describes about the various infections affecting humans

1. Infections
Dr.Ch.Nikhila

2. Actinomycosis:
Causative organism : Actinomyces israelii
It is an anaerobic gram positive fungal like bacterium,which is branching filamentous organsim.It is
called as Ray fungus because of sun ray appearance.
Types:
Facio-cervical :Mc type
Thorax
In right iliac fossa
Liver
Pelvic

3. Features:
Discharging sinus with induration and nodules,no lymph nodal
involvement,through blood spread it may cause pyaemia and endanger life.
Pus under microscopy shows branching filaments.
Gram’s staining shows Gram positive mycelia in centre with gram negative
radiating peripheral filaments .
Cultured in brain heart infusion agar and thioglycolate media.

4. Differential diagnosis:
Chronic pyogenic osteomyelitis,carcinoma at the site,Tuberculous disease
Treatment:
Penicillins for longer period (6-12 weeks)
Tetracylcines,streptomycin
Dapsone and iodides may be useful
Surgical debridement is occasionally required.
Welsh regimen: Injection Amikacin 15mg/kg Iv daily for 21 days;such cycle is repeated 3 times at a gap of
15 days along with tablet Trimethoprim (7 mg/kg) sulfamethoxazole (35 mg/kg ) daily for 6 months.

5. Septicaemia:
It is the presence of overwhelming and multiplying bacteria in the blood with toxins
causing SIRS ( systemic inflammatory response syndrome) or MODS which later may
progress multi system organ failure.Actually ,sepsis which means body’s response to
infection eventually causing damage to own organs.Sepsis is SIRS with infection.
Severe sepsis is sepsis syndrome with MODS or MSOF.
Even though two or more of SIRS criteria are used to diagnose sepsis.
SOFA score is ideal using 6 parameters
respiratory,neurological,cardiovascular,liver,coagulation,and renal system ;each having
0,1,2,3,4 scores.Quick SOFA score is also used based on 3 parameters. - Low Blood
pressure <100 mmhg;increased respiratory rate >22 /min;altered mentation GCS <13.

6. Septicaemia can be Gram positive or gram negative .
Gram positive septicaemia is due to staphylococci, streptococci,pneumococci,etc infection.
It is common in children ,old age,diabetes and after splenectomy.
Gram negative septicaemina is common in acute abdomen like
peritonitis,abscess,biliary,pancreatic,operative sepsis.
It is commonly seen in malnourished ,old age,immunosuppressed people and diabetics.Common bacteria
are E.coli,Klebsiella , pseudomonas,proteus etc.
Gram negative septicaemina causes endotoxic shock.Initial reversible warm stage present with fever,chills
and rigor which is due to pyogenic response;eventual irreveraible cold stage develops where in patient
goes for complications like -ARDS , renal , liver, and multi organ failure DIC , bone marrow suppression

7. Evaluation:
Clinical assessment,Blood parameters( haemocrit,LFT,RFT,coagulation
profile,electrolyte estimation, ABG,C reactive protein .) culture of urine
/pus/discharge/bile/blood/chest xray, imaging as per need.
Treatment:
Fluid therapy,antibiotics,vitals monitoring,oxygen supplementation,FFP,or fresh
blood transfusion,critical care with ventilator support,electrolyte management ,CVP line
, parenteral nutrition management complications
Complications:
DIC,ARDS,Liver dysfunction,renal failure,bone marrow suppression,Multiorgan failure

8. Pyaemia:
Presence of multiplying bacteria in blood as emboli which spread and lodge in
different organs in the body like liver,lungs,kidneys,spleen,brain causing pyaemic
abscess .This may lead to multiorgan dysfunction syndrome(MODS).
Clinical features:
Fever with chills and rigors,jaundice oliguria,drowsiness,Hypotension ,peripheral
circulatory collapse and later coma with MODS.
Treatment : Similar to septicaemina.

9. Cancrum oris:
It is a rapidly spreading ,progressive,mutilating,gangrenous stomatitis,beginning in the mucous
membrane of the corner of the mouth or cheeck,progressing rapidly to involve the entire thickness
of the lips or cheek or both with necrosis and sloughing of the entire tissue,usually observed in
poorly nourished childern,and debilitated adults caused by polymicrobial ,opportunistic infection
caused by components of the normal flora that become pathogenic during periods of compromised
immune status.It is also common in HIV patients.
It is an infective gangrene , a severe form of Vincent’s acute ulcerative gingivitis and stomatitis.
Seen in poirly nourished ,ill child due to Borrelia vincentii and fusiform bacteria.
It starts in lips later extends to gums,spreads into cheek,bone,soft tissues and skin causing
extensive tissue loss with severe toxaemia.

10. Extensive necrosis of the mucus membrane of the oral cavity with destruction of deeper soft tissue and often bone.
In children it may follow after an attack of measles,gastroenteritis,typhoud,bronchopneumonia. Malnutrition is a predisposing
factor.
Eccessive salivation ,fetid odour with destruction , discharge and toxic features.
Borellia vincentii can be cultured.
Xray part shows bone destruction.
Treatment:
Systemic antibiotics ,high dose penicillins,metronidazole.
High protein and vitamin rich diet ,through nasogastric tube.
Wound irrigation and liberal excision of the dead tissue
Blood transfusion,TPN.
Later patient requires flaps to cover the defect.

11. SYPHILIS:
● Syphilis is a venereal (sexually-transmitted) bacterial disease caused by
Treponema pallidum usually spread by sexual contact. The disease starts as
pain less sore (typically on genitals, rectum or mouth )
● MODE OF TRANSMISSION:
Sexual intercourse
Intimate person-to-person contact
Transfusion of infected blood
Materno-foetal transmission
● INCUBATION PERIOD: 10 days- 3 weeks (may be upto 3 months).

12. CLINICAL PRESENTATION:
● Primary syphilis
● Secondary syphilis
● Latent syphilis
● Tertiary (late) syphilis
- Syphilitic Gumma
- Diffuse lesions (cardiovascular syphilis, neurosyphilis)
● Congenital syphilis

13. DIAGNOSIS:
1. Dark field microscopic examination: Direct fluorescent antibody (test) for T.
pallidum (DFA-TP)
2. Serological tests: •Nontreponemal tests Venereal Disease Research
Laboratory (VDRL) slide test
rapid plasma reagin (RPR) card test
unheated serum reagin (USR) test
•Treponemal tests Fluorescent treponemal antibody absorption (FTA-ABS)
luidine red unheated serum test (TRUST)

14. •Other serologic tests:
T. pallidum hemagglutination assay (TPHA)
Microhemagglutination assay for antibodies to T. pallidum (MHA-TP)
T. pallidum particle agglutination assay (TPPA)

15. TREATMENT:

16. Penicillin-allergic patients:

17. PREVENTION:
● Avoid recreational drugs
● Abstain or be monogamous
● Use a latex condom

18. GONORRHEA:
● Gonorrhoea is highly contagious sexually transmitted infection caused by
Neisseria gonorrhoeae, which can cause an infection of the urethra, cervix,
anus, throat and eyes.
● Rarely gonorrhoea can infect the bloodstream and cause fever, joint pain and
skin lesions.
● It can infect both males and females.
● The bacteria are mainly found in discharge from the penis and vaginal fluid
from infected men and women.

19. INCUBATION PERIOD
● 1-14 days
MODE OF TRANSMISSION
● vaginal or anal sex with an infected partner
● oral sex (less common)
● touching parts of the body with fingers
● any very close physical contact
● the bacteria can be passed from hand to hand (very rare isolated cases)
● from a mother to her baby at birth

20. Gonorrhea symptoms in Women
● strong smelling vaginal discharge-thin & watery/ thick & yellow/green irritation
or discharge from the anus
● abnormal vaginal bleeding
● possibly some low abdominal or pelvic tenderness
● pain or a burning sensation when passing urine
● low abdominal pain sometimes with nausea

21. Gonorrhea Symptoms in Men
● white, yellow or green thick discharge from the tip of the penis
● inflammation of the testicles & prostate gland
● irritation or discharge from the anus
● urethral itch & pain or burning sensation when passing urine

22. DIAGNOSIS
● Urine test
● Swab of affected area

23. TREATMENT

24. PREVENTION
● Practice safer intercourse
● Complete treatment should be taken
● Follow-up tests should be done to make sure that treatment has cleared the
infection
● Living conditions should be improved
● Impart health education

25. Vincent’s angina:
● Is due to infection by gram negative anaerobic bacteria Borrelia vincentii and
fusiformis.
● It is common in adolescents and young adults below the age of 35 yrs.
● Presents with fever ,excessive salivation,red swollen gums with painful ulcers
covered with yellow slough which can be removed like membrane – ulcerative
gingivitis.
● From the gums it spreads to cheek,palate,pharynx.
● Tender lymph nodes are palpable.
● Musty foetor oris is typical.
● Edenulous patients will not develop this infection

26. ● It is confirmed by swab culture.
● It is treated by antibiotics,penicillin group
● Peeling of membrane,
● Mouth wash
● Supportive measures
● Vitamin B and C.

27. THANK YOU