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Bacterial Diseases. Victor Politi,M.D., FACP, Medical Director, SVCMC School of Allied Health Professions, Physician Assistant Program. Introduction. Bacteria consist of only a single cell Bacteria fall into a category of life called the Prokaryotes

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Bacterial diseases

Bacterial Diseases

Victor Politi,M.D., FACP, Medical Director, SVCMC School of Allied Health Professions, Physician Assistant Program


Introduction
Introduction

  • Bacteria consist of only a single cell

  • Bacteria fall into a category of life called the Prokaryotes

  • There are thousands of species of bacteria, but all of them are basically one of three different shapes.


Classification of bacteria
Classification of Bacteria

  • Until recently classification has done on the basis of such traits as:

    • shape

      • bacilli: rod-shaped

      • cocci: spherical

      • spirilla: curved walls

    • ability to form spores

    • method of energy production (glycolysis for anerobes, cellular respiration for aerobes

    • nutritional requirements

    • reaction to the Gram stain.


Classification of bacteria1
Classification of Bacteria

  • The Gram stain is named after the 19th century Danish bacteriologist who developed it.

    • The bacterial cells are first stained with a purple dye called crystal violet.

    • Then the preparation is treated with alcohol or acetone.

    • This washes the stain out of gram-negative cells.

    • To see them now requires the use of a counterstain of a different color (e.g., the pink of safranin).

    • Bacteria that are not decolorized by the alcohol/acetone wash are gram-positive


Gram positive bacteria
Gram Positive Bacteria

  • I-Gram Positive Cocci

  • A-Streptococcus (e.g. streptococcus Pneumoniae)

  • B-Staphylococcus (e.g. Staph. aureus)

  • C-Enterococcus (Previously Group D Strep.)

  • II-Gram Positive Rods

    • A-Corynebacteria: Corynebacterium diphtheria

    • B-Listeria monocytogenes

    • C-Bacillus anthracis (Anthrax)

    • D-Erysipelothrix rhusiopathiae

  • III-Gram Positive Branching Organisms

    • A-Actinomycetes


Gram positive cocci
Gram Positive Cocci

  • I-Beta-hemolytic Streptococcus (Lancefield Groups)

  • - Group A Streptococcus (Streptococcus Pyogenes)

  • - Group B Streptococcua (Streptococcus agalactiae)

  • - Group C Streptococcus

  • - Group G Streptococcus

  • II-Alpha-hemolytic Streptococcus

  • - Streptococcus Pneumoniae (Pneumococcus)

    - Viridans streptococcus (bacterial endocarditis)

  • III-Non-hemolytic Streptococcus

  • - Streptococcus faecalis (Group D)

  • - Certain members of Groups B, C, D, H, and O


  • Strep throat is caused by group A Streptococcus bacteria. These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected, or through contact with infected wounds or sores on the skin


Group b streptococcus streptococcus agalactiae
Group B Streptococcus (Streptococcus agalactiae)

  • Epidemiology

  • Most common US cause of neonatal sepsis and meningitis

  • Incidence

    • Overall: 2 to 4 per 1000 live births

    • Invasive: 1.8 per 1000 live births

  • Primarily occurs in newborns

    • Very rare after 5 months of age


Group b streptococcus streptococcus agalactiae1
Group B Streptococcus(Streptococcus agalactiae)

  • Pathophysiology

  • Group B Beta-hemolytic streptococcus infection

  • Perinatal transmission

    • Delivery via a birth canal colonized with GBS

    • Incidence of U.S. vaginal GBS colonization: 15-20%

  • Onset of infection (Mean onset 20 hours of life)

    • Early onset neonatal disease (<6 days of life in 80%)

      • Sepsis

      • Pneumonia

    • Late onset neonatal disease of sepsis or mengitis


Group b streptococcus streptococcus agalactiae2
Group B Streptococcus (Streptococcus agalactiae)

  • Labs: Maternal Screening

  • GBS Culture

  • Management

  • Sepsis (treat for 10-14 days)

    • Pencillin G 200,000 units/kg/day divided q4-6 hours

  • Meningitis (treat for 14-21 days)

    • Penicillin G 400,000 units/kg/day divided q2-4 hours

  • Prevention

  • Perinatal Group B Streptococcus Prophylaxis

  • Prognosis

  • Mortality 10-40%


Streptococcus pneumoniae pneumococcus
Streptococcus Pneumoniae (Pneumococcus)

  • Epidemiology

    • Most common cause of community acquired pneumonia

  • Classic Symptoms

    • Shaking rigors

    • Fever

    • Purulent sputum

      • Rust colored

    • Pleuritic chest pain

    • Dyspnea

    • Chest splinting


Alpha hemolytic streptococcus
Alpha-hemolytic Streptococcus

  • Lab

  • CBC

    • WBC elevated with left shift

  • Gram stain

    • Gram positive encapsulated organisms

    • Elongated lancet shaped diplococci

  • Blood Culture

    • Positive in only 33% of cases

  • Sputum culture

    • Positive in only 40% of pneumococcal pneumonias

  • Radiology

  • Chest X-ray

    • Lobar consolidation (often lower lobe)

    • patchy infiltrates


Management
Management

  • Increasing Pencillin Resistance

    • Penicillin Sensitive

    • Ampicilin IV or Amoxicillin PO

    • Erythomycin

    • Azithromycin

    • Clarithromycin

    • Penicillin G IV

    • Doxycycline

    • Oral second generation cephalosporin

    • Parenteral third generation cephalosporin


Management1
Management

  • High-Level Penicillin Resistance

    • Broad spectrum Fluoroquinolone

      • Levofloxacin

      • Gatifloxacin

      • Grepafloxacin

      • Moxifloxacin

      • Sparfloxacin

    • Parenteral third generation Cephalosporin

    • High dose Ampicillin

    • Vancomycin IV with or without Rifampin


Gram positive cocci1
Gram Positive Cocci

  • Organisms

  • -Staphylococcus aureus

  • -Staphylococcus epidermidis


Pus smear wound staphylococcus aureus
Pus smear (wound)  Staphylococcus aureus


Enterococcus
Enterococcus

  • I-Characteristics

  • Gram Positive Cocci

  • Previously defined as Group D Streptococcus

    II-Organisms

  • Enterococcus faecalis

  • Enterococcus faecium



Corynebacterium
Corynebacterium

  • Epidemiology

    • Rare in United States due to Immunization (DTP, DTaP)

      • However 20% of adults may be inadequate immune status

      • Ongoing epidemic in the former USSR

  • Etiology

    • Corynebacterium Diphtheriae


Corynebacterium1
Corynebacterium

  • Symptoms

  • sore throat

  • dysphagia

  • Weakness

  • Malaise


Corynebacterium2
Corynebacterium

  • Signs

    • Toxic appearance

    • fever

    • Tachycardia (out of proportion to fever)

    • Pharyngeal erythema

    • Gray-white tenacious exudate or "membrane"

    • Occurs at tonsillar pillars and posterior pharynx

    • Leaves focal hemorrhagic raw surface when removed

    • Cervical lymphadenopathy


Differential dx
Differential Dx

  • Vincent's Angina (trench mouth)

    • Also shows pseudomembrane formation

  • Pharyngitis

  • Labs

    • CBC

    • Leukocytosis

    • Throat culture (+ for corynebacterium org.)

  • Management

    • Diphtheria antitoxin

    • Erythromycin

      • 20-25 mg/kg q12 hours IV for 7-14 days

  • Prevention

    • DTP/DTaP vaccination



Bacillus anthracis anthrax
Bacillus anthracis (Anthrax)

  • Etiology

    • Bacillus anthracis

  • Transmission

  • Contact with hides of infected animals

    • Cattle

    • Sheep

    • Camels

    • Antelopes

  • Ingestion of contaminated meat

  • Inhalation of spores

    • Infective aerosol dose: 8,000-50,000 spores

    • Spores may remain viable in soil for >40 years

  • No transmission person to person


Bacillus anthracis anthrax1
Bacillus anthracis (Anthrax)

  • Symptoms and Signs: Cutaneous ("Malignant Pustule")

    • Inoculation at site of broken skin

    • Painless pruritic pustules develop at inoculation site

    • Begins as erythematous papule on exposed skin

    • Vesiculates and then ulcerates within 1-2 days

    • Surrounded by a ring of non-tender Brawny edema

      • Black eschar may form



Bacillus anthracis anthrax3
Bacillus anthracis (Anthrax)

  • Symptoms and Signs: Inhalation Anthrax

  • Malaise

  • Regional lymphadenopathy

  • Two phases

    • Initial Phase

      • Viral upper respiratory symptoms

      • rhinorrhea

      • pharyngitis

    • Later Phase

      • dyspnea and hemoptysis during dissemination


Symptoms and signs

Acute GI type symptoms

Hematemesis

Severe diarrhea

Differential Diagnosis

Cutaneous Anthrax

Spider bite

Ecthyma gangrenosum

Ulceroglandular tularemia

Plague

Staph. Or strep. cellulitis

Inhalational Anthrax

Community acquired pneumonia (late phase anthrax)

Mycoplasma pneumonia (early phase anthrax)

Influenza (early phase anthrax)

Legionnaires' Disease

Psittacosis

tularemia

Q fever

Viral pneumonia

Histoplasmosis

Coccidiodomycosis

Symptoms and Signs:


Bacillus anthracis anthrax4
Bacillus anthracis (Anthrax)

  • Labs

  • Rapid ELISA test now available

  • Cultures

    • Blood culture (high sensitivity)

    • Cultures of Vomitus or feces (Intestinal Anthrax)

    • CSF culture (Inhalational Anthrax)

    • Nasal Swab (Epidemiologic tool to identify outbreak)

    • Sputum culture (Inhalational Anthrax)

    • Vesicular fluid (Cutaneous Anthrax)

  • Gram stain - blood or vesicular fluid from lesion

    • Gram positive bacilli

  • CBC

    • Neutrophilic leukocytosis in severe cases

  • Radiology:

  • Chest x-ray - Widened Mediastinum (hemorrhagic mediastinitis


Management antibiotics

Antibiotic course: 60 days

Empiric Treatment

Cipro

Adults: 400 mg IV q12 hours

Children: 20-30 mg/kg/day IV divided q12 hours

Levofloxacin

Adults: 500 mg IV q24 hours

Specific Treatment for confirmed anthrax

Adults

Pencillin G 4 MU IV q4 hours or

Doxycycline 200 mg IV, then 100 mg IV q12 hours

Children > age 12 same as adults

Children < age 12

Penicillin G 50,000 U/kg IV q6 hours

Management: Antibiotics


Postexposure prophylaxis
Postexposure prophylaxis

  • Concurrently begin vaccination

  • Continue antibiotics for 60 days

  • Ciprofloxacin

    • Adults: 500 mg PO bid

    • Children: 20-30 mg/kg/day divided bid up to 1g/day

  • Amoxicillin

    • Adults: 500 mg PO tid

    • Children: 40 mg/kg up to 500 mg PO tid

  • Doxycycline

    • Adults: 100 mg PO bid

    • Children over age 8: 5 mg/kg/day divided q12 hours


Anthrax
Anthrax

  • Course

    • Incubation: 4-6 days

    • Duration of illness: 3-5 days

  • Prognosis

  • Inhalation Anthrax (inhaled spores)

    • Untreated: 95% mortality

    • Treated: 80% mortality

  • Cutaneous Anthrax (skin contact)

    • Untreated: 20% mortality

    • Treated: Rare mortality

  • Intestinal Anthrax (ingested contaminated meat)

    • Mortality 25 to 60%


  • Prevention

  • Anthrax Vaccine 93% effective

    • Initial: 0, 2, and 4 weeks

    • Next: 6, 12, 18 months and then annually

  • Postexposure Prophylaxis as above

    • Empiric prophylaxis for any suspected exposure

    • Best prognosis with antibiotics prior to symptoms


Gram negative
Gram Negative

  • Gram Negative Rods

  • Anaerobes

    • Bacteroidaceae (e.g. Bacteroides fragilis)

  • Facultative Anaerobes (enteric/nonenteric)

    • Enterobacteriaceae (e.g. Escherichia coli)

    • Vibrionaceae (e.g. Vibrio Cholerae)

    • Pasturella,Brucella,Yersinia

  • Aerobes

    • Pseudomonadaceae (e.g. Pseudomonas aeruginosa)


Facultative anaerobes
Facultative Anaerobes

  • Enterobacteriaceae (e.g. E. coli)

  • Vibrionaceae (e.g. Vibrio Cholerae)

  • Salmonella,Shigella,Klebsiella,Proteus

  • GI pathogens !!!!!

  • non-enteric Pasturella,Brucella,Yersinia

  • Francisella,Hemophilus,Bordetella


Enterobacteriaceae
Enterobacteriaceae

  • Characteristics

    • Facultative Anaerobic Gram negative rods

    • EKP Gram negative bacteria

  • Escherichia coli

  • Klebsiella

  • Proteus


Vibrionaceae
Vibrionaceae

  • Characteristics

    • Facultative Anaerobic gram negative rods

  • Vibrio Cholerae

  • Vibrio parahaemolyticus

    • Genus: Aeromonas (motile with single polar flagellum)


Vibrionaceae1
Vibrionaceae

  • Genus: Campylobacter (motile with single polar flagellum)

  • Campylobacter jejuni

  • Genus: Helicobacter (motile with multiple flagella)

  • Helicobacter Pylori


Pasteurellaceae
Pasteurellaceae

  • Characteristics

  • Facultative Anaerobic gram negative rods

  • Genus: Pasteurella

  • Pasteurella multocida


Pasteurellaceae1
Pasteurellaceae

  • Genus: Haemophilus (coccobacilli)

    • Haemophilus Influenzae

    • Haemophilus aegyptius

    • Haemophilus ducrei


Gram negative rod
Gram Negative Rod

  • Aerobes

  • Pseudomonadaceae (e.g. Pseudomonas aeruginosa)

  • Brucella

  • Legionellaceae


Pseudomonadaceae
Pseudomonadaceae

  • Characteristics

  • Aerobic Gram Negative Rod

  • Family: Pseudomonadaceae

  • Pseudomonas aeruginosa

  • Pseudomonas mallei (Glanders)


Gram negative rod aerobic
Gram Negative Rod Aerobic

  • Family: Legionellaceae

  • Legionella pneumophila


Legionellaceae

Pathophysiology

Aerobic, intracellular, Gram negative rod

Virulent organism

More severe disease than other atypical pneumonia

Transmission

Optimal conditions for growth

Temperature: 89 to 113 F water

Stagnant water

Transmission

Waterborne

Freshwater or moist soil near ponds

Air conditioning

Condensers

Cooling towers

Respiratory therapy equipment

Showers or water faucets

Whirlpools

Incubation

Two to ten days

Legionellaceae


Legionellaceae1

Symptoms

Prodrome for 12-48 hours

Malaise

Myalgia

HA

Symptoms for 2-3 days

Fever to 40.5 C persists for 8-10 days

GI symptoms- 20-40% of cases

Nausea/vomiting

Diarrhea

Later Symptoms: Cough

Minimal to no sputum production

Slightly blood tinged sputum

Signs

Severe respiratory distress

Confusion

Disorientation

Legionellaceae


Legionella pneumophila
Legionella pneumophila

  • Complications

  • Respiratory failure (20-40% of cases)

  • Extrapulmonary complications

    • Myocarditis/pericarditis

    • Prosthetic valve endocarditis

    • Glmoerulonephritis

    • Pancreatitis

    • Peritonitis


Legionella pneumophila1
Legionella pneumophila

  • Radiology: chest x-ray

  • Small pleural effusions

  • Unilateral parenchymal infiltrates

    • Round, fluffy opacities

    • Spread contiguously to other lobes

    • Progresses to dense consolidation

    • Progresses to bilateral infiltrates


Legionella pneumophila2
Legionella pneumophila

  • Labs

  • CBC

    • leukocytosis

    • leukopenia

  • Erythrocyte Sedimentation Rate

    • Elevated markedly

  • LFTs increased

  • Sputum Exam

    • Fluorescent antibody studies of sputum

    • Legionella can not be seen on gram stain


Legionella pneumophila3
Legionella pneumophila

  • Diagnosis

  • Legionella urine antigen testing

    • High sensitivity/ serogroup 1

      • Serogroup 1 (LP1) causes most U.S. cases

    • Sputum Culture - to ID other serogroups

      • Urine antigen and sputum culture all cases

  • Legionella Serologies

    • Legionella fourfold titer rise to >= 1:128 or

    • Legionella titer >= 1:256


Legionella pneumophila4
Legionella pneumophila

  • Management (Antibiotic course for 21 days)

  • Azithromycin IV

  • Levofloxacin IV

  • Trovafloxacin IV

  • Erythromycin IV

    • Add Rifampin in immunocompromised or severe disease

  • Course

  • Response to antibiotics may not be seen for 4-5 days

  • Up to 15% mortality in some studies


Brucellosis
Brucellosis

  • Epidemiology

    • US Incidence

      • <100 cases per year (0.34/100,000)

  • Etiology

    • Brucella abortus

    • Brucella suis

    • Brucella melitensis


Brucellosis1
Brucellosis

  • Pathophysiology

  • Facultative intracellular parasite

    • Releases endotoxin when dies

  • Infective dose: 10-100 organisms

  • Incubation: 5-60 days


Brucellosis2
Brucellosis

  • Transmission

  • Infected animal products

    • Tissue from Sheep in U.S.

    • Unpasteurized milk

  • Vaccine exposure

  • No transmission person to person

  • Enters via mucus membranes, broken skin, or inhalation


Brucellosis3
Brucellosis

  • Risk Factors

  • Veterinarians

  • Farm workers

  • Meat processing plants

  • Travel or residence in endemic region

    • Mediterranean

    • India

    • North Africa, East Africa

    • Central Asia, South Asia


Brucellosis4
Brucellosis

  • Symptoms

  • Intermittent fevers

    • Undulating fever

    • Temperature peaks in evening to 101-104

  • Arthralgia (90%)

  • Weakness

  • Lassitude

  • Weight loss

  • Headache

  • Sweating

  • Chills


Brucellosis5
Brucellosis

  • Course

    • Weeks to months

  • Prognosis

    • Case Fatality

    • <5% treated


Gram negative cocci aerobes
Gram Negative CocciAerobes

  • Moraxella(Branhamella catarrhalis)

  • Acinetobacter

  • Neisseria


Neisseriaceae
Neisseriaceae

  • Neisseria meningitidis

  • Neisseria gonorroeae


Neisseria gonorrhoeae
Neisseria gonorrhoeae

  • Epidemiology

    • Much less common than chlamydia

  • Incidence: 500-700,000 cases per year

    • Decreasing except in inner city, drug abuse (crack)

    • Highly contagious: 50% transmission

    • Chlamydia coexists in 45-50% of patients with gonorrhea

  • Pathophysiology

    • Incubation: 2-7 days


Neisseria gonorrhoeae1
Neisseria gonorrhoeae

  • Symptoms and Signs: General

  • Urinary Symptoms

    • Urinary frequency

    • Urinary urgency

    • Dysuria

  • Copious urethral discharge

    • Green, yellow, or sanguinous discharge

  • Meatus and anterior urethra inflammation


Neisseria gonorrhoeae2
Neisseria gonorrhoeae

  • Conjunctivitis

    • Direct inoculation

    • Copious exudate

    • Beefy Conjunctiva

    • Serious complications

      • Corneal ulceration or opacification

      • Visual loss

      • Globe perforation

  • Pharyngitis

    • Rarely the only site of infection

    • Usually asymptomatic

  • Acute Diarrhea


Neisseria gonorrhoeae3
Neisseria gonorrhoeae

  • Symptoms and Signs: Women

  • Mucopurulent Cervicitis

    • Often asymptomatic

    • Vaginal d/c or spotting

  • Bartholin’s Gland inflammation

  • Skene's gland inflammation


Neisseria gonorrhoeae4
Neisseria gonorrhoeae

  • Symptoms and Signs: Men (often asymptomatic)

  • Epidiymitis under age 35 years

  • Proctitis

    • Receptive anal intercourse or vaginal secretions

    • Mild anal irritation or itching


Neisseria gonorrhoeae5
Neisseria gonorrhoeae

  • Symptoms and Signs: Disseminated Infection

  • More common in pregnancy

  • Dermatitis

    • Rash over trunk, extremities, palms and soles

    • Necrotic pustule on red base over distal extremity

    • May become hemorrhagic

    • Usually less than 20 total lesions

  • Tenosynovitis

  • Gonococcal arthritis

  • Endocarditis risk


Neisseria gonorrhoeae6
Neisseria gonorrhoeae

  • Complications

  • PID

  • Systemic Gonorrhea

  • Chronic Arthritis

  • Neonatal Gonorrhea

    • Gonorrheal conjunctivitis

  • Preterm labor


Neisseria gonorrhoeae7
Neisseria gonorrhoeae

  • Labs

  • Gram stain: Urethral /cervical smear

    • Numerous WBCs

    • Gram negative biscuit-shaped diplococci

      • False positive Gram stain (saprophytic Neisseria)

  • Gonorrhea culture and Sensitivity

  • Antigen Testing (e.g. Gonozyme)

    • Indicated in symptomatic men

    • Inaccurate in other populations

  • DNA probe testing

    • Rapid: 30 minutes

    • Sensitivity: 85-100%

    • Specificity: 99-100%


Neisseria gonorrhoeae8
Neisseria gonorrhoeae

  • Management: Drug Resistance

  • Tetracycline resistance: 17-23%

  • Penicillin resistance 15-19%

  • Emerging Fluroquinolone resistance

  • No resistance to 3rd generation cephalosporins

    • Ceftriaxone (Rocephin)

    • Cefixime (Suprax)

  • Azithromycin requiring higher dosages for some GC

  • References


Moraxella catarrhalis
Moraxella catarrhalis

  • Diagnosis

    • Represents less than 5% of all pneumonias

    • More common in COPD

    • Lobar consolidation is rare


Moraxella catarrhalis1
Moraxella catarrhalis

  • Labs

    • Gram stain

    • Kidney bean shaped gram negative diplococci

  • Radiology

    • Chest xray

    • patchy bronchopulmonary infiltrate


Moraxella catarrhalis2
Moraxella catarrhalis

  • Management: Antibiotic

  • Amoxicillin-clavulanate (Augmentin)

  • Second generation Cephalosporin (e.g. Cefuroxime)

  • 3rd generation Cephalosporin (e.g. Cefotaxime)

  • Erythromycin

  • Azithromycin (Zithromax)

  • Clarithromycin (Biaxin)

  • Trimethoprim Sulfamethoxazole (Bactrim or Septra)

  • Doxycycline


Gram negative obligate intracellular parasites
Gram Negative Obligate Intracellular Parasites

  • Rickettsia

  • Ehrlichia

  • Coxiella

  • Rochalimaea (not obligate intracellular)


Rickettsia
Rickettsia

  • Genus: Rickettsia

  • Typhus Group

    • Rickettsia prowazekii (epidemic typhus,louse)

    • Rickettsia mooseri

  • Spotted Fever Group

    • Rickettsia rickettsii (rmsf,tick)

  • Scrub Typhus Group

    • Rickettsia tsutsugamushi (scrub typhus,)


Rickettsia rickettsii
Rickettsia rickettsii

  • Pathophysiology

  • Transmission: Tick bite

  • Infects blood vessel walls

    • Endothelial cells

    • Smooth muscle cells

  • Rickettsia rickettsii is causative organism

    • Small pleomorphic organism

    • Obligate intracellular parasite


Rocky mountain spotted fever
Rocky Mountain Spotted Fever

  • Epidemiology

  • Bimodal age distribution

    • Ages 5 to 9 years old

    • Age over 60 years old

  • Endemic area

    • North America

      • Atlantic coast states

      • Midwest

    • Central America

    • South America


Rocky mountain spotted fever1
Rocky Mountain Spotted Fever

  • Symptoms (follows seven day incubation)

  • Fever

  • HA

  • Myalgias

  • Malaise

  • vomiting


Rocky mountain spotted fever2
Rocky Mountain Spotted Fever

  • Signs: Rash (occurs in 90% of patients)

  • Onset in first week of illness

  • Characteristics

    • Initial: Blanching Macules 1 to 4 mm in diameter

    • Later: Macules transition to Petechiae

  • Distribution

    • Onset: Wrists and Ankles

    • Later: Trunk, Palms and Soles

  • Labs


Rocky mountain spotted fever3
Rocky Mountain Spotted Fever

  • Labs

  • CBC

    • WBC normal or slightly decreased

    • Thrombocytopenia

  • Liver transaminases increased

    • AST /ALT

  • Serum sodium -Hyponatremia

  • Cerebrospinal Fluid

    • CSF pleocytosis w/monocytic predominance

  • Rickettsia Serology

    • Positive 7 to 10 days after symptom onset

    • Used for confirmation, not for diagnosis


Rocky mountain spotted fever4
Rocky Mountain Spotted Fever

  • Management

  • Antibiotic Course

    • Minimum course: 5 to 7 days

    • Continue antibiotics until afebrile for 2 days

  • Antibiotics

    • Doxycycline or Tetracycline or

    • Chloramphenicol


Rocky mountain spotted fever5
Rocky Mountain Spotted Fever

  • Complications

  • Encephalitis

  • Noncardiac pulmonary edema

  • ARDS

  • Cardiac arrhythmia

  • Coagulopathy

  • GI bleeding

  • Skin Necrosis


Rocky mountain spotted fever6
Rocky Mountain Spotted Fever

  • Prognosis

  • Untreated:

    • 25% Mortality within 8 to 15 days

  • Treated:

    • 5% Mortality


Ehrlichia
Ehrlichia

Ehrlichia sennetsu

  • Ehrlichia canis


Coxiella
Coxiella

  • Coxiella burnetii – Q fever, no arthropod vector cattle,sheep, goats, inhallation of dust with dried feces urine or milk


Rochalimaea not obligate intracellular
Rochalimaea (not obligate intracellular)

  • Rochalimaea quintana (trench fever seen in military settings)


Chlamydia

Eye Diseases

Trachoma

Inclusion conjunctivitis

Genitourinary Disease

Lymphogranulmoa venereum

Urethritis

cervicitis

Salpingitis

Respiratory

Chlamydia pneumonia in newborns

Other

Chlamydia psittaci (Human psittacosis)

Bird borne zoonosis

Respiratory illness or typhoidal illness

Chlamydia pneumoniae

pneumonia

Chlamydia


Chlamydia trachomatis
Chlamydia trachomatis

  • Epidemiology: Very Prevalent

  • Asymptomatic teenage female test positive: 5-10%

  • Sexually active persons: 10%

  • Chlamydia 6 to 10 times more common than Gonorrhea

  • Incidence: 3-5 million cases/year


Chlamydia trachomatis obligate intracellular organism
Chlamydia Trachomatis (obligate intracellular organism)

  • Cause

    • Chlamydia Trachomatis (obligate intracellular organism)

  • Complications

    • PID

    • Infertility

    • Preterm labor

  • Perinatal transmission to newborn

    • Chlamydia conjunctivitis

    • Neonatal pneumonia


Chlamydia trachomatis obligate intracellular organism1
Chlamydia Trachomatis (obligate intracellular organism)

  • Symptoms: Women

  • Vaginal d/c

  • dysuria

  • Pelvic pain

  • Untreated infections may persist for months

  • Usually asymptomatic

  • Urethritis

    • Dysuria-Sterile pyuria Syndrome

    • Persistent dysuria and pyuria

    • Negative urine culture


Chlamydia trachomatis obligate intracellular organism2
Chlamydia Trachomatis (obligate intracellular organism)

  • Symptoms: Men

  • Urethritis

  • Often symptomatic

  • Associated Conditions: Reiter’s Syndrome in Men

  • Arthritis

  • Conjunctivitis

  • Urethritis


Chlamydia trachomatis obligate intracellular organism3
Chlamydia Trachomatis (obligate intracellular organism)

  • Management

    • Refer all sexual contacts for treatment

  • First Choice

    • Azithromycin 1 gram PO for 1 dose

    • Doxycycline 100 mg PO bid for 7 days

  • Alternatives

    • Ofloxacin 300 mg PO bid for 7 days

    • Erythromycin 500 mg PO qid for 7 days

    • Erythromycin Ethylsuccinate (EES)

      • Dose: 800 mg PO qid for 7 days

    • Amoxicillin 500 mg PO tid for 7 days

    • Clindamycin 450 mg PO qid for 14 days


Chlamydia trachomatis obligate intracellular organism4
Chlamydia Trachomatis (obligate intracellular organism)

  • Pregnancy

    • Azithromycin 1 gram PO as single dose

    • Erythromycin OR EES as above for 7 days

    • Amoxicillin 500 PO tid x7 days (Only 50% effective)

  • Neonates (conjunctivitis or pneumonia)

    • Erythromycin for 14 days



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