treatment indicates drainage. The lack of improvement may indicate inadequate drainage or any other source of infection. If left untreated, inevitably sepsis multiorgan failure. The transabdominal approach open to intra-abdominal abscess can be extremely difficult. Even Matt bowel and adhesions, and loss of anatomic integrity can pose serious problems. This is particularly true when the sensitive organs, like a loop of small intestine, observed intermittent wall abscess or cavity. Therefore, whenever possible, CT-guided drainage is a useful first step.

Food poisoning - Cholera - v.cholerae - rota virus infections

2011-04-29T07:00:00.000-07:00

Babies in day care have an increased risk of infection by rotavirus ,giardia lamblia and compylobactor
INFECTIOUS NON - INFLAMMATORY DIARRHEAS

BACTERIAL FOOD POISONING

Evidence of a common source outbreaks occur frequently. First Staphylococcus aureus enterotoxin produced in food left at room temperature (eg a picnic). The incubation period is 1-6 hours. Disease products within 12 hours, and consist of diarrhea, vomiting and stomach cramps usually without fever. Second Bacillus cereus . (A). emetic form : this is a food poisoning associated with S. aureus contaminated fried rice. (B). Diarrhea as: incubation period of 8-16 hours, diarrhea, cramping, no vomiting. 3rd Clostridium perfringens : spores resistant to heat sufficient in meat, poultry and legumes, incubation 8-14 hours, 24 hours of diarrhea and cramping abdominal disease, without vomiting or fever.

CHOLERA

Etiology

Vibrio cholerae serogroups OI (EI biotypes classical and Tor and O139 ).

Epidemiology

Occur in the delta of the Ganges in the Indian subcontinent and South east Asia and sometimes in coastal areas of Texas and Louisiana: the spread of faecal contamination of water and food sources. Infection requires a large consumption of inoculation. toxin to cause disease symptoms. clinical symptoms.

Clinical Manifestations

Incubation period of 24-48 hours following a painless diarrhea and vomiting, which can cause serious and rapid dehydration and death within hours. Rice water turbid liquid stool gray with patches of mucus.

Diagnosis .. stool culture on selective medium (e.g. TCBS agar).

TREATMENT

Rapid replacement of fluid, electrolytes and base with high sodium levels to correct the loss of Na in the stool or Ringer's lactate in patients with> 10% weight loss.Antibiotics can be used together, doxycycline, ciprofloxacin single dose of 1 g / d or erythromycin three divided doses for 3 days.

VIBRIO PARAHAEMOLTICUS AND NON - OI ,CHOLERA

These infections are associated with the consumption or contaminated by sea water, badly seafood.After an incubation period of four hours to four days, darrhea aqueous, abdominal cramps, nausea, vomiting and sometimes fever and chills develop.The disease lasts 3-7 days and requires supportive care. Patients with comorbid illness (eg liver disease), sometimes extra-intestinal infections requiring antibiotics

NORWALK VIRUS AND RELATED HUMAN CALCIVIRUSES

These viruses are common causes of traveler's diarrhea and viral gastroenteritis in patients of all ages and epidemics worldwide, with U.S. higher prevalence in colder climates. Shellfish concentrate the virus by filtration and are at particular risk. Very small Inocults required for infection. Thus, although the fecal-oral route is the main form of transmisson, aerosol, fomites of contact, and person to person contact can cause an infection.

Clinical Manifestations

After incubation period of 24 hours (range 12-72 hours). The patients experience sudden onset of nausea, vomiting, diarrhea or abdominal cramps with constitutional symptoms. the stool is soft, watery, without blood or mucus leukocytes. disease lasts 12 60 hours.

Treatment

Only the necessary support measures.

ROTA VIRUS

Rotavirus is the leading cause of severe diarrhea in infants and young children, and is one of several viruses that cause infections, often called stomach flu, but not from the flu. It is a kind of double-stranded RNA virus in the family Reoviridae. At the age of five years, nearly all children worldwide have been infected with rotavirus at least once. But each infection, immunity develops, subsequent infections are less serious, and adults are rarely affected. There are five species of this virus, called A, B, C, D and E. A rotavirus, the most common causes of more than 90% of infections in humans.

Rotavirus is transmitted by fecal-oral contact with contaminated hands, surfaces and objects, and possibly by the respiratory route. The faeces of an infected person can contain more than 10 billion of infectious particles per gram, only 10-100 of them are required to transmit the infection to another person.

Clinical Manifestations

Rotavirus gastroenteritis is a mild to severe illness characterized by vomiting, watery diarrhea and mild fever. When a child is infected with the virus has an incubation period of about two days before the onset of symptoms. Symptoms often start with vomiting, followed by four to eight days of severe diarrhea. Dehydration is more common than rotavirus infection in most of those caused by pathogenic bacteria, and is the most common cause of deaths related to rotavirus infection.

Diagnosis

Enzymes immunoassays (EIAs ) or viral RNA detection ,like PCR can identify this virus in sample of stool .

Treatments

Only necessary treatment is required .Antimotility agents should be avoided .

Prevention

For prevention ,vaccine was withdrawn shortly after approval by the U.S . Drug and Food intake because it was causally linked to intussusception .

Diarrhea causes

2011-04-29T06:36:00.000-07:00

Diarrhea in the 14 days called persistent diarrhea

INFECTIOUS NON - INFLAMMATORY DIARRHEAS

Diarrhea is a deviation from normal intestinal movements are characterized by increased stool frequency or liquidity, or both, often accompanied by an abnormal increase in stool weight per day (200 grams / day). It is classified as acute if the onset occurred within 14 days. Diarrhea in the 14 days called persistent, and beyond 30 days, is considered chronic. Diarrhea can be recurrent diarrhea, infectious and noninfectious diarrhea, inflammatory diarrhea, which causes inflammation of the colon and diarrhea that are not lit noninflamatory colon.

There are different clinical settings where patients are more at risk than the general population of developing diarrhea. Babies in day care have an increased risk of infection by rotavirus, Giardia lamblia, and Campylobacter. Although HIV / AIDS patients may have atypical infections are most often infected with pathogens such as Escherichia coli usual. Cryptosporidiosis, Isospora belli, herpes simplex, Chlamydia trachomatis, Clostridium difficile, Shigella and other types of infection causes diarrhea in AIDS patients. Travelers are at risk from the bacterium E. enterotoxigenic E. coli, Rotavirus, Salmonella and Shigella.

Inflammatory diarrhea is suspected when patients present with acute diarrhea accompanied by bloody stools, fever, tenesmus, or abdominal pain. If the inflammation is in the colon, the stool is frequent and small in volume, whereas diarrhea due to small bowel inflammation is usually high in volume. In either case, stool leukocytosis is present, with more leukocytes the more distal the inflammation, as a rule. Infectious causes of inflammatory diarrhea include Salmonella, Shigella, Campylobacter, enterohemorrhagic E. coli, enteroinvasive E. coli, C. difficile, Entamoeba histolytica, and Yersinia. When inflammatory diarrhea is recurrent, noninfectious etiology should be suspected, such as Crohn's disease, ulcerative colitis, and radiation or ischemic colitis.

inflammatory diarrhea characterized by watery stools that may exceed 1 liter in volume, without symptoms suggestive of inflammation. It is caused by bacteria such as Vibrio cholerae, E coli and Staphylococcus food poisoning and Clostridium, viruses such as rotavirus and Norwalk virus and protozoa such as Cryptosporidium and Giardia. enterotoxins Many of these organizations and the development of interfering with the mechanism of absorption or secretion of diarrhea in the intestine, causing.

TRAVELER'S DIARRHEA

People traveling in Asia, Africa and South and Central America 20 to 50% experience sudden onset of stomach cramps, loss of appetite and diarrhea. The disease usually begins within 3-5 days of arrival, containated associated with eating food or water, it takes 1-5 days, mostly due to enterotoxigenic Escherichia coli, subsalicylates bismuth can be used preventively. Liquefaction is usually adequate treatment, but if desired, 1-3 days during the fluoroquinolones can reduce the duration of illness is 24-36 hours. Antimotility agents can control diarrhea.

Chemotherapy protocols

2011-04-29T05:27:00.000-07:00

Anti microbial ( antibiotics ) chemotherapy have had a major impact on life threatening infections

ANTIMICROBIAL CHEMOTHERAPY PROTOCOLS

One of the greatest triumphs of modern medicine has been the introduction of a rational system of antimicrobial chemotherapy to fight against infectious diseases. Since time immemorial, people have used use mussels or mussel extracts to treat infections. In the early days of microbiology, an attempt was made to use extracts of fungal cultures to prevent infections of surgical wounds.

PRINCIPLES OF USE

Antibiotics are among the safest of medicines, especially for community infections, and a significant impact on life-threatening infections and reduce morbidity associated with many common infectious disease.This in turn is partly responsible for the overprescribing of these drugs, which led to concern about the increasing resistance to antibiotics.

Most antibiotic prescribing, particularly in the community, is empirical. While in hospital practice, microbiological documentation of the nature of infection and the sensitivity of the pathogen is not usually available for a day or two. the initial choice of treatment depends on clinical diagnosis and in turn a provisional microbiological diagnosis. This treatment "blind therapy targeting the pathogen most likely responsible for a specific syndrome, such as meningitis, urinary tract infection or pneumonia. Initial critically ill patients are often broad to cover the range of possible pathogens, but should be reduced when the microbiological data available.

BACTERICIDAL VERSUS BACTERIOSTATIC

In most infections there is no conclusive evidence that bactericidal drugs (penicillins, cepholosporins, aminoglycosides) are more effective than bacteriostatic drugs, but it is generally considered necessary to resort to the former i treat bacterial endocarditis in patients with mechanisms host defense are involved, particularly those with neutropenia. drug combinations are often necessary for reasons other providin spectrum covers - large. Initially Tuberculosis is treated with three or four agents to avoid resistance to inhibition emerging.Synergistic is obtained through the use of penicillin and gentamicin in enterococcal endocarditis or gentamicin and ceftazidime in life - threatening Pseudomonas infection.

PHARMACOKINETIC FACTORS

To be successful enough to receive an antibiotic to penetrate the site of infection. Knowledge of standard pharmacokinetic aspects of absorption, distribution, metabolism and excretion of drugs have varied. difficult areas are the brain, eye and prostate cancer, but loculated abscesses are inaccssible most authors. Many of mild to moderate infections can be treated is compatible. Parenteral administration is reported seriously ill patients to ensure a rapid blood and tissue concentrations of antibiotics drug.Some only be administered parenterally, such as aminoglycosides and broad-spectrum cephalosporins. parenteral therapy is needed even to those who are unable to swallow or if gastrointestinal absorption is unreliable.

ANTIBIOTIC CHEMOPROPHYLAXIS

These are some indications the use of condoms antibiotics.These understand the conditions where the risk of infection is high (colon surgery), or the consequences of a severe infection (endocarditis, sepsis, post-splenectomy). The selection is determined by representatives of the likely risk of infectious disease and confirmed the efficacy and safety of treatment..... read more

Chemotherapy regimens

2011-04-29T05:20:00.000-07:00

ANTIMICROBIAL CHEMOTHERAPY REGIMENS

DOSE AND DURATION OF THERAPY

This varies depending on the nature, severity, and response to therapy. The long-term treatment (up to 6 weeks) is required for some varieties of infective endocarditis when pulmnary tuberculosis were treated for at least 6 months. Treat many common infections, improvement occurs within 2-3 days, when the patient is afebrile or leukocytosis have been resolved, the mouth should be considered in these parenteral therapy.Five started seven days of therapy is sufficient for most infections. A short course of therapy (3 days or less) should these symptoms of uncomplicated bacteria (cystitis), minimizing the duration of treatment reduces the risk of side effects and super-infection of Candida spp or Clostridium difficile, as well as the cost of care. Breasts that concentrates in the cell, such as erythromycin, quinolones and tetracyclines are used in the treatment of mycoplasma, brucellosis, and Legionella infections.

RENAL AND HEPATIC INSUFFICIENCY

Many drugs require dose reduction of renal failure to prevent toxic buildup. This is particularly true beta lactums and aminoglycosides. Nalidixic acid and tetracycline, other doxycyclines, should be avoided. This hepatic impairment, caution and the dose should be reduced by agents such as isoniazid, ketoconazole, rifampin, and interferon.

THERAPEUTIC DRUG MONITORING

In order to ensure more non-toxic concentrations of therapeutic drugs, drugs such as aminoglycosides and vancomycin serum monitored, especially those with impared renal or change function.Peak (after 1 hour - the dose) and through the (pre-dose) on serum samples be tested. However, the increasing use of once daily doses of aminoglycosides, but the time randm serum analysis are being adopted.

MECHANISMS OF ACTION AND RESISTANCE TO ANTIMICROBIAL AGENTS

Antibiotic works in different places for bacteria. Penecillin, cephalosporins and vancomycin, erythromycin cell wall and protein synthesis aminoglycosides, rifampicin effect on RNA synthesis and effect of metronidazole, quinolones and DNA synthesis. Sulfonamides and trimethoprim are folic acid antagonists and amphotericin B to prevent the synthesis of fungal sterols. Antibiotic resistance may be due to:

Failure to reach the target site, for example, because the causes of deterioration of permeability does not reach the outer membrane of bacteria (eg, penicillin and Gram-negative).

Enzyme inactivation (eg, enzymes beta-lactamase).

Change the target site (eg, a point mutation in E. coli penicillin binding protien Strep.pneumoniae lead to resistance.

The development or acquisition of resistance to an antibiotic that the bacteria always involves either a mutation in a single point in a gene or transfer of genetic material from another organism. large fragments of DNA can be introduced into bacteria either by transfer of " naked " DNA or by a bacteriophage (a virus) DNA vector.Both the past (processing), and one (transduction) depend integration of new DNA into the chromosomal DNA recipient. This requires a high degree of homology between donor and recipient of the chromosomal DNA. Finally, resistance to antibiotics can be transferred from one bacterium to another by conjugation, where DNA extrachromosomal (plasmid) that contains resistance factor (R factor) is transferred from one cell to another by contact Direct. Transfer of these plasmids R factors can occur between unrelated bacterial strains and involve large amounts of DNA and often code for multiple resistance antbiotic.

The transformation is probably the least clinically relevant mechanism, while the transduction and transfer of R factors are generally responsible for the immediate emergence of antibiotic resistance in bacteria, increasing resistance to many antibiotics has developed...... read more

What is a respiratory infection ?

2011-04-29T03:28:00.000-07:00

This system is much more vulnerable to infections than other body parts

RESPIRATORY TRACT INFECTIONS

Respiratory infections are divided into upper respiratory tract infections and lower, separated by Carina. In health, the lower respiratory tract is normally sterile because of an extremely effective defense system. Upper respiratory tract infections are particularly common in the paranasal sinuses and childhood.The Middle ear structures are consistent and may be involved minor viral infections of lower respiratory nasopharynx.The is often compromised by smoking, pollution air, aspiration of airway secretions and chronic lung diseases, including chronic bronchitis and chronic obstructive pulmonary disease. Respiratory infections is defined clinical, radiological, sometimes, as in cases of pneumonia, and appropriate microbiological sampling.

The respiratory system is much more vulnerable to infection than other body parts. This is because it is easier for bacteria or viruses from entering the channel when someone breathes in. respiratory tract infections are more common during the winter. This is probably due to the winter people are more likely to stay in close contact with each other. Children tend to get more respiratory infections such as colds than adults. Because they have not yet developed immunity to many viruses that cause colds.

Respiratory infections are a common cause of the disease. Respiratory infection is most common cold. The respiratory system is a general term used to describe all parts of the body that are involved in helping a person to breathe. health professionals generally make a distinction between:

UPPER RESPIRATORY TRACT INFECTIONS
LOWER RESPIRATORY TRACT INFECTIONS

PATHOPHYSIOLOGY

The transmission of microorganisms responsible for the URI is produced aerosol droplets or direct contact with the hand in hand with infected secretions, including transport as a result of the nostrils or eyes. 7Thus, transmission occurs most often in crowded conditions. Direct invasion of respiratory epithelium results in symptoms compatible with the area (s) in question. sinusitis and acute bronchitis is often preceded by a cold. sinus allergies, anatomical abnormalities like a deviated septum, sinus ostium blockage caused by swelling of the mucosal immune disorders such as hypogammaglobulinemia and infection with human immunodeficiency virus, the abuse of cocaine and predispose to the development of acute sinusitis.

The majority of influenza epidemics, 20 century were caused by viruses, but few have been caused by influenza B. Most of the epidemics is believed to spread from students to their families. Annual influenza epidemics due to the supply of influenza virus mutants that most people have no immunity (antigenic drift). Pandemics, on the other hand, occur when a completely new influenza virus is transmitted to humans from other species, pigs and birds most common (antigenic shift). Persons aged 65 years and the underlying disease are at higher risk than healthy people to death and hospitalization due to worsening of their underlying disease as a result of influence....... read more

Upper respiratory infections

2011-04-29T03:12:00.000-07:00

Children tend to get more respiratory infections such as colds than adults because they have not yet developed immunity to many viruses

UPPER RESPIRATORY TRACT INFECTIONS

upper respiratory tract infections (URTI or URI), are diseases caused by an acute infection involving the upper respiratory tract: nose, sinuses, pharynx and larynx.

upper respiratory tract infection is a non-specific term used to describe acute infections of the nose, sinuses, pharynx, larynx, trachea and bronchi. The prototype is the disease known by the name of common colds, which will be discussed here, in addition to pharyngitis, sinusitis, and tracheo-bronchitis. Influenza is a systemic disease involving the airways and should be distinguished from other URI.

CAUSES

Viruses cause most Upper Respiratory tract Infections with rhinovirus, parainfluenza virus, coronavirus, adenovirus, RS virus, Coxsackievirus, and the influence accounted for the majority of cases. Human Metapneumovirus was recently found to cause material URI. beta-hemolytic streptococcus group (GABHS) causes 5% to 10% of cases, pharyngitis in adults. Other less common causes of bacterial pharyngitis are C beta-hemolytic streptococcus group, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Chlamydia pneumoniae, Mycoplasma pneumoniae, and herpes simplex virus. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and are the most common organisms that cause bacterial super-infection of virus in acute sinusitis. Less than 10% of acute tracheobronchitis due to Bordetella pertussis, B. parapertussis, M. or C. pneumoniae pneumoniae.

SIGN AND SYMPTOMS

Acute upper respiratory tract infections are fever, pharyngitis / tonsillitis is often called the flu, and their complications: sinusitis, otitis, laryngitis, bronchitis, and sometimes (even if the bronchi are generally classified as part of the lower respiratory tract.) Symptoms URI common cough, sore throat, runny nose, nasal congestion, headache, low fever, facial pressure and sneezing. Onset of symptoms usually begin 1-3 days after exposure to pathogenic microorganisms. The illness usually lasts 7-10 days.

Group A beta hemolytic streptococcal pharyngitis / tonsillitis (strep throat) presents with sudden onset of sore throat, painful swallowing and fever. Strep throat usually does not cause a runny nose, changes in voice or cough. pain and ear pressure caused by middle ear infection (otitis media) and redness of the eye caused by a viral conjunctivitis is often associated with upper respiratory infections.

DIAGNOSIS

Upper respiratory tract infections are diagnosed on the type and duration of symptoms. cold symptoms last for months, but do not cause sinus problems, allergies may actually be related.

TREATMENT

The preferred treatment of upper respiratory infections is rest and plenty of fluids. Over-the-counter cold, flu and sinus remedies and pain relievers may provide temporary relief from symptoms but does not reduce infection. Gargle with salt water can help relieve the symptoms of sore throat. Steaming bowl of soup can help relieve nasal congestion opening. Antibiotics are not effective in treating viral infections, and only prescribed if the cause is a bacterial symptoms, such as sore throat, tonsillitis, earaches, or sinus infections. The best treatment for laryngitis is to rest his voice. repeated periods of tonsillitis treated surgically remove the infected tonsils. Mild croup can be treated at home with rest, fluids and a humidifier. However, children are hard to beat the basin in the hospital.

If you have an upper respiratory infection, take plenty of rest and fluids. Call your doctor if symptoms worsen or last more than a week. Keep mucous membranes moist with a humidifier and petroleum jelly around the nose. nosedrops Saline may also help loosen mucus. Your doctor may tell you how this solution and how to use it often. You can help prevent upper respiratory tract, avoiding touching your eyes, nose and mouth, which would spread the virus your hands have contacted.

Bacterial infection of the central nervous system can cause abscesses

2011-04-28T12:59:00.000-07:00

INFECTIONS OF THE NERVOUS SYSTEM

The central nervous system or central nervous system includes the brain, spinal cord and membranes. In certain circumstances, bacteria can penetrate the central nervous system areas. If this occurs, abscesses or empyemas may be established. In general, the CNS is well defended against infection. The spine and brain are sheathed in hard, protective membrane. The outer membrane, the dura, and the next layer, the arachnoid, totally covering the brain and spinal cord. However, these defenses are not absolute. In rare cases, bacteria have access to areas of central nervous system.

There are four main causes of infections of the central nervous system (CNS): bacteria, viruses, fungi and protozoa.

Bacterial infection of the central nervous system can cause abscesses and empyema (accumulation of pus). Abscesses have fixed boundaries, but no definable shape and size empyema. CNS infections are classified according to where they occur. For example, a spinal epidural abscess is located above the dura mater, and subdural empyema occurs between the dura and arachnoid injury. As the pus and other material of an infection accumulate, pressure is exerted on the brain or spinal cord. This pressure can damage the nervous system tissue, perhaps permanently. Without treatment, CNS infection is fatal.

The brain is highly protected, and is essential for the maintenance of life. Yet the central nervous system infections are occurring. They range from a latent is rapidly fatal. This guide describes some of the features of CNS infection and laboratory diagnosis. The membranes surrounding the brain infections called meningitis. When the content of the brain that is infected with meningitis. brain abscesses are defined, localized lesions within the brain. "Slow" brain infections also occur, and these are usually fatal. Rapid diagnosis of CNS infections is important because many of the central nervous system infections are life threatening.

Viruses that infect the central nervous system (brain and spinal cord) include herpesviruses, arboviruses, coxsackieviruses, echoviruses and enteroviruses. Some of these infections primarily affect the meninges (the tissues covering the brain and spinal cord) and the result of meningitis. Others affect primarily the brain and cause encephalitis. Infections that affect both the meninges and brain after a meningo-encephalitis. Meningitis is most common in children than is encephalitis.

The virus affects the central nervous system in two ways. They can directly infect and destroy cells of the central nervous system during acute illness. After recovery from an infection of the central nervous system or elsewhere in the body's immune response to infection sometimes causes secondary damage to cells that surrounds nerve. These secondary damage (postinfectious encephalomyelitis or acute disseminated encephalomyelitis) results in children having more symptoms weeks after recovery from acute illness.

Meningitis is usually caused by viruses. Viral meningitis is a self-limiting disease. Bacterial meningitis is much less common, but is a potentially fatal condition. Other organizations may be a rare cause meningitis, for example, spirochetes and fungi. Symptoms include fever, severe headache, neck stiffness and photophobia. Due to the severity of the condition, so it may be caused by a number of staff, fast and accurate diagnosis of the cause is essential for prompt initiation of appropriate treatment.

Fungal infections of the central nervous system (CNS) are increasingly diagnosed both in immunocompromised and immunocompetent persons. Sinocranial aspergillosis more frequently described from temperate countries, most often in otherwise immunocompetent individuals. The clinical syndromes as fungal infections of the central nervous system can present are protean and may involve most neuroaxis. Certain clinical syndromes are specific to certain fungal infections. The nose shape is the most common syndrome with zygomycosis and skull-base syndromes frequently in clinical syndromes in patients with aspergillosis sino-cranial. Sub-acute and chronic meningitis in patients infected with HIV are more likely to be due to cryptococcal infection. Early recognition of clinical syndromes in an appropriate clinical context, it is the first step towards full recovery in some of these infections.

CONGENITAL INFECTIONS OF CENTRAL NERVOUS SYSTEM

Although vaccines, new antimicrobial agents and improvement in hygiene practices, congenital infections remain a major cause of mortality and neurological morbidity in children long term worldwide. important players are Toxoplasma gondii, cytomegalovirus, Treponema pallidum, herpes simplex virus types 1 and 2, and rubella. In addition, several other agents, such as varicella-zoster, parvovirus B19, and Borrelia burgdorferi, which potentially can infect the fetus and result in the fetus. This paper provides an overview of these infectious disorders, and outlines current strategies for the treatment of acute and long-term treatment.

Infectious diseases

2011-04-28T12:26:00.000-07:00

INFECTION AND INFECTIOUS DISEASE

INFECTIOUS AGENTS

The world is full of microorganism ,the vast majority of which are harmless to man and many of which are essential to life .Some of these organism live on or within human hosts: most of these form part of our normal flora and are benign passenger or symbiotes.A minority ,however ,ar pathogenic ,causing illness or even death to their host .It is thses viruses ,bacteria , protozoa ,and worms which are responsible for the infectious disease.

Infection remains the main cause of morbidity and mortality in man ,particularly in underdeveloped areas where it is associated with poverty and overcrowding .In the developed world increasing prosperity ,universal immunization and antibiotics have reduced the prevalence of infectious disease .However ,antibiotic -resistant strains of bacteria as well as viruses and ' new ' diseases such as human immunodeficiency virus ( HIV ) infection and variant Creutzfeldt-jakob disease ( vCJD) have emerged .Increased global mobility has aided the spread of infectious disease and allowed previously localized pathogens to establish themselves world-wide .Deteriorating social conditions in the inner city areas of our major conurbations have facilitated the resurgence of tuberculosis and other infection.Changes in farming and food-processing methods have controlled to an increase in the incidence of food and water-borne disease.

In the developing world successes such as the eradication of smallpox have been balance or outweighed by the new plagues.Infectious cause nearly 25% of all human deaths .Two billion people -one third of the world's population-are infected with tuberculosis ,250-300 million people catch malaria every year ,and 200 million are infected with schistosomiasis .Infections are often multiple and there is synergy both between different infections ,and between infection and other factors such as malnutrition.Many of the infectious diseases affecting developing countries are preventable or treatable ,but continue to thrive owing to lack of money and political will.

INFECTIOUS AGENTS

The causative agents of infectious diseases can be divided into four groups.

Prions are the most recently-recognized and the simplest infectious agents ,consisting of a single protein molecule.They contain no nucleic acid and therefore no genetic information : their ability to propagate within a host relies on inducing the conversion of endogenous protein into prion protein.

viruses contain both protein and nucleic acid and so carry the genetic information for their own reproduction.However ,they lack the apparatus to replicate autonomously ,relying instead on "hijacking " the cellular machinary of the host .They are smalll ( usually less than 200 nanametres in diameter ) and each virus possesses only one species of nucleic acid ( either RNA or DNA ).

Bacteria are usually though not always ,larger than viruses .Unlike the latter they have both DNA and RNA , with the genome encoded by DNA ,They are enclosed by a cell membrane ,and even bacteria which have adopted an intracellular existence remain enclosed within their own cell wall. Bacteria are capable of fully autonomous reproduction ,and the majority are not dependent on host cells.

Eukaryotes are the most sophisticated infectious organism ,displaying sub-cellular compartmentalization .Different cellular functions are restricted to specific organelles ,e.g photosynthesis takes place in the choloroplast ,DNA transcription in the nucleus and respiration in the mitochondria ,Eukaryotic pathogens include unicellular protozoa ,fungi ( which can be unicellular or filamentous ) ,and multicellular parasite worms.

Other higher classes ,notably the insects and the arachnids ,also contain species which can parasitize man and cause disease .

Infection

2011-04-28T12:22:00.000-07:00

INFECTION AND INFECTIOUS DISEASE

ORGANISM INTERACTION AND SOURCES OF INFECTION

HOST / ORGANISM INTERACTIONS

Each of us is colonized with huge numbers of micro-organism ( bacteria plus viruses ,fungi , protozoa , and worms ) with which we coexist .The relationship with some of these organism is symbolic ,in which both partners benefit ,while others are commensals , living on the host without causing harm .Infection and illness may be due to these normally harmless commensals and symbiotes evading the body's defences and penetrating into abnormal sites.Alternatively ,disease may be caused by exposure to exogenous pathogenic organism which are not part of our normal flora.

The symptoms and signs of infection are a result of the interaction between host and pathogen .in some cases ,such as the early stages of influenza ,symptoms are almost entirely due to killing of host cells by the invading organism .Usually ,however ,the harmful effects of infection are due to a combination of direct microbial pathogenicity ,and the body's response to infection .In meningococcal septicemia ,for example ,much of the tissue damage is caused by cytokines released in an attempt to fight the bacteria .In a few instances , such as chronic South American trypanosomiasis ( Chaga's disease ) ,mortality is almost entirely immunological ,with the parasite itself having little effect once the inflammatory process has been triggered .

SOURCES OF INFECTION

The endogenous skin and bowel commensals can cause disease in the host ,either because they have been transferred to an inappropriate site ( e.g bowel coliforms causing urinary tract infection ) ,or because host immunity has been attenuated ( e.g candidiasis in an immune compromised host ) .Many infections are acquired from other people ,who may be symptomatic themselves or be asymptomatic carriers .Some bacteria ,like the meningococcus ,are common transient commensals ,but cause invasive disease in a small minority of those colonized .Infection with other organisms ,such as the hepatitis B virus ,can be followed in some cases by an asymptomatic but potentially infectious carrier state.

Zoonoses are infections that can be trasmitted from wild or domestic animals to man .Infections can be acquired in a number of ways : direct contact with the animal ,ingestion of meat or animal products , contact with animal urine or faeces ,aerosol inhalation ,via an arthropod vector ,or by inoculation of saliva in a bite person to person .

Most microorganisms do not have a vertebrate or arthropod host but are free-living in the environment . The vast majority of these environmental organisms are non-pathogenic ,but a few can cause human disease.Person to person transmission of these infections is rare .Some parasites may have a stage of their life cycle which is environmental ( for example the free-living larval stage of Strongyloides stercoralis and the hookworms ) even though the adult worm requires a vertebrate host.Other pathogens can survive for periods in water or soil and may be transmitted from host to host via this route ,these should not be confused with true environmental organisms.

World -wide mortality from infectious disease such as :

Acute lower respiratory infections
HIV/AIDS.
Diarrheal disease.
Tuberculosis.
Malaria.
Measels.
Tetanus.
Whooping cough.
Meningitis.
Leishmaniasis.

Infectious endocarditis

2011-04-28T11:50:00.000-07:00

INFECTIOUS ENDOCARDITIS

Infective endocarditis is a form of endocarditis caused by infectious agents. Agents are usually bacteria, but other agencies may also be responsible. Heart valves do not receive the blood supply is engaged. Consequently, immune defense mechanisms (such as white blood cells) can not directly reach the valve through the bloodstream. If an organism (like bacteria) binds to a valve surface and forms of vegetation, the host immune response is blunted. The lack of blood supply to the valve also has implications for treatment, because medicines are also difficult to reach the infected valve. Normally, blood flows smoothly through these valves. If damaged - rheumatic fever, for example - the risk of bacterial adhesion is higher.

Infective endocarditis (IE) is an infection of the endocardial surface of the heart. The impact of this infection include severe valvular regurgitation intracardiac, which can lead to intractable congestive heart failure and myocardial abscesses. IE also produces a wide variety of systemic signs and symptoms through several mechanisms, including both sterile and infected emboli and various immunological phenomena.

There are several ways to classify endocarditis. The simplest classification is based on the causes of this disease , whether infected or not the infection, depending on whether the organism causes inflammation. Regardless, the diagnosis of endocarditis on the basis of clinical features, investigations such as cardiac ultrasound, as well as all blood cultures demonstrated the presence of micro-organisms that cause endocarditis.

PATHOPHYSIOLOGY

Though uncertain, it is believed that the heart valve of infective endocarditis and other surfaces of heart when exposed to bacteria or fungi microemboli moves into the bloodstream. Dextran-producing bacteria for example Streptococcus mutans, a virulence factor in promoting compliance with the endovascular surfaces. Coagulase-negative staphylococci to produce biofilm is a prosthetic surface, which also contribute to a commitment. beta-hemolytic streptococci and enteric gram-negative bacteria is recognized factors such as respect, and seems less likely to cause blood poisoning. Endocardial surface is already damaged heart valve disease, endocarditis, surgery, or pacemaker wires create a favorable environment for the formation of thrombi. Over time, microorganisms multiply in whirlwinds, which is a classic vegetation. Micro-organisms to be put into circulation, usually continuously, which often leads to interesting results.

CAUSES

The infection of the heart valve relatively resist by normal structure. Bacteria and fungi are not easy to attach to the endocardial surface, and constant good blood supply can prevent it from depositing in the structures of the endocardium. Thus, two factors generally required for infective endocarditis: predisposing alteration of the endocardium and microorganisms in the bloodstream (bacteremia). In a rare cases , bacteremia or mass of microorganisms specifically virulent cause of endocarditis on normal valves of the heart.

Endocarditis commonly involves the cardiac valves. The main predisposing factors are congenital heart defects, rheumatic valve disease, bicuspid or calcific aortic, mitral valve prolapse and hypertrophic cardiomyopathy. artificial valves are at particular risk. Sometimes, the sites of mural thrombus, ventricular septal defects and patent ductus arteriosus will be infected. The actual nidus of infection is usually a sterile fibrin-platelet vegetation ,it can formed when tissue factor release by damaged endothelial cells.

The microorganisms that infect the some layer of heart ( endocardium ) can originate from distant infected sites (example, skin abscesses, inflammation or infection of the gums, urinary tract infection) or visible portals of entry like in a central venous catheter or an injection site . Almost all the foreign material implanted (eg, ventricular peritoneal implants) runs the risk of bacterial colonization, thereby becoming a source of infection and therefore endocarditis. Infective Endocarditis can also be asymptomatic bacteremia, as occurs during invasive dental procedures, medical or surgical procedures. Even brushing your teeth, chewing, can cause septicemia (usually due to Streptococcus viridans) in gingivitis patients........ read more

Endocarditis treatment

2011-04-28T11:44:00.000-07:00

It rapidly damages cardiac sites seeds extra-cardiac sites hematogenously and can progress to death within weeks ,incidence increases in elderly

The incidence of infective endocarditis in the general population is estimated approximately at 2 and 6 cases of 100 000 person-years, but significantly higher in patients with underlying valvular heart disease and the abuse of intravenous drugs. In addition, invasive procedures are performed also technically strong health care system can cause infections of the bloodstream and cause blood poisoning. Although historically rheumatic valvulitis has often been regarded as a predisposing factor in endocarditis, times have changed. mitral valve prolapse, bicuspid aortic disease and aortic valvular heart disease are now the most frequent causes. Furthermore, the prosthetic valve heart defects in about one third of all cases of endocarditis, and affects 1% to 3% of patients after cardiac valvular surgery.

SIGN AND SYMPTOMS

In many cases the infection develops very slowly. Sometimes called subacute bacterial endocarditisor SBE. Symptoms can develop gradually, over weeks or months and may be vague. You tend to feel generally unwell and may have general aches and pains, fatigue, and may be out of food. The fever (high temperature) develops at some point in most cases. In these early symptoms may be caused by many other conditions, the cause of the symptoms can not be diagnosed for a while. Murmurs tend to develop heart. These are sounds that can be heard by a doctor listens to your heart with a stethoscope. murmurs are caused by an abnormal flow of blood through faulty valves or damaged. If you already have a murmur heart of an existing valve problem, the murmur may change or become more intense. A new murmur or change is often what alerts a physician to suspect infective endocarditis.

In some cases, the symptoms pretty quickly and it can be very bad for several days. Speed at which the disease develops depends in part on which bacteria or fungi that cause infection. Some bacteria are more virulent than others.

DIAGNOSIS

Infective endocarditis diagnosis based on symptoms, results of medical examinations and results of diagnostic tests:

Blood cultures show bacteria or microorganisms commonly found in endocarditis. blood cultures, blood tests can be time consuming for the laboratory to isolate specific bacteria causing the infection. Must be taken before antibiotics are started, if you have blood poisoning.

Echocardiogram (heart ultrasound) may show growths, abscesses (holes), the new regurgitation (leakage) or stenosis (narrowing), or an artificial heart valve that has begun to move away from the heart tissue. Occasionally, doctors insert an ultrasound probe in your esophagus or esophageal (TEE) to obtain a very detailed look at heart.

Other signs and symptoms of infective endocarditis included :

Emboli (small clots), bleeding (internal bleeding).
Stroke .
Shortness of breath .
Night sweats.
Loss of appetite or weight loss .
Muscle and joint pain

TREATMENT

When bacteria cause infective endocarditis , identified by blood culture tests ,Doc should start immediately intravenous (IV) antibiotic therapy. Intravenous antibiotics may be administered up to six weeks to control the infection. The symptoms will be monitored during treatment and blood tests to determine the effectiveness of treatment. If damage of cardiac valves occurs, surgery may be needed to establish the heart valve and improve cardiac function.Treatment of infective endocarditis starts with prevention. When endocarditis occurs, prompt treatment is necessary to prevent damage to heart valves and for more serious complications, including death...... read more

Rheumatic fever symptoms - Leptospirosis -Listeria symptoms

2011-04-28T11:12:00.000-07:00

SYSTEMIC / MULTISYSTEM INFECTIONS

RHEUMATIC FEVER

Rheumatic fever is an inflammatory disease that can develop after an infection with Streptococcus bacteria (such as strep throat and scarlet fever) and can involve the heart (especially the valves), joints, skin and brain. Rare in developed countries like Great Britain, USA and Australia. Incidence has dropped by 10% of children in 1920 to 0.01% of all children today. This reduction in the incidence reflect advances in infection control and treatment of streptococcal infections to antimicrobials. The disease is still prevalent in developing countries such as the Middle and Far East and Latin America.

Rheumatic fever is preceded by a throat infection with Streptococcus organsisms. After infection with group A streptococcal pharyngeal, usually in childhood (5-15And) is followed by a systemic syndrome I think it is caused by an autoimmune reaction triggered by an infection. Syndrome includes: 1) Arthritis (multiple join pain and swelling) 2), carditis (heart inflammation) 3) The cutaneous manifestations 4) manifestations5 nervous system), fever, joint pain 50% etc.About Patients who develop carditis during the initial phase of the disease will continue to develop long-term heart disease and rheumatic valvular disease.

1) Blood tests: ESF and CRP (non-specific inflammation), leukocytosis2) Studies in X-ray may be a sign of heart infection, pericarditis, pericardial effusion effusion.3) ECG may signs of inflammation of the heart (extended range PR) or, and pericarditis (saddle-shaped ST elevation). Parts of the acute clinical syndrome may recur after the first period. However, projected common disease, skin disease and nerve disease associated with rheumatic fever is excellent with no known long-term consequences. rheumatic heart disease has traditionally been hailed as an important causal factor of cardiac valvular disease and makes the associated morbidity and mortality.

LEPTOSPIROSIS

Leptospirosis is a rare infection, serious and contagious caused by bacteria of several species of the genus Leptospira, a micro-organism spiral (spirochete). Leptospirosis is often called the swineherd's disease, swamp fever, or mud fever. The organism enters the body when mucous membranes or abraded skin comes into contact with contaminated environmental sources. The infection causes a systemic disease that can often lead to renal and hepatic failure as possible.

Leptospirosis is a zoonosis (animal care) infection with a worldwide distribution and incidence. The incidence varies from sporadic in temperate zones endemic in some tropical countries. The disease has a seasonal incidence. Most cases occur during the rainy season in the tropics and in western countries in late summer or early fall, when soil is moist and alkaline. Leptospirosis is usually associated with tropical countries and heavy rains, but most cases occur in temperate climates, probably due to underreporting in some countries.

In general, the prognosis associated with this disease is good, usually with full recovery after infection. more serious systemic infections (Weil's disease), can lead to renal (kidney) or hepatic (liver), myocarditis (heart inflammation), and can be potentially fatal.

Approximately 15-40% of patients are exposed, but do not become ill show serologic (blood or urine or saliva) evidence of a past existing infection. This statistic includes 15% of abattoir workers, home workers, and the incubation period is usually between 7-12 days veterinarians.The, with a range of 2-20 days. About 90% of patients experience a mild form of the disease,
and about 5-10% have the severe form with jaundice, also known as Weil's disease. The natural course of leptospirosis is divided into two very distinct phases, sepsis and immune systems. For a brief period of 1-3 days between the first and second phase, the patient shows some improvement.

LISTERIOSIS

Listeriosis is an infectious disease caused by foodborne bacteria Listeria monocytogenes. The symptoms are the symptoms of upper respiratory tract and septiceamia. Listeriosis is of particular concern during pregnancy because it can cause miscarriage, stillbirth, premature delivery and sepsis (full body infection) and pneumonia in newborns.

It is an environmental organization that is ubiquitous in soil and rotting matter.It affect both animals and humans, the most common way of infection to humans in contaminated food. The organism can grow at temerature as low as 4 degrees Celsius, and the foods most frequently implicated are soft cheeses, unpasteurized, raw vegetables and the chicken heads. Listeriosis is a rare but serious infection that mostly affects infants, pregnant women, elderly and immunocompromised, L. monocytogenes has also been recently recognized as a cause of self-limiting gastroenteritis, foodborne healthy adults, but the incidence of this phenomenon is unknown....... read more

Lyme disease symptoms

2011-04-28T10:59:00.000-07:00

SYSTEMIC / MULTISYSTEM INFECTIONS

LYME DISEASE

Lyme disease, or other name is Lyme borreliosis, is an emerging clinical infection caused by at three type of species of bacteria ,that belong to the genus Borrelia.Borrelia burgdorferi sensu stricto is the major cause of Lyme disease in the U.S. while Borrelia afzelii andBorrelia garinii cause most of the European cases.

The disease name is given after the town of Lyme,Connecticut, in United States of America , where a large number of cases were found in 1975. According to the Allen Steere Lyme disease was a tick-borne disease in 1978, the main cause of this disease remained a mysterious until 1981, when B. burgdorferi was identified by another person Willy Burgdorfer.

Lyme disease is caused by a bacterial infection transmitted by ticks and the individual's immune response to infection later. It is characterized by arthritis, neurological and cardiac complications, which is a characteristic rash, which extends from the original tick bite. Lyme disease is caused by spirochete Borrelia burgdorferi, which is sent to Ixodes. Spirochete can be transmitted during the blood meal of an infected tick. Studies have shown that the transfer requires at least 24-48 hours of tick attachment. Ticks carrying the voles, moles, sheep and horses, and wide distribution in the U.S., the UK and Europe. They are particularly numerous in wooded areas along or pasture, ie farmers, loggers and bush walkers usually more at risk. Activities are seasonal and peak in spring, summer and early autumn.

Traditionally, the progression of Lyme disease is divided into three phases, but it is somewhat artificial as the progression from the beginning to a later stage is not inevitable, even in the absence of antibiotic treatment. The first, and in most cases the only clinical characteristic of Lyme disease is a rash of classic erythema migrans - an area of redness migrate outwards from the site of a tick bite might have happened anytime from 20-40 days earlier. The second stage of Lyme disease occurs weeks to months after initial infection and the results spread to more distant locations via the bloodstream and lymphatic system. many organs and tissues are potential targets, especially the skin, nervous system, heart and joints. The clinical signs depend on the system and the severity of injuries. Patients may complain of flu-like symptoms with night sweats and muscle aches.

Lyme disease should always be considered if there is a history of exposure to ticks. A negative history of tick bite does not develop the disease. The study was made to work, travel and leisure exposure and pets. Samples can be performed on blood or cerebrospinal fluid. The organism can be cultured in the laboratory for 3-4 weeks. DNA detection is also possible. The prognosis is generally excellent, and only a few deaths have been reported. Even without treatment, a tendency to recurrent episodes of Lyme arthritis to resolve over time. Children seem to have a better chance of complete recovery than adults.

Ebola virus

2011-04-28T10:15:00.000-07:00

INSECT AND - ANIMAL BORNE VIRAL INFECTIONS

EBOLA AND MARBURG VIRUS INFECTIONS

Ebola and Marburg viruses are related viruses that cause hemorrhagic fevers - diseases characterized by bleeding (hemorrhage), organ failure, and in many cases, death. Both Ebola and Marburg virus are in Africa, where outbreaks have occurred sporadically for decades. No human case of Ebola haemorrhagic fever have been reported in the United States. Ebola and Marburg live in one or more host animals and humans can contract the virus from infected animals. After the initial transmission, the virus can spread from person to person by contact with bodily fluids or contaminated needles. There is no effective treatment for hemorrhagic fever caused by Ebola and Marburg virus. People diagnosed with Marburg or Ebola virus receive supportive care and treatment of complications.

Virus causes Marburg hemorrhagic fever (MHF), also called the Marburg virus disease, and previously also known as green monkey disease because of its primate origins. Marburg Central and Eastern Europe, and infects humans and nonhuman primates. Marburg virus is the same taxonomic family, Ebola, and both are similar in structure, although it would different antibodies.

HISTORY
This virus has been documented in 1967 when 31 people became sick in the German city of Marburg ,after which it is named Frankfurt am Main and the then Yugoslav city of Belgrade. The outbreak involved 25 primary infections, with seven dead and six secondary cases, no deaths. The primary infections were in laboratory staff exposed to Marburg virus while working with monkeys or their tissues. The secondary cases involved two doctors, a nurse, a post-mortem worker, and married to a veterinarian. All were in direct contact, usually involving blood, with a primary case. Both doctors became infected through accidental skin pricks when drawing blood from patients.

TRANSMISSION
Disease spreads to body fluids such as blood, faeces, saliva and vomit. The first symptoms are often vague, and usually include fever, headache and muscle aches after the incubation period is 3-9 days. After five days, maculopapular rash is often present in the body. At a later stage of Marburg infection is acute and may have jaundice, pancreatitis, weight loss, delirium and neuropsychiatric symptoms, bleeding, hypovolemic shock and multi-organ failure, liver failure most common. offshore accounts to evade physical gaps are widespread popular references to the disease, but in fact rare. Now, of course, varies, but symptoms usually last from one to three weeks, to repair disease or kill the infected host. The mortality rate is 23% more than 90%....... read more

PRECAUTIONARY MEASURES FOR TREATING PATIENT'S OF EBOLA AND MARBURG INFECTION

Ebola virus and marburg virus disease spread from person to person by contact

2011-04-28T10:14:00.000-07:00

INSECT AND - ANIMAL BORNE VIRAL INFECTIONS

EBOLA AND MARBURG VIRUS INFECTIONS

CAUSES

Marburg and Ebola virus has risen to tropical rainforests in Africa, in mid-20th century. Live virus animal host or reservoir's .People were probably infected when they invaded their habitats, and found a virus for the first time. Researchers Have identified a type of African fruit bat as a source of virus. Even if infected with Ebola and Marburg in contact with monkeys, chimpanzees and other nonhuman primates, these animals are not subject to natural virus. Instead, they are a ring of infection.

Once a person has been infected with Ebola or Marburg virus, the virus can spread to others through contact with bodily fluids that his person or through the use of contaminated needles or syringes. Investigators do not believe that humans produce enough Ebola or Marburg virus in droplets to cause infection through casual contact.

SIGN AND SYMPTOMS

After the incubation period of 5-10 days, fever, muscle aches and headaches often occur abdominal symptoms (nausea, vomiting, pain, diarrhea), and upper respiratory symptoms (cough, chest pain, pharyngitis). Photophobia, conjunctival injection, jaundice and lymphadenopathy occur. Delirium, stupor and coma may occur, suggesting the involvement of the CNS. hemorrhagic symptoms begin within the first days and include petechiae, bruising, bleeding and Frank puncture sites and mucous membranes. Maculopapular rash, mainly in wood, from about 5 days.

During the second week of symptoms, or fever clearance occurs and patients begin to recover, or multiple organ failure patients develop fatal. The recovery is long and may be complicated by recurrent hepatitis, uveitis, transverse myelitis, and orchitis. Mortality ranges from 25-90% (higher Ebola).

DIAGNOSIS

Ebola and Marburg hemorrhagic fever is difficult to diagnose because many of the early signs and symptoms resemble other infectious diseases such as typhoid and malaria. But if doctors suspect that you have been exposed to Ebola or Marburg virus, using laboratory tests to identify the virus in a few days. Most people with Ebola or Marburg haemorrhagic fever have high concentrations of virus in their blood. Blood tests known as enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase chain reaction (PCR) can detect specific genes or viruses or antibodies against them.

TREATMENT

No antiviral drug has proven effective in the treatment of infection with Ebola or Marburg virus. Consequently, treatment consists of medical support. This includes the provision of fluids to maintain adequate blood pressure to replace blood loss and treat all infections that develop. Some people receive transfusions of plasma to restore blood proteins to enhance coagulation. Public health officials urge hospitals to keep people with Ebola or Marburg haemorrhagic fever isolated from others in negative pressure rooms, which maintain the flow of air rather than enclosed spaces. Health workers should follow strict precautions for infection control.

COMPLICATIONS

Both Ebola and Marburg hemorrhagic fever lead to death for a large percentage of people who suffer. As the disease progresses, it can cause multiple organ failure, severe bleeding, jaundice, delirium, convulsions, coma and shock. Death often occurs within 10 days after the onset of signs and symptoms. One reason why viruses are so deadly is that they interfere with the immune system's ability to defend itself. But scientists do not understand why some people recover from Ebola and Marburg and others not. For those who survive, recovery is slow. It can take months to regain weight and strength, and the virus remains in the body for several weeks. People may experience hair loss, sensory changes, hepatitis, weakness, fatigue, headache, inflammation of eye , inflammation of the testicles........ read more

Lower respiratory infections

2011-04-28T07:12:00.001-07:00

In the health the lower respiratory tract is normally sterile owing to a highly efficient defence system and lower respiratory tract is frequently compromised by smoking

LOWER RESPIRATORY TRACT INFECTIONS

Lower respiratory infections cause disease in the air sacs and the infection that results is called pneumonia. This part of the paper will address the various types of pneumonia (eg, generally, chronic interstitial pneumonia and fungal) and agents that cause them.

Acute respiratory infections are a public health problem of constant and widespread. Cause a greater burden of disease in the world that infection with human immunodeficiency virus, malaria, cancer or heart attacks.In United States, causing more diseases and deaths than any other disease, and there was little change in mortality from respiratory tract infection for more than five decades.1 2 the results of an acute lower respiratory tract depends on the virulence of the organism and response of inflammation in the lung.

Changes in the characteristics of the aging population and the swelling numbers of immunocompromised patients with conditions increased the number of people in danger. A wide selection of new pathogens also provides challenges for the microbiology laboratory. Overtreatment of uncomplicated acute bronchitis, which is largely due to viruses, has led to unprecedented levels of multidrug resistance among invasive pathogens such as Streptococcous pneumoniae. Guidelines for a rational approach to evaluation and treatment of patients with acute bronchitis have been published recently in an attempt to reduce misuse of antibiotics and an attempt to prevent further increases in resistance rates. The role of the laboratory are very limited.

PNEUMONIA

Pneumonia. It comes in a variety of situations and treatment should vary depending on the situation. It is classified as community or hospital acquired, depending on where the patient contracted the infection. Sometimes it is fatal in older people or those who are immunocompromised. The most common treatment is antibiotics and vary in their side effects and effectiveness. Pneumonia is the leading cause of death among children under five years. The most common cause of pneumonia is a bacterial pneumonia, Streptococcus pneumoniae accounts for two thirds of bacteremic pneumonia.

A dangerous type of lung infection with a mortality of about 25%. For optimal management of a pneumonia patient, the following assessment - pneumonia severity (including whether to treat as home, hospital or intensive care), identification of the bacteria, the analgesia for chest pain, need for supplemental oxygen, physical therapy, hydration, bronchodilators and possible complications of emphysema or lung abscess.

Community respiratory infections appropriate use of fluoroquinolones is a therapeutic option. These have been shown to be targeted in vitro and typical and atypical pathogens of interest. newer fluoroquinolones (eg moxifloxacin or gatifloxacin) have extended the activities Gram + ve, and once a day and, consequently, the potential first-line treatment of lower respiratory tract infections. However, clinical response is the best indicator of effectiveness of moxifloxacin or gatifloxacin, and have proved effective against community-acquired respiratory tract infections clinically.

Bronchitis contagious

2011-04-28T07:12:00.000-07:00

BRONCHITIS

Bronchitis can be classified into acute or chronic. Acute bronchitis can be defined as an acute bacterial or viral respiratory tract in healthy patients without a history of recurrent disease. It affects more than 40 per 1000 adults each year and consists of a transient inflammation of the bronchi and trachea large. In most cases it is due to a viral infection, so antibiotic treatment is not indicated for immunocompetent persons. Are no effective treatments for acute bronchitis virus bronchitis.Treatment antibiotics is common, but controversial, because their use is only moderate performance weighed against the possible adverse effects (nausea and vomiting), increased resistance, and the cost of condition self-care. beta2-agonists are sometimes used to relieve cough associated with acute bronchitis. A recent systematic review concluded there was no evidence of their use.

Acute chronic bronchitis are usually caused by an infection does not cause the same virus. 50% of patients colonized by Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis o. Antibiotics are only found to be effective if all three of the following symptoms are present: - wheezing, increased mucus volume and purulence. In these cases, amoxicillin 500 mg orally every 8 hours for five days or doxycycline 100 mg orally for five days should be used.

TREATMENT

An important consideration in treating a patient with lower respiratory tract infection is to determine if an antibiotic is needed in all. Many infections are viral, and symptomatic treatment is necessary. If an antibiotic is necessary that the choice of drug depends on the site of infection, disease severity, patient age, presence of other underlying diseases, history of drug reactions and the likely performance of the patient.

Antibiotics will not help many lower respiratory tract infections caused by viruses. Although acute bronchitis is often not need treatment with antibiotics, the antibiotics administered to patients with acute exacerbation of chronic bronchitis. The indications for treatment are increased dyspnea and increased volume or purulence of sputum. The treatment of bacterial pneumonia is chosen taking into account the patient's age, severity of disease and the presence of underlying disease. Amoxicillin and doxycycline are suitable for many lower respiratory tract infections seen in general practice.

Bone infection

2011-04-28T06:33:00.000-07:00

BONE AND JOINT INFECTIONS

Osteomyelitis is the name given to infections of the bone. This may be acute or chronic in nature. More than 90% of acute osteomyelitis caused by Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae but also cause an acute infection of Haemophilus inflenzae bone is rare due to the widespread use of Hib vaccine.

Bone has been infected by the bacteria move into the bloodstream, where seeds of infection. Acute osteomyelitis usually affects the long bones points higher, because blood flow is slow in these areas. This allows the possibility of bacteria in motion to resolve the infection and establish at these sites. Although rare, osteomyelitis more often in children and adolescents who are growing rapidly. Sometimes, acute osteomyelitis can cause the spread of infection to adjacent tissues. In such cases, the infection is likely to be polymicrobial.

The bacterium Mycobacterium tuberculosis is the most common cause of chronic osteomyelitis. This condition causes the secondary spread of a lung infection. Unlike osteomyelitis, which affects the growing points of long bones chronic osteomyelitis caused by Mycobacterium tuberculosis is most likely to affect the vertebrae. Other bones, including hip and knee and leg in your hands or feet, may be involved in chronic osteomyelitis. The pressure on the spinal cord due to chronic osteomyelitis may be enough to cause paralysis in the affected region.

A bacterial infection of a joint can cause serious and potentially destructive form of arthritis, often called septic arthritis. Common bacterial infections can be caused by a variety of organisms and can occur in natural and artificial joints (eg after total knee arthroplasty). The most frequent common infection caused by N. gonorrhea, sexually transmitted bacteria that cause gonorrhea, this is called a gonococcal joint infection. mixed infection with other types of bacteria called nongonococcal bacterial (septic) arthritis. Infection of an artificial joint is known that infection prosthesis.

People who have artificial joints are at risk of developing a common infection. Approximately 0.5 to 1 percent of the population with replacement joints to develop such an infection. Infections may occur during early recovery from hip replacement surgery (within the first two months) or much later. Unfortunately, artificial joint infections are difficult to treat. This is due, in part, the development of structures known as biofilms within the commune. Biofilm develops when bacteria are in accordance with the common artificial solid surface. Biofilm can act as a shield against some bacteria, making it difficult for bacteria to find and destroy the body's natural defenses or antibiotics.

Other bacteria that cause chronic osteomyelitis include salmonella and other coliform bacteria, Pseudomonas aeruginosa and the spirochetes Treponema pallidum. This can cause bone lesions in children with congenital syphilis. Also cause sensitization to gum formation of bone in patients suffering from tertiary syphilis. Recent archaeological evidence suggests that bone lesions caused by syphilis is evident in the bones of Europe before the discovery of America. These doubts about the theory that Christopher Columbus brought syphilis during his first return from the New

World.

Bone and joint infections occur when a bacterial infection spread from one part of the body for a bone or joint through the bloodstream. The infected bone begins to produce pus, which may cause an abscess or pocket of pus. Over time, the infection can disrupt the blood supply of bone. This can cause the bone to die. One of the most common bone and joint infection called osteomyelitis. Bone and joint infections can cause symptoms such as bone pain, swelling, fever and nausea. Several factors increase a person's risk of bone and joint infections, including trauma, diabetes, dialysis and the use of intravenous drugs. If you experience symptoms similar to those of a bone or joint infection, you should be seen by a specialist in infectious diseases.

Gram-positive organisms, particularly staphylococci and streptococci, which are responsible for most infections in bones and joints. The treatment of these infections can be difficult, usually associated with long-term course of antibiotics, often with surgery. The choice of antibiotics depends on the sensitivity profile, patient tolerance and long-term goals, such as the treatment or suppression, but only a few randomized controlled trial in patients compared the efficacy of different antibiotics. Varying degrees of bone penetration and clinical outcome of certain antibiotics, such as beta-lactams, clindamycin and quinolones, has been described, although the method of these studies are not standardized and results are not always be applied directly to patients.

The effect of achieving a minimum bactericidal concentration of serum in patients has also been studied, but no longer routinely recommended in clinical practice. Comparative clinical trials are few but have demonstrated the efficacy of oral fluoroquinolones in combination with rifampicin or fusidic acid for selected Gram-positive infections. In the last decade, more and more resistant organisms such as Staphylococcus aureus resistant to methicillin and vancomycin resistant enterococci have been recognized as causes of infection in orthopedics. Individual case reports describe successful treatment with new antibiotics, for example, linezolid and quinupristin / dalfopristin, but results of clinical trials are expected.

Systemic infection

2011-04-28T06:10:00.000-07:00

SYSTEMIC / MULTISYSTEM INFECTIONS

SEPTICAEMIA

Sepsis is a serious condition characterized by inflammation in the body. It is caused by bacteria entering the bloodstream, which triggers an immune response, causing inflammation and a closing body systems slow to treat the infection. This disease can be fatal, especially if the patient is allowed to make progress in the shock phase and departure can be alarmingly quickly. If sepsis is suspected, a patient transported to hospital for immediate medical care.

SEPTICAEMIA

The causes of sepsis are varied. Typically, the patient is vulnerable due to age or condition, and bacteria simply enjoy the situation. Surgery latent infections, and burns can all cause blood poisoning, which is a very good reason to keep any infections to ensure they do not spread. A case of sepsis begins with bacteria that produce toxins in the bloodstream, causing blood clotting, the body tries to fight against bacteria.

MENINGOCOCCAL SEPTICAEMIA

Meningococcal septicemia (blood poisoning) - This is the most dangerous and deadly of the two diseases. It occurs when bacteria enter the bloodstream and multiply uncontrollably, damaging the walls of blood vessels and cause bleeding under the skin. The disease is called sepsis and meningitis is usually associated with the eruption of purple. Sepsis can cause death within hours, or permanent disabilities such as scars and amputations. See the animation below shows how it travels through the blood system.

MENINGOCOCCAL SEPTICAEMIA

The disease is carried in asmptomatically 50-20% of the population. It is found worldwide in the five major serogroups. Meningococcal group A causes epidemic disease in sub-Saharan Africa and parts of Asia. Groups Y and W also cause an infection outbreak. B and C tend to cause sporadic infections in Europe and North America. The disease occurs only in a small percentage of those colonized. It depends on both host and bacterial factors and are more likely following viral upper respiratory tract. Man is the only known reservoir of disease. Meningococcal disease occurs when bacteria invade the nasal mucosa and into the bloodstream.

TULAREMIA

Tularemia, also known as "rabbit fever", is a disease caused by the bacterium Francisella tularensis. Tularemia is typically found in animals, especially rodents, rabbits and hares. Tularemia is a disease usually in rural areas and has been reported in all states of the United States except Hawaii. Typically, people infected by the bites of infected insects (most commonly, ticks and horseflies) by handling infected sick or dead animals, eating or drinking contaminated food or water by respiration bacteria from the air.

Tularemia

Its a common widespread disease in animals. About 200 human cases of tularemia are reported each year in the United States. In most cases occur in parts of south-central and western states. Almost all cases occur in rural areas, and those resulting from bites of ticks and biting flies or handling infected rodents, rabbits or hares. Cases the result of breathing the bacteria into the air and laboratory accidents. people develop symptoms depends on how they are exposed to tularemia. Possible symptoms include skin sores, swollen lymph nodes, painful, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If bacteria are inhaled, symptoms may include sudden onset of fever, chills, headache, muscle aches, joint pain, dry cough and progressive weakness. People with pneumonia can develop chest pain, difficulty breathing, spitting blood and respiratory failure. Rabbit fever can be fatal if the person has not been treated with appropriate antibiotics.

Francisella tularensis is highly contagious. A small number of bacteria (10-50 organisms) can cause disease. If Francisella tularensis were used as a bioweapon, the bacteria were probably made in the air to be inhaled. People who inhale the bacteria can experience severe respiratory diseases like pneumonia and systemic infection serious if not treated.

The incubation period (time to be exposed to fall ill) for tularemia is usually 3-5 days, but can vary from 1-14 days. If you think you have been exposed to tularemia bacteria, consult a doctor quickly. Treatment with antibiotics for a period of 10-14 days or more after exposure may be recommended. If you have any antibiotics, it is important to take following the instructions you receive. All medications you take, be taken.