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CHAPTER 8 Microbiological Diseases: Non-Respiratory Infectious Diseases 8-2 Introduction • This chapter includes a discussion of infectious diseases of systems of the body (except respiratory system) • Includes • • • • Diseases Symptoms Diagnostic procedures Treatments 8-3 Infectious Diseases of Head and Neck • Meningitis – Inflammation of meninges (viral or bacterial) – Signs/Symptoms (S/S): fever, nuchal rigidity, fatigue, headache, decline in mental status – Diagnostics: blood culture, lumbar puncture, gram stain, CSF culture – Transmission: respiratory droplets – Treatment: antibiotics (if bacterial) (Continues) 8-4 Infectious Diseases of Head and Neck • Encephalitis – Inflammation of brain tissue – S/S: fatigue, headache, abnormal brain function, seizures, paralysis, abnormal movements – Diagnostic: lumbar puncture – Treatment: acyclovir – Prognosis: death (if untreated) (Continues) 8-5 Infectious Diseases of Head and Neck • Otitis media – Inflammation of middle ear – S/S: irritability, ear tugging, decreased energy and appetite, fever, vomiting – Treatment • Antibiotics/topical steroids/analgesics/NSAIDs • Myringotomy • No ASA due to possibility of Reye syndrome (Continues) 8-6 Infectious Diseases of Head and Neck • Parotitis ─Infection of parotid gland ─S/S: localized redness, swelling, firmness, and pain; difficulty swallowing; high fever; chills ─Treatment • Antibiotics 8-7 Infections of the Eye • Conjunctivitis – Inflammation of sclera – Acute: noninfectious (allergies) – Bacterial: usually contagious – Viral: contagious, often preceded by URI – Treatment • Bacterial: topical antibiotics • Viral: antihistamines/decongestants (Continues) 8-8 Infections of the Eye • Keratitis – Inflammation of cornea – Due to: viruses, bacteria, parasites, fungi – Can cause blindness; refer to ophthalmologist immediately – Diagnostic: culture – Treatment: antibiotics if bacterial (medication is compounded by pharmacist, since not commercially available), antivirals if due to Herpes simplex 8-9 Cardiovascular Infections • Endocarditis – Infection in one or more heart valves – S/S: dyspnea; fever; edema of legs/feet; petechiae/lesions of skin, hair, nails – Diagnostic: echocardiogram – Treatment • Valve replacement • IV antimicrobials – Prognosis: death if not properly treated 8-10 Catheter-Related Bloodstream Infections (CRBIs) • Types of catheters (based on infusion site) – Central (subclavian, internal jugular, femoral) • S/S: localized redness and purulent drainage, fever, hypotension, change in mentation • Diagnostic: culture from catheter and from a peripheral vein • Treatment: antimicrobials, removal of catheter – Peripheral (arms/hands), rarely infected 8-11 Infectious Diseases of Skin and Soft Tissues • Cellulitis – Infection of lower dermis/fat tissue – S/S: flat, red area on skin; difficult to distinguish border; possible drainage – Slow development – Risk factors: non-intact skin; chronic edema of extremities – Treatment • Antibiotics (Continues) 8-12 Infectious Diseases of Skin and Soft Tissues • Erysipelas – Infection of upper dermis and lymphatics of skin – S/S: redness with swelling of tissue above level of skin, fever, chills – Abrupt onset – Treatment • Antibiotics (Continues) 8-13 Infectious Diseases of Skin and Soft Tissues • Necrotizing skin and soft tissue infections (including necrotizing fasciitis) – Serious, rapid destruction of skin/fascia – Anaerobic or aerobic – S/S: edematous, fluid-filled blisters at site; fever; tachycardia; hypotension; confusion; decreased urine output – Treatment • Debridement, antibiotics 8-14 Intra-Abdominal Infections • Appendicitis – S/S: abdominal pain, radiating from navel to right lower abdomen; nausea; vomiting; loss of appetite – Treatment • Surgery • Antibiotics, if required (Continues) 8-15 Intra-Abdominal Infections • Acute cholecystitis – Presence of stone blocking bile flow – S/S: fever, right upper abdominal pain radiating to back or right shoulder, nausea; vomiting; lack of appetite, onset of pain one hour after eating fatty meal – Diagnostic: gallbladder ultrasound – Treatment: surgery, antibiotics, if required (Continues) 8-16 Intra-Abdominal Infections • Diverticulitis – Inflammation of diverticula – Rupture can cause localized abscess, diffuse peritonitis (or death if not treated) – S/S: pain in left lower abdomen, nausea, vomiting, constipation or diarrhea – Treatment • Antibiotics (Continues) 8-17 Intra-Abdominal Infections • Clostridium difficile colitis – Mild to severe and/or life-threatening – Usual history of antibiotic therapy 10 weeks prior to onset of symptoms – S/S: diarrhea, abdominal pain with cramping, low-grade fever, leukocytosis – Diagnostic: symptoms, history of antibiotics – Treatment: contact isolation, combination therapy (Continues) 8-18 Intra-Abdominal Infections • Infectious diarrhea – Associated with consumption of contaminated food, travel, or exposure to pets – S/S: abdominal cramps, diarrhea that might be bloody – Treatment: self-limiting, replacement fluids – Source: usually food, not water – Prevention: handwashing, cautious food and beverage consumption 8-19 Genitourinary Tract Infections • Sexually transmitted diseases • Preventable with safe sex practices – Chlamydia • Incubation period 7–21 days • Males: asymptomatic (or) painful urination, mucoid discharge from penis • Females: cervicitis, urethritis, salpingitis, endometritis, PID • Treatment: doxycycline or azithromycin (Continues) 8-20 Genitourinary Tract Infections • Sexually transmitted diseases – Gonorrhea • Asymptomatic (or) urogenital, pharyngeal and rectal infections (males and females) • Conjunctivitis (young children and adults) • Coinfection with chlamydia is common • Treatment: ceftriaxone, cefixime, azithromycin (Continues) 8-21 Genitourinary Tract Infections • Herpes simplex 1 or 2 – Type 2 usually causes genital herpes – S/S: asymptomatic (or) blisters around rectum/genitals – Outbreaks may recur since viruses cannot be eliminated from the body – Treatment • Antivirals (Continues) 8-22 Genitourinary Tract Infections • Human immunodeficiency virus (HIV) – If untreated, progresses to AIDS – Risk factors: STD, injection drug use, receiving blood products, needle stick of health care workers – S/S: similar to common cold – Treatment • Antiretrovirals • Lack of treatment leads to opportunistic infections 8-23 Bone and Joint Infections • Osteomyelitis – Infection in one or more bones of the body – S/S: localized pain, redness, warmth and edema at site; fever; chills – Treatment • Debridement • Antibiotics • Surgery to remove necrotic bone (Continues) 8-24 Bone and Joint Infections • Septic arthritis – Infection in one or more joints of the body – Risk factors: diabetes, steroid use, surgery or trauma to joint, rheumatoid arthritis, IV drug use, advanced age – S/S: painful, swollen joint; warmth at site; fever with chills; pain with movement of joint – Treatment • Antibiotics 8-25 Summary • Clinical presentation, diagnosis, treatment of common non-respiratory infections – Infectious diseases of the head and neck – Infections of the eye – Cardiovascular infections – Infectious diseases of the skin and soft tissues – Intra-abdominal infections – Genitourinary tract infections – Bone and joint infections 8-26 Summary • Treatment – Empiric therapy if required – Appropriate anti-infective when microbe is targeted • Refer to text/tables for expanded information related to diseases, treatments 8-27