Transcript Document 7791267

Inflammation of the conjunctiva
Organism list
 Adenovirus
 Enteroviruses
 Herpes Simplex
Conjunctivitis (Pink eye)
HSV-1
OTITIS MEDIA
Otitis Media is an inflammation of the
middle ear. It is defined by the presence
of fluid in the middle ear accompanied
by signs or symptoms of acute illness. In
1990, there were an estimated 24.5
million visits made to offices of
physicians in the United States at which
the principal diagnosis was otitis media.
The peak incidence is in the first three
years of life.
Organism
Percentage of children with pathogen
Streptococcus pneumoniae
Haemophilus influenza
Streptococcus group A
Staphylococcus aureus
Moraxella catarrhalis
39
27
3
2
10
Moraxella cararrhalis
Gram negative bacillus
Bronchitis and bronchopneumonia in elderly
patients with chronic pulmonary disease
Sinusitis and Otitis in healthy people
INFECTIONS OF THE THROAT AND MOUTH
ORAL AND RESPIRATORY VIRUSES
COMMON COLDS
Rhinovirus
++++
Enterovirus
Coronavirus
Respiratory Syncytial Virus
++
++
+ +
Influenza Virus Type A
Influenza Virus Type B
Parainfluenza Virus Type 1
Parainfluenza Virus Type 2
Parainfluenza Virus Type 3
+
+
+
+
+
Coronavirus
ssRNA, (+)
Enveloped
Small # of serotypes
Common cold, esp. children
Rhinovirus
Rhinovirus
Picornavirus-small + Strand RNA
Non-enveloped
Over 100 serotypes
Grows best at 33 C
o
Labile to acids, not able to grow in GI.
Bacterial Causes of Common Cold
Group A -hemolytic Streptococci-cause 5-10%
of the common cold infections.
PHARYNGITIS
Acute pharyngitis is an inflammatory
syndrome of the pharynx caused by
several different groups of
microorganisms.
Group A streptococcal pharyngitis (strep throat)
• 1-5 million cases/yr, U.S
• Mainly children age 5-15
• Sore throat (abrupt onset)
• May have fever, malaise,
headache, vomiting
• Posterior pharynx: edema,
erythema, purulent exudate
• Cervical lymphadenopathy
• Spectrum of clinical severity
• Strep throat + rash = scarlet fever
• Scarlet fever strains express SpeA, B and/or C
• Suppurative complications: peritonsillar cellulitis, otitis media, sunusitis, pneumonia etc.
• Nonsuppurative complications: acute rheumatic fever, acute glomerulonephritis
Microbial Causes of Acute Pharyngitis
VIRA L
SYNDROM E
Rhinovirus-over 100 types
Co mmon cold
Coronovirus 3 or more types
Co mmon cold
Adenovirus types 3, 4, 7, 14, 21
Pharyngoconjunctival fever
Herpes Simp lex Virus 1 and 2
Gingiv itis, stomatit is, pharyngitis
Parain fluenza virus types 1-4
Co mmon cold, croup
Influenza virus types A and B
Influenza
Co xsackievirus A
Herpangina
Epstein-Barr v irus
Infectious mononucleosis
Cytomegalovirus
Infectious mononucleosis
HIV-1
Primary HIV infection
BACTERIA L
Streptococcus pyogenes
Group A -hemolyt ic strep
Group C -hemo lytic strep
Pharyngitis, tonsillitis,
scarlet fever
Pharyngitis/tonsillitis
PERCENTA GE OF CASES
20
>5
5
4
2
2
<1
<1
<1
<1
15-30
5-10
Antigenic Drift of Influenza Virus
EBV Mono
Flu
onset of illness
sudden
Fever
high
Exhaustion level
severe
Cough
dry
Throat
fine
Nose
dry and clear
Head
achy
Muscles and joints achy
Chills
yes
Cold
slow
no, or mild
mild
severe or hacking
sore
runny
headache-free
fine
no
ACUTE LARYNGITIS
The recent onset of hoarseness or a harsh
voice with a deepened pitch.
Respiratory Pathogens Associated with Laryngitis
Rhinovirus
Influenza
Parainfluenza
Adenovirus
Coronavirus
Mycoplasma pneumoniae
Chlamydia pneumoniae
Group A-hemolytic streptococci
EPIGLOTTITIS
Acute epiglottitis or supraglottitis, is a
cellulitis of the epiglottis and adjacent
structures that has the potential for
causing abrupt, complete airway
obstruction. The typical patient is a 2-4
year old boy having a 6 to 12 hour
history of fever, irritibility, dysphonia
and disphagia. However, the use of a
conjugate vaccine from Haemophilus
influenza type B has changed the typical
patient into an adult with a sore throat.
INFECTIONS OF THE LOWER
RESPIRATORY TRACT
 Croup
 Bronchiolitis
 Pneumonia
ACUTE LARYNGOTRACHEOBRONCHITIS (CROUP)
An age-specific viral infection of the upper
and lower respiratory tract that produces
inflammation of the subglottic area and
results in a striking picture of dyspnea
accompanied on inspiration by the
characteristic stridulous notes of croup.
Symptoms of Croup
 Breathing difficulty
 Barking, spasmodic cough
 Noisy sound on inspiration
(stridor)
 Rapid breathing
 Increased use of neck muscles
in inspiration
 Bluish skin
AGENT
Parainfluenza virus type 1
Parainfluenza virus type 2
Parainfluenza virus type 3
Influenza virus A
Influenza virus B
Respiratory syncytial virus
Adenovirus
Rhinovirus
Enterovirus
Mycoplasma pneumoniae
PERCENTAGE OF CASES
21
8
10
8
0
8
4
<1
<1
<1
Bronchiolitis-an acute viral lower
respiratory tract illness occurring during the first
two years of life. It has also been called
"wheezy bronchitis" and "asthmatic bronchitis."
Clinical manifestations include an acute onset of
wheezing and hyperinflation, most commonly
associated with cough, rhinorrhea, tachypnea,
and respiratory distress.
Bronchiolitis
AGENTS
PERCENTAGE OF CASES
Respiratory Syncytial virus
45-75
Parainfluenza virus type 3
8-15
Parainfluenza virus type 1
5-12
Parainfluenza virus type 2
1-5
Rhinovirus
3-8
Adenovirus
3-10
Influenza virus
5-8
Mycoplasma pneumoniae
1-7
Enterovirus
1-5
PNEUMONIA
Typical - Bacterial
Rales
Productive cough
Gram stain of sputum sample
Consolidated x-ray
Atypical-Viral or Mycoplasma
Rales
Non-productive cough
Sputum sample negative
Cobweb x-ray
Typical consolidated, well
defined densities
Atypical pneumonia, patchy nondefined infiltrate, cobweb
appearance
VIRAL in CHILDREN
Respiratory Syncytial virus
Parainfluenza virus
Influenza A virus
VIRAL IN ADULTS
Influenza A virus
Influenza B virus
Adenovirus types 4 and 7
(military recruits)
BACTERIAL
Streptococcus pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Mixed anaerobic (aspiration)
Bacteroides, Fusobacterium,
Peptostreptococcus, Peptococcus
Prevotella
EnterobacteriaceaeE. coli,
Klebsiella pneumoniae,
Enterobacter,
Serratia
Pseudomonas aeurginosa
Legionella pneumonphila
FUNGAL
Aspergillus
Candida
Coccidiodes immitis
Cryptococcus neoformans
Histoplasma capsulatum
Agents of mucomycosisRhizopus, Absidia, Mucor
RICKETTSIAL
Coxiella burnetii
Rickettsia rickettsiae
MYCOPLAMA AND CHLAMYDIA
Mycoplasma pneumoniae
Chlamydia psittaci
Chlamydia trachomatis
Chlamydia pneumoniae
PARASITIC
Ascaris lumbricoides
Pneumocystis carinii
Strongyloides sterocoralis
Toxoplasma gondii
Paragonimus westermani
ACUTE PNEUMONIA
A) Community-acquired
1) Person-to-person transmission
Influenza virus, Streptococcus pneumoniae,
Mycoplasma pneumoniae, Haemophilus
influenzae, Staph aureus, Klebsiella
pneumoniae
2) Animal or environmental exposure
Legionella pneumophila, Francisella
tularensis, Coxiella burnettii, Chlamydia
psittici, Yersinia pestis, Bacillus anthracis,
Pasteurella multicoda
Legionella-intracellular organism,
environmental exposure
Francisella tularensis-intracellular organism,
bite of an infected tick or contact with infected
animal, e.g., rabbit, cat. Tularemia, glands,
sometimes systemic
Coxiella burnetti-More like Legionella and
Francisella than Rickettsia. Is an intracellular
organism, Q fever, no vector
Chlamydophila psittaci-Obligate intracellular
organism. Parrot fever, inhalation of bird
excrement, urine or respiratory secretions
Yersinia pestis-Gram negative bacillus,
resists phagocytic killing by type III secretion
system-injected proteins de-phosphorylate
proteins needed for phagocytosis, disrupt actin
filaments, induce apoptosis. zoonotic
transmission by rats or other animals, urban or
bubonic plague, systemic disease with high
mortality.
Bacillus anthracis-Gram positive bacillus,
spore former, wool sorter’s disease from spores.
Pasteurella multicoda-Gram negative
bacillus, similar to Haemophilus but colonizes
animals. Transmission to humans via scratch,
bite, etc.
3) Pneumonia in the infant and young child
Respiratory Syncytial Virus, Chlamydia
trachomatis, Staph aureus, Group B
streptococci, Strep pneumoniae,
Haemophilus influenza type b (capsule)
B) Nosocomial pneumoniae
Enterobacteria, Pseudomonas aeruginosa,
Staph aureus
II. Chronic Pneumoniae
A) Pulmonary tuberculosisMycobacterium tuberculosis
B) FungalHistoplasma capsulatum, Blastomyces
dermatitidis, Coccidioides immitis,
Cryptococcus neoformans
C) Aspiration pneumonia and lung abscess
Mixed anaerobic and aerobic bacteria
III. Pneumonia in the immunocompromised
Pneumocystis carinii
Cytomegalovirus
Nocardia
Aspergillus
Candida
CHRONIC PNEUMONIA
Chronic pneumonia can be causes by
a fraction of those organisms that cause
acute pneumonia. For example, in
patients who have a necrotizing process
due to:
ALCOHOLISM
DIABETES MELLITUS,
INTRATHORACIC MALIGNANCY,
CHRONIC OBSTRUCTIVE LUNG
DISEASE,
PATIENTS WHO ARE
HOSPITALIZED.
CASE
A 5-year old boy with a one day
history of sore throat and fever. The
next day he had headache and abdominal
pain and was still complaining of sore
throat.
Physical exam: red anterior pharynx, soft
palate and tonsillar region. No skin
lesions or rash.
Possible organisms?
Microbial Causes of Acute Pharyngitis
VIRAL
SYNDROME
% OF CASES
Rhinovirus
Common cold
20
Coronovirus
Common cold
>5
Adenovirus types
Pharyngoconjunctival fever
5
HSV 1, 2
Gingivitis, stomatitis, pharyngitis
4
Parainfluenza virus
Common cold, croup
2
Influenza virus
Influenza
2
Coxsackievirus A
Herpangina
<1
Epstein-Barr virus
Infectious mononucleosis
<1
Cytomegalovirus
Infectious mononucleosis
<1
HIV-1
Primary HIV infection
<1
BACTERIAL
Streptococcus pyogenes
Pharyngitis, tonsillitis,
Group A -hemolytic strep
Pharyngitis, tonsilitis,
scarlet fever
Group C -hemolytic strep
Pharyngitis/tonsillitis
15-30
5-10
Mixed anaerobic infection
Gingivitis, (Vincents's angina)
Peritonsillitis/peritonsillar abcess
<1
<1
Neisseria gonorrhoeae
Pharyngitis
Corynebacterium diptheriae
Diphtheria
Corynebacterium haemolyticum
scarlitiniform rash
Yersinia enterocolitica
Pharyngitis, enterocolitis
Treponema pallidum
secondary syphilis
<1
<1
<1
<1
<1
What kind of hemolysis?
Culture of throat grew gram positive
organism that was beta-hemolytic on
sheep red blood cell agar.
Organism?
Streptococcus pyogenes or group A
streptococcus. 95% of GAS are
inhibited by bacitracin disc.
Treatment?
Penicillin
Remarkably, strep continues to be
sensitive to penicillin.
If penicillin-allergic, then
erythromycin.
The patient is at risk for what two
noninfectious sequelae?
The patient is at risk for what two
noninfectious sequelae?
1. Rheumatic fever
2. Glomerulonephritis.
What are the factors governing his risk
of acquiring these two sequelae?
What are the factors governing his risk
of acquiring these two sequelae?
1. Antibiotic treatment
2. Serotype of GAS strep, based on the
M protein. M1 and M3 are associated
with rheumatic fever, M12 and M49 are
associated with glomerulonephritis.
What are the factors governing his risk
of acquiring these two sequelae?
1. Antibiotic treatment
2. Serotype of GAS strep, based on the
M protein. M1 and M3 are associated
with rheumatic fever, M12 and M49 are
associated with glomerulonephritis.
Sore throat with a maculopapular rash is
frequently seen with this organism.
What is this usually benign condition
called?
Scarlet fever
What virulence factor is responsible for
the production of this rash?
Streptococcal pyrogenic exotoxins A-C
What potentially fatal infection has been
seen with increasing frequency with this
organism?
What potentially fatal infection has been
seen with increasing frequency with this
organism?
Invasive disease due to GAS resulting in
toxic shock syndrome. Patients are
usually bacteremic.
What virulence factor is associated with
this disease?
What virulence factor is associated with
this disease?
Some exotoxins that act as
superantigens.
How does a superantigen cause disease?
How does a superantigen cause disease?
It can bind inappropriately to the TCR
and stimulate up to 20% of T cells to
overproduce a variety of cytokines such
as tumor necrosis factor, IL-1 and
interferon.
INFECTIONS OF THE LIVER
Viral infections of the liver
Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Delta virus (Hepatitis D virus)
Hepatitis E virus
Hepatitis G virus
Epstein-Barr virus
Cytomegalovirus
Yellow fever (and other arboviruses)
Bacterial infections of the liver
Leptospira species
Coxiella burnetti
Brucella species
Mycobacteria
Abscesses of the liver
E. coli
Klebsiella
Serratia
Other Enterobacteriaciae
Enterococci
Streptococcus milleri
Staphylococcus aureus
Bacteroides
Anaerobic Streptococci
Parasites of the liver
Schistosoma mansonii
Echinococcus
Fasciola hepatica
INFECTIONS OF THE CNS
Viral meningitis
Bacterial meningitis
Viral encephalitis
Abscess in the brain
Meningitis-an inflammation of the
meninges.
Symptoms:
Headache
Neck stiffness
Nausea and vomiting
Photophobia.
Viral meningitis
Organism list of viral meningitis
Echovirus
Coxsackie virus
Poliovirus
Mumps virus
Herpes simplex virus type 2
Varicella Zoster Virus
Influenza virus
Arboviruses
Bacterial Meningitis
In the CNS
Lower glucose
Higher protein
Neutrophils
Organism list
Neisseria meningitidis
Streptococcus pneumoniae
Listeria monocytogenes
Haemophilus influenzae
Mycobacterium tuberculosis
Streptococcus milleri
E. coli
ENCEPHALITIS AND
MENINGOENCEPHALITIS
Organism list
Herpes simplex virus type 1
Tick-borne encephalitis virus
Japanese B encephalitis virus
Many mosquito-borne arboviruses
Rabies virus
Cererbral and intracranial abscesses
Organism list
Anarobic Gram positive cocci
Prevotella melanogenicus
Bacteroides fragilis
Fusobacterium species
Actinomyces species
Aerobic staph and strep
Listeria monocytogenes
Haemophilus
INFECTIONS OF THE
CARDIOVASCULAR SYSTEM
Pericarditis
Myocarditis
Endocarditis
Pericarditis
Organism list
Enteroviruses, especially coxsackievirus
Influenza virus
Mycoplasma pneumoniae
Streptococcus pneumoniae
Mycobacterium tuberculosis
Coxiella burnetti
Myocarditis
Organism list
Coxsackie B virus
Coxsackie A virus
Echovirus
Influenza virus
Epstein-Barr virus
Rubella
Cytomegalovirus
Adenovirus
Mumps
Infective endocarditis
Organism list
Viridans streptococci
Oral streptococci
Enterococci
Staphylococci
Coxiella burnetti
CASE 
The patient was a 64-year old retired
postal worker with a medical history of
extensive facial reconstruction for squamous
cell carcinoma of the head and neck. He had
a 30-year history of smoking. The patient
presented with shortness of breath; a
persistent, productive cough; purulent
o
sputum, and a fever to 39.0 C two days prior
to admission.
On physical examination he had a
temperature of 37.3, respiratory rate of
18/min, pulse rate of 103 beats/min, blood
pressure of 154/107 mm Hg, and pO2 of 92
mmHg. Chest auscultation revealed coarse
breath sounds at the left lower base with
bibasilar fine crackles. He was found to
have a left lower lobe infiltrate on chest
radiograph.
His admission white blood cell count was
10,600 with 76% neutrophils. Sputum Gram
stain at admission revealed >25
polymorphonuclear cells. Two blood
cultures obtained at admission revealed a
Gram positive diplococcus that showed
alpha hemolysis on sheep blood agar.
What is the organism causing this
individual's infection?
Streptococcus pneumoniae
What are his risk factors for becoming
infected with this organism?
Age
Immunocompromised state due to his
carcinoma
Long-standing smoking history
What other patient populations are at risk for
infection with this organism?
Children of less than 2 years of age are at
greatest risk for invasive disease.
Other patient populations at risk include
AIDS patients
Patients who are functionally asplenic
Immunosuppressed patients.
What is the major virulence factor of this
organism?
The polysaccharide capsule
What strategies are available to prevent
infections with this organism?
1. A 23 valent polysaccharide vaccine for
adults.
2. A 7-valent conjugate vaccine for use in
children.