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Respiratory Tract Infections gastritis

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Respiratory Tract Infections gastritis

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									                                Respiratory Tract Infections

                            Major Types and Major Etiologies

Upper Respiratory Tract Infections (URI):
 Common cold       (Children)              Parainfluenzavirus & Coronaviruses
                   (Adult)                 Rhinoviruses > others

                   Winter>Summer           person-person spread (esp hand contact)
                   No fever or mild fever (mainly in kids)

 Pharyngitis
     < 3 yr and adults                    Viruses (Rhino-, Adeno-, Coronaviruses)
     Children 5-15 yr youngadults         Strep pyogenes (Group A) less int adults
                                          Mycoplasma pneumoniae
                                          EBV
     5-15 yr children, usually not adults Enteroviruses (community outbreaks)
     Non-immunized                        Corynebacterium diphtheriae
     All                                  Influenzaviruses A, B, C

 Laryngitis
    Hoarseness with concurrent URI (can include Moraxella catarrhalis/.TB)

 Sinusitis
    Often mixed including anaerobes and sometimes fungi

 Otitis media (in children almost always)
   Strep pneumoniae, non-typable Haemophilus influenzae, Moraxella catarrhalis

 Tracheobronchitis
                 Viral
                    Adult – adeno, parainfluenza, influenza
                    Children RSV
                 Bacterial
                    Bordetella pertussis, Mycoplasma, Chlamydia
  In COPD different causes – more like pneumonia
                    Nontypable H. influenzae, Strep pneumoniae (not easily cleared)

 Croup
  Stridor and “seal’s bark”. Children < 3 yr, parainfluenzaviruses
                                Respiratory Tract Infections

                            Major Types and Major Etiologies

Lower Respiratory Tract Infections (URI):
Pneumonia (inflammatory disease involving lung parenchyma)

 Typical (rapid onset of chills, fever, dyspnea, pus in sputum)
   Strep pneumoniae                         (common post-viral)
   Klebsiella pneumoniae
   Haemophilus influenzae
   Moraxella catarrhalis
   Staph aureus                             (common post-viral)

 Atypical (gradual onset)
   Mycoplasma,
   Chlamydia,
   Legionella

 Viral pneumonia
  Not so common in adults (except bad influenza)
  but seen in children (esp RSV and influenza)

 ARDS
  VZV
  Adenovirus
  Hantavirus (deer mouse contact)

 TB (depends on exposure risks on the whole: though worse in AIDS)

 Immunosuppressed
   Many etiologies including CMV, Fungi, Actinomycetes (Nocardia)
Causes of pneumonia


   Newborn (0-6 wks)                     Strep Group B + E. coli
   Children (6 wk-18 yr)                 Viruses (RSV)
                                         Mycoplasma and Chlamydia
                                         Strep pneumoniae
   Adults (18-40 yr)                     Mycoplasma and Chlamydia
                                         Strep pneumoniae
   Adults (45-65 yr)                     Strep pneumoniae
                                         Haemophilus influenzae
                                         Viruses
                                         Anaerobes
   Old adults (>65 yr)                   Strep pneumoniae
                                         Viruses
                                         Anaerobes
                                         Haemophilus influenzae
                                         Gram-negative rods
                                           (Entereobacteriaceae and Pseudomonas)
   Nosocomial                            Gram-negative rods
                                         (e.g. Klebsiella pneumoniae + Pseudomonas)
                                         Staphyloccus aureus
                                         Drug-resistant bacteria
   Immunocompromised                     Gram-neg rods
                                         Strep pneumoniae
                                         Fungi (Crypto, Pneumocystis, Aspergillus)
                                         Actinomycetes (Nocardia)
                                         Viruses

Alcoholics (Anaerobes, Strep pneumo, Klebsiella)
Gross aspiration (Anaerobes)
Neutropenia (Aspergilllus)
i.v. drugs (Staph aureus)
Travel history with/without immunosuppression (Histo, Blasto Cocci) but look at
morphology
                                  Urogenital tract infections

Urinary tract infections (UTIs)
 Mainly E. coli ( also Proteus and Klebsiella)
 Gram pos cocci mainly Staph saprophyticus (also Enterococcus)
 Increase in women and during pregnancy

 Obstructive (urinary stasis) and catheters –
  mixed infections E coli, Proteus
  Skin microbes seen in catheterized (Candida Staph epi)


STDs (Exudative, Inflammatory lesions)
 Urethrits, cervicitis               gonorrhea
                                     Chlamydia (non-gonococcal urethritsis/cervicitis)
                                     Mycoplasma genitalium
 Vaginitis                           Trichomonisasis
                                     Candidiasis

STDs (Non exudative)
   Syphilis                   painless ulcer
   Herpes (HSV-2>> HSV-1) painful, vesicles
   Chancroid (Haemophilus ducreyi)
   Lymphogranulona venereum (Chlamydia trachomatis)
   Genital warts (papillomaviruses)

STDs (Infections)
 HIV?AIDS
 Pelvic inflammatory disease (mixed microbes often including Neisseria gonorrhoeae,
                                          Chlamydia trachomatis, anaerobes)
 HBV

Cancer
 Cancer or cervical neoplasia due to HPV
 Kaposi’s sarcoma (human herpesvirus 8)
                           Gastrointestinal and Liver infections


Chronic gastritis (ulcer)
  Stomach/abdominal pain: improves after mea, no diarrhea          Helicobacter pylori

Food poisoning (preformed toxins with rapid onset))
                  Nausea and vomiting (+/- diarrhea)      Bacillus cereus
                                                          Staph aureus

                   Weakness (longer 12-24 h incubation) Botulism

Acute infectious gastroenteritis
       Secretory diarrhea (watery with few fecal leukocytes)

                   E. coli (ETEC, EPEC, EAEC)
                   Vibrio. cholerae
                   Norovirus (Norwalk)
                   Rotavirus
                   Giardia
                   Cryptosporidium

Dysentery (signs of true invasion)
      Colonic pain, Diarrhea, Bloody feces often containing many white cells

                   Campylobacter
                   Salmonella
                   Shigella
                   Yersinia enterocolitica
                   EIEC Enteroinvasive E coli
                   Entamoeba histolytica
                   Strongyloides (larvae in feces, autoinfective)
                   Clostridium difficile (often post-antibiotic, pseudomembrane)
                          High temp killing of spores is necessary

Hemorrhagic colitis
     Colonic pain, Diarrhea, seriously bloody feces but few white cells, HUS

                   EHEC (E. coli O157:H7 and a few other serotypes)
                   Salmonella
                   Shigella
Gastrointestinal infections (cont.)

Enteric fever - Salmonella typhi (typhoid fever)
               Salmonella paratyphi (paratyphoid fever)
 Infection via small intestine but systemic illness (Bacteria found in bone marrow)


Chronic Yersinia enterocolitica (terminal ileitis/pseudoappendicitis in ~1/4 patients) can
persist months. Most times patients have simple enterocolitis with 1-2 weeks of pain


Chronic diarrhea in AIDS : wateru diarrhea from small intestine

 Cryptosporium
 Microsporidium species (protozoan parasites – allied to fungi)
 Cyclospora
 CMV
 Mycobacterium avium complex




Hepatitis:
 Jaundice (remember icteric sclera), fatigue, often abdominal pain, loss of appetite

 Blood HB, HCV, HDV (delta agent) - cause chronic infections

 Gut     HAV, HEV acute infections that resolve

 Parasites (Schistosoma, hydatid cyst (Echinococcus)


Liver abscess (Amebiasis, TB lesion might be ahydatid cyst if history suggests)
Nervous System

Bacterial Meningitis
   Newborn (0- 3 months)                   Strep Group B +
                                           E. coli
                                           Listeria monocytogenes
   Infants Children (3 months-18 yr)       Strep pneumoniae
                                           Neisseria meningitides
                                           Haemophilus influenzae type b (not immunized)
   Adults (18-50 yr)                       Strep pneumoniae
                                           Neisseria meningitidis
   Older Adults (> 50 yr)                  Strep pneumoniae
                                           Listeria
                                           Gram neg rods (Klebsiella, Pseudomonas)

 Head trauma (any age)

                                           Staph aureus
                                           Strep pneumoniae
                                           Anaerobes

 Immunosuppressed           (additional)    Listeria
                                           Gram-negative rods
                                            (Klebsiella and Pseudomonas)
 AIDS                                      Cryptococcus
                                       Note Toxoplasma causes ring-enhancing lesion in CNS,
                                            not a meningitis
Skin and Wound and Soft tissue

Impetigo (vesicles with purulent contents)
   Staph aureus and Strep (Group A)
   Staph may cause large blisters (bullae)

Erysipelas (dermis and lymphatics inflamed) Lesions show sharp borders.
   Strep (group A)

Cellulitis (all skin layers – fever leukocytosis)
 Group A strep and Staph aureus are most common causes
 Severe progression may lead to gangrene

Necrotizing fasciitis (Group A strep: certain M serotypes are much more common)
   Flesh eating: post chicken pox, post surgery / trauma in majority suggests skin breaks
   enhance access to deeper tissues.

Viruses
 Measles and rubella (maculopapular rash). Rash starts on face and moves down
 .    Measles: Koplik spots on buccal mucosa.
 Chickenpox vesicles - several crops of lesions crusting at different times
 Smallpox lesions tend to be all present at same stage of maturity

Rashes
 Rickettsia such as Rocky Mountain spotted fever. Significant rash (almost always)
 Ehrlichiosis. Rash may be absent
 Lyme disease (bull’s eye and target: spreading rash)

Sporotrichosis      Lymphocutaneous spreading lesions

Ringworm (sepatate hyphae +/- arthrospores in skin)         often itchy
Candida (yeasts and filaments)                              often itchy
Tinea versicolor (clusters of yeast and some filaments: depigmented patches) –
                     no symptoms usually

Scabies (Female mite and eggs within tunnels in epidermis)      itchy
Lice (eggs attached to hair)                                    itchy
Pinworm (eggs on anal skin- Scotch tape test)                   itchy

								
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