This document provides information about blood stream infections (BSI) and discusses topics such as bacteremia, septicemia, types of bacteremia, epidemiology, microbiology, pathogenesis, clinical manifestations, laboratory diagnosis, treatment and prevention. It defines bacteremia and septicemia, classifies bacteremia by duration and place of acquisition. Common causative agents of bacteremia include bacteria such as staphylococci and streptococci, viruses such as HIV and hemorrhagic fever viruses, and fungi such as Candida species. Signs and symptoms of sepsis and septic shock are described. Laboratory diagnosis involves blood culture collection and identification of pathogens. Treatment involves administering
The document discusses bloodstream infections, including the etiological agents, types, clinical manifestations, laboratory diagnosis, and fever of unknown origin. It defines various types of bloodstream infections such as bacteremia, septicemia, and fungemia. The document also outlines the diagnostic process for bloodstream infections including specimen collection, culture methods, identification, and antimicrobial susceptibility testing.
This document discusses cardiovascular system infections, including infective endocarditis. Some key points:
- Infective endocarditis is an infection of the heart valves that can have mortality rates as high as 20-50% despite antibiotic treatment.
- Predisposing factors for infective endocarditis include congenital heart defects, rheumatic heart disease, intravenous drug use, and degenerative cardiac diseases.
- Subacute infective endocarditis typically has a chronic course and is caused by less virulent organisms like streptococci that infect damaged heart valves, forming large vegetations. It accounts for 70% of cases.
- Acute infective endocarditis has a rapidly progressive course
Dr. Md. Nazmus Sakib discusses the history and management of septicemia. Key points include that Ignaz Semmelweiss first introduced hand washing to reduce childbirth mortality, Alexander Fleming discovered penicillin in 1928, and the Sepsis Six bundle recommends giving IV fluids, antibiotics, and oxygen and monitoring output while taking blood cultures, full blood counts, and lactate levels to reduce sepsis mortality. Septicemia occurs when bacteria enter the bloodstream from an infection and cause systemic symptoms, and if not promptly treated can lead to septic shock and multiple organ dysfunction syndrome.
This document discusses various types of bloodstream infections including bacteraemia, septicaemia, and infective endocarditis. It provides details on the causative agents, pathogenesis, clinical features, complications, diagnosis and prevention. The key points are:
- Bacteraemia refers to the presence of bacteria in the blood without multiplication, while septicaemia involves bacterial multiplication in the bloodstream.
- Common causative agents of septicaemia are gram-negative bacilli and gram-positive cocci such as Staphylococcus aureus.
- Infective endocarditis involves bacterial or fungal infection of the heart valves, with predisposing factors like rheumatic heart disease or intravenous drug
Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response to infection, which can rapidly lead to tissue damage, organ failure, and death if not treated promptly. Common causes include bacterial infections like pneumonia and UTIs, and symptoms include fever, altered mental status, and low blood pressure. Diagnosis involves assessing for signs of infection and organ dysfunction using tools like SOFA and lactate levels, and treatment focuses on early antibiotic administration, fluid resuscitation, and vasopressor support if needed to stabilize the patient.
This document discusses infective endocarditis, including trends, classifications, microbiology, pathogenesis, clinical manifestations, diagnosis and treatment. Some key points:
- IE is an infection of the heart valves or endocardium that is usually caused by bacteria. Common predisposing factors include rheumatic heart disease and intravenous drug use.
- It is classified based on several factors such as the site of infection, causative organism, and underlying risk factors. Acute IE has a rapid course while subacute IE progresses more slowly.
- Common symptoms include heart murmurs, heart failure, embolic phenomena affecting organs like the brain, lungs and kidneys. Specific findings include petechiae, splinter
This document provides information about blood culture procedures. It defines blood culture and different types of bacteremia. Common organisms isolated from blood cultures are discussed. Proper collection of blood culture samples is important, including collecting the appropriate amount of blood from veins or catheters. Multiple blood cultures may increase the sensitivity of detection. Samples should be incubated aerobically and anaerobically so that a variety of organisms can be grown. Following proper collection and incubation procedures can help identify the causative microorganism in cases of bacteremia, fungemia or sepsis.
The document discusses bloodstream infections, including the etiological agents, types, clinical manifestations, laboratory diagnosis, and fever of unknown origin. It defines various types of bloodstream infections such as bacteremia, septicemia, and fungemia. The document also outlines the diagnostic process for bloodstream infections including specimen collection, culture methods, identification, and antimicrobial susceptibility testing.
This document discusses cardiovascular system infections, including infective endocarditis. Some key points:
- Infective endocarditis is an infection of the heart valves that can have mortality rates as high as 20-50% despite antibiotic treatment.
- Predisposing factors for infective endocarditis include congenital heart defects, rheumatic heart disease, intravenous drug use, and degenerative cardiac diseases.
- Subacute infective endocarditis typically has a chronic course and is caused by less virulent organisms like streptococci that infect damaged heart valves, forming large vegetations. It accounts for 70% of cases.
- Acute infective endocarditis has a rapidly progressive course
Dr. Md. Nazmus Sakib discusses the history and management of septicemia. Key points include that Ignaz Semmelweiss first introduced hand washing to reduce childbirth mortality, Alexander Fleming discovered penicillin in 1928, and the Sepsis Six bundle recommends giving IV fluids, antibiotics, and oxygen and monitoring output while taking blood cultures, full blood counts, and lactate levels to reduce sepsis mortality. Septicemia occurs when bacteria enter the bloodstream from an infection and cause systemic symptoms, and if not promptly treated can lead to septic shock and multiple organ dysfunction syndrome.
This document discusses various types of bloodstream infections including bacteraemia, septicaemia, and infective endocarditis. It provides details on the causative agents, pathogenesis, clinical features, complications, diagnosis and prevention. The key points are:
- Bacteraemia refers to the presence of bacteria in the blood without multiplication, while septicaemia involves bacterial multiplication in the bloodstream.
- Common causative agents of septicaemia are gram-negative bacilli and gram-positive cocci such as Staphylococcus aureus.
- Infective endocarditis involves bacterial or fungal infection of the heart valves, with predisposing factors like rheumatic heart disease or intravenous drug
Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response to infection, which can rapidly lead to tissue damage, organ failure, and death if not treated promptly. Common causes include bacterial infections like pneumonia and UTIs, and symptoms include fever, altered mental status, and low blood pressure. Diagnosis involves assessing for signs of infection and organ dysfunction using tools like SOFA and lactate levels, and treatment focuses on early antibiotic administration, fluid resuscitation, and vasopressor support if needed to stabilize the patient.
This document discusses infective endocarditis, including trends, classifications, microbiology, pathogenesis, clinical manifestations, diagnosis and treatment. Some key points:
- IE is an infection of the heart valves or endocardium that is usually caused by bacteria. Common predisposing factors include rheumatic heart disease and intravenous drug use.
- It is classified based on several factors such as the site of infection, causative organism, and underlying risk factors. Acute IE has a rapid course while subacute IE progresses more slowly.
- Common symptoms include heart murmurs, heart failure, embolic phenomena affecting organs like the brain, lungs and kidneys. Specific findings include petechiae, splinter
This document provides information about blood culture procedures. It defines blood culture and different types of bacteremia. Common organisms isolated from blood cultures are discussed. Proper collection of blood culture samples is important, including collecting the appropriate amount of blood from veins or catheters. Multiple blood cultures may increase the sensitivity of detection. Samples should be incubated aerobically and anaerobically so that a variety of organisms can be grown. Following proper collection and incubation procedures can help identify the causative microorganism in cases of bacteremia, fungemia or sepsis.
Infective endocarditis is an infection of the inner lining of the heart chambers and heart valves. It has varying presentations from subacute to acute. Diagnosis involves blood cultures, echocardiography, and clinical criteria. Common causes are bacteria like streptococci and staphylococci. Complications include heart failure, embolic events, and kidney or brain infections. Treatment involves prolonged antibiotics and sometimes surgery.
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. It can progress to severe sepsis and septic shock with significantly increased risk of death. The key aspects of diagnosis involve identifying a potential infection source using clinical exams, labs, and cultures, then assessing for signs of organ dysfunction using tools like SOFA and qSOFA scores. Treatment focuses on early antibiotics, IV fluids, vasopressors if needed, and supporting failing organs. Outcomes depend on prompt recognition and management of sepsis.
Infective Endocarditis(IE)
Is due to bacterial or fungal infection of the heart valves (endocardium).
Characterized by:
Formation of bulky, friable,easily detached and infected vegetations.
Damage to heart Valves and Chorda tendinae
perforation, ulceration, destruction (causes valve dysfunction)
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Infective Endocarditis and It's Surgical ManagementAlireza Kashani
This document defines and describes infective endocarditis. Key points include:
- Infective endocarditis involves infection of the heart valves or structures, most commonly the valves. This can lead to valvular dysfunction, sepsis, or embolism.
- The infection involves bacterial, viral, or fungal invasion of the endocardium and formation of vegetations on the valves or endocardium.
- Risk factors include underlying heart conditions, IV drug use, dental procedures, and indwelling catheters. The aortic and mitral valves are most commonly involved.
- Symptoms may include fever, heart murmur, embolic phenomena, and heart failure. Diagnosis
Blood stream infections- clinical microbiologySijo A
Blood stream infections (BSI) refers to the presence of organisms in blood which are threat to every organ in the body.
It causes shock, multiple organ failure and DIC (Disseminated Intravascular Coagulation).
The presence of bacteria in blood is called Bacteremia.
The bacteria circulate and actively multiply in the blood stream is called Septicemia.
The presence of virus in blood is called Viremia.
The presence of parasite in blood is called Parasitemia.
The presence of fungi in blood is called Fungemia.
Infective endocarditis is an infection of the inner lining of the heart (endocardium) that involves the heart valves and adjacent structures. It is caused by bacteria or fungi entering the bloodstream and can lead to heart valve damage or death. Common symptoms include fever, fatigue, heart murmur. Diagnosis involves blood cultures, echocardiogram, and the modified Duke criteria. Treatment involves antibiotic therapy, which depends on the identified organism. Prevention focuses on proper dental hygiene and antibiotic prophylaxis for certain at-risk patients before invasive procedures.
1. Septic shock is a life-threatening condition that occurs when sepsis leads to dangerously low blood pressure and organ dysfunction. It is caused by an uncontrolled immune response to infection that damages the cardiovascular system.
2. Early and aggressive treatment of septic shock is crucial and involves rapid administration of broad-spectrum antibiotics, controlling the infection source, and fluid resuscitation along with vasopressors to maintain adequate blood pressure over the first six hours.
3. The goals of fluid resuscitation in septic shock are to restore adequate tissue perfusion as indicated by targets such as a mean arterial pressure over 65 mmHg, urine output over 0.5 ml/kg/hr, and normalization of lactate
This document defines terms related to septicemia in children such as bacteremia, sepsis, severe sepsis, and septic shock. It describes the risk factors, common pathogens, clinical manifestations, diagnostic workup, and management of sepsis in children. Sepsis is diagnosed clinically based on signs of infection meeting two or more SIRS criteria. The most common infections are pneumonia, bloodstream, skin, and urinary tract infections. Treatment involves ABCDE approach, managing shock, administering early antibiotics, and providing supportive care.
The document discusses definitions, epidemiology, etiology, risk factors, and scoring systems related to sepsis. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated response to infection. Sepsis exists on a continuum of severity, ranging from infection to septic shock, which can lead to multiple organ dysfunction syndrome and death. The Sequential Organ Failure Assessment (SOFA) score and quick SOFA (qSOFA) score are used to assess organ dysfunction and predict mortality in sepsis patients.
This document summarizes types and features of bloodstream infections (bacteremia and sepsis). It describes different types of bacteremia including intermittent, continual, and those related to infections in the bloodstream, artificial materials, and special circumstances. It also outlines features of sepsis, types according to origin, fulminant sepsis, and nosocomial sepsis. Diagnosis involves blood cultures and treatment involves empiric antibiotics, removal of infected tissues/devices, and organ support.
This document discusses bloodstream infections (bacteremia and sepsis). It defines the different types of bloodstream infections including bacteremia, sepsis, severe sepsis, and septic shock. It describes the typical clinical features and pathophysiology of sepsis. It also outlines the various causes and sources of bacteremias including those related to specific infections, medical devices, intravenous drug use, and hospital-acquired infections. Finally, it discusses the diagnostic approach using blood cultures and treatment approach typically involving antibiotics, organ support, and source control.
This document discusses infective endocarditis (IE), a serious infection of the heart valves or inner lining of the heart. It provides details on the epidemiology, symptoms, physical exam findings, causative organisms, risk factors, diagnostic criteria (Modified Duke Criteria), investigations including echocardiography and blood cultures, and treatment approach for IE. Staphylococcus aureus is a leading cause worldwide and viridans group streptococci are common causes after dental procedures. Diagnosis relies on modified Duke criteria incorporating positive blood cultures, echocardiogram findings, and clinical features.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It infects the lungs and can spread to other parts of the body. Symptoms include cough, fever, weight loss, and night sweats. It is diagnosed through skin tests, chest x-rays, and sputum analysis. Treatment involves a combination of antibiotics over several months. With proper treatment, TB patients can fully recover but the disease remains a major global health problem.
1) Sepsis is defined as a life-threatening organ dysfunction caused by the body's dysregulated response to infection. It is a common complication in critically ill patients that can lead to high morbidity and mortality.
2) Nosocomial or hospital-acquired infections are a major cause of sepsis in intensive care units. Common sites of infection include the urinary tract, lungs, wounds, and bloodstream.
3) The pathophysiology of sepsis involves a systemic inflammatory response triggered by bacterial toxins or cytokines. This leads to organ dysfunction through neutrophil activation, endothelial damage, coagulation abnormalities, and hypotension. Timely diagnosis and treatment are important to prevent further organ failure.
Sepsis is the body's extreme response to infection which can lead to widespread inflammation and organ damage. It is a growing problem, with over 18 million cases worldwide each year resulting in 1.4 million deaths daily. Those at highest risk include the very young, very old, and those with compromised immune systems. Early recognition and treatment is key to survival, with screening tools looking for signs of infection combined with altered vital signs. The sepsis resuscitation bundle provides a standardized approach to initial treatment within the first 6 hours, including antibiotics, fluids, and vasopressors to stabilize the patient.
Infective endocarditis is an infection of the heart valves or endocardial surfaces. It most commonly involves the mitral and aortic valves. Staphylococcus aureus is the most common cause of acute infective endocarditis while viridans streptococci most commonly cause subacute infective endocarditis. Diagnosis requires a high index of suspicion and is confirmed through blood cultures, echocardiography, and applying modified Duke criteria. Treatment involves prolonged intravenous antibiotics targeting the causative organism along with surgery to address valvular complications or poor prognostic factors. Prevention strategies focus on proper dental and skin care to reduce risk of infection from procedures.
Shock is a condition where inadequate blood flow to tissues results in poor delivery of oxygen and nutrients. This can lead to cellular hypoxia and death, progressing to organ dysfunction and death without treatment. Adequate blood flow requires an effective cardiac pump, circulatory system, and sufficient blood volume. Septic shock is caused by infection leading to toxins that damage tissues and blood vessels, reducing blood flow. It most commonly affects those with weakened immune systems. Treatment focuses on rapid restoration of blood flow through fluids, antibiotics, and vasoactive drugs, as well as organ support like mechanical ventilation or dialysis.
#seminar on how to approach a patient with anemiaLuzSan3
This document provides an overview and outline of a seminar on the approach to anemia. It defines anemia and discusses the epidemiology and causes of anemia including nutritional deficiencies, genetic disorders, infections, and physiologic anemia. It covers the classification of anemia based on morphology and pathophysiology. The document outlines the physiological adjustments in anemia and discusses the approach to evaluating an anemic child, including taking a history, physical exam, and laboratory tests such as complete blood count, reticulocyte count, and peripheral smear. General management of anemia including supplementation, dietary changes, and transfusions is also summarized.
The document summarizes the key structures and functions of the human visual system. It describes the eyeball's layers including the sclera, choroid, iris, ciliary body, retina and its structures like the macula and optic disk. It explains how light enters the eye and is refracted by the cornea and lens to form an image on the retina. The roles of the retina's layers and cell types in visual transduction are outlined. Accommodation and errors of refraction are also summarized.
Infective endocarditis is an infection of the inner lining of the heart chambers and heart valves. It has varying presentations from subacute to acute. Diagnosis involves blood cultures, echocardiography, and clinical criteria. Common causes are bacteria like streptococci and staphylococci. Complications include heart failure, embolic events, and kidney or brain infections. Treatment involves prolonged antibiotics and sometimes surgery.
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. It can progress to severe sepsis and septic shock with significantly increased risk of death. The key aspects of diagnosis involve identifying a potential infection source using clinical exams, labs, and cultures, then assessing for signs of organ dysfunction using tools like SOFA and qSOFA scores. Treatment focuses on early antibiotics, IV fluids, vasopressors if needed, and supporting failing organs. Outcomes depend on prompt recognition and management of sepsis.
Infective Endocarditis(IE)
Is due to bacterial or fungal infection of the heart valves (endocardium).
Characterized by:
Formation of bulky, friable,easily detached and infected vegetations.
Damage to heart Valves and Chorda tendinae
perforation, ulceration, destruction (causes valve dysfunction)
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Infective Endocarditis and It's Surgical ManagementAlireza Kashani
This document defines and describes infective endocarditis. Key points include:
- Infective endocarditis involves infection of the heart valves or structures, most commonly the valves. This can lead to valvular dysfunction, sepsis, or embolism.
- The infection involves bacterial, viral, or fungal invasion of the endocardium and formation of vegetations on the valves or endocardium.
- Risk factors include underlying heart conditions, IV drug use, dental procedures, and indwelling catheters. The aortic and mitral valves are most commonly involved.
- Symptoms may include fever, heart murmur, embolic phenomena, and heart failure. Diagnosis
Blood stream infections- clinical microbiologySijo A
Blood stream infections (BSI) refers to the presence of organisms in blood which are threat to every organ in the body.
It causes shock, multiple organ failure and DIC (Disseminated Intravascular Coagulation).
The presence of bacteria in blood is called Bacteremia.
The bacteria circulate and actively multiply in the blood stream is called Septicemia.
The presence of virus in blood is called Viremia.
The presence of parasite in blood is called Parasitemia.
The presence of fungi in blood is called Fungemia.
Infective endocarditis is an infection of the inner lining of the heart (endocardium) that involves the heart valves and adjacent structures. It is caused by bacteria or fungi entering the bloodstream and can lead to heart valve damage or death. Common symptoms include fever, fatigue, heart murmur. Diagnosis involves blood cultures, echocardiogram, and the modified Duke criteria. Treatment involves antibiotic therapy, which depends on the identified organism. Prevention focuses on proper dental hygiene and antibiotic prophylaxis for certain at-risk patients before invasive procedures.
1. Septic shock is a life-threatening condition that occurs when sepsis leads to dangerously low blood pressure and organ dysfunction. It is caused by an uncontrolled immune response to infection that damages the cardiovascular system.
2. Early and aggressive treatment of septic shock is crucial and involves rapid administration of broad-spectrum antibiotics, controlling the infection source, and fluid resuscitation along with vasopressors to maintain adequate blood pressure over the first six hours.
3. The goals of fluid resuscitation in septic shock are to restore adequate tissue perfusion as indicated by targets such as a mean arterial pressure over 65 mmHg, urine output over 0.5 ml/kg/hr, and normalization of lactate
This document defines terms related to septicemia in children such as bacteremia, sepsis, severe sepsis, and septic shock. It describes the risk factors, common pathogens, clinical manifestations, diagnostic workup, and management of sepsis in children. Sepsis is diagnosed clinically based on signs of infection meeting two or more SIRS criteria. The most common infections are pneumonia, bloodstream, skin, and urinary tract infections. Treatment involves ABCDE approach, managing shock, administering early antibiotics, and providing supportive care.
The document discusses definitions, epidemiology, etiology, risk factors, and scoring systems related to sepsis. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated response to infection. Sepsis exists on a continuum of severity, ranging from infection to septic shock, which can lead to multiple organ dysfunction syndrome and death. The Sequential Organ Failure Assessment (SOFA) score and quick SOFA (qSOFA) score are used to assess organ dysfunction and predict mortality in sepsis patients.
This document summarizes types and features of bloodstream infections (bacteremia and sepsis). It describes different types of bacteremia including intermittent, continual, and those related to infections in the bloodstream, artificial materials, and special circumstances. It also outlines features of sepsis, types according to origin, fulminant sepsis, and nosocomial sepsis. Diagnosis involves blood cultures and treatment involves empiric antibiotics, removal of infected tissues/devices, and organ support.
This document discusses bloodstream infections (bacteremia and sepsis). It defines the different types of bloodstream infections including bacteremia, sepsis, severe sepsis, and septic shock. It describes the typical clinical features and pathophysiology of sepsis. It also outlines the various causes and sources of bacteremias including those related to specific infections, medical devices, intravenous drug use, and hospital-acquired infections. Finally, it discusses the diagnostic approach using blood cultures and treatment approach typically involving antibiotics, organ support, and source control.
This document discusses infective endocarditis (IE), a serious infection of the heart valves or inner lining of the heart. It provides details on the epidemiology, symptoms, physical exam findings, causative organisms, risk factors, diagnostic criteria (Modified Duke Criteria), investigations including echocardiography and blood cultures, and treatment approach for IE. Staphylococcus aureus is a leading cause worldwide and viridans group streptococci are common causes after dental procedures. Diagnosis relies on modified Duke criteria incorporating positive blood cultures, echocardiogram findings, and clinical features.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It infects the lungs and can spread to other parts of the body. Symptoms include cough, fever, weight loss, and night sweats. It is diagnosed through skin tests, chest x-rays, and sputum analysis. Treatment involves a combination of antibiotics over several months. With proper treatment, TB patients can fully recover but the disease remains a major global health problem.
1) Sepsis is defined as a life-threatening organ dysfunction caused by the body's dysregulated response to infection. It is a common complication in critically ill patients that can lead to high morbidity and mortality.
2) Nosocomial or hospital-acquired infections are a major cause of sepsis in intensive care units. Common sites of infection include the urinary tract, lungs, wounds, and bloodstream.
3) The pathophysiology of sepsis involves a systemic inflammatory response triggered by bacterial toxins or cytokines. This leads to organ dysfunction through neutrophil activation, endothelial damage, coagulation abnormalities, and hypotension. Timely diagnosis and treatment are important to prevent further organ failure.
Sepsis is the body's extreme response to infection which can lead to widespread inflammation and organ damage. It is a growing problem, with over 18 million cases worldwide each year resulting in 1.4 million deaths daily. Those at highest risk include the very young, very old, and those with compromised immune systems. Early recognition and treatment is key to survival, with screening tools looking for signs of infection combined with altered vital signs. The sepsis resuscitation bundle provides a standardized approach to initial treatment within the first 6 hours, including antibiotics, fluids, and vasopressors to stabilize the patient.
Infective endocarditis is an infection of the heart valves or endocardial surfaces. It most commonly involves the mitral and aortic valves. Staphylococcus aureus is the most common cause of acute infective endocarditis while viridans streptococci most commonly cause subacute infective endocarditis. Diagnosis requires a high index of suspicion and is confirmed through blood cultures, echocardiography, and applying modified Duke criteria. Treatment involves prolonged intravenous antibiotics targeting the causative organism along with surgery to address valvular complications or poor prognostic factors. Prevention strategies focus on proper dental and skin care to reduce risk of infection from procedures.
Shock is a condition where inadequate blood flow to tissues results in poor delivery of oxygen and nutrients. This can lead to cellular hypoxia and death, progressing to organ dysfunction and death without treatment. Adequate blood flow requires an effective cardiac pump, circulatory system, and sufficient blood volume. Septic shock is caused by infection leading to toxins that damage tissues and blood vessels, reducing blood flow. It most commonly affects those with weakened immune systems. Treatment focuses on rapid restoration of blood flow through fluids, antibiotics, and vasoactive drugs, as well as organ support like mechanical ventilation or dialysis.
#seminar on how to approach a patient with anemiaLuzSan3
This document provides an overview and outline of a seminar on the approach to anemia. It defines anemia and discusses the epidemiology and causes of anemia including nutritional deficiencies, genetic disorders, infections, and physiologic anemia. It covers the classification of anemia based on morphology and pathophysiology. The document outlines the physiological adjustments in anemia and discusses the approach to evaluating an anemic child, including taking a history, physical exam, and laboratory tests such as complete blood count, reticulocyte count, and peripheral smear. General management of anemia including supplementation, dietary changes, and transfusions is also summarized.
The document summarizes the key structures and functions of the human visual system. It describes the eyeball's layers including the sclera, choroid, iris, ciliary body, retina and its structures like the macula and optic disk. It explains how light enters the eye and is refracted by the cornea and lens to form an image on the retina. The roles of the retina's layers and cell types in visual transduction are outlined. Accommodation and errors of refraction are also summarized.
This chapter discusses business planning and opportunity identification. It begins by outlining the chapter objectives, which are to understand how to identify opportunities in the environment, evaluate business ideas, explain the concept of business planning, identify business plan components, and develop a business plan. The chapter then covers opportunity identification and evaluation processes. It describes how to scan the environment, identify and develop opportunities, and evaluate them. It also discusses assessing the entrepreneurial team. Next, the chapter defines business ideas and describes methods for generating and screening ideas. It concludes by explaining the business planning process and identifying the essential components of a business plan.
The document discusses the special senses of vision, hearing, balance, taste and smell. It focuses on the anatomy and physiology of hearing and balance. Key points include:
- The ear is divided into external, middle and inner sections. Sound waves cause the eardrum and ossicles to vibrate, transmitting vibrations to the cochlea.
- The cochlea contains the organ of Corti with hair cells that transduce vibrations into nerve impulses. Different hair cell regions respond to different frequencies.
- Loudness is determined by vibration amplitude and number of activated hair cells. Reflexes protect from loud noises.
- The vestibular system detects head position
The document provides information about the skeletal system. It describes that the skeletal system includes bones, cartilage, joints, and ligaments. It then discusses the various parts and functions of the skeletal system in more detail. This includes descriptions of the axial skeleton (skull, vertebral column, ribs) and appendicular skeleton (shoulder girdle, arm bones, hand bones, pelvic girdle, leg bones). Diagrams are also included to illustrate the different bones.
This document provides an overview of protein nutrition for medical students. It defines proteins and amino acids, classifying amino acids as essential, nonessential, and conditionally essential. The document discusses protein digestion and absorption in the stomach and small intestine. It also covers protein classification based on nutritional value as complete or incomplete proteins, as well as other classification schemes. Food sources of proteins are mentioned.
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
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TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
2. Objectives
• At the end of the session, the students will be able to understand:
– Define bacteremia and differentiate this condition from septicemia
– Classify each type of bacteremia and describe when each condition
occurs.
– Discuss the epidemiology and pathogenesis of bacteremia.
– Associate specific organisms with each type of bacteremia
– Explain the pathophysiology of sepsis and septic shock
– Describe the proper procedure for blood culture collection.
– Discuss the methods for the detection of bacteremia,
– Describe therapies for sepsis and septic shock.
3. Outline of lesson
• Introduction
• Epidemiology
• Microbiology
• Pathogenesis
• Clinical manifestation
• Laboratory diagnosis and AMST
• Treatment and prevention
5. Introduction
• Blood stream infections (BSI) - presence of
microorganisms in blood - constitute one of the
most serious situations among infectious diseases.
• Microbial invasion of blood stream can have
serious immediate consequences such as shock,
multiple organ failure, and DIC (disseminated
intravascular coagulopathies)
6. Bacteremia vs. septicemia
• Bacteremia - presence of bacteria in blood
without any multiplication.
• Septicemia - bacteria circulate and actively
multiply in the bloodstream and may
produce their products (e.g. toxins) that
cause harm to the host.
7. What is septicemia and Sepsis?
• Sepsis is defined as life-threatening organ dysfunction
caused by a deregulated host response to infection.
– Evidence of organ dysfunction includes clinical and laboratory
abnormalities of the respiratory system, coagulation, liver,
cardiovascular system, nervous system, and kidneys
8. Types of Bacteremia
• Classification by Duration
– 3 type (transient, intermittent ,Continuous. Fig 1)
9. 1. Transient bacteremia:
• Occur spontaneously or with minor events (brushing
teeth or chewing food, instrumentation of contaminated
mucosal site and surgery involving non-sterile site)
• Usually small number of microbes and cleared by the
immune
• But May also lead to septicemia or sepsis
10. Type of …….
2,.Intermittent bacteremia
– Organisms from Undrained abscess (bacteria are released
approximately 45 minutes before a febrile episode).
– Or due to Early course of meningitis, pneumonia, pyogenic arthritis and
osteomyelitis.
– organisms are periodically released from the primary site of
infection into the blood
11. Type of …….
3. Continuous bacteremia:
– Organisms from an intravascular source released
into the bloodstream at a fairly constant rate.
– present in the bloodstream
– Septic shock, endocarditis and other endovascular
infections.
12.
13.
14. • Classification by Place of Acquisition
– Community-acquired bacteremia,
• occurs in individuals living in the general community
– Nosocomial or health care associated
• bacteremia occurs in patients who are hospitalized or
living in a nursing home or other facility.
• occurring more than 48 -72 hours after hospital
admission
• more likely to be due to resistant organisms that express
β-lactamases
15. • Classification by site of origin
– There are two major categories of bloodstream infections (BSIs):
Primary bacteremia or Intravascular
occurs when the bacteria are present in an endovascular source such as an
infected cardiac valve
Infection of the heart (endocarditis, myocarditis and pericarditis)
or an infected intravenous catheter,
secondary bacteremia
Organisms comes from an infected extravascular source, such as the
lung in patients with pneumonia.
Refer Cardiovascular diseases
16. • Extravascular
– Organisms multiply at the primary site such as
lungs and are drained by lymphatics and reach the
bloodstream.
– The organisms are either removed by the cells of
the reticuloendothelial system or they multiply
more widely and thereby causing septicemia.
19. Bacterial etiology
• Bacterial agents account for the majority of
bloodstream infections.
• Common agents causing primary BSI- typhoidal
salmonellae, brucellae or spirochetes (Leptospira,
Borrelia), HACEK group of pathogens, viridans
streptococci and rickettsiae (infect vascular
endothelium).
26. Viral
• LEARNING OBJECTIVE
– Describe the epidemiologies of Burkitt's
lymphoma, infectious mononucleosis. and CMV
inclusion disease
– Compare and contrast the causative agents,
vectors. reservoirs, and symptoms of yellow fever.
dengue. dengue hemorrhagic fever. and
chikungunya fever,
– Compare and contrast the causative agents,
reservoirs. And symptoms of Ebola hemorrhagic
fever and Hamavirus pulmonarysyndrome.
27. Viral Etiology
• HIV & other human retroviruses– attack CD4 T lymphocytes and macrophages.
• Agents of hemorrhagic fever - dengue, chikungunya, Ebola, Marburg, Lassa, yellow
fever, and other viruses – they infect endothelial cells (Yellow fever virus)
• Epstein-Barr virus- Invades lymphocytes - causes infectious mononucleosis and
various malignancies.
• Cytomegalovirus- Invades monocytes, polymorphonuclear cells, and lymphocytes -
causes hepatitis and congenital infections.
• Hemorrhagic Fevers
• Chikungunya Fever
28. Fungal Etiology
• Fungemia - occur primarily in immunocompromised
patients
• Candida species – MC agent; (8-10% of all nosocomial
BSI) C.albicans & non-albicans Candida species - C.
tropicalis, C. parapsilosis & C. auris
• Agents of systemic mycoses (Histoplasma,
Blastomyces, Coccidioides, and Paracoccidioides).
33. Signs and Symptoms
• Sepsis and septic shock: 2 stages of Septicemia
• Septicemia is characterized by fever (over 38°C, 99°F),
chills, nausea, vomiting, diarrhea, shortness of breath,
malaise (feeling of general discomfort), and changes in
mental status such as confusion, anxiety, and an impending
feeling of doom.
• These signs and symptoms can progress rapidly to septic
shock, a condition of extremely low blood pressure
resulting from dilation of blood vessels. Decrease in body
temperature, decrease in or absence of urine output, rapid
breathing, aberrant blood clotting, increased heart rate,
anxiety, and death characterize septic
36. Clinical DX: Sepsis
SOFA score
• Sepsis is diagnosed by SOFA (Sepsis-related organ failure assessment) score which in
turn depends on six parameters. (Laboratory parameters)
• 1. Respiratory system—PaO2/FiO2
• 2. Coagulation system—Platelet count
• 3. Liver—Serum bilirubin
• 4. Cardiovascular—Mean arterial pressure (MAP)
• 5. Central nervous system—Glasgow coma scale score
• 6. Renal—Serum creatinine and urine output
• Organ dysfunction can be identified as an acute change in the total SOFA score ≥2 points
following the infection
qSOFA (Quick SOFA) Criteria
• Determination of SOFA score takes considerable time as it depends upon a number of
laboratory parameters. However, before the result of SOFA score is available, sepsis can
promptly be identified
• at the bedside with qSOFA score
Respiratory rate ≥22/min
Altered mentation
Systolic blood pressure ≤100 mm Hg
37. • Septic shock
• Patients with septic shock can be identified
with a clinical construct of sepsis with:
Persisting hypotension requiring
vasopressors to maintain MAP (mean arterial
pressure) ≥65 mm Hg and
Serum lactate level >2 mmol/L (18 mg/dL)
despite adequate volume resuscitation
• Patients with septic shock have a mortality of
>40% in contrast to 10%, for sepsis cases
38.
39. Who is at Risk to Develop Sepsis?
• Host Factors
– Elderly account for 60-85 percent of all cases of severe
sepsis
• Immunosuppression
– Disease related, medications related
• Exposure risk
– Community acquired: pneumonia, urinary, wounds,
trauma
– Health care acquired: invasive devices, secondary
infections and skin breakdown
41. LAB DX
• Site: Blood for culture should always be collected in pairs; from two
separate venipuncture and 2 separate skin decontamination
process.
• Preparation of the site: To avoid contamination with skin flora,
blood should be collected under strict aseptic conditions using
sterile disposable syringe.
• Skin decontamination
• Timing of collection: Blood - collected before starting antimicrobial
therapy
42. • Blood volume: At least 8–10 mL of blood per bottle for an
adult and 1–3 mL per pediatric bottle is recommended.
• Number of blood cultures: At least 2–3 blood culture sets
(each set consists of two bottles: 1 aerobic and 1
anaerobic) are required.
• Dispensing: Collected blood is then directly dispensed into
either blood culture bottle at the bedside (conventional or
automated blood culture).
43. • Transport of blood specimen: The collected blood is gently mixed with the
broth and then transported immediately to the Microbiology laboratory.
• In case of delay, blood culture bottle should never be refrigerated.
• It can be kept at 350C in an incubator (if available) or left at room temperature
44.
45. • Dilution: The blood is inoculated in the medium at a dilution of 1:5
so that the antibacterial components in the blood, if any, will get
diluted.
• SPS (sodium polyanethol sulfonate) is added to the medium as an
anticoagulant. It also counteracts the bactericidal action of blood.
• Incubation: Upon receipt, the bottles should be directly incubated
in the upright position at 37° C for up to 7 days.
• Repeat subcultures are made from the BHI broth onto blood agar
and MacConkey agar.
46. • Other specimens
• Culture of IV catheter tips
• Wound Swabs
• Burn Swab
• Urine: UTI
• Sputum: RT infections
• Stool: GIT infections
47. Automated system
• BACTEC and BacT/ALERT
• Bact/ALERT Virtuo- most advanced system
• Growth is continuously monitored, & reading is recorded
every 15–20 min
• When the growth is detected, the system gives a positive
signal.
• Then the bottle is removed and processed similarly as done
for conventional bottles.
48. Identification
• The isolated organism is identified by colony
morphology, Gram staining, followed by either
conventional biochemical reactions or
automated identification system such as
MALDI -TOF or VITEK
49. Non culture techniquies
• Direct Microscopy: eg. Borrelia spp.
• LAT: GB strptococci, H. influenza type b, S.
pneumoniae, N. meningitiidis, Staph.
50. AMST
• AMST is carried out for guiding the institution
of appropriate therapy.
• MIC based method (e.g., VITEK) is preferred
over disk diffusion
• It is ideal for endocarditis isolates, especially
while reporting susceptibility of penicillin.
51. Treatment
• Due to higher prevalence of MDROs and higher mortality in sepsis,
antibiotics should be instituted at the earliest, as soon as sepsis is clinically
suspected
• Empirical treatment consists of higher class of antimicrobials with both
gram-negative and gram-positive coverage; e.g. carbapenem such as
meropenem plus vancomycin.
• Combination therapy in the case of polymicrobial infections
Definitive treatment can be tailored according to AMST report.
Intravenous fluid to prevent shock
52. Brucellosis
Obligate aerobic, fastidious, small gram-
negative coccobacallus.
Brucellosis (undulant fever) - primarily a zoonotic
disease affecting various domestic animals, such
as sheep, goat or cattle
Human infection - associated with occupational
or domestic exposure to infected animals or their
products.
53. Nomen species: Important nomen species
associated with human infections are as follows:
B. melitensis -pathogenic to sheep, goat
and camel; man is also a susceptible host
B. abortus - acquired from cattle and buffalo
B. suis - infects most often pigs
B. canis – causes abortion in dogs.
54. Structure of Ag
▰ Two major types of lipopolysaccharide (LPS) antigens - M &
A
▰ Present in varying proportion in three major species of
Brucella:
B. melitensis - M antigen is predominant
B. abortus - A antigen is predominant
B. suis - either M or A antigens
55. ▰ Sources of infection:
Infected animals excreting the organisms in urine, milk,
placenta or vaginal discharge
Contaminated animal food products – dairy products,
especially soft cheeses, milk, icecream and rarely raw
meats and bone marrows
▰ Occupational risk - farmers, shepherds, goatherds,
butchers and abattoir workers in endemic areas.
56. Transmission: From infected animals to man by various modes
Direct contact- direct contact of abraded skin or mucosa with
the infected animal tissue, blood, urine, vaginal discharge or
placenta
Food-borne - unpasteurized milk or dairy products or
undercooked meat
Air-borne - inhalation of dust or aerosols in the infected
cowshed or slaughterhouses
Person-to-person- breast milk or tissue transplantation or
blood transfusions.
57. Pathogenesis
▰ Spread: From the initial site of infection, the organisms spread to
bloodstream resulting in bacteremia and then disseminate to involve
various organs.
▰ Organs involved: Reticuloendothelial system, such as lymph nodes,
spleen, liver and bone marrow. Other organs such as placenta,
musculoskeletal tissues and genitourinary systems are also involved.
▰ Local tissue response: Initially, neutrophilic infiltration occurs - later on
replaced by chronic inflammatory cells leading to granuloma formation.
▰ Intracellular survival: The cell-wall LPS appears to be the major
virulence factor - plays a key role in their intracellular survival.
58. ▰ Classic triad: Profuse night sweats, arthralgia/ arthritis and
hepatosplenomegaly . Foul-smelling perspiration is considered as a
classical sign, but uncommon.
▰ Typhoid-like illness (except that it is less acute, less severe with undulating
pattern of fever and more musculoskeletal symptoms)
▰ Undulating fever - typical remittent course, i.e. in between febrile periods
(which last for weeks), there will be afebrile periods (Malta fever or
Mediterranean fever)
▰ Musculoskeletal symptoms (Vertebral osteomyelitis or Septic arthritis)
▰ Other nonspecific symptoms - abdominal pain, headache, diarrhea, etc.
▰ CNS, CVS and Genitourinary manifestations
59. Lab dx
▰ A. Blood culture bottles (Biphasic medium);
▰ B. Automated
▰ C. Gram-stained smear of Brucella species
showing small gram-negative coccobacilli
60. Specimens: Blood, bone marrow, etc.
Blood culture by:
Castaneda’s biphasic media (BHI broth/agar)
Automated techniques such as BACTEC
Culture smear and motility testing: Reveals non-
motile, gram-negative coccobacilli
Biosafety precautions: highly infectious pathogen, all laboratory procedures should be carried out
with adequate biosafety precautions
61. ▰ Serological tests (antibody detection)
Standard agglutination test (SAT)- detects IgM
Tests to detect IgG antibody -2ME test, ELISA
62. ▰ Standard regimen in adults: Gentamicin for 7 days plus
doxycycline for 6 weeks. Streptomycin can be given
alternative to gentamicin
▰ WHO regimen in adults: Rifampin for 6 weeks plus
doxycycline for 6 weeks
▰ Relapse or treatment failure occurs in 5–10% of cases
▰ For CNS involvement: Ceftriaxone - added to the regimen
and treatment - prolonged for 3–6 months.
63. ▰ General precautions such as:
▰ Use of pasteurized milk or properly cooked food
▰ Use of protective measures to prevent direct contact with
animals.
▰ Vaccine: Live attenuated B. abortus 19–BA - available for
human - provides short term protection and had shown high
reactogenicity.
64. Borrelia
▰ Larger spirochete, 10–30 μm in length; consists of
lesser number (3–10) of spirals.
▰ Most of the species of Borrelia occur as commensals
on the buccal and genital mucosa.
▰ Few are pathogenic to men, such as:
B. recurrentis causes epidemic relapsing fever
B. burgdorferi is the agent of Lyme disease
B. vincentii causes an ulcerative
gingivostomatitis called
▰ Vincent’s angina, in association with fusiform bacilli
65. ▰ Characterized by recurrent episodes of fever and
nonspecific symptoms following exposure to insect vector
carrying Borrelia species.
▰ Relapsing fever is of two types:
1. Epidemic RF - Caused by B. recurrentis and
transmitted by louse.
2. Endemic RF - caused by Borrelia species other than
B. recurrentis such as B. duttonii, B. hermsii andB.
turicatae. It is transmitted by tick.
66. ▰ Mode of transmission - Relapsing fever is vector-borne.
▰ Epidemic RF - Transmitted by human body louse (Pediculus
humanus).
Borreliae are introduced by crushing of the louse (e.g. by
scratching) - deposition of numerous spirochetes on the
abraded skin and mucous membranes
▰ Endemic RF - Transmitted by bite of an infected tick
(Ornithodoros species).
67. ▰ From the inoculated site, Borrelia spreads rapidly - bacteremia and
fever.
▰ Host’s immune system tries to eliminate the bacilli from the body.
▰ Borrelial surface antigens frequently undergo antigenic variation.
▰ Each time, new antigens are produced - evade host’s immune
system leading to repeated bacteremia and recurrent febrile
episodes.
68. ▰ Incubation period is about 7–8 days.
▰ Recurrent febrile episodes lasting for 3–5 days occur
intervening with afebrile periods of 4–14 days.
▰ Hemorrhages: Petechiae, epistaxis and blood-tinged
sputum - epidemic RF
▰ Neurologic features - meningitis, seizure, focal deficits,
paraplegia and psychosis
69. Lab dx
▰ Microscopy:
Peripheral thick or thin smear-stained by Wright- or Giemsa-stain
Direct fluorescent antibody test using monoclonal antibody (species
identification)
Dark ground or phase-contrast microscopy - demonstrate motile
spirochetes (but low sensitivity)
It is poorly gram-negative.
▰ Culture:
During afebrile period, microscopy fails to detect Borrelia -
confirmation is made by isolation of Borrelia from blood
▰ Serology - Done for detection of antibodies.
ELISA and IFA (indirect fluorescence assay)
70.
71. ▰ Antibiotics - doxycycline or erythromycin - drug of choice for
relapsing fever.
▰ Recommended schedule is single dose for epidemic RF, and
7–10 days course for endemic RF.
72. Lyme disease or Lyme borreliosis
▰ Borrelia burgdorferi-
▰ Widespread in USA
▰ Rodents and deer are main reservoirs
▰ Transmitted by tick bite
73.
74. ▰ Stage 1: Early localized infection (annular maculopapular lesion
at the site of the tick bite - erythema migrans)
▰ Stage 2: Early disseminated infection (hematogenous spread -
secondary annular skin lesions, arthralgia, malaise and
neurological abnormalities)
▰ Stage 3: Late persistent infection (Lyme arthritis) - arthritis of
large joints, lasting for months; which may be refractory to the
treatment.
75. ▰ Isolation of B. burgdorferi - culturing specimens like skin
lesions, blood or CSF in special medium - BSK medium
(Barbour-Stoenner-Kelly)
▰ Serology (antibody detection) - Most common method of
diagnosis of Lyme disease
▰ Molecular methods: PCR detecting specific DNA- sensitive
in joint fluid.
76. ▰ For all stages of Lyme disease - except CNS and CVS
infection:
Oral doxycycline - drug of choice,
Except for children - amoxicillin is given.
Duration of treatment - 14 days (for skin lesions) and 30-
60 days (for arthritis)
▰ For CNS or CVS infection: Ceftriaxone -14–28 days.
77. Rickettsia
• Objective
– Compare and contrast the causative agents,
vectors. reservoirs, symptoms,treatments and
preventive measures
• for plague,Lyme disease. and Rocky Mountain spotted
fever
– Identify the vector. etiology. and symptoms of five
diseases transmitted by ticks
– Describe the epidemiology of epidemic typhus.
endemic murine typhus. and spotted fevers.
78. Gram-negative bacilli obligate intracellular parasites
All associated with an arthropod vector
Pathogenic species parasitize endothelial cells
almost exclusively
Distinct groups:
• Typhus group
• Spotted fever group
• Scrub typhus group
Rickettsia species
79.
80. Pathogenesis
• The organisms enter the body
• The first step virulence is adherence to a host cell
• phospholipase A2
• Disseminate through bloodstream
– > endothelial cells by induced phagocytosis
=>> escape from phagosome =>> multiply
intracellularly =>> destroy host cell.
81. Rickettsial Diseases
• Most symptoms associated with acute rickettsial infections are nonspecific
and require further tests to make an accurate diagnosis.
• many rickettsial diseases cause mild or moderate illness
• Epidemic Typhus and Rocky Mountain Spotted Fever can be severe and may
be fatal in 20%–60% of untreated cases.
Epidemic typhus
Transmitted from human to human by body louse (Pediculus humanus) (R.
prowazekii). Incubation period: 5-15 days
• Macular rash: 4-7 days after illness and begin to fade after 1-2 days
• In severe: rash may last longer and become haemorrhagic
Recrudescent typhus (Brill’s disease) is a relapse of louse-borne typhus
appearing 10 to 40 years after the primary attack. Factors triggering the
relapse are unknown.
This typhus type is usually milder than the primary infection and is less often
fatal, presumably because of partial immunity.
82. Flea-borne fevers (Murine typhus)
• Caused by R. typhi
• Rats and their infected fleas
• Tropical and subtropical coastal regions
• Ports with large number of rats
• Disease: similar to epidemic typhus but milder
Tick-borne spotted fever (group)
• Eg: R. rickettsii, R. africae
• Can be life-threatening
• Maintained in enzootic cycle (ticks and their wild animal
hosts)
83. Scrub typhus
• Orientia tsutsugamushi (previously R.
tsutsuga..)
• Larval stages (chiggers) of mites
(Leptotrombidium)
• Hosts: Rats or other small mammals
• Scrub typhus is endemic in Asian pacific
region.
84. Laboratory Diagnosis
Serological Methods
Detection of hetrophile Abs
Weil-Felix test (Agglutination test)
Detection of Abs to Rickettsial species by:
Immunofluorescence
Latex agglutination
Enzyme immuno-assay
Death may occur before detectable levels of Ab are
present
PCR test on skin biopsy or whole blood
85. Lab Dx
Weil -Felix
• By virtue of its simplicity, it has been one of the
most widely employed tests in the “world”.
• The basis of the test is the presence of antigenic
cross-reactivity between Rickettsia spp. and certain
serotypes of Proteus spp.
• The somatic (O) antigen that cross-reacted with
anti-rickettsial antibodies
86. – Typhus group rickettsiae (e.g R. prowazeki , R.
typhi) react with P. vulgaris OX19, and
– Scrub typhus reacts with P. mirabilis OXK.
– The spotted fever group rickettsiae (: R.
rickettsii, R. africae, etc.) react with P. vulgaris
OX2 and OX19, to varying degrees, depending
on the species.
W-F
87. • W-F test suffers from poor sensitivity and
specificity (with a recent study showing:
sensitivity of ≈33% & specificity of 46%).
• In resource-limited settings, it still
remains an important tool in the
diagnosis and identification of public
health concerns, such as outbreaks of
epidemic typhus.
W-F
89. Preventive measures
• Minimize exposure to infectious arthropods and animal
reservoirs (: dogs and cats) when traveling in endemic areas.
• People should avoid handling wild animals: rats.
• No vaccines or drugs are available for preventing rickettsial
infections. But for R. prowazekii, a killed vaccine is
recommended for people at high-risk .
• Improving the quality of life of both people and wild animals.
• Pesticides are useful for rats and fleas, proper use of insect
repellents,.
• Self-examination after visits to vector-infested areas, and
wearing protective clothing are ways to reduce risk.