part 4 spcon module 5

What are under Gram Negative Bacteria

● ENTEROBACTERACIAE

○ Escherichia Coli (E. Coli)

○ Pseudomonas Aeroginosa

What is this

● Major opportunistic pathogen

● One of the most common hospital acquired pathogen

● Thrives on moist environment surface (Swimming pool, RT equipments, endoscope, bronchoscope are prime target for growth)

● Several virulence factor

● Resistant to antibiotics

PSEUDOMONAS AEROGINOSA

PSEUDOMONAS AEROGINOSA

PATHOGENESIS

● Begins with bacterial attachment and superficial colonization of cutaneous or mucosal surface then progress to invasion and damage to underlying tissues

● Can go bloodstream invasion

● Initial attachment to respiratory epithelium appears to be mediated by bacterial organelles called _________________

RESPIRATORY TRACT INFECTION:

● LRTI occurs mainly in immunocompromised patients

● Most common in intensive care setting in association with mechanical ventilator usage

● Can be acute life threatening presented with fever, chills, dyspnea, cyanosis, and productive cough

● Can cause pneumonia

● Tachypnea, wheezing are findings

DIAGNOSIS:

● Blood C&S

● Chest X-Ray: Overaeration, patchy infiltrates, atelectasis, and peribronchial fibrosis

TREATMENT:

● Treated with 1 or more antibiotics

● Aminoglycosides (Gentamycin, Amikacin)

● 3rd Generation Cephalosporin (Ceftazidime) ● Carbapenems (Meropenem)

SKIN AND SOFT TISSUES:

● Common predisposing factors are breakdown in the integument (Surgery, burns, trauma, pressure ulcers)

● Wound is hemorrhagic and necrotic and rarely may have a characteristic fruity odor (sweet, grape-like odor) with a blue green exudate that forms a crust on wounds

● May produce distinctive skin lesions known as _________________

BONE AND JOINT INFECTION:

● Results from hematogenous spread

● Related to penetrating trauma, surgery, or overlying soft tissue infections

● Most common organism that causes osteochondritis of the foot following a punctured wound

● Infections involves the cartilage of the small joints

● Average duration of symptoms before diagnosis is usually several weeks

PSEUDOMONAS AEROGINOSA

PATHOGENESIS

● Begins with bacterial attachment and superficial colonization of cutaneous or mucosal surface then progress to invasion and damage to underlying tissues

● Can go bloodstream invasion

● Initial attachment to respiratory epithelium appears to be mediated by bacterial organelles called FIMBRIAE

RESPIRATORY TRACT INFECTION:

● LRTI occurs mainly in immunocompromised patients

● Most common in intensive care setting in association with mechanical ventilator usage

● Can be acute life threatening presented with fever, chills, dyspnea, cyanosis, and productive cough

● Can cause pneumonia

● Tachypnea, wheezing are findings

DIAGNOSIS:

● Blood C&S

● Chest X-Ray: Overaeration, patchy infiltrates, atelectasis, and peribronchial fibrosis

TREATMENT:

● Treated with 1 or more antibiotics

● Aminoglycosides (Gentamycin, Amikacin)

● 3rd Generation Cephalosporin (Ceftazidime) ● Carbapenems (Meropenem)

SKIN AND SOFT TISSUES:

● Common predisposing factors are breakdown in the integument (Surgery, burns, trauma, pressure ulcers)

● Wound is hemorrhagic and necrotic and rarely may have a characteristic fruity odor (sweet, grape-like odor) with a blue green exudate that forms a crust on wounds

● May produce distinctive skin lesions known as ECTHYMA GANGRENOSUM

BONE AND JOINT INFECTION:

● Results from hematogenous spread

● Related to penetrating trauma, surgery, or overlying soft tissue infections

● Most common organism that causes osteochondritis of the foot following a punctured wound

● Infections involves the cartilage of the small joints

● Average duration of symptoms before diagnosis is usually several weeks

What is this
● Major cause of BACTERIAL GASTROENTERITIS

● Comes in many pathogenic varieties with a different mechanism of production

○ ETEC (Enterotoxigenic E. Coli)

○ EPEC (Enteropathogenic E. Coli)

○ EIEC (Enteroinvasive E. Coli)

○ EHEC (Enterohemorrhagic E. Coli)

ESCHERICHIA COLI (E. COLI)

Under ESCHERICHIA COLI (E. COLI), what is this?

● Important cause of TRAVELER’S DIARRHEA

● Individual who travels from industrialized countries to topical regions

● Acquired through fecal-oral route

● Inoculum of organism is high enough to resist destruction by the acid in stomach

● Within 1-2 days of exposure

○ Abdominal cramps and explosive bowel movement (3-4 days)

○ TREATMENT: Oral Trimethoprim-Sulfamethoxazole or Fluoroquinolones

ETEC (ENTEROTOXIGENIC E. COLI)

Under ESCHERICHIA COLI (E. COLI), what is this?

● Cause of CHILDHOOD DIARRHEA

● Bacteria binds to the membranous cells of Peyer’s patches disrupting the overlying mucosa of the host

EPEC (ENTEROPATHOGENIC E. COLI)

Under ESCHERICHIA COLI (E. COLI), what is this?

● Causes a dysentery-like disease

● Rare

● Invade the host cell and provokes an inflammatory response

● Fever and bloody stools is

EIEC (ENTEROINVASIVE E. COLI)

Under ESCHERICHIA COLI (E. COLI), what is this?
● Causes HEMORRHAGIC COLITIS

● Associated with hemolytic uremic syndrome in children

● Characterized by hemolytic anemia, thrombocytopenia, and acute renal failure

EHEC (ENTEROHEMORRHAGIC E. COLI)

Under ESCHERICHIA COLI (E. COLI), what is this?
● Urinary tract is sterile

● Most common uncomplicated UTI

● Typical infection appears in a sexually active female following a bacterial colonization at the periurethral region ascending to urethra

● Asymptomatic bacteriuria, cystitis, urethritis, pyelonephrit

URINARY TRACT INFECTION

What are the PART III VIRUSES?

● Herpes Simplex Virus

● Varicella Zoster Virus

● Influenza

● Dengue

What is this

● Herpes means “To creep”

● Refers to tendency of virus to become chronic, latent and recurrent are morphologically similar but biologic and epidemiologic features of each are distinct

● Subclinical primary infection is more common than clinically symptomatic illness

● Each type then persists in a latent state for the rest of the host’s life

● Herpes simplex virus (HSV) and varicella-zoster virus (VZV) remains latent in sensory ganglia, upon reactivation, lesions appear in the distal sensory nerve distribution

HERPES SIMPLEX VIRUS

A type of Herpes Simplex Virus

○ 70% >12 y/o (Americans)

○ Responsible for cold sores

● HSV TYPE 1:

A type of Herpes Simplex Virus

○ One of the most common sexually transmitted diseases in the world

○ Principal cause of genital ulcers and genital herpes

● Both strains can infect visceral organ or mucocutaneous site

● HSV TYPE 2:

A type of Herpes Simplex Virus

Can be transmitted to genital area during oral sex

● HSV TYPE 1:

A type of Herpes Simplex Virus
Increases the risk of acquiring HIV infection

○ Sexual contact

● HSV TYPE 2

A type of Herpes Simplex Virus

Affects primarily oral mucocutaneous areas (Cold sores and mouth sores)

● HSV TYPE 1:

A type of Herpes Simplex Virus

On genital areas

● HSV TYPE 2:

A type of Herpes Simplex Virus

● Typically affects mouth and oral cavity

● Vesicles in the mouth, throat, and around lips

● Vesicles form moist ulcers after several days

● Often asymptomatic

● Recurrence are milder, short duration

HSV TYPE 1:

A type of Herpes Simplex Virus

● Acquired through sexual contact

● Vesicles to form on the mucosal and cutaneous surface of genital area

● Lesions are painful, small, grouped, vesicular with possible burning and itching

● Blister-like sore break and weep

● Leaving ulcer-like sores that usually crusts and heal in 1-3 weeks

HSV TYPE 2:

What is this

● Inflammation of the meninges surrounding the brain

● Occurs more commonly from HSV type 2 than HSV type 1

● Aseptic meningitis may develop 3-12 days following the appearance of lesions

● Typical symptoms are headache, nausea, stiff neck, and fever

VIRAL MENINGITIS

What is this

● Known to cause CHICKEN POX and SHINGLES

● 1 in 3 people will develop the secondary, or reactivation form of Varicella Zoster Virus in their lifetime

○ Shingles or Herpes Zoster

● Risk of developing shingles starts to rise around 50 years

● Immunocompromised persons are at increased risk

VARICELLA ZOSTER VIRUS

VARICELLA ZOSTER VIRUS

CLINICAL MANIFESTATIONS:

● Symptomatic

● Mild prodrome of headache, photophobia, and malaise may precede the onset of rash in adults

● CHILDREN: _____ is the first sign of the disease

● _____ typically described as “dewdrop on a rose petal” vesicle on an erythematous base

● Appears first on scalp and moves to trunk the extremities

● _____: Generalized pattern of eruption with no specific dermatome

● _____ : Along a specific dermatome level

● When contracted during the first or second trimesters of pregnancy, it carries a low risk of congenital malformations

● Mother develops Varicella within 5 days before delivery to 2 days after delivery, the newborn is at risk of serious disseminated disease

VARICELLA ZOSTER VIRUS

CLINICAL MANIFESTATIONS:

● Symptomatic

● Mild prodrome of headache, photophobia, and malaise may precede the onset of rash in adults

● CHILDREN: Rash is the first sign of the disease

● Rash typically described as “dewdrop on a rose petal” vesicle on an erythematous base

● Appears first on scalp and moves to trunk the extremities

● VARICELLA: Generalized pattern of eruption with no specific dermatome

● SHINGLES: Along a specific dermatome level

● When contracted during the first or second trimesters of pregnancy, it carries a low risk of congenital malformations

● Mother develops Varicella within 5 days before delivery to 2 days after delivery, the newborn is at risk of serious disseminated disease

What is this

● Affects the respiratory tract

● The mode of transmission is from person to person

● By inhalation of aerosolized virus

○ (Sneezing, coughing into the air)

● Direct contact

● Incubation period is usually 1 to 4 days

○ (Average of 2 days)

● Onset of symptoms is usually abrupt, with high fever, chills, malaise, muscular aching (myalgia), headache, sore throat, nasal congestion, and nonproductive cough

● Fever lasts about 1 to 7 days

○ (Usually 3-5)

● Infection can progress rapidly in the first few days, causing pneumonia, and respiratory failure, predominantly in high-risk groups

INFLUENZA VIRUS

What is this

● Flaviviridae

● AEDES AEGYPTI: Principal vector

● Same vector of yellow fever and Chikungunya virus

● Breeds near human habitation (Fresh water, water jars, vases, discarded containers)

● Bites during the day

● Incubation period of 2-7 days

● BREAK BONE FEVER: Sudden onset of fever, headache, retroorbital pain, back pain along with severe myalgia

● Systemic and dynamic disease

● Wide clinical spectrum

● 3 PHASES:

○ Febrile Phase

○ Critical Phase

○ Recovery Phase

DENGUE VIRUS

What is the principal vector in Dengeu

Aedes Aegypti

Under dengue, what is being defined

: Sudden onset of fever, headache, retroorbital pain, back pain along with severe myalgia

BREAK BONE FEVER