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Bacterial Infections Part 2

by Phoebe on February 17, 2015

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Cholera

Cholera

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Cholera

Things you should know

  • The Ghost Map by Steven Johnson
    Vibrio cholerae – Gram negative, comma shaped with a single flagellum
    Fecal oral route
  • Common in places with poor sanitation and crowding
  • Toxin produced by the bacteria results in hypersecretion of water and Chloride.

Signs and Symptoms

  • “Rice water” diarrhea and lots of it! 10-20 liters (3-5 gallons) per day!
  • Dehydration
    • Rapid heart rate
    • Loss of skin elasticity
    • Dry mucous membranes, to include the inside of the mouth, throat, nose, and eyelids
    • Low blood pressure
    • Thirst
    • Muscle cramps

Diagnosis

  • Physical assessment
  • Stool cultures
  • Cholera dipstick tests

Treatment

  • Fluids!!  Oral is sufficient most cases
  • Electrolyte replacement
  • Intravenous fluids – for severely dehydrated affected people
  • Self limiting, but antibiotics will speed up recovery and shorten the course.
    • Doxycycline
    • Azithromycin

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Bacterial Infections

by Phoebe on February 4, 2015

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Strep

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Streptococcus

Things you should know

  • Gram positive, cocci in chains, catalase positive

Pharyngitis

  • The majority of pharyngitis is caused by viral infections
  • The most important bacteria here is strep pyogenes

I came in to see my physician assistant today because of…

  • Sudden onset of sore throat
  • Odynophagia
  • Fever / Chills

Physical exam

  • Fever
  • Tonsillopharyngeal erythema
  • Exudates
  • Beefy red swollen uvula
  • Tender anterior cervical lymphadenopathy
  • Petechiae on the palate

Diagnosis

  • Very difficult to clinically distinguish the viral vs bacterial
    • Viral signs include rhinorrhea, cough and hoarseness
  • Rapid antigen test and cultures should be used for diagnosis

Treatment

  • Antibiotic treatment should only be used for confirmed cases.
  • Typically self limiting however treatment is recommended to decrease the risk of rheumatic fever
  • Penicillin x 10 days is first line
  • Amoxicillin x 10 days – tastes better and is easier to give to kids.

Scarlet Fever

  • Strep throat with a rash
    • Diffuse erythema
    • Blanches
    • Fine papules (Sandpaper rash)
    • Circumoral pallor
  • Strawberry tongue

Cellulitis

  • Painful erythema
  • Borders a visible but not well defined
  • Group A strep are the number one cause of cellulitis in the U.S.
  • Treatment  – penicillin

Impetigo

  • Increased risk with poor hygiene
  • Golden or honey crusted lesions
  • Very contagious – think  preschools
  • Treatment
    • Cleaning the wounds
    • Augmentin

Erysipelas

Things you should know

  • More superficial than cellulitis
  • Strep pyogenes

I came in to see my physician assistant today because of…

  • Possible history of sore throat
  • Fever malaise
  • Rash
    • Historically found on the face but now most common on the legs
    • Painful
    • Itching / burning

Diagnosis

  • Diagnosis is made clinically
  • Well demarcated rash help make the diagnosis
  • No puss, only serous fluid

Treatment

  • Antibiotics
    • Penicillin x 5 days
  • Supportive care
    • Hydration
    • Cold compresses
    • Elevation of affected limb
  • Surgical debridement may be necessary

Acute Rheumatic Fever

Things you should know

  • Occurs after a Streptococcus pyogenes infection
  • Symptoms begin about 1 to 5 weeks after initial infection
  • Common cause of cardiac issues in childhood. May cause:
    • valve stenosis
    • valve regurgitation
    • heart muscle damage
    • atrial fibrillation
    • heart failure
  • Children aged 5 to 15 years old

I came in today to see my physician assistant because…

  • Fever
  • Painful polyarthritis – multiple large joints
  • Weird involuntary movements – Chorea
  • Pink ringed rash – Erythema marginatum
  • Subcutaneous nodules

Physical Exam

  • Fever
  • Chorea – unlikely to see this in the office
  • Erythema marginatum (< 10% of patients)
  • Subcutaneous nodules (< 10% of patients)
  • New or changing murmur
  • Signs of CHF
  • Pericarditis

Labs and studies

  • Anti-streptococcal antibody test – there are several
  • C-reactive protein
  • ESR
  • CXR
  • ECG
  • Echo

Diagnosis

  • Jones Criteria
    • Should have history of Strep infection and 2 Major Criteria  OR 1 Major Criteria, 2 Minor Criteria
    • Major Diagnostic Criteria
      • Carditis
      • Polyarthritis
      • Chorea
      • Erythema marginatum
      • Subcutaneous Nodules
    • Minor Diagnostic Criteria
      • Fever
      • Arthralgia
      • Previous rheumatic fever or rheumatic heart disease
      • Acute phase reactions: Elevated ESR / CRP / Leukocytosis
      • Prolonged PR interval

Treatment

  • Antibiotics
    • Penicillin
  • Anti-inflammatory
    • Aspirin
    • Naproxen

Botulism

Things you should know

  • Clostridium botulinum – anaerobic organism
  • Toxin inhibits the release of acetylcholine at the neuromuscular junction
  • Infant botulism
    • Between the ages of 2 and 6 months
    • Floppy baby
    • No honey during first one year of life
  • Foodborne botulism
    • Canned food
  • Wound botulism
  • Medical emergency, can be fatal

Signs and Symptoms

  • Adult
    • Afebrile
    • Symmetric neurologic symptoms
    • Nausea, vomiting and abdominal cramps
    • Dry mouth
    • Diplopia
    • Dilated pupils
    • Facial weakness with drooping eyelids
    • Dysphagia – drooling
    • Dysarthria
    • Diaphragmatic paralysis – Trouble breathing
  • Infant
    • Ptosis
    • Slow pupillary reaction
    • Flaccid expression
    • Poor anal sphincter tone

Diagnosis

  • Physical exam
    • Signs of symmetrical muscle weakness or paralysis
    • Weakening voice
    • Drooping eyelids
  • Blood tests
  • Feces
  • Gastric aspiration
  • Wound culture

Treatment

  • Antitoxin available from the CDC
  • Breathing assistance
    • Mechanical ventilator
  • Rehabilitation therapy – for paralysis

Chlamydia

Things you should know

  • Chlamydia trachomatis
  • Most common sexually transmitted bacteria
  • The most common cause of nongonococcal urethritis in men
  • In woman may cause cervicitis, salpingitis and pelvic inflammatory disease (A major cause of infertility)
  • Once the leading cause of blindness in the world

Signs and Symptoms

  • Most often no symptoms at all
  • Men
    • Watery discharge
    • Less painful than gonococcal urethritis
    • Burning and itching around the opening of the penis
    • Pain and swelling around the testicles
  • Women
    • Abnormal vaginal discharge that may have an odour
    • Bleeding between periods
    • Painful periods
    • Abdominal pain with/without a raised temperature
    • Pain when having sex
    • Itching or burning in or around the vagina
    • Pain when urinating

Labs and studies

  • Gram stain negative
  • Swab for culture and polymerase chain reaction (PCR)
    • Discharge sample for women is taken from the cervix
    • Discharge sample for men is taken from the urethra
    • Urine sample

Treatment

  • Prevention
    • Abstinence
    • Use of barrier protection
    • Few sexual partners
  • Screening
    • Woman under 25 who are at risk
    • Pregnant woman
  • Medications
    • Azithromycin
    • Doxycycline
  • All sexual partners need to be treated.

Study Tip

  • What do you wear to your exam?

Review Questions

  • Strawberry tongue?
    • Scarlet fever
  • Describe chorea
    • Involuntary large muscle movements
  • A skin infection with an extremely clear margin – cellulitis or erysipelas?
    • Erysipelas
  • List all five major jones criteria.
    • Carditis
    • Polyarthritis
    • Chorea
    • Erythema marginatum
    • Subcutaneous Nodules
  • Is Chlamydia gram positive or negative
    • Gram negative

 

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