Vol.3-Ch.10 "Infectious Diseases and Sepsis" Flashcards
(77 cards)
1
Q
What is the first individual to introduce an infectious agent called?
A
The Index Case
2
Q
What are normal flora?
A
The normal bacteria in our body that don’t cause problem and are a part of our Host Defenses and produce an environment that is not livable for pathogens
3
Q
What are Opportunistic Pathogens?
What are Pathogens?
A
Opportunistic Pathogens are ordinarily non harmful bacteria that cause disease only under unusual circumstances.
Pathogens are disease producing microorganisms
4
Q
What are bacteria?
A
They are microscopic single celled organisms. They are classified as Prokaryotes b/c they do not have a distinct nuclear membrane and possess only one chromosome in the cytoplasm. They reproduce independently but require a host for nutrients.
They are easily identified by their staining or appearance under a microscope
5
Q
What is the Gram Stain test?
A
It is the most common method of differentiating different bacteria.
If PURPLE it is POSITIVE
If RED it is NEGATIVE
6
Q
What are the 3 appearance categories of bacteria?
Which are Gram Stain positive or negative?
A
- Cocci or Spheres (Staphylococci, Streptococci) are
round and are Gram Positive - Rods (Enterobacter sp., E. Coli) are elongated and are
Gram Negative - Spirals (Spirochetes, Vibrio) are coiled
7
Q
Exotoxin VS Endotoxin
A
- Exotoxin:
are poisonous proteins shed by bacteria during
bacterial growth. They are more dangerous of the 2.
The body CAN create antibodies against this, but heat
also destroys these - Endotoxin:
consist of proteins, polysaccharides, and lipids. They
come from the bacterial cell wall and are released
when the bacterial cell is destroyed. The body
CANNOT create antibodies against this unless BOTH
the protein and polysaccharide portions are present.
ONLY gram negative bacteria make endotoxins.
8
Q
Bactericidal VS Bacteriostatic Antibiotics?
A
Bactericidal Antibiotics kill bacteria
Bacteriostatic Antibiotics inhibit bacterial growth and reproduction
9
Q
What are Viruses?
A
Viruses are much smaller than bacteria and require an electron microscope instead of just a microscope.
They cannot reproduce themselves and therefore must get inside a host cell and take it over so that it can make the cell itself grow and produce other virus bodies. This is why they are called OBLIGATE INTRACELLULARPARASITES (not prokaryotes or eukaryotes).
B/c they live inside a host cell it resists antibiotics and makes it hard to kill b/c it will also kill the cell.
A common one is the common Cold
10
Q
What are Prions?
A
A new class of disease producing agents that are referred to as “slow viruses”. They are not prokaryotes or eukaryotes but are actually protein particles that fold in a way that Proteases (enzymes that break down proteins) cannot act on them.
These collect in the nervous system and brain tissue, destroying them and giving them a spongy appearance on gross examination.
Remember this is what causes they Creutzfeldt-Jakob disease
11
Q
What are Fungi?
A
They are plant like microorganisms that are mostly not pathogenic. Examples are yeast, mold, and mushrooms. Usually not a problem unless the pt has HIV or is taking a lot of antibiotics that kill the normal flora and allow an environment that does not inhibit fungal growth
12
Q
What are Protozoa?
A
Single celled parasitic organisms with flexible membranes and can MOVE. Most live in soil and ingest decaying organic matter. May enter the body through fecal-oral route or mosquitos. Causes malaria and form of gastroenteritis
13
Q
What are Parasites?
A
Common where sanitization is very poor. Round worms live in the intestinal mucosa. Diagnosis is done by finding eggs in stool
14
Q
What are Pinworms?
A
Common in Civilized countries. Tiny worms that live in the distal colon and crawl onto anal mucosa to lay eggs while the host sleeps. Typically only cause an itchy butt but is very contagious and runs rampant in institutionalized kids. One rounds of antibiotics usually kills them
15
Q
What are Hookworms?
A
They hook onto barefeet and travel to the intestines where they grip and irritate the intestinal wall and feed on blood. Epigastric pain and anemia are possible
16
Q
What is Trichinosis?
A
Contracted through raw or poorly cooked pork. The females lay thousands of eggs that travel to the skeletal muscle and each creates a cyst that stays. Causes GI disturbances, edema (especially in eyelids), fever, and others. Death may result if they travel to the heart, lungs, or brain
17
Q
What are infectious RESERVIOIRS?
A
Animals, humans, insects, and the environment
18
Q
What are the 2 basic ways that diseases can spread?
A
- Direct:
cough, sneeze, kiss, or sexual contact - Indirect:
Received from environment like touching a doorknob,
handrail, or keyboard
19
Q
Communicable VS Contamination VS Infection
A
Communicable is the ABILITY of diseases to be transmitted
Contamination is when the agent only exists on the surface of the host
Infection is when the agent actually penetrates the host
20
Q
What are the 5 things that infection probability depends on?
A
- Correct mode of entry
- Virulence (the disease’s strength or ability to infect
and overcome the body’s defenses - Number of organisms Transmitted (dose)
- Host Resistance
- Other host factors (age, status, population, travel
tendency, ect)
21
Q
Latent Period VS Communicable Period VS Incubation Period
A
Latent Period is when the pt is first infected and CANNOT infect others
Communicable Period is the pt may now start to show symptoms and CAN infect others
Incubation Period is the time between exposure to presentation of S&S
22
Q
Seroconversion VS Window Phase VS Disease Period
A
Seroconversion is when a person takes a test for antibodies developed against a disease to see if it is present, sometimes a person has the disease and tests negative but then later the antibodies form and then the test becomes positive; this is Seroconversion
Window phase is the time between exposure and Seroconversion (or the development of antibodies)
Disease Period is the time from onset of symptoms until the resolution of the disease normally or death of host
23
Q
What are the three major body defense systems?
A
- Immune system
- Complement system
- Lymphatic System
24
Q
Lymphocytes are in charge of what respose?
A
Cell mediated and Humoral
Cell mediated uses T lymphocytes and does not end in antibody production but Humoral uses B lymphocytes and does end in antibody production (autoimmunity is the dark side of humoral immunity).
25
Immunoglobulins M, A, D, G, & E
- IgM:
formed early in most immune responses
- IgA:
the main one in exocrine excretions
- IgD:
present on surface of B lymphocytes and acts as an antigen receptor
- IgG:
remembers an antigen and recognizes any repeated
invasions. it has the principal immunoglobulin in
human serum and is the major class of
immunoglobulin in the immune response. it crosses
the placental barrier from mother to fetus and is
important in producing immunity prior to birth.
- IgE:
attach to mast cells in the respiratory and intestinal tract. plays major role in allergic reactions. allergy pts usually have an increased amount
26
What is the Complement System?
It is about 20 proteins that work with antibody formation and inflammation to combat infection. It responds to by recognizing surface complex molecules (endotoxins) from Gram-Negative bacteria. It results in acute inflammation, helps phagocytosis, and outright killing certain bacteria
27
What is the Reticuloendothelial System (RES)?
It is the name given to the collection of involved cells in the immune response b/c their locations are so widely scattered throughout the body.
28
A pts Resistance is the combination of _____x6 at work defending against present and future infection
Cell mediated immunity, humoral immunity, complement system, lymphatic system, the leukocytes, and all the working cells of the RES
29
What are the 4 phases of prehospital care preparation for in infectious pt?
- Preparation for response
- response
- patient contact
- recovery
30
What are the 4 levels of decontamination?
- Low-Level Disinfection:
Used for routine housekeeping and cleaning and
removing visible body fluids. Destroys most bacteria
and some viruses and fungi. It does NOT kill
Mycobacterium tuberculosis or bacterial spores. Most
EPA-registered disinfectants are usable for this
- Intermediate-Level Disinfection:
This DOES destroy Mycobacterium tuberculosis but
NOT bacterial spores. Use for all equipment that
came into contact with skin. Can use EPA-registered
disinfectants/chemical germicides, Hard surface
germicides, or a 1:10 to 1:100 dilution of water and
chlorine bleach
- High-Level Disinfection:
Destroys all forms of microorganisms except certain
bacterial spores. Required for all reusable devices
that have come into contact with mucous membranes.
Done by immersing object for 10 to 45 seconds into
EPA approved chemical sterilizing agent or for 30
seconds in hot water
- Sterilization:
Destroys all microorganisms and is required for all
invasive equipment. Usually done via autoclave in a
hospital or soaking for 6-10 hours in EPA approved
chemical sterilizing agent
31
What is the Ryan White Act?
It is an act that gives an exposed employee the right to request the pts infectious status to know if they are at risk of contracting anything. However, if the pt does not know you CANNOT force them to be tested.
32
Employers are required to provide _____ following an employee exposure to an infectious disease?
Employers are required to provide testing and treatment as well as counseling following an employee exposure to an infectious disease?
33
What is HIV/AIDS?
It is not a disease per se but a collection of S&Ss that share common anatomic, physiologic, and biochemical derangements in the immune system. It is a RETROVIRUS which means that it carries it's genetic material in RNA and uses an enzyme called Reverse Transcriptase to use RNA to synthesize DNA (this is opposite of normal), this is how it is able to become permanent.
There are actually 2 types; HIV-1 and HIV-2, most research is on HIV-1 which is more pathogenic of the two.
HIV specifically targets T lymphocytes with the CD4 marker (a surface molecule that attaches the virus to the cell). This is actually how the disease severity is tracked, by watching the number of CD4 markers. The less there are of T lymphocytes with CD4 the worse the disease and symptoms got.
This disease is not curable but treatable to the extent pts can live relatively normal lives and for almost normal lifespans
It is spread via blood and ALL body fluids(except spit or snot) and it mostly spread by sex or needles. It can get in through breaks in the skin, mucous membranes, eyes, or placental transmission
A common sign of severe stage is the development of KAPOSI'S SARCOMA (cancerous purplish lesions)
Recommended testing is for CD4 count and Viral Load (the number of copies of the HIV virus in the pts blood)
S&S:
- Mono like symptoms of fatigue, fever, sore throat, lymphadenopathy (lymph node disease), splenomegaly (enlarged spleen), rash, and diarrhea
34
What is Hepatitis?
It is inflammation of the liver for any cause (viruses, bacteria, parasites, alcohol, or meds). But viruses are the most common. mid to late stages are marked by jaundice, dark urine, and clay colored stool
S&S:
- headache
- fever
- weakness
- joint pain
- anorexia
- nausea/vomiting
- RUQ abd pain
35
What is Hepatitis A?
AKA Infectious or Viral Hepatitis
Transmitted via Fecal-Oral route
Can last on unwashed hands for up to 4 hours, Pts are usually asymptomatic.
There IS a vaccine
36
What is Hepatitis B?
AKA Serum Hepatitis
Transmitted via Body fluids and Blood; it is much more contagious than HIV; causes joint pain and rash more than the others
Can last on surfaces up to 7 days
There IS a vaccine
37
What is Hepatitis C?
Transmitted via Body fluids and Blood; Primarily transmitted by IV drug abuse and sexual contact.
Often causes liver fibrosis which evolves into cirrhosis over decades
There is NO vaccine
38
What is Hepatitis D?
Transmitted via Body fluids and Blood
Depends on the surface antigen of Hep B in order to produce it's structural protein shell. This makes the symptoms of hep B much more severe and acute
39
What is Hepatitis E?
Transmitted via Fecal/Oral route, mostly via contaminated water and is highest in pregnant women
There is NO vaccine
40
What is Tuberculosis?
It is the most preventable adult infectious disease; it involves the bacteria collectively called Mycobacterium Tuberculosis Complex.
It primarily involves the respiratory system including a highly contagious form in the larynx.
This disease has the ability to become drug resistance, especially in early treatment with just one drug. That is why it is important to treat with several drugs.
It is primarily spread through airborne respiratory droplets but can also be contracted from mucous membranes, broken skin, or contaminated milk. Animals that also carry it are cattle, swine, badgers, and primates.
The Purified Protein Derivative (PPD) skin test identifies candidates for drug therapy but a positive test result actually means that the person DID have it but it is NOT active or dormant when the test was given.
S&S:
- chills
- fever
- fatigue
- chronic cough
- weight loss
- night sweats that "drench" bed
41
Where does N95 masks get its name?
B/c the N series respirator must filter 95% of 0.3 microns
42
What is Pneumonia?
It is acute inflammation of the lungs, and is not a single disease but several. Most commonly present is Streptococcus Pneumoniae, a Gram-Positive sphere found in pair chains.
It is spread through droplet nuclei and contact with linens soiled with respiratory secretions or direct contact
B/c of the fluids in the lungs from the inflammation the alveoli change acoustic properties to those of solid tissue, this is called CONSOLIDATION
There is Immunization available against it
S&S: (acute onset)
- high fever
- chills
- dyspnea
- chest pain worsening on deep insp
- productive cough with phlegm of various color
43
What is Severe Acute Respiratory Syndrome (SARS)?
It is a Viral respiratory illness, the virus is called SARS-associated Coronavirus (SARS-CoV)
Coronaviruses play a major role in upper resp tract infections and the common cold. It can last on surfaces for days and spreads via direct contact or by resp water droplets in close person to person contact.
SARS pts are considered to be contagious so long as they have symptoms; Pts should quarantine for 10 days until fever and symptoms have dissipated.
S&S:
- sore throat
- rhinorrhea (runny nose)
- chills
- rigors (sudden paroxysmal chills)
- myalgias (muscle aches)
- headache
- diarrhea
44
What is Middle East Respiratory Syndrome (MERS)?
This is very similar to SARS and is caused by the virus MERS-CoV (MERS-coronavirus).
Most deaths are caused by secondary pneumonia and acute renal failure
45
What is Ebola Virus Disease (EVD)?
There are 4 types and early signs are fever an abdominal pain.
It can be spread via direct contact with broken skin and mucous membranes of blood or any other body fluids.
Primates and fruit bats also carry the disease
Any pt contact with expected EVD should be assessed from at least 3 ft away
B/c this disease ends with unexplained hemorrhaging, fluid control as well as airway and O2 control is needed
S&S:
- fever
- severe headache
- loss of appeitie
- joint/muscle pain
- weakness/fatigue
- vomiting
- diarrhea
- abd pain
- unexplained hemorrhaging
46
What is the Zika Virus?
Mostly spread through mosquitos, specifically the Aedes species, but there is evidence of mother to fetus transmission or sexual contact as well.
Fatality is rare and most are asymptomatic. Fetus' infected can develop birth defects
S&S:
- rash
- fever
- joint pain
- headache
- conjunctivitis
47
What is Chikungunya Virus?
Also spread by Aedes species of mosquito.
S&S:
- Fever (most common)
- joint pain (most common)
- headaches
- muscle pain
- joint swelling
- rash
48
What is Chickenpox (Varicella)?
Caused by the virus Varicella Zoster Virus (VZV) and is in the herpesvirus family. Normal and not fatal for kids but can be for adults and about 15% of cases develop into shingles
Transmission occurs via inhalation of airborne droplets and direct contact with weeping lesions or tainted linens. The classic rash is usually the first presentation and contagion ends once those lesions rupture and scab over
Previous contraction of VZV often indicates immunity, or you can get Varivax, the vaccine
S&S:
- Rash (mostly only on face and trunk)
- respiratory symptoms
- malaise
- low fever
49
What is Meningitis?
BRUDZINSKI'S SIGN?
KERNIG'S SIGN?
It is inflammation of the meninges and CSF caused by bacterial and viral infections. The Meningococcal meningitis (spinal meningitis) is of greatest concern.
It asymptomatically colonizes in the upper resp tract and is transmitted via respiratory droplets. Almost everyone has been a carrier at some point but the epithelial lining of the pharynx has prevented access to the CSF preventing entry for the disease.
CAN BE TESTED WITH:
- BRUDZINSKI'S SIGN if positive causes flexion of the
knees and hips when the neck is flexed. Have pt lie
supine on pillow and flex the neck watching for
flexion in knees and hips.
- KERNIG'S SIGN if positive the knee will not be able to
be extended while the hips are flexed. Have pt lie
supine and flex the hips, then try to extend the knee.
S&S: (develop rapidly over hours lik other bacterial inf)
- fever
- chills
- headache
- nuchal rigidity on flexion
- arthralgia
- lethargy
- malaise
- AMS
- vomiting
- seizures
- Petechiae
50
What is Influenza and the Common Cold?
Influenza is named via the type (A, B, or C) and the 2 glycoproteins (along with hemagglutinin and neuraminidase) that determine it's virulence. H and N denote the two glycoproteins so a common name might be A (H1N1). This disease mutates VERY FAST.
Influenza is the leading cause of respiratory disease in the world. It is very easily transmitted and can last on surfaces for hours and is much more serious than the common cold.
S&S: (acute onset)
- fever
- chills
- malaise
- muscle ache
- nasal discharge
- cough
The Common Cold (Viral Rhinitis) is caused by rhinoviruses (there is 200+ types). It transfers via direct contact, airborne drupelets, but mostly via hand and soiled linens.
S&S are similar to influenza making it hard to distinguish but it does not include fever or muscle aches generally
51
What is Avian Influenza?
It is a type of influenza common with birds that usually does not infect humans unless is mutates to merge with a human type influenza. (As happened with the H5N1 virus (Bird Flu) not too long ago)
S&S:
- common influenza symptoms
- conjunctivitis
- pneumonia
- acute resp distess
- viral pneumonia
52
What is the Measles?
It is highly communicable. Transmitted via ineffective droplets and direct contact.
```
S&S:
- severe cold
- fever
- conjunctivitis
- swollen eyelids
- photophobia
- malaise
- cough
- nasal congestion
- Rash of Koplik's Spots (blueish white specks with a
red halo) that first presents on oral mucosa but
spreads over body
```
53
What is the Mumps?
Transmitted via resp droplets and direct contact with saliva. Characterized by painful enlargement of salivary glands.
S&S:
- feverish cold
- swelling and stiffening of parotid glands bilaterally
- earaches
- difficulty chewing/swallowing
54
What is Rubella?
(German Measles)
Is transmitted via inhalation of infected droplet; it is a milder case of the measles. Like measles, it has lifelong immunity after its is beaten. It is normally only severe if transferred to a fetus in the first trimester and will cause birth defects. The MMR vaccine covers this as well as measles and mumps and is given with the vaccine for varicella.
S&S:
- sore throat
- low fever
- fine pink rash
55
What is Respiratory Syncytial Virus?
A common cause of pneumonia and bronchiolitis in infants and children, and in this group it may be fatal as this in combo with one of the two previously listed is much more sever. It is often associated with lower respiratory tract infections.
It starts in the upper airway as just a runny nose and nasal congestion but then moves to the lower airway marked by wheezing, tachypnea, and signs of respiratory distress.
A 1yo or younger with wheezing should be assumed to have this until proven otherwise.
56
What is Pertussis?
"Pertussis" means "violent cough" AKA "Whooping Cough"
Transfers via respiratory secretions or in an aerosolized form, mostly contagious before the paroxysmal phase
Is caused by bacterium Bordetella Pertussis and affects the oropharynx in 3 clinical phases:
- Catarrhal Phase; symptoms like the common cold for
1-2 weeks
- Paroxysmal Phase; fever subsides, development of
mild cough that quickly becomes severe. Consecutive
coughs are followed by a deep high pitched
inspiration making a Whooping noise, that will
produce large amounts of thick mucus
- Convalescent Phase; cough frequency and severity
decrease and the pt is no longer contagious
Has a vaccine called Diphtheria-tetanus-pertussis (DTP)
57
What is Mononucleosis?
Spread via contact (especially saliva aka kissing), is caused by the Epstein-Barr Virus (EBV). Affects the oropharynx, tonsils, and the reticuloendothelial system (the phagocytes).
Characteristically begins with fatigue.
S&S:
- Fatigue
- fever
- sore throat
- oral discharges
- enlarged, tender lymph nodes
- Splenomegaly (enlarged spleen, occurs in 1/2 of pts)
58
What is Herpes Simplex Virus Type 1?
| Type 2?
Type 1 - Transmitted via saliva and infects the oropharynx, face, lips, skin, fingers, and toes. Typically causes some sort of sores or lesions that occur more frequently following periods of stress.
Type 2 is genital herpes
59
What is Epiglottitis?
Inflammation of the epiglottis and possible the areas above or below it. It very dangerous in children with smaller airways.
Pts present with one or more of the 4 D's:
- Dysphonia (hoarseness)
- Drooling
- Dysphagia (difficulty swallowing)
- Distress
60
What is Croup?
AKA Laryngotracheobronchitis and is a common cause of acute airway obstruction in children (full obstruction is rare), if often occurs secondary to upper resp tract infection
Has characteristic notes of inspiratory and expiratory stridor and a seal-bark-like cough
61
What is Pharyngitis?
A common infection of the pharynx and tonsils. Is characterized by sudden onset of sore throat and fever.
S&S:
- sore throat
- fever
- red and swollen palate and tonsils
- enlarged cervical lymph nodes
Strep Throat (Group A Streptococcus) is a serious version that if left untreated can lead to Scarlett fever or rheumatic fever depending on strain. Strep Throat is VERY contagious
62
What is Sinusits?
Inflammation of the paranasal sinuses (ethmoid, frontal, maxillary, or sphenoid). Occurs when mucus or pus cannot drain out and is usually secondary to an upper resp tract infection or allergens.
S&S:
- post nasal drip
- blood tinged or purulent nasal drainage
- sinus pressure (worsens when bending over)
63
What is the Hantavirus?
A virus carried by rodents, particularly the deer mouse but also the rice and cotton rats (not known in common house mice)
Transmitted by inhalation of aerosols created by stirring up the dried urine, saliva, and fecal droppings of these mice. Person to person transition is not possible.
The virus causes Hantavirus Pulmonary Syndrome (HPS)
```
S&S:
(Initial)
- fatigue
- fever
- muscle aches
(Sometimes)
- headaches
- nausea/vomiting/diarrhea/abd pain
(Rarely)
- ear aches
- sore throat
- rash
(Fatality related, severe)
- severe myocardial depression
- lethal rhythms
- hemodynamic compromise
```
64
What is Encephalitis?
Inflammation caused by infection of the brain and its structures
```
S&S: (similar to meningitis)
- Decreased LOC
- fever
- headache
- drowsiness
- coma
- tremors
- stiff neck/back
- seizures (most common in infants)
(characteristic neurological signs)
- incoordinated/involuntary movements
- weakness in arms or legs
- unusual sensitivity of the skin to stimuli
```
65
What is Rabies?
Transmitted in the saliva of the infected animal. It travels along motor and sensory fibers to the spinal ganglia corresponding to the site of invasion then travels to the brain causing encephalomyelitis which is almost always fatal. Mammals are at high risk of infection.
When caring for a bit patient look for bite wound and presence of saliva. Irrigate thoroughly and DO NOT bandage but let it drain freely
```
S&S: (Rabies has characteristic, nonspecific Prodrome
or symptoms that precede the appearance of a
disease)
- malaise
- headache
- fever
- chills
- sore throat
- myalgias
- anorexia
- nausea/vomiting
- diarrhea
```
Once the Encephalitis Phase Begins:
- periods of excessive motor activity, excitement,
agitation
- soon followed by confusion, hallucinations,
combativeness, bizarre aberrations of thought, muscle
twitches and tetany, and seizures. Later focal
paralysis.
- attempts to drink water may cause laryngospasms
producing profuse drooling commonly known as
hydrophobia (fear of water)
- death occurs within 2-6 days if left untreated
66
What is Tetanus?
An acute bacterial infection of the central nervous system. Presents with musculoskeletal sign and symptoms caused by tetanospasmin, an exotoxin of the Clostridium Tetani bacillus. It is present as extremely durable spores in the soil, street dust, and feces
Local S&S:
- rigidity of muscles in close proximity to the injury site
Generalized S&S:
- pain and stiffness in jaw muscles which can progress to the entire body. Respiratory arrest may result.
Rigidity occurs after the toxin is taken up at the myoneural junction and transported to the CNS. Then it acts on inhibitory neurons which normally suppress unnecessary efferent impulses and muscle movements.
67
What is Lyme Disease?
It is a recurrent inflammatory disorder accompanied by skin lesions, polyarthritis, and involvement of the heart and nervous system.
It has 3 stages:
- Early Localized Stage: (3-30 days)
a painless, flat, red lesion appears at the bite site. a ring like rash may present spreading outwards ("bull's eye" rash). Also possibly present is headache, malaise, and muscle aches.
- Early Disseminated Stage:
The bacteria spreads to the skin, nervous system, heart, and joints. More EM lesions develop. At this point a slew of serious life threatening secondary diseases can arise from a cardiac and neuro nature.
- Late Stage (persistent infection): (months to years)
At this point cardiac risks has gone down but the neuro risks are the same and often a monoarthritic of the joints has started
68
Bacterial STDs vs Viral STDs
Bacterial:
- gonorrhea
- syphilis
- chancroid
- chlamydia
Viral:
- HIV
- Herpes
69
What is Gonorrhea?
Caused by Neisseria Gonorrhoeae, a Gram-Negative bacteria. It is one of the most common communicable diseases, transmitted by exudates of mucous membranes primarily from direct sexual contact
Antibodies post infection give some immunity but only to the specific serum, there are other strains that it will not protect against unless contracted
Presents in males with pain on urination and purulent discharge from penis. For women they may get urinary frequency, vaginal discharge (minimal), fever, and abdominal pain; but more importantly infected females are at increased risk for sterility, ectopic pregnancy, abscesses, or peritonitis.
It may become systemic causing sepsis or meningitis. Septic arthritis may cause fever, pain, swelling, or limited range of motion in one or more joints
70
What is Syphilis?
Caused by the spirochete Treponema Pallidum, and is transmitted by direct contact with exudates from other syphilitic lesions of skin and mucous membranes, semen, blood, saliva, and vaginal discharges.
(Needle stick transmission is low)
It is characterized by lesions that can involve any organ or tissue. It usually has cutaneous manifestations with frequent relapses. Immunity does develop after contraction but aggressive antimicrobial therapy may disrupt this.
It occurs in 4 stages:
- Primary Syphilis (first stage); presents with painless
lesion or chancre. It is possible for nontender
enlargement of regional lymph nodes
- Secondary Syphilis (Second stage); aka the
bacteremic stage that starts 5-6 weeks after the
chancre heal. It is characterized by maculopapular
skin rash (small, flat, red lesions) on the palms and
soles, condyloma latum (painless, wart-like lesions on
warm, moist skin area that are very infectious), and
cutaneous infection in areas of hair growth. These last
for about 6 weeks. CNS disease (syphilitic meningitis)
are arthritis may also occur as well as infection of the
eyes and kidneys
- Latent Syphilis (third stage); symptoms improve or
disappear and may last months to years.
- Tertiary Syphilis (fourth stage); "great imitator", lesions with sharp borders called Gummas may appear on skin and bones causing severe pain. It can also lead to cardiovascular syphilis that causes aortic aneurysms that antibiotics wont help. Can also cause a stroke or meningitis
71
What is Chlamidia?
It is an intracellular parasite with an inner and outer membrane that contains both RNA and DNA making it vulnerable to antibiotics. It lacks peptidoglycan, a net polysaccharide found in all true bacterial walls, thus it is not considered a true bacteria or virus.
It is the most clinically significant STD b/c it affects the genitals, eyes, and respiratory system. S&S are similar to gonorrhea but less severe. For women it can cause sterility or may infect newborns causing pneumonia or blindness.
It is spread via sexual contact or hand to hand transfer of eye secretions (which would also cause conjunctivitis). It is known to be the internationally leading cause of preventable blindness.
72
What is Trichomoniasis?
It is often seen in combo with gonorrhea, and is a protozoan parasite that often causes vaginitis in women. It causes a greenish-yellow discharge and irritation of the perineum and thighs, and dysuria. Men are often asymptomatic carriers.
73
What is a Chancoid?
A highly contagious ulcer caused by bacteria. It causes a painful, inflamed pustule or ulcer that appears on the penis, anus, urethra, or vulva but can spread to thighs or fingers if contacted.
74
What are Nosocomial Infection?
Hospital acquired diseases. VRE and MRSA are big ones and very harmful to pt
75
What is Sepsis?
It is a whole body inflammatory response called Systemic Inflammatory Response Syndrome (SIRS).
It occurs in response to a known or unknown infection (usually bacterial).
It is the 10th leading cause of death in the world but 1st for debilitated pts in hospital intensive care units.
The people most at risk are:
- people with immunosuppressants
- pts that are hospitalized
- pts with preexisting infections or medical conditions
- people with severe trauma
- people with genetic tendencies towards sepsis
- very old or young
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A pt is said to have sepsis if they have 2 or more of the following _____?
What about severe sepsis?
Septic Shock?
Pt is SEPTIC if has 2 or more of the following:
- Heart rate greater than 90
- Abnormal body temp greater than 100.4 or lower than
96.8
- Tachypnea greater than 20 breaths per minute or a
PaCO2 of less than 32mmHg
- Abnormal white blood cell count less than 4k or
greater than 12k
SEVERE SEPSIS is when the pt has sepsis AND signs of hypoperfusion
SEPTIC SHOCK is if the pt has severe sepsis AND one of the two following:
- Mean systemic blood pressure below 60mmHg
- The maintenance of MAP above 60mmHg requires
vasopressors
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How do you manage a pt with sepsis?
With Early Goal-Directed Therapy (EGDT) which includes:
- Supp O2 with or without intubation
- Fluid Resuscitation
- Maintenance of systolic BP above 90mmHg with
vasopressors
- Admin of broad-spectrum antibiotics
