surgical non specific infection

1. Non Specific Surgical Infection
Dr. Sushil Dhungel
Assist Prof,
Department of Surgery
KISTMCTH

2. • Syphilis
• Gonorrhea
• Cancrum Oris
• Anthrax
• Actinomycosis
• Carbuncle
• Pyaemia

3. SYPHILIS
• Syphilis is a venereal (sexually-transmitted) bacterial
disease.
• causative agent : Treponema pallidum
• starts as a painless sore
• typically on genitals, rectum or mouth.

4. INCUBATION PERIOD:
10 days- 3 weeks (may be upto 3 months)
MODE OF TRANSMISSION
Sexual intercourse
Intimate person-to-person contact
Transfusion of infected blood
Materno-foetal transmission

5. CLINICAL
Congenital syphilis
PRESENTATIONS
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary (late) syphilis
- Syphilitic Gumma
- Diffuse lesions (cardiovascular
syphilis, neurosyphilis)

6. 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
toluidine red unheated serum test (TRUST).

7. antibody absorption
•Treponemal tests
 Fluorescent treponemal
(FTA-ABS)
•Other serologic tests
 T. pallidum hemagglutination assay (TPHA)
 Microhemagglutination assay for antibodies to
T. pallidum (MHA-TP)
 T. pallidum particle agglutination assay (TPPA)

8. TREATMENT
Primary/
secondary/
latent
syphilis
Benzathine penicillin
G
Neurosyphilis
Aqueous crystalline
penicillin G OR
Aqueous procaine
penicillin G
Congenital
syphilis
Aqueous crystalline
penicillin G OR
Procaine penicillin
G

9. Penicillin-allergic patients
Primary/
secondary/
early latent
Doxycycline
Tetracycline
Doxycycline
Tetracycline
Ceftriaxone
Late latent
syphilis

10. PREVENTION
Avoid recreational drugs
Abstain or be monogamous
Use a latex condom

11. GONORRHEA
highly contagious sexually transmitted infection
caused by Neisseria gonorrhoeae,
 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.

12. INCUBATION PERIOD
1-14 days
MODE OF TRANSMISSION
vaginal or anal sex with an infected partner
oral sex (lesscommon)
touching parts of the body with fingers
any very close physicalcontact
the bacteria can be passed from hand to
hand (very rare isolatedcases)
from a mother to her baby at birth

13. Female Male
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
white, yellow or green
thick discharge from the tip
of the penis
irritation or discharge
from the anus
inflammation of the
testicles & prostate gland
urethral itch & painor
burning sensation when
passing urine
Symptoms

14. DIAGNOSIS
 Urine test
 Swab of affected area

15. TREATMENT
infection (prophylaxis)
Uncomplicated infections of the
cervix,
urethra, and rectum in adults
Ceftriaxone, Cefixime,
ciprofloxacin, Ofloxacin,
levofloxacin
Gonococcal infections in
pregnancy
Ceftriaxone, Cefixime
Disseminated gonococcal
infection in
adults (>45 kg)
Ceftriaxone
Uncomplicated infections of the
cervix, urethra,
and rectum in children (<45 kg)
Ceftriaxone
Gonococcal conjunctivitis in
adults
Ceftriaxone
Ophthalmia neonatorum Ceftriaxone
Infants born to mothers with
gonococcal
Erythromycin, Tetracycline

16. 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

17. Cancrum oris
Orofacial Gangrene; Gangrenous Stomatitis ;
Necrotizing Stomatitis, Noma
DEFINITION-
Noma is arapidly progressive , polymicrobial,
opportunistic infection causedby components of
the normal oral flora that become pathogenic
during periods of compromised immune status.

18. CAUSATIVEORGANISMS
Fusobacterium Necrophorum.
Prevotella intermedia.

19. PREDISPOSINGFACTORS
 Poverty
 Malnutrition or Dehydration
 Poor Oral hygiene
 Unsafe drinking water
 Proximity to unkemptlivestock
 Recent illness
 Malignancy
 An immunodeficiency disorder ,includingAIDS.

20. CLINICALFEATURES
In Children's of age1-10years.
In Adults with major debilitatingdiseases(eg-diabetes
mellitus,leukemia,lymphoma,HIV infection)
Beginsasasmall ulcer of the gingival mucosa which
rapidly spreads and involves the surrounding tissuesof
jaw, lips and cheeks by gangrenousnecrosis.

21. Initial site is commonly an area of stagnation arounda
fixed bridge or crown.
Theoverlying skin becomes inflamed ,edematous ,and
finally Necrotic, With the result that aline of
demarcation develop between healthy and dead
tissues, and large massof tissues may slough out,
leaving the jawexposed.

22. Gangrene is denoted by appearance of blackeningof the
skin.
Subcutaneous fat pad and buccal fat padundergo
necrosis in advanceof other adjoiningtissues.
Foul Odour from gangrenous
tissue.
Palate and Tonguemay get involved.
Patient with
1- increase intemperature .
2-Suffers secondary infection.
3-may die from toxemia or pneumonia.
NOMA PUDENDI- Thiscondition canalso
Causetissue damage to the genitals.

23. NOMA NEONATORUM

24. TREATMENTANDPROGNOSIS
 Mortality rate- 75%before the avability ofantibiotics.
 “Penicillin” and “Metronidazole” are the firstline
therapeutic antibiotics for NecrotizingStomatitis.
 Sincetherapy is directed against the pseudomonas
organisms and often consists of Piperacillin, Gentamicinor
Clindamycin.
 Surgicalexcision of grossnecrotic areasis recommended ,
but aggressiveremoval contraindicated to stop the
extension of the processand create reconstructionprocess.
 Necrotic bone is left in ace to help hold the facial form but
is removed asit sequestrates. Reconstruction should be
delayed by one year to ensure completesurgery.

26. Causative organism
 - Etiologic agent: Bacillus anthracis Cohn 1875.
 - Large (8 x 1.2 mm) Gram positive, nonmotile,
weakly hæmolytic; central spores, straight ends,
encapsulated in vivo, produces long chains.
 - Pathogenic to herbivores, man, lab animals.

27. STAGES OF INFECTION
 Encounter: organism and body surfaces
 Adhesion: generalized and receptor-specific
 Initial multiplication  in situ colonization
 Invasión  breaching of anatomic barriers
 Lymphatic stage  invasion of bloodstream
 Generalized infection, metastases.

28. Transmission:
 Contact with tissues of animals (cattle, sheep, goats,
horses, pigs and others) dying of the disease.
 Biting flies that have partially fed on such animals.
 Contact with contaminated hair, wool, hides or
products made from them (e.g. drums, brushes, rugs).
 Contact with soil associated with infected animals or
with contaminated bone meal used in gardening.

29. Transmission cont.
 Anthrax is not transmitted person to person.
 Articles and soil contaminated with spores in
endemic areas may remain infective for
many years.

30. Clinical manifestations:
1. a skin lesion
2. a respiratory illness
3. abdominal distress
 Ninety percent of cases are cutaneous anthrax

31. Cutaneous Anthrax
• Mainly in professionals( Veterinarian, butcher, Zoo
keeper
• Spores infect skin- a characteristic gelatinous edema
develops at the site (Papule- Vesicle-Malignant Pustule-
Necrotic ulcer)
• 80-90% heal spontaneously ( 2-6wks)
• 0-20% progressive disease – develop septicemia
• 95-99% of all human anthrax occur as cutaneous
anthrax

32. Site of Malignant pustule
 Head: usually no complication
 Face: severe, superinfection; gangrene near eye
 Neck, breast or chest wall: massive edema, over thorax and
sometimes involving scrotum
 Shoulders, arms: may be multiple, small lesions
 Forearms, fingers: atypical on palms
 General symptoms, fever, chills, depend on site.
 Weakness, hypotension are danger signs.

34. Notice the edema and typical lesions

36. Intestinal Anthrax
• Due to in ingestion of infected carcasses
• Mucosal lesion to the lymphatic system
• Rare in developed countries
• Extremely high mortality rate

37. Intestinal Anthrax
 Nausea, anorexia, vomiting, fever
 Progresses to severe abdominal pain and
bloody emesis and diarrhea
 Ascites may develop on day 2 - 4
 Death 2 to 5 days after onset of symptoms
 Very difficult to diagnose

38. PULMONARYANTHRAX
• Require very high infective dose ( > 10,000 spores)
• Acquired through inhalation of spores ( Bioterrorism -
aerosol)
• Present with symptoms of severe respiratory infection( High
fever & Chest pain)
• Haemorrhagic mediastinitis
• Progress to septicemia very rapidly
• 10 7 to 10 9 bacilli/ ml of blood at the time of death
• Mortality rate is very high > 95%

39. Anthrax Meningitis
 Usually a complication of anthrax septicemia.
 Subarachnoid haemorrhage is a common
feature
 Very often fatal

40. Diagnosis:
 Clinical; symptoms and signs.
 Incubation period—From 1 to 7 days,
although incubation periods up to 60 days
are possible

41.  Laboratory confirmation requires at least
one of the following:
1. isolation of Bacillus anthracis from a clinical
specimen
2. demonstration of B. anthracis in a clinical
specimen by immunofluorescence
3. significant antibody titres developing in an
appropriate clinical case.

42. Management:
 Investigation
Obtain a history of travel and contact with imported
animal
 Restriction
Standard infection control precautions apply for all
direct clinical care. Although a cutaneous lesion
will be sterile after 24 hours’ treatment, dressings
soiled with discharges from lesions should be
burned and reusable surgical equipment
sterilised.

43. Treatment
 The case should be under the care of an infectious
diseases physician.
 Penicillin is the drug of choice for cutaneous
anthrax and is given for 5–7 days.
 Tetracyclines, erythromycin and chloramphenicol
are also effective.
 The U.S. military recommends parenteral
ciprofloxacin or doxycycline for inhalation anthrax
though the duration of treatment is not well defined.

44. Vaccination
 Cell-free filtrate
 At risk groups
Veterinarians
Lab workers
Livestock handlers
Military personnel
 Immunization series
Five IM injections over 18-week
period
Annual booster
9/19/2015

45. Actinomycosis
Rare type of bacterial infection caused by bacteria
actimycetaceae
Symptoms:
• swelling and inflammation of affected tissue
• tissue damage resulting scar tissue
• abscess formation
• small holes or tunnels leaking pus
Causative agent : actimycetaceae
• common flora found in mouth, throat, digestive system,
• uterus & Vagina
• In tissue line injury bacteria penetrate deeper inside body
• they cannot survive outside body

46. Types:
• Oral Cervicofacial
• Thoracic
• Abdominal
• Pelvic
Oral Cervicofacial Actinomycisis
• infection inside neck, jaw or mouth
• mostly caused by dental caries or injury
Oral Symptoms:
• Swollen cheek or neck which increases in size
• high fever
• initially tender lump, later painless
• difficulty moving jaw
• sinus seen outside skin
Oral causes
Tooth decay
Gum disease
Dental Absess
Tonsilitis
otitis media
Dental surgery
RCT

47. Thoracic Symptoms:
High Temperature
Weight loss
Fatigue
Loss of appetite
Shortness of breath
Chest pain, cough
sinus in chestwall
Thoracic Causes:
ingestion of contamination
of bacteria
alcoholic people
drug abuser

48. Abdominal Symptoms:
similar thoracic +
change of boel habit (constipation, diarrhea)
pain abd
nausea / vomit
abdminal mass
sinus tract from abd wall
Causes
Injury in intestinal wall
Pelvic symptoms
thoracic +
lower abd pain
abnormal vaginal bleeding
vaginal discharge
mass in pelvis
Causes
IUD device user Copper T

49. Diagnosis:
Sinus tract seen in skin
Sulphur granules produced from sinus tract seen in
microscope
Treatment:
• Long term antibiotics
2-6 wks injection _ 6-12 months oral
• Surgery
• InD , Repair damaged tissue
Prevention:
Maintain good dental hygeine

50. Carbuncle
50
•
•
•
•
•
•
•
causative agent: Staphylococcus aureus
extend into the subcutaneous fat in areas
covered by thick inelastic skin
more severe and painful than furuncles
multiple pustules
with fever and malaise
usually located at the nape, neck, back and
thigh
blood stream invasion may occur usually as a
result of manipulation causing osteomyelitis,
endocarditis or other metastatic foci

51. Carbuncle
51
• Carbuncle: S.
aureus A very large,
inflammatory plaque
studded with
pustules, draining
pus, on the nape of
the neck. Infection
extends down to the
fascia and has
formed from a
confluence of many
furuncles.

52. 52

53. Treatment:
53
Moist heat, compresses
Dicloxacillin, Clindamycin, Erythromycin
 Bed rest
Immobilize involved area
Hand washing
Need systemic flucloxacillin
Incision of abscess

54. Pyaemia
A condition in which multiple small abscesses (pyemic
abscesses) form in various organs as a result of
impaction of septic emboli.
Pathogenesis:
1.Injury of venous endothelium or valvular
endocardium by bacterial toxins followed by
thrombosis.
2. Infection of thrombus by bacteria.

55. Pyaemia
3.Fragmentation of infected thrombus by proteolytic
enzymes from neutrophils leading to the
formation of septic thrombotic emboli which
circulate in the blood stream.
4.Impaction of septic emboli in small blood vessels in
various organs leading to pyemic abscesses.

56. Pyaemia
Types of pyemia:
1. Systemic pyemia resulting from either:
a) Septic thrombosis in sytemic veins or right
heart valves leading to pyemic abscesses in
the lungs.
b) Septic thrombosis in pulmonary veins or left
heart valves leading to pyemic abscesses in
brain, kidney, spleen and other organs
supplied by the systemic arterial circulation.
2. Portal pyemia resulting from septic
thrombosis in portal vein tribuitaries leading
to pyemic abscesses in the liver.

57. Pyaemia
Characteristics of
pyemic abscesses:
1. Multiple
2. Usually peripheral
3. Usually small

58. Treatment
• Antibiotics