Meningitis, URTI, Endocarditis, SSTI, Bone & Joint Infection, GI Infection, Intra-abdominal Infection, UTI, Sepsis
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Epidemiology/Facts
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- 1.2 million cases every year worldwide
-30% to 50% of survivors develop neurologic disabilities |
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Risk Factors
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- passive and active exposure to cigarette smoke
- children with cholera implants - sickle cell disease - URI, otitis media - alcoholism - immunosuppression |
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Organisms
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- Strep pneumoniae (available vaccine)
- Neisseria meningitidis (vaccine available) - Haemophilus influenzae (vaccine available) - Listeria monocytogenes (between 1 month and 60 years) - Herpes Simplex Virus - West Nile Virus |
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Infection process originates with nasopharyngeal colinations and translocation
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Signs/Symptoms
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- fever, chills, vomiting
- headache, photophobia - nuchal rigidity - Brudzinkski sign - Kernig sign - altered mental status, seizure - lethargy, drowsiness |
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Diagnostics
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- abnormal CSF chemistries
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a.) elevated WBC count (>100 cells/mm3)
b.) elevated protein (>50 mg/dL) c.) decreased glucose levels (<40 mg/dL) |
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- CSF gram stain & cultures
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Etiology
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- most common reason patients seek medical attention
- pneumonia most common infectious cause of death in the US - usually follows colonization of the upper respiratory tract with potential pathogens |
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Pathophysiology
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- inhaled aerosolized particles
- enter lung via bloodstream from extra pulmonary infection - aspiration of oropharyngeal contents |
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Organisms & Risk Factors
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Acute Bronchitis
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viral, self-limiting
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Chronic Bronchitis
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environmental, bacterial
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Influenza
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Respiratory Syncytial Virus (RSV): newborns (baseline health status)
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CAP
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S.pneumonia
H. flu N. Menin M. cattar |
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HAP/HCAP
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S. aureus
GNR resistance |
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Aspiration PNA
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oropharyngeal (CAP) + anaerobes
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Signs & Symptoms
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- cough
- coryza - rhinitis - sore throat - malaise - fatigue - headache - fever - fever rhonchi - coarse bilateral rales - wheezing purulent sputum - hemoptysis - chest pain - dense infiltrate on CXR (pneumonia only) - increased WBC - WBC - decreased O2 saturation - labored breathing - tachycardia - tachypnea |
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Diagnostics
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- sputum gram stain & cultures
- rapid flu swabs CXR |
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Organisms
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Osteomyelitis & infectious arthritis
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Staphylococcus aureus (usually)
Pseudomonas aeruginosa streptococcus e. coli staphylococcus epidermis anaerobes all can be isolated |
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Hematogenous vs. contiguous spread
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Signs & Symptoms
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- significan tenderness, pain, swelling, fever, chills, decreased motion, and malaise
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- elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count, positive blood cultures, synovial build analysis (increased WBC, cultures)
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- bone changes observed on radiographs 10-14 days after the onset of infection
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- contrasted CT scans positive even sooner
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Pathophysiology
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- Defect in the GI tract (polymicrobic)
- Necrotizing pancreatitis (polymicrobic) - Perforated ulcer (polymicrobic) - Appendicitis (polymicrobic) - Penetrating trauma (polymicrobic) - IBD (polymicrobic) |
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- Peritoneal dialysis (eg: staphylococcus auerus)
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- Cirrhosis (eg: e. coli)
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Signs & Symptoms
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- Fever
- Hypoactive bowel sounds - Abdominal distension/tenderness - Nausea/vomiting - Elevated WBC - Hypovolemic shock - Ascites fluid (eg: high WBC, high protein, gram stain) |
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Patho & Organisms
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- E. coli (85%)
- Staph saprophyticus - Proteus spp. - Klebsiella spp. - pseudomonas aeruginosa - enterococcus |
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- Recurrent UTIs (reinfection more than two weeks apart)
- Relapse less than two weeks (due to unsuccessful treatment, resistant organisms, anatomical abnormalities) |
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Risk Factors
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Uncomplicated
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Often post-coital; healthy adult female
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Complicataed
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Male, kids
Diabetes Immunocompromised Pregnancy Device-related (foley catheter) Menopause |
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Lower UTI Signs/Symptoms (Cystic)
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- Dysuria
- Urgency - Frequency - Nocturia - Suprapubic heaviness - Hematuria |
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Upper UTI Signs/Symptoms (Pyelonephritis)
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- Systemic symptoms
- Fever - Nausea - Vomiting - Flank pain |
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Diagnostics (Urinalysis)
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- Significant bacteriuria
- > 100,000 (10^5)/mL - > 10^2/mL + symptoms - RBCs - WBCs - Nitrites |
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Epidemiology
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- most URI's have a viral etiology and resolved spontaneously
a.) sinusitis, pharyngitis, otitis b.) symptoms lasting more than 7 days = bacterial? - antibiotic use puts recipient at increased risk of selection/carriage of resistant organisms and future antibiotic failure - bacterial infection may follow viral infection |
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Otitis
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- day-care attendance
- recent antibiotic exposure - age younger than 2 years - frequent bouts of otitis media - often follows viral nasopharyngeal infection that causes eustachian tub dysfunction - otalgia, fever, irritability, tugging ears, discolored (grey), thickened, bulging eardrum - S. pneumoniae - H. influenzae - M. catarrhalis - S. aureus - S. progenies - P. aeruginosa |
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Sinusitis
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- nasal discharge/congestion
- maxillary tooth pain - facial or sinus pain that may radiate - cough - nasal discharge - often follows visual URI that leads to inflamed nasal passages, trapping bacterial in sinuses - chronic/recurrent infections occur three to four times a year - S. pneumoniae and H. influenza |
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Pharyngitis
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- viruses, group A strep, S. pyogenes
- seasonal outbreaks occur in winter and early spring, spread via direct contact with droplets - sore throat, odynophagia, fever, headache - erythma/inflammation of the tonsils and pharynx with or without patch exudates - enlarged, tender lymph nodes - red swollen uvula - petechiae on the soft palate - rapid antigen test for GAS |
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Organisms & Risk Factors
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- Cardia valve abnormalities: regurgutation, prosthetic heart valves
- intravenous drug abuse |
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- viridian's streptococci
- Streptococcus bovis - Staphylococcus aureus - fungal - HACEK: haemophilus, aggregatibacter, cardiobacterium, eikenella corrodens, kingella |
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Diagnostics
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- persistent bacteremia/fungemia
- echocardiography: valvular vegetation |
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Signs/Symptoms
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- fever & murmur
- osler nodes - infective emboli: renal, pulmonary, CNS |
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Organisms
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Folliculitis, furnucles (boils), and carbuncles*
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Staphylococcus aureus (MRSA)
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Erysipelas
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Streptococcus pyogenes
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Impetigo*
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Staphylococcus aureus
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Lymphangitis
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S. pyogenes
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Cellulitis
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S. pyogenes and S. aureus
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Necrotizing Faciitis
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S. progenes
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Diabetic Foot Infections, Decubitus Ulcers
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Staphylococci, streptococci, enteric gram negative bacilli, and anaerobes
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HUman/Animal Bite Wounds
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Pasteurella multocida, eikenella ocrrodens, S. aureus, and anaerobes
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* Highly Contagious *
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Notes
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- use caution with "spider bites"
- many of these infections originate as minor trauma, scratches (soap and water) - predisposing factors: diabetes mellitus, local trauma or infection, recent surgery - MRSA tips: transmission on fomites |
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Key Facts
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Diarrhea is
Usually Viral |
eg: E. coli
eg: Shigella eg: campylobacter eg: salmonella eg: clostridium |
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Patient education & prevention strategies are key
eg: traveller's diarrhea eg: food poisoning eg: vaccination |
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Pathophysiology: inflammatory secretion
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Signs/Symptoms
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- nausea
- abdominal pain - cramping - bloating - dehydration fever - frequent urge to evacuate - fever blood & severe dehydration |
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Risk Factors
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- ingestion of raw or undercooked seafood (eg: vibrio cholera or noroviruses)
- use of antibiotics (eg: c. diff) - use of PPI - travel to tropical areas(eg: parasitic infections like guard, entamoeba, strongyloides, and cryptosporidium) - travel to endemic areas (eg: vibrio cholera) |
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Definition: life-threatening organ dysfunction due to a dysregulated host response to infection; it arises when the body's response to an infection injures its own tissues and organs
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Infection + Quick Sepsis Organ Failure Assessment
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Altered Mental Status
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GSC < 15
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Fast Respiratory Rate
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> 22 BPM
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Low Blood Pressure
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< 100 SBP
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Increased O2 Consumption
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Decreased O2 Delivery
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Procalcitonin Levels
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Healthy
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0.01
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Local Infection
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0.1 - 0.5
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Systemic Infection
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0.5 - 2.0
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Severe Sepsis
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2.0 - 10
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Septic Shock
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> 10
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C-Reactive Protein (mg/L)
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Minor Infection
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10 - 20
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Moderate Infection
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20- 50
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Severe Infection
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> 50
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