Rotavirus is the leading cause of severe diarrhea in children worldwide. In India, it results in 100,000-150,000 child deaths per year. The virus is highly prevalent in India and symptoms include non-bloody diarrhea, vomiting, and dehydration. It is spread through the fecal-oral route. While the infection itself is self-limiting, treatment focuses on fluid replacement to prevent dehydration. Handwashing and vaccination are important for control and prevention.
Bordetella pertussis is a Gram-negative coccobacillus that causes whooping cough (pertussis) in humans. It colonizes the respiratory tract and is transmitted through respiratory droplets. Its virulence factors include adhesins and toxins like pertussis toxin and adenylate cyclase toxin. Expression of virulence factors is controlled by the bvg locus. Whooping cough was a major cause of childhood death before vaccination. While vaccination decreased cases, pertussis is reemerging as vaccine-induced immunity wanes and the bacteria adapts to vaccines through antigenic divergence. Improved vaccines are needed to address ongoing problems with pertussis vaccination and control.
This document provides information on arboviruses and dengue fever. It discusses:
1) Arboviruses belong to three virus families including Togaviruses, Bunyaviruses, and Flaviviruses. Dengue fever is caused by any one of four related flaviviruses.
2) Dengue is the biggest arbovirus problem worldwide, transmitted by Aedes mosquitoes. It causes dengue fever and the potentially lethal dengue hemorrhagic fever/dengue shock syndrome.
3) Diagnosis involves serology to detect IgM and IgG antibodies or isolation of the virus. There is no vaccine or antiviral treatment, so management focuses on supportive care and
This document summarizes characteristics of the Salmonella genus, including pathogenic species such as Salmonella typhi and Salmonella paratyphia. It describes Salmonella's morphology, optimal growth conditions, virulence factors, mechanisms of pathogenesis, and diseases caused such as gastroenteritis and typhoid fever. The document also outlines methods for laboratory diagnosis of Salmonella including culture-based identification and biochemical testing, as well as treatments including antibiotics and preventive vaccination measures.
Shigella is a gram-negative rod bacteria that causes the infectious disease bacillary dysentery in humans. There are four species of Shigella - S. dysenteriae, S. flexneri, S. sonnei, and S. boydii - which are classified based on their O antigens. Shigella infection results in diarrhea, dysentery, fever, and abdominal pain and is transmitted through the fecal-oral route. In the lab, Shigella can be identified by culturing samples on nutrient agar, MacConkey agar, or Salmonella-Shigella agar where they form colorless colonies. Treatment involves fluid replacement and antibiotics. Vibrio bacteria are
This document provides information about Pseudomonas aeruginosa, including:
- It is a gram-negative, motile, aerobic bacillus that can cause various infections.
- It has three colony types on agar - rough, smooth, and mucoid. It produces several pigments.
- It causes diseases like endocarditis, respiratory infections, bacteremia, UTIs, and skin infections.
- Identification involves culture and biochemical tests. Treatment involves antibiotics like gentamicin, though resistance has emerged.
Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum. It exists in the mycelial phase in the environment and the yeast phase in tissues. Infection occurs via inhalation of microconidia from contaminated soil. Most infections are asymptomatic, but some may cause flu-like symptoms. Diagnosis involves microscopy of clinical samples or cultures to identify the yeast cells. Serological tests and skin tests also assist in diagnosis. Amphotericin B and itraconazole are used to treat severe or disseminated cases.
This document provides clinical guidelines for pneumococcal vaccination in older adults. It describes pneumococcal disease as a leading cause of vaccine-preventable illness and death in the US, especially dangerous for young children and adults aged 65 and older. It recommends vaccination with PPSV23 for adults aged 65 and older, as well as younger adults with certain medical conditions that increase risk. PPSV23 protects against the 23 serotypes known to cause the majority of invasive pneumococcal disease. While it is effective at preventing severe disease, it may not prevent all cases of pneumococcal pneumonia.
Rotavirus is the leading cause of severe diarrhea in children worldwide. In India, it results in 100,000-150,000 child deaths per year. The virus is highly prevalent in India and symptoms include non-bloody diarrhea, vomiting, and dehydration. It is spread through the fecal-oral route. While the infection itself is self-limiting, treatment focuses on fluid replacement to prevent dehydration. Handwashing and vaccination are important for control and prevention.
Bordetella pertussis is a Gram-negative coccobacillus that causes whooping cough (pertussis) in humans. It colonizes the respiratory tract and is transmitted through respiratory droplets. Its virulence factors include adhesins and toxins like pertussis toxin and adenylate cyclase toxin. Expression of virulence factors is controlled by the bvg locus. Whooping cough was a major cause of childhood death before vaccination. While vaccination decreased cases, pertussis is reemerging as vaccine-induced immunity wanes and the bacteria adapts to vaccines through antigenic divergence. Improved vaccines are needed to address ongoing problems with pertussis vaccination and control.
This document provides information on arboviruses and dengue fever. It discusses:
1) Arboviruses belong to three virus families including Togaviruses, Bunyaviruses, and Flaviviruses. Dengue fever is caused by any one of four related flaviviruses.
2) Dengue is the biggest arbovirus problem worldwide, transmitted by Aedes mosquitoes. It causes dengue fever and the potentially lethal dengue hemorrhagic fever/dengue shock syndrome.
3) Diagnosis involves serology to detect IgM and IgG antibodies or isolation of the virus. There is no vaccine or antiviral treatment, so management focuses on supportive care and
This document summarizes characteristics of the Salmonella genus, including pathogenic species such as Salmonella typhi and Salmonella paratyphia. It describes Salmonella's morphology, optimal growth conditions, virulence factors, mechanisms of pathogenesis, and diseases caused such as gastroenteritis and typhoid fever. The document also outlines methods for laboratory diagnosis of Salmonella including culture-based identification and biochemical testing, as well as treatments including antibiotics and preventive vaccination measures.
Shigella is a gram-negative rod bacteria that causes the infectious disease bacillary dysentery in humans. There are four species of Shigella - S. dysenteriae, S. flexneri, S. sonnei, and S. boydii - which are classified based on their O antigens. Shigella infection results in diarrhea, dysentery, fever, and abdominal pain and is transmitted through the fecal-oral route. In the lab, Shigella can be identified by culturing samples on nutrient agar, MacConkey agar, or Salmonella-Shigella agar where they form colorless colonies. Treatment involves fluid replacement and antibiotics. Vibrio bacteria are
This document provides information about Pseudomonas aeruginosa, including:
- It is a gram-negative, motile, aerobic bacillus that can cause various infections.
- It has three colony types on agar - rough, smooth, and mucoid. It produces several pigments.
- It causes diseases like endocarditis, respiratory infections, bacteremia, UTIs, and skin infections.
- Identification involves culture and biochemical tests. Treatment involves antibiotics like gentamicin, though resistance has emerged.
Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum. It exists in the mycelial phase in the environment and the yeast phase in tissues. Infection occurs via inhalation of microconidia from contaminated soil. Most infections are asymptomatic, but some may cause flu-like symptoms. Diagnosis involves microscopy of clinical samples or cultures to identify the yeast cells. Serological tests and skin tests also assist in diagnosis. Amphotericin B and itraconazole are used to treat severe or disseminated cases.
This document provides clinical guidelines for pneumococcal vaccination in older adults. It describes pneumococcal disease as a leading cause of vaccine-preventable illness and death in the US, especially dangerous for young children and adults aged 65 and older. It recommends vaccination with PPSV23 for adults aged 65 and older, as well as younger adults with certain medical conditions that increase risk. PPSV23 protects against the 23 serotypes known to cause the majority of invasive pneumococcal disease. While it is effective at preventing severe disease, it may not prevent all cases of pneumococcal pneumonia.
Legionellosis is a respiratory disease caused by Legionella bacteria.
The term“legionellosis” may be used to refer to either Legionnaires’ disease or Pontiac fever.
https://www.cdc.gov/legionella/index.html
(1) Aspergillosis is caused by the fungus Aspergillus and can cause a spectrum of diseases in humans ranging from mild to severe and even fatal.
(2) The most common disease types are pulmonary aspergillosis (allergic, aspergilloma, invasive), disseminated disease affecting multiple organs, and sinus infections.
(3) Risk factors include immunosuppression, corticosteroid use, lung disease, and sinusitis. Diagnosis involves microscopy, culture, histology and serology of samples from infected sites.
Aeromonas Postgraduate Seminar Maulana Azad Medical College DelhiSayantan Banerjee
This document provides information on the genus Aeromonas. It begins by defining key characteristics, such as being gram negative, oxidase and catalase positive, and facultatively anaerobic. It describes their morphology and discusses the 3 major species implicated in human disease. It then covers the clinical significance of Aeromonas, focusing on gastroenteritis, wound/soft tissue infections, sepsis, and other miscellaneous infections. The document concludes by describing laboratory techniques for diagnosis, including use of selective media and biochemical testing.
Poxviruses are a family of viruses that can infect both vertebrates and invertebrates. The most notable member is the smallpox virus. Four genera may infect humans, including orthopox (which includes smallpox, cowpox, and monkeypox viruses) and molluscipox (which causes molluscum contagiosum). Poxviruses have complex brick-shaped particles that contain double-stranded DNA and replicate in the cytoplasm of infected cells. Notable human infections include cowpox, molluscum contagiosum, monkeypox, and smallpox.
The document discusses arboviruses, which are viruses transmitted by arthropod vectors like mosquitoes and ticks. It describes the characteristics and transmission cycles of arboviruses, examples of diseases they cause like dengue, yellow fever and Japanese encephalitis, and the viruses that cause these diseases including togaviruses and flaviviruses. Key information provided includes the virus families and genera, vectors involved in transmission, symptoms of associated diseases, and prevention and treatment methods.
Rotavirus is a common virus that causes severe diarrhea in infants and young children. It infects the intestines and causes inflammation of the stomach and bowels. The main symptoms are watery diarrhea, vomiting, fever and dehydration. It is transmitted through the fecal-oral route. Diagnosis involves detecting the virus or its proteins in stool samples. Treatment focuses on preventing dehydration through oral rehydration. Vaccines have been developed to help prevent rotavirus infection and reduce its global impact.
Differential diagnosis of cough in pediatric patients6nhstkf7f2
The document discusses differential diagnosis and management of cough in children. It covers acute cough, which usually lasts 3-7 days and is often infectious in origin. Chronic cough lasts over 8 weeks and requires further evaluation. Specific conditions covered include acute laryngitis, croup (laryngotracheobronchitis), and acute bronchitis. Diagnosis is made based on history, symptoms, and examination. Management involves treating underlying causes and symptoms.
This document provides information on the genus Yersinia including:
1) Yersinia pestis causes bubonic plague in humans and some animal species. Y. pseudotuberculosis and Y. enterocolitica can cause enteric diseases in humans and animals.
2) Yersinia species are facultative anaerobes that can grow at temperatures from 5-42°C. They are classified as Enterobacteriaceae.
3) Yersinia infections in animals include enteric disease in young ruminants and septicaemia in caged birds. Human infections include bubonic plague, as well as enteric diseases from Y. enterocolitica and Y. pseudotuberculosis
This document discusses the link between COVID-19 and tuberculosis (TB). It notes that COVID-19 disruptions have severely impacted TB treatment and care. It discusses whether TB increases risk for COVID-19 or vice versa, and notes that lung damage from TB may increase COVID-19 risk. The use of corticosteroids for COVID-19 could increase risk of reactivating latent TB infections. Screening for both diseases is recommended. Managing both diseases simultaneously may require continued TB treatment. Vaccines for both are generally safe and should not be delayed. Certain drug interactions between TB and COVID-19 treatments are also discussed.
This document summarizes aspergillosis, including invasive pulmonary aspergillosis (IPA), chronic necrotizing aspergillosis (CNA), and aspergilloma. Aspergillus is a common mold that can cause a variety of pulmonary diseases. IPA predominantly affects immunocompromised patients and presents as pneumonia. Diagnosis involves tissue biopsy, galactomannan testing, and imaging. Voriconazole is recommended treatment. CNA occurs in patients with underlying lung disease and is characterized by slow lung tissue invasion. Itraconazole is effective treatment. Aspergilloma involves a fungus ball in a pre-existing lung cavity.
- Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei found in soil and water in Southeast Asia and northern Australia. It is contracted through contact with contaminated soil or water.
- Symptoms range from skin ulcers to pulmonary or disseminated infection. Diagnosis involves culture of the bacteria from clinical samples which grows readily on laboratory media. Treatment requires prolonged use of antibiotics like ceftazidime or cotrimoxazole to which the bacteria is intrinsically resistant. There is currently no vaccine available for melioidosis.
The document summarizes key information about HIV/AIDS, including:
- HIV is transmitted sexually, through shared needles, or mother-to-child. It causes AIDS by destroying CD4 cells.
- The disease was first recognized in 1981 in the US. The virus was isolated in 1983-1984.
- High risk groups for HIV infection include men who have sex with men, intravenous drug users, and heterosexual contact.
- HIV progresses from acute infection to asymptomatic latency to full-blown AIDS as CD4 cell counts decline below 200.
- Opportunistic infections define AIDS as the immune system is compromised.
- Diagnosis involves detecting antibodies or viral components. Treatment aims to suppress viral
This document discusses emerging and re-emerging infectious diseases. It provides examples of diseases that emerged in recent decades such as Ebola, HIV/AIDS, Hepatitis C, Nipah virus, SARS, H1N1 flu, Chikungunya and Zika. Examples of diseases that have re-emerged after being controlled include dengue, malaria, meningitis, cholera and polio. For several of these diseases, brief descriptions of the causative agents and transmission methods are provided.
El documento proporciona información sobre la tuberculosis y la coinfección con VIH. En 3 oraciones resume que la tuberculosis es una enfermedad bacteriana crónica causada principalmente por Mycobacterium tuberculosis, que puede ser pulmonar o extrapulmonar, y su diagnóstico y tratamiento en pacientes con y sin VIH. La coinfección TB-VIH es un problema de salud pública importante debido al mayor riesgo de progresión de la TB y mayor mortalidad en personas viviendo con VIH.
Mycoplasma pneumoniae is the smallest free-living organism that causes pneumonia in humans. It lacks a cell wall and resides extracellularly in the respiratory tract. Common symptoms include fever, cough, headache, and sore throat. Examination may reveal rhonchi or rales in the lungs. Diagnosis is confirmed through PCR testing of respiratory samples, though this is not used in clinical practice. Treatment involves antibiotics like erythromycin, clarithromycin, or azithromycin for 7-10 days.
This document discusses Burkholderia cepacia, a gram-negative bacterium that can cause serious infections in immunocompromised individuals such as those with cystic fibrosis. It was originally known as Pseudomonas cepacia and is commonly found in soil and water. For cystic fibrosis patients, B. cepacia infections can lead to a rapidly fatal necrotizing pneumonia called cepacia syndrome. The bacteria are highly resistant to antibiotics and can form biofilms, contributing to its ability to cause infections. Proper diagnosis requires use of selective media such as Burkholderia cepacia Selective Agar to detect the bacteria.
Laboratory investigation of dengue in Jeddahhosammadani
The document discusses laboratory diagnosis of dengue hemorrhagic fever. It describes dengue virus characteristics and various diagnostic techniques used including virus isolation, serological tests like ELISA and hemagglutination inhibition, and molecular detection of dengue virus RNA through reverse transcription PCR. It provides details of specific diagnostic tests and procedures used at the Jeddah Regional Laboratory.
Epidemiological characterisation of Burkholderia cepacia complex (Bcc) from c...Bhoj Raj Singh
The presentation is extracted from the thesis talking about
1. The presence of Bcc organisms in the clinical infections of animals.
2. Ultrasound gels as a potential source of pathogens, especially Bcc.
3. Multidrug resistance in BCCs.
4. Lack of regulatory guidelines in Indian Pharmacopeia as existing in USP.
Este documento describe tres infecciones oportunistas comunes en pacientes VIH+: toxoplasmosis, neumocistosis y CMV. La toxoplasmosis es causada por el parásito Toxoplasma gondii y puede causar encefalitis. La neumocistosis es una infección pulmonar causada por Pneumocystis jirovecii. El CMV puede causar retinitis, enterocolitis, esofagitis, radiculopatía y encefalopatía. Todas estas infecciones se tratan con medicamentos como TMP-SMX,
Legionellosis is a respiratory disease caused by Legionella bacteria.
The term“legionellosis” may be used to refer to either Legionnaires’ disease or Pontiac fever.
https://www.cdc.gov/legionella/index.html
(1) Aspergillosis is caused by the fungus Aspergillus and can cause a spectrum of diseases in humans ranging from mild to severe and even fatal.
(2) The most common disease types are pulmonary aspergillosis (allergic, aspergilloma, invasive), disseminated disease affecting multiple organs, and sinus infections.
(3) Risk factors include immunosuppression, corticosteroid use, lung disease, and sinusitis. Diagnosis involves microscopy, culture, histology and serology of samples from infected sites.
Aeromonas Postgraduate Seminar Maulana Azad Medical College DelhiSayantan Banerjee
This document provides information on the genus Aeromonas. It begins by defining key characteristics, such as being gram negative, oxidase and catalase positive, and facultatively anaerobic. It describes their morphology and discusses the 3 major species implicated in human disease. It then covers the clinical significance of Aeromonas, focusing on gastroenteritis, wound/soft tissue infections, sepsis, and other miscellaneous infections. The document concludes by describing laboratory techniques for diagnosis, including use of selective media and biochemical testing.
Poxviruses are a family of viruses that can infect both vertebrates and invertebrates. The most notable member is the smallpox virus. Four genera may infect humans, including orthopox (which includes smallpox, cowpox, and monkeypox viruses) and molluscipox (which causes molluscum contagiosum). Poxviruses have complex brick-shaped particles that contain double-stranded DNA and replicate in the cytoplasm of infected cells. Notable human infections include cowpox, molluscum contagiosum, monkeypox, and smallpox.
The document discusses arboviruses, which are viruses transmitted by arthropod vectors like mosquitoes and ticks. It describes the characteristics and transmission cycles of arboviruses, examples of diseases they cause like dengue, yellow fever and Japanese encephalitis, and the viruses that cause these diseases including togaviruses and flaviviruses. Key information provided includes the virus families and genera, vectors involved in transmission, symptoms of associated diseases, and prevention and treatment methods.
Rotavirus is a common virus that causes severe diarrhea in infants and young children. It infects the intestines and causes inflammation of the stomach and bowels. The main symptoms are watery diarrhea, vomiting, fever and dehydration. It is transmitted through the fecal-oral route. Diagnosis involves detecting the virus or its proteins in stool samples. Treatment focuses on preventing dehydration through oral rehydration. Vaccines have been developed to help prevent rotavirus infection and reduce its global impact.
Differential diagnosis of cough in pediatric patients6nhstkf7f2
The document discusses differential diagnosis and management of cough in children. It covers acute cough, which usually lasts 3-7 days and is often infectious in origin. Chronic cough lasts over 8 weeks and requires further evaluation. Specific conditions covered include acute laryngitis, croup (laryngotracheobronchitis), and acute bronchitis. Diagnosis is made based on history, symptoms, and examination. Management involves treating underlying causes and symptoms.
This document provides information on the genus Yersinia including:
1) Yersinia pestis causes bubonic plague in humans and some animal species. Y. pseudotuberculosis and Y. enterocolitica can cause enteric diseases in humans and animals.
2) Yersinia species are facultative anaerobes that can grow at temperatures from 5-42°C. They are classified as Enterobacteriaceae.
3) Yersinia infections in animals include enteric disease in young ruminants and septicaemia in caged birds. Human infections include bubonic plague, as well as enteric diseases from Y. enterocolitica and Y. pseudotuberculosis
This document discusses the link between COVID-19 and tuberculosis (TB). It notes that COVID-19 disruptions have severely impacted TB treatment and care. It discusses whether TB increases risk for COVID-19 or vice versa, and notes that lung damage from TB may increase COVID-19 risk. The use of corticosteroids for COVID-19 could increase risk of reactivating latent TB infections. Screening for both diseases is recommended. Managing both diseases simultaneously may require continued TB treatment. Vaccines for both are generally safe and should not be delayed. Certain drug interactions between TB and COVID-19 treatments are also discussed.
This document summarizes aspergillosis, including invasive pulmonary aspergillosis (IPA), chronic necrotizing aspergillosis (CNA), and aspergilloma. Aspergillus is a common mold that can cause a variety of pulmonary diseases. IPA predominantly affects immunocompromised patients and presents as pneumonia. Diagnosis involves tissue biopsy, galactomannan testing, and imaging. Voriconazole is recommended treatment. CNA occurs in patients with underlying lung disease and is characterized by slow lung tissue invasion. Itraconazole is effective treatment. Aspergilloma involves a fungus ball in a pre-existing lung cavity.
- Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei found in soil and water in Southeast Asia and northern Australia. It is contracted through contact with contaminated soil or water.
- Symptoms range from skin ulcers to pulmonary or disseminated infection. Diagnosis involves culture of the bacteria from clinical samples which grows readily on laboratory media. Treatment requires prolonged use of antibiotics like ceftazidime or cotrimoxazole to which the bacteria is intrinsically resistant. There is currently no vaccine available for melioidosis.
The document summarizes key information about HIV/AIDS, including:
- HIV is transmitted sexually, through shared needles, or mother-to-child. It causes AIDS by destroying CD4 cells.
- The disease was first recognized in 1981 in the US. The virus was isolated in 1983-1984.
- High risk groups for HIV infection include men who have sex with men, intravenous drug users, and heterosexual contact.
- HIV progresses from acute infection to asymptomatic latency to full-blown AIDS as CD4 cell counts decline below 200.
- Opportunistic infections define AIDS as the immune system is compromised.
- Diagnosis involves detecting antibodies or viral components. Treatment aims to suppress viral
This document discusses emerging and re-emerging infectious diseases. It provides examples of diseases that emerged in recent decades such as Ebola, HIV/AIDS, Hepatitis C, Nipah virus, SARS, H1N1 flu, Chikungunya and Zika. Examples of diseases that have re-emerged after being controlled include dengue, malaria, meningitis, cholera and polio. For several of these diseases, brief descriptions of the causative agents and transmission methods are provided.
El documento proporciona información sobre la tuberculosis y la coinfección con VIH. En 3 oraciones resume que la tuberculosis es una enfermedad bacteriana crónica causada principalmente por Mycobacterium tuberculosis, que puede ser pulmonar o extrapulmonar, y su diagnóstico y tratamiento en pacientes con y sin VIH. La coinfección TB-VIH es un problema de salud pública importante debido al mayor riesgo de progresión de la TB y mayor mortalidad en personas viviendo con VIH.
Mycoplasma pneumoniae is the smallest free-living organism that causes pneumonia in humans. It lacks a cell wall and resides extracellularly in the respiratory tract. Common symptoms include fever, cough, headache, and sore throat. Examination may reveal rhonchi or rales in the lungs. Diagnosis is confirmed through PCR testing of respiratory samples, though this is not used in clinical practice. Treatment involves antibiotics like erythromycin, clarithromycin, or azithromycin for 7-10 days.
This document discusses Burkholderia cepacia, a gram-negative bacterium that can cause serious infections in immunocompromised individuals such as those with cystic fibrosis. It was originally known as Pseudomonas cepacia and is commonly found in soil and water. For cystic fibrosis patients, B. cepacia infections can lead to a rapidly fatal necrotizing pneumonia called cepacia syndrome. The bacteria are highly resistant to antibiotics and can form biofilms, contributing to its ability to cause infections. Proper diagnosis requires use of selective media such as Burkholderia cepacia Selective Agar to detect the bacteria.
Laboratory investigation of dengue in Jeddahhosammadani
The document discusses laboratory diagnosis of dengue hemorrhagic fever. It describes dengue virus characteristics and various diagnostic techniques used including virus isolation, serological tests like ELISA and hemagglutination inhibition, and molecular detection of dengue virus RNA through reverse transcription PCR. It provides details of specific diagnostic tests and procedures used at the Jeddah Regional Laboratory.
Epidemiological characterisation of Burkholderia cepacia complex (Bcc) from c...Bhoj Raj Singh
The presentation is extracted from the thesis talking about
1. The presence of Bcc organisms in the clinical infections of animals.
2. Ultrasound gels as a potential source of pathogens, especially Bcc.
3. Multidrug resistance in BCCs.
4. Lack of regulatory guidelines in Indian Pharmacopeia as existing in USP.
Este documento describe tres infecciones oportunistas comunes en pacientes VIH+: toxoplasmosis, neumocistosis y CMV. La toxoplasmosis es causada por el parásito Toxoplasma gondii y puede causar encefalitis. La neumocistosis es una infección pulmonar causada por Pneumocystis jirovecii. El CMV puede causar retinitis, enterocolitis, esofagitis, radiculopatía y encefalopatía. Todas estas infecciones se tratan con medicamentos como TMP-SMX,
Lezione numero 3.2 del progetto "L'Ospedale Va a Scuola" a cura dell'Ospedale Pediatrico Bambino Gesù di Roma in collaborazione con l'Istituto Bambino Gesù per la Salute del Bambino e dell'Adolescente.
PPT Ferrarese "The diagnosis of the disease: laboratory & clinic"StopTb Italia
PPT Ferrarese "The diagnosis of the disease: laboratory & clinic", Symposium on TB, 14 October, III Session (nurses & healthcare providers), Monza, Italy.
2. Introduzione
•Casi di tubercolosi isolati ogni anno in aumento
•Isolati microorganismi chemioresistenti
•Negli U.S.A sono infettate da M. tube rculo sis 10-15
milioni di persone
•Se non trattate, il 10% di esse svilupperà la malattia
3. La piu’ alta prevalenza TBC in AfricaLa piu’ alta prevalenza TBC in Africa
25 - 49
50 - 99
100 - 299
< 10
10 - 24
No estimate
per 100 000 pop
300 or more
Global Tuberculosis Control. WHO Report 2004. WHO/HTM/TB/2005.331
4. CASI DI TBC IN IMMIGRATI (2005)CASI DI TBC IN IMMIGRATI (2005)
% di casi di
origine straniera
5-19
< 5
20-39
> 40
No dati
Global Tuberculosis Control. WHO Report 2004. WHO/HTM/TB/2005.331
5. Epidemiologia della TBC in Italia
Dalla seconda metà del novecento fino agli anni ottanta, progressiva
riduzione della frequenza della TBC
negli ultimi venti anni trend stabile Italia paese a bassa
prevalenza: meno di 10 casi/100.000 ab.
ATTUALMENTE:
• leggero seppur costante aumento nella classe di età 15-24 anni
• dal 22 al 44% sul totale dei casi notificati “cittadini non italiani”
• concentrazione della maggior parte dei casi in alcuni gruppi a
rischio
• emergenza di ceppi multifarmacoresistenti
7. Trasmissione di M. tube rculo sis
•Disseminazione via areosol
•Espulso quando la persona infetta tossisce,
starnutisce, parla
•Contatti con individui infetti ad alto rischio di
infezione
•Trasmissione avviene da persona con malattia in
atto (non latente)
8. Patogenesi
•10% delle persone infettate con un sistema
immunitario normale sviluppano TB
•Rischio di sviluppare TB negli infetti aumenta dal 7 al
10% ogni anno
•Infezione da HIV è il più elevato fattore rischio
•Altri fattori rischio: diabete mellito, silicosi, cancro,
terapia immunosoppressiva o con corticosteroidi
10. TBchemioresistente
TB chemioresistente trasmessa con le stesse
modalità di TB chemiosensibile
- Chemioresistenza primaria
in soggetti infettati da micobatteri resistenti
- Chemioresistenza secondaria (acquisita)
in corso di terapia antitubercolare
11. Classificazione della TB
No TB exposure
Not infected
No history of exposure
Negative reaction to tuberculin skin test
TB exposure
No evidence of infection
History of exposure
Negative reaction to tuberculin skin test
TB infection
No disease
Positive reaction to tuberculin skin test
Negative bacteriologic studies (if done)
No clinical, bacteriological, or radiographic
evidence of active TB
TB, clinically active M. tuberculosis cultured (if done)
Clinical, bacteriological, or radiographic
evidence of current disease
TB
Not clinically active
History of episode(s) of TB
or
Abnormal but stable radiographic findings
Positive reaction to the tuberculin skin test
Negative bacteriologic studies (if done)
and
No clinical or radiographic evidence of
current disease
TB suspected Diagnosis pending
Class Type Description
0
1
2
3
4
5
12. Test cutaneo alla Tubercolina
•Iniezione intradermica
di 0.1 ml di 5 TU di
tubercolina PPD
13. Lettura del test della tubercolina
•Lettura 48-72 ore dopo
l’iniezione
•Misurare in millimetri solo
l’indurimento
14. Classificazione della Reazione allaTubercolina
5 mm è classificata positiva se:
• Paziente HIV-positivo
• Recente contatto con caso di TB
• Persona con segni di fibrosi a RX torace
compatibile con vecchia TB
• Pazienti trapiantati o immunodepressi
15. 10 mm è classificata positiva se:
• Provenienza da un paese ad alta prevalenza di TB
• Tossicodipendente
• Residente o impiegato in comunità ad alto rischio
• Impiegato in laboratorio di micobatteriologia
• Paziente con condizioni cliniche ad alto rischio
• Bambini con età <4 anni, o bambini o adolescenti
esposti ad adulti a rischio
Classificazione della Reazione allaTubercolina
16. 15 mm è classificata positiva se:
• Persone non a rischio per TB
• Programmi di screening con test della tubercolina
dovrebbe essere condotto solo in gruppi ad alto
rischio
Classificazione della Reazione allaTubercolina
17. Fattori che possono influenzare il test alla Tubercolina
Type of Reaction Possible Cause
False-positive Nontuberculous mycobacteria
BCG vaccination
Anergy
False-negative Recent TB infection
Very young age (< 6 months old)
Live-virus vaccination
Overwhelming TB disease
18. Anergia
•Non escludere la diagnosi basandosi sulla negatività
del test cutaneo
•Considerare possibilità di anergia in soggetti
- HIV positivi
- malattia tubercolare in atto
- malattia febbrile severa
- infezioni virali
- vaccinazioni con virus vivi
- terapia immunosoppressiva
19. Stimolazione
•Soggetti con malattia tubercolare latente possono
essere negativi al test della tubercolina effettuato
ad alcuni anni dall’infezione
•Il test iniziale alla tubercolina può stimolare la
capacità di rispondere alla tubercolina ad un test
successivo
•Reazioni positive ad un test successivo possono
essere misinterpretate come una nuova infezione
20. Test della tubercolina va effettuato due volte
• Se il primo test è positivo, considerare la persona infetta
• Se il primo test è negativo, effettuare secondo test dopo
1-3 settimane
• Se il secondo test è positivo, considerare la persona
infetta
• Se il secondo test è negativo, considerare la persona
non infetta
25. Colture
•Confermano la diagnosi di TB
•Coltivare tutti i campioni, anche se negativi allo striscio
•Risultati in 4-14 giorni
Colonie di M. tuberculosis
27. Principi di base perla terapia
•Effettuare tempestivamente la terapia
•Utilizzare più farmaci a cui il batterio è suscettibile
28. Esempio di schema di trattamento della TB
•Regime iniziale:
- Isoniazide (INH)
- Rifampicina (RIF)
- Pirazinamide (PZA)
- Etambutolo (EMB) o streptomicina (SM)
•Modificare la terapia quando si conosce il profilo di
chemiosensibilità
30. Contagiosità
Pazienti sono da considerare contagiosi se
• Tossiscono
• Sono sottoposti a terapie che generano tosse o
areosol, o
• Presentano nello sputo bacilli acido resistenti e
• Non sono trattati
• Hanno appena iniziato la terapia, o
• Hanno scarsa risposta alla terapia
31. Obbligo di notifica di caso Classe III
(D.M. 15 dicembre 1990 e D.M. 29 luglio 1998)
• comprende le malattie per le quali sono richieste
particolari documentazioni e con flussi informativi
differenziati.
• La segnalazione deve essere effettuata all’ASL
entro 48 ore dal riconoscimento del caso anche solo
sospetto.
32. Misure di profilassi per esigenze di sanità pubblica
TUBERCOLOSI ICD-9 010.-/018.-
Classe di notifica: III
Periodo di incubazione Periodo di contagiosità Provvedimenti nei confronti del
malato
Provvedimenti nei confronti di
conviventi e di contatti
Circa 4-12 settimane
dall’infezione alla
comparsa di una lesione
primaria dimostrabile o
della positività del test alla
tubercolina.
L’infezione può persistere
allo stato latente per tutta
la vita; il rischio di
evoluzione verso la
tubercolosi polmonare e/o
extrapolmonare è massimo
nei primi due anni dopo la
prima infezione.
Fintanto che bacilli
tubercolari sono presenti
nell’escreato e in altri
fluidi biologici.
La terapia antimicrobica
con farmaci efficaci
determina la cessazione
della contagiosità entro 4-
8 settimane.
Isolamento respiratorio in stanze
separate e dotate di sistemi di
ventilazione a pressione negativa
per i soggetti affetti da tubercolosi
polmonare, fino a negativizzazione
dell’escreato;
precauzioni per
secrezioni/drenaggi nelle forme
extrapolmonari;
sorveglianza sanitaria per almeno
6 mesi. In caso di scarsa
compliance alla terapia, di sospetta
farmacoresistenza, o di condizioni
di vita che possono determinare
l’infezione di altre persone, in caso
di recidiva è indicato il controllo
diretto dell’assunzione della
terapia antitubercolare.
Sorveglianza sanitaria di
conviventi e contatti stretti per
la ricerca di altri casi di
infezione o malattia.
Esecuzione di test alla
tubercolina con successiva
radiografia del torace dei casi
positivi e, in caso di negatività,
ripetizione del test a distanza di
2-3 mesi dal momento della
cessazione dell’esposizione.
Chemioprofilassi nei contatti
stretti cutipositivi; questa è,
altresì, indicata per i contatti
cutinegativi ad alto rischio di
sviluppare la malattia.
33. Misure per il controllo della TBMisure per il controllo della TB
–trattamento farmacologico e gestione dei
pazienti con TBC
–identificazione, sorveglianza e trattamento dei
gruppi ad alto rischio
•contatti di casi di TBC
•persone con infezione da HIV
•altri gruppi a rischio
–vaccinazione con BCG
• I ritardi diagnostici contribuiscono ad aumentare i casi di malattia in
fase avanzata, con maggiore potenziale di contagio
34. Misure di controllo dell’infezione
•Misure procedurali per ridurre il rischio di
esposizione
•Misure strutturali per prevenire la disseminazione e
ridurre la formazione di areosol
•Protezione respiratoria personale nelle aree ad
elevato rischio di esposizione
35. Misure procedurali
Ridurre il rischio di esposizione delle persone non infette:
• Sviluppare e migliorare protocolli di
- Rapida identificazione
- Isolamento
- Diagnosi
- Trattamento
• Educazione delle persone che lavorano nelle strutture sanitarie
• Effettuare test della tubercolina in tali persone
36. Misure strutturali
Per prevenire la diffusione e ridurre la formazione
di particelle di areosol infette
• Uso di sistema di ventilazione nelle stanze di isolamento
per TB
• Uso di filtri HEPA e raggi U.V. come altre misure di
controllo
37. Protezione respiratoria personale
Da utilizzare nelle aree ad alto rischio di esposizione:
• Stanze di isolamento
• Stanze in cui i pazienti sono sottoposti a procedure
che generano tosse
• Abitazioni con pazienti affetti da TB
39. Vaccinazione con BCGVaccinazione con BCG
• BCG deriva da un ceppo attenuato di M. bovis
• La vaccinazione routinaria è raccomandata alla nascita
nei paesi ad alta prevalenza di TBC
• Bassa efficacia:Bassa efficacia: 0-80%
• Protezione dei bambini da forme severe (meningiti e
miliari)
• Effetti collaterali (1-10%): ulcerazione locale e
linfoadenite
• Determina positività al TST, che diminuisce col
passare degli anni
Brewer T.F. Clin Infect Dis 2000
40. DPR 7 novembre 2001 n. 265DPR 7 novembre 2001 n. 265
Vaccinazione obbigatoria nelle seguenti categorie:
• neonati e bambini di età inferiore a 5 anni, con test
tubercolinico negativo, conviventi o aventi contatti stretti con
persone affette da tubercolosi in fase contagiosa,qualora
persista il rischio di contagio;
• personale sanitario, studenti in medicina, allievi infermieri e
chiunque, a qualunque titolo, con test tubercolinico negativo,
operi in ambienti sanitari ad alto rischio di esposizione a
ceppi multifarmaco resistenti oppure che operi in ambienti ad
alto rischio e non possa, in caso di cuticonversione, essere
sottoposto a terapia preventiva, perché presenta
controindicazioni cliniche all’uso di farmaci specifici.
41. Controindicazioni alla vaccinazione BCG
Soggetti con alterata risposta immune per
• Infezione da HIV
• Immunodeficienza congenita
• Leucemia
• Linfoma
• Terapia con corticosteroidi
• Radioterapia
• Terapia con agenti alchilanti od antimetaboliti
42. Vaccinazione BCG e
Test della Tubercolina
• Test della tubercolina non controindicato nei soggetti vaccinati
con BCG
• Diagnosi di tubercolosi latente e trattamento nei soggetti
vaccinati con BCG con test della tubercolina di 10 mm se una di
tali circostanze è presente:
- avvenuto contatto con persona infetta da TB
- soggetto nato o residente in un’area geografica ad alto
rischio per TB
- esposizione frequente ad una popolazione ad elevato
rischio per TB