Microbiology Exam 2 - Part 6 (Microbial Diseases of the Cardiovascular System/Systemic Diseases)

What term refers to the microbial infection of the blood that causes illness?

Septicemia Sepsis

What term is bacteria in the blood?

Bacteremia

What term is when bacteria remains at the site of infection but release toxins into the blood?

Toxemia

What term is viral blood infection?

Viremia

What term is an infection and inflammation of the lymphatic vessels?

Lymphangitis

Fever, chills, N/V, diarrhea, SOB, malaise, confusion, anxiety can be symptoms of what conditions, where septic shock can develop rapidly, there can be petechiae, osteomyelitis (infection fo bone from staph aureus), and toxemia symptoms varying depending on the toxin? (4)

Septicemia, Bacteremia, Toxemia, and Viremia

What toxin in toxemia is released form living microbes? What toxin is released from Gram (-) bacteria?

Exotoxins

Endotoxins

What is the pathogenesis of Septicemia, Bacteremia, Toxemia, and Viremia?

Often opportunistic or nosocomial infections

T/F: Immunocompetent individuals rarely have septicemia

TRUE

T/F: Exotoxins form living microbes more often produce severe septicemia due to the release of Lipid A after destruction of cell wall?

FALSE

-- Gram (-) bacteria more often; due to endotoxin (Lipid A)

How is Septicemia, Bacteremia, Toxemia, and Viremia diagnosed? Treated? Prevented?

Diagnosed = signs/symptoms suspicious; blood work confirmatory

Treatment = Prompt diagnosis and antimicrobial drugs

Prevention = Immediate treatment of infections

What bacterial CV pathology has fever, chills, new or changed heart murmur, fatigue, night sweats, SOB, persistent cough, lower extremity swelling, weight loss, and petechiae?

Endocarditis

What pathogens can cause Endocarditis?

Viridans streptococci cause 1/2 of the cases

-- Streptococcus sanguis

-- S. mutans (causes cavities)

-- S. anginosus

-- S. Bovis

Other pathogens -->

Staphylococcus aureus

Streptococcus pneumoniae

Streptococcus pyogenes

Escherichia coli

What is the pathogenesis of Endocarditis?

Patients usually have obvious source of infection

-- abnormal heart have increased risk

How is Endocarditis treated? Prevented?

Treat with IV antibiotics

-- prophylactic antibiotics for high-risk patients when needed (ex: antibiotics before dental surgery)

What bacterial CV pathology shows joint inflammation, small nodules or hard round bumps under the skin, change in neuromuscular, rash, fever, weight loss, fatigue, stomach pains, & heart murmur?

Rheumatic Fever / Heart Disease

What is the pathogen for Rheumatic Fever / Heart Disease?

Streptococcus pyogenes

What is the pathogenesis of Rheumatic Fever / Heart Disease?

Inflammation of heart vcalves occur 1-5 weeks following infection with S. pyogenes (strep throat or scarlet fever)

-- children ages 5-15 are most at risk

-- not as common in US

How is Rheumatic Fever / Heart Disease treated? Prevented?

Antibiotics, bed rest

-- surgical valve repair or replacement if severe damage

-- best prevention is prompt antibiotics if child develops strep throat

What bacterial systemic disease is a fluctuating fever that spikes every afternoon, chills, sweating, headache, myalgia, weight loss, and is often an asymptomatic or mild disease?

Brucellosis

What valve is most commonly affecgted in Rheumatic Fever / Heart Disease?

Mitral valve

What pathogen causes Brucellosis?

Brucella melitensis (typically found in sheep/goats, cattle & pigs; farm animals)

-- Gram (-) bacteria, endotoxin causes some of the signs and symptoms

How is Brucellosis transmitted?

Consumption of contaminated dairy products

-- contact w/ infected animal blood, urine, or placentas

How is Brucellosis treated? Prevented?

Treatment = usually requires no treatment but antibiotics if severe

Prevention = attenuated vaccine exists for animals

Do you adjust a patient with Brucellosis?

YES

What condition is skin lesions and swollen lymph nodes at the infection site with ascending lymphangitis and other symptoms such as fever, lethargy, anorexia, signs of septicemia, and possibly death?

Tularemia (Rabbit Fever)

What pathogen causes Tularemia (Rabbit Fever)?

Franscisella tularensis

How is Tularemia (Rabbit Fever) transmitted?

Via bite of infected tick or contact w/ infected animal (if contact w/ dead animal, highest risk)

What is Tularemia (Rabbit Fever) considered since it has ease of transmissibility and high infectivity?

Category A bioterrorist threat

How is Tularemia (Rabbit Fever) diagnosed? Treated? Prevented?

Diagnosed = difficult, requires serological confirmation

Treated = antibiotics

Prevention = wear rubber gloves when handling/skinning wild animals (rabbits/rodents); vaccine available for people at risk of exposure

Do you adjust a patient with Tularemia (Rabbit Fever)?

Yes at first, until lymphangitis signs

What bacterial systemic disease has a high fever, swollen painful lymph nodes (buboes), bacteremia, disseminated intravascular coagulation (DIC), subcutaneous hemorrhaging, death of tissues, with necrotic skin that darkens ("Black Death")?

Bubonic Plague

If Bubonic plague is treated, its a fatality rate of ______%, whereas if its untreated, its ______%

5-15%

50%

What bacterial systemic disease occurs when the bacterium spreads to the lungs, including fever, malaise, pulmonary distress wtihin day of infection, and is 100% fatal if not treated within the first 24 hours?

Pneumonic plague

What pathogen causes Plague (Bubonic & Pneumonic)?

Yersinia pestis (Pestilence)

T/F: Pneumonic plague can become co-infected with Clostridium and develop gangrene.

FALSE

Bubonic plague

How is the bubonic plague transmitted?

Flea bite (vector) or by contact w/ infected rodent (esp. rats) or flea feces

NOTE: THIS IS THE ONLY FLEA ONE THUS FAR

How is pneumonic plague transmitted?

Person-to-person via aerosols and sputum

T/F: Out of the two plagues, the pneumonic plague is considered a category A bioterrorist due to its virulence.

FALSE

-- Pneumonic & Bubonic plague both

How is the bubonic & pneumonic plague diagnosed? Treated? Prevented?

Diagnosed = based on characteristic symptoms; must be diagnosed and treated immediately

Treated = various antibiotics

Prevented = Rodent & flea control; good hygeine

Would you adjust someone with bubonic/pneumonic plague?

NO; medical emergency

What bacterial systemic disease has three phases in untreated patients:

1 - Expanding red "bull's-eye" rash (erythema migrans) around site of bite; in addition to malaise, headaches, dizziness, stiff neck, severe fatigue, fever, chills, muscle & joint pain, lymphadenopathy

2 - Neurological symptoms and cardiac dysfunction (10% of patients); meningitis, encephalitis; peripheral neuropathy, Bell's Palsy (one sided face paralysis)

3 - Severe debilitating arthritis that can last years

Lyme Disease

What pathogen causes Lyme Disease?

Spirochete Borrelia burgdorferi (Lyme Borreliosis)

Lyme disease is one the MOST reported vector-borne diseases in the US and is transmitted by what?

Tick bite

What two events contributed to an increase in Lyme disease?

1) Movement of human populations into woodland areas

2) Deer population protected/encouraged to feed in suburban yards

How is Lyme disease diagnosed? Treated? Prevented?

Diagnosed = signs/symptoms; bacteria rarely detected in blood; often mis/undiagnosed without "bulls-eye" rash

Treated = Antibiotics in early phase; later phase difficult since symptoms caused by immune system

Prevented = Repellents containing DEET and protective clothing

Where is Lyme disease most prevalent?

Localized in states in northeastern, mid-atlantic, and north-central regions

Would you adjust a person with Lyme's disease?

YES

What bacterial systemic disease is characterized by recurring episodes of septicemia and fever?

Relapsing Fever

What pathogen causes Louse-borne Relapsing Fever? Endemic Relapsing Fever?

Louse-borne Relapsing Fever = Borrelia recurrentis

Endemic Relapsing Fever = Several Borrelia spp

NOTE: remember this is NOT Brucellosis (Undulant Fever); don't mix the two

How is Louse-borne Relapsing Fever transmitted? Endemic Relapsing Fever?

Louse-borne = Human Body louse vector

--> louse = LICE

Endemic = Tick

How is Relapsing Fever diagnosed? Treated? Prevention?

Diagnosed = Observation of spirochetes

Treated = antibiotics

Prevention = avoidance of ticks/lice; good personal hygeine; repellent chemicals

What bacterial systemic disease affects the lungs, liver, heart, and other body parts, consisting of chest pain with breathing, shortness of breath, clay-colored stools, cough, fever, headache, jaundice, muscle pains, and/or rash?

Q fever

What pathogen causes Q fever?

Coxiella burnetii

What is the pathogenesis of Q fever?

Infected sheep, goats, cattle, dogs, cats, birds, rodents --> shed bacteria in birth products, feces, urine, milk

Humans get it by breathing in contaminated droplets or drinking raw milk

How is Q fever diagnosed? Treated? Prevented?

Diagnosed = Blood antibody test

Treated = antibiotics, possibly several months

Prevention = disposal of animal products, handwashing, pasteurization

What viral systemic disease includes a severe sore throat and fever initially, followed by swollen lymph nodes, fatigue, anorexia, enlargement of the spleen (50%) and sometimes liver?

Infectious Mononucleosis (MONO)

What pathogen causes Infectious Mononucleosis?

Human Herpes Virus-4 (HHV-4)

-- aka Epstein-Barr virus (EBV)

How is Infectious Mononucleosis transmitted?

Via saliva (kissing disease)

How is Infectious Mononucleosis (MONO) diagnosed? Treated? Prevented?

Diagnosed = presence of large, lobed B-lymphocytes and neutropenia in blood

Treatment = NONE; medication can help relieve symptoms

Prevent = difficult since EBV occurrence is widespread

What is unique abotu the pathogenesis of EBV?

It establishes latent infection in host

-- EBV associated w/ Hodgkin's lymphoma, Burkitt's lymphoma, Chronic fatigue syndrome; & risks autoimmune conditions such as SLE, RA, Sjogrens, MS

Would you adjust someone with MONO?

YES; unless it becomes a medical emergency (aka spleen ruptures)

-- also adjustment style changes

What viral systemic disease is typically asymptomatic, but can be symptomatic in fetuses, newborns, and immunocompromised patients causing birth defects, Mono-like symptoms, and eye infections?

Cytomegalovirus

What pathogen causes Cytomegalovirus?

Human Herpes Virus-5 (HHV-5)

-- aka cytomegalovirus (CMV)

Human Herpes Virus SUMMARY

HHV 1 = above the waist

HHV 2 = below the waist

HHV 3 = Chicken pox/shingles

HHV 4 = MONO

HHV 5 = Cytomegalovirus

HHV 6 = Roseola

Cytomegalovirus is one of the MORE common infections of humans (opportunistic) and is transmitted via what?

Bodily secretions

-- usually via sexual intercourse

-- can also be transmitted via utero exposure, vaginal birth, blood transfusions, and organ transplants

How is Cytomegalovirus diagnosed? Prevented?

Treated = fetuses & newborns difficult; damage usually occurs before infection discovered

-- fomiversen treats CMV eye infections (injected into eye -- don't need to know this drug name)

Prevented = abstinence, mutual monogamyh safe sex can reduce chance of infection

Would you adjust Cytomegalovirus?

YES

What viral systemic disease has three stages: the first including a fever, headache, and muscle aches; the second stage is a period of remission; the third stage includes jaundice, delirium, seizures, coma, hemorrhaging, and blood in the vomit (black vomit)?

Yellow Fever

NOTE: remember jaundice = yellowish tint

What pathogen causes Yellow Fever?

Yellow Fever virus

-- arbovirus

How is Yellow Fever transmitted?

Mosquito

-- cases occur in South America & Africa today

How is Yellow Fever diagnosed? Treated? Prevented?

Diagnosed = viral antigens in blood; diagnosis relies on history of travel to endemic regions

Treatment = NONE; supportive only

Prevention = Vaccine (travel)

What viral systemic disease has two phases: first with fever, edema, head and severe muscle pain; second with return of fever and a red rash; but this condition is usually asymptomatic or mild (80%)?

Dengue fever (Break-bone fever)

NOTE: The severe muscle pain/cramping will cause breaking of bones

What viral systemic disease is more severe with internal bleeding, shock, and possibly death, and makes up <5% of all Dengue cases?

Dengue Hemorrhagic Fever (DHF)

What pathogen causes Dengue Fever & Dengue Hemorrhagic Fever?

Dengue Viruses 1, 2, 3, 4

T/F: After getting Dengue Fever & Dengue Hemorrhagic Fever once, you have lifelong immunity.

FALSE

You do get lifelong immunity after recovery, but since there are 4 strains, you could get it 4 times before immunity

(Need to get each strain to be immune)

How is Dengue Fever & Dengue Hemorrhagic Fever transmitted?

Mosquito vector

What is the MC mosquito-borne viral disease in the world?

Dengue Fever & Dengue Hemorrhagic Fever

What viral systemic disease includes fever and fatigue, minor petechiae that progresses to severe internal hemorrhaging and uncontrolled bleeding under the skin and from every body opening?

Ebola Hemorrhagic Fever

How is Dengue Fever & Dengue Hemorrhagic Fever diagnosed? Treated? Prevented?

Diagnosed = signs/symptoms (S/S), history of travel to endemic (tropical) region; bloodwork confirmatory

Treatment = NONE

Prevention = mosquito control

What pathogen causes Ebola Hemorrhagic Fever?

Ebolavirus

(CATEGORY A BIOTERRORIST THREAT; BSL-4

How is Ebola Hemorrhagic Fever transmitted?

Natural reservoir and ORIGINAL mode of transmission to humans unknown, but it spreads from person to person by contaminated body fluids & syringes

-- occurs primarily in Africa

How is Ebola Hemorrhagic Fever treated? What is the prognosis?

Treated = fluid & electrolyte replacement

Prognosis = Up to 90% of human victims die

Would you adjust someone with Ebola Hemorrhagic Fever?

NO; medical emergency

What protozoan cardiovascular/systemic disease consists of fever, chills, diarrhea, headache, occasionally cardiac or pulmonary dysfunction, anemia, weakness, fatigue, jaundice?

Malaria

NOTE: ATLEAST 2 TQs on EXAM about Malaria

What is the severe form of malaria called, which includes extreme fever, erythrocyte lysis, renal failure, and dark urine that can be fatal within 24 hours?

Blackwater fever

What pathogens cause Malaria? What is the ranking of severity of these pathogens? Which is the most common?

4 plasmodium species:

1) Plasmodium ovale --> generally mild disease

**2) Plasmodium vivax --> chronic malaria (MC)*

3) Plasmodium malariae --> more serious malaria

**4) Plasmodium falciparum --> most severe* malaria

How is Malaria transmitted? How is immunity develops?

Mosquito vector

-- endemic through tropics & subtropics

-- immunity develops if victim survives repeated bouts of acute stage malaria

How does genetics play a role in Malaria resistance?

Certain genetic traits can increase resistance to malaria

-- sickle hemoglobin trait protects

How is Malaria diagnosed? Treated? Prevented?

Diagnosed = identifying Plasmodium in blood

Treated = varies by species & disease severity

Prevention = Requires control of mosquitoes

-- if traveling to endemic area, can take prophylactic anti-protozoal medication several weeks before and after travel

Would you adjust someone with Malaria?

YES, unless they had blackwater fever

-- make sure they have concurrent care though

What protozoan CV/systemic disease is in majority of cases have no symptoms, and if symptomatic, can get fever, malaise, inflammation of the lungs, liver, and heart?

Toxoplasmosis

Toxoplasmosis is more severe in what two populations?

1) AIDS patients: spastic paralysis, blindness, myocarditis, encephalitis, death

2) Fetuses: most danger is in first trimester of pregnancy -- spontaneous abortion, stillbirth, epilepsy, mental retardation, microcephaly, retinal inflammation, blindness, anemia, jaundice, other diseases

What pathogen causes Toxoplasmosis?

Toxoplasma gondii

What is the definitive host of Toxoplasmosis?

Cats

How is Toxoplasmosis diagnosed? Treated? Prevented?

Diagnosis = detecting organisms in tissues

Treatment = antiprotozoal only in AIDS patients, pregnant moms, and newborns

Prevention = difficult; numerous hosts

How is Toxoplasmosis transmitted?

Ingestion or inhalation of feces contaminated soil

-- transmission across the placenta can occur, which is why PREGNANT MOMS should AVOID cleaning kitty litter boxes

Consuming undercooked, contaminated meat (especially pork, lamb, and venison)

Do you adjust someone with Toxoplasmosis?

YES

What protozoan CV/systemic disease progresses through four stages:

1) Acute stages characterized by chagomas (swellings at site of bites)

2) Generalized stage of fever, swollen lymph nodes, myocarditis, enlargement of spleen, esophagus, & colon

3) Asymptomatic chronic stage

4) Symptomatic stage (congestive heart failure following formation of pseudocysts which are cyst like clusters in heart muscle tissue)

Chagas' Disease

What pathogen causes Chagas' Disease?

Trypanosoma cruzi