Infectious Disease

1. Review on Infectious Diseases http://crisbertcualteros.page.tl

2. Fever and Skin Lesions

3. S. pneumoniae , H. influenzae , N. meningitidis Purpura fulminans Rickettsia rickettsii Rocky Mountain spotted fever N. meningitidis Meningococcemia Petechiae: Sepsis with skin findings Erythroderma: toxic shock syndrome Group A Streptococcus , Staphylococcus aureus

4. Lesion, Clinical Syndrome Infectious Agent Vesicles Smallpox Variola virus Chickenpox Varicella-zoster virus Shingles (herpes zoster) Varicella-zoster virus Cold sores, herpetic whitlow, herpes gladiatorum Herpes simplex virus Hand-foot-and-mouth disease Coxsackievirus A16 Orf Parapoxvirus Molluscum contagiosum Pox-like virus Rickettsialpox Rickettsia akari Blistering distal dactylitis Staphylococcus aureus or Streptococcus pyogenes Bullae Staphylococcal scalded-skin syndrome S. aureus Necrotizing fasciitis S. pyogenes , Clostridium spp., mixed aerobes and anaerobes Gas gangrene Clostridium spp. Halophilic vibrio Vibrio vulnificus

5. Crusted lesions Bullous impetigo/ecthyma S. aureus Impetigo contagiosa S. pyogenes Ringworm Superficial dermatophyte fungi Sporotrichosis Sporothrix schenckii Histoplasmosis Histoplasma capsulatum Coccidioidomycosis Coccidioides immitis Blastomycosis Blastomyces dermatitidis Cutaneous leishmaniasis Leishmania spp. Cutaneous tuberculosis Mycobacterium tuberculosis Nocardiosis Nocardia asteroides Folliculitis Furunculosis S. aureus Hot-tub folliculitis Pseudomonas aeruginosa Swimmer's itch Schistosoma spp. Acne vulgaris Propionibacterium acnes

6. Papular and nodular lesions Fish-tank or swimming-pool granuloma Mycobacterium marinum Creeping eruption (cutaneous larva migrans) Ancylostoma braziliense Dracunculiasis Dracunculus medinensis Cercarial dermatitis Schistosoma mansoni Verruca vulgaris Human papillomaviruses 1, 2, 4 Condylomata acuminata (anogenital warts) Human papillomaviruses 6, 11, 16, 18 Onchocerciasis nodule Onchocerca volvulus Cutaneous myiasis Dermatobia hominis Verruca peruana Bartonella bacilliformis Cat-scratch disease Bartonella henselae Lepromatous leprosy Mycobacterium leprae Secondary syphilis (papulosquamous, nodular, and condylomata lata lesions) Treponema pallidum Tertiary syphilis (nodular gummatous lesions) T. pallidum

7. Ulcers with or without eschars Anthrax Bacillus anthracis Ulceroglandular tularemia Francisella tularensis Bubonic plague Yersinia pestis Buruli ulcer Mycobacterium ulcerans Leprosy M. leprae Cutaneous tuberculosis M. tuberculosis Chancroid Haemophilus ducreyi Primary syphilis T. pallidum Erysipelas S. pyogenes Cellulitis Staphylococcus spp., Streptococcus spp., various other bacteria

8. Necrotizing fasciitis Streptococcal gangrene S. pyogenes Fournier's gangrene Mixed aerobic and anaerobic bacteria Myositis and myonecrosis Pyomyositis S. aureus Streptococcal necrotizing myositis S. pyogenes Gas gangrene Clostridium spp. Nonclostridial (crepitant) myositis Mixed aerobic and anaerobic bacteria Synergistic nonclostridial anaerobic myonecrosis Mixed aerobic and anaerobic bacteria

9. Dengue

18. Warning Signs for Dengue Shock

19. Unusual Presentations of Severe Dengue Fever ~Encephalopathy ~Hepatic damage ~Cardiomyopathy ~Severe gastrointestinal hemorrhage

21. Tourniquet Test ~Inflate blood pressure cuff to a point midway between systolic and diastolic pressure for 5 minutes ~Positive test: 20 or more petechiae per 1 inch² (6.25 cm²)

23. TREATMENT: Outpatient Triage ~No hemorrhagic manifestations and patient is well-hydrated: home treatment ~Hemorrhagic manifestations or hydration borderline: outpatient observation center or hospitalization ~Warning signs (even without profound shock) or DSS: hospitalize

24. Treatment of Dengue Fever ~Fluids ~Rest ~Antipyretics (avoid aspirin and non-steroidal anti- inflammatory drugs) ~Monitor blood pressure, hematocrit, platelet count, level of consciousness ~Continue monitoring after defervescence ~If any doubt, provide intravenous fluids, guided by serial hematocrits, blood pressure, and urine output ~The volume of fluid needed is similar to the treatment of diarrhea with mild to moderate isotonic dehydration (5%-8% deficit)

25. Acquired Immune Deficiency Syndrome (AIDS)

26. Acquired Immune Deficiency Syndrome (AIDS) ~1st recognized in the U.S. in 1981 when Center for Disease Control (CDC) reported the unexplained occurrence of Pneumocystis carinii pneumonia in 5 previously healthy homosexual men in Los Angeles ~Kaposi’s sarcoma (KS) was also noted in 26 previously healthy homosexual men in New York and L.A. ~1983 – HIV was isolated from pxs with lymphadenopathy ~1984 – clearly demonstrated as causative agent of AIDS ~1985 – ELISA was developed leading to appreciation of the scope and evolution of HIV epidemic in the U.S. and other nations

27. Definition ~currently, CDC classification system for HIV-infected adolescents and adults categorizes persons on the basis of clinical conditions associated with HIV infections and CD4+ T lymphocyte count ~the system is based on 3 ranges of CD4+ T lymphocyte counts and 3 clinical categories and is represented by a matrix of nine mutually exclusive categories

28. 1993 Revised classification System for HIV Infection and Expanded AIDS Surveillance Case Definition for Adolescents and Adults Clinical Categories CD4+ T Cell categories A Asymptomatic, Acute(Primary) HIV or PGL B Symptomatic, Not A or C Conditions C AIDS-Indicator Conditions >500/µL A1 B1 C1 200-499/µL A2 B2 C2 <200/µL A3 B3 C3

41. Pathophysiology and Pathogenesis - hallmark is profound immunodeficiency resulting from progressive qualitative and quantitative -deficiency of the subset of t helper cells or inducer cells with CD4 molecule on its surface w/c serves as primary cellular receptor for HIV

42. Clinical Manifestations a.Acute HIV syndrome - in 50%-70% of indiv. with primary infection - high levels of viremia measured in million of copies of HIV RNA/ml that last for several wks. - 3-6 weeks after primary infection - fever, pharyngitis, lmphadenopathy, meningitis, encephalitis, mucocutaneous ulceration - Most will recover spontaneously w/ mildly depressed CD4+ T cells

43. b.Asymptomatic stage - Median time for untreated pats. - 10 yrs. - Rate of progression is directly correlated w/ HIV RNA levels c.Symptomatic dse - More severe & life threratening complic. of HIV infec. occurs with CD4+ T cell counts <200/µL - 60% of deaths among - due to P. carinii & viral hepatitis

45. - Oropharynx and GIT * Thrush - candida * Hairy leukoplakia - EBV * Aphthous ulcers * Esophagitis * Diarrhea cauased by Shigella,Salmonella, * Shigella, Campylobacter -Kidney and GUT * HIV-assoc. nephropathy * dysuria, heamturia or pyuria * Condyloma lata – most common presentation of syphilis in HIV pats.

46. Advanced HIV dis. - CD4+ T cells count falls below a critical level <200/µL & pat. becomes susceptible to opportunistic dse Long term nonprogressors Those who had been infected with HIV for long periods (>10yrs) whose CD4 + T cell counts move w/in normal range & remained stable over the years who had not received antiretroviral tx

47. Diagnosis and Lab Monitoring depends on demonstrations of Ab to HIV & or direct detection of HIV or one of its components ELISA - enzyme immunoassay (EIA) - standard screening test - Sensitivity 99.5%, - nonspecific - 10% of EIA (+) pat . developed HIV infec.

48. Western blot - Confirmatory test If western blot patterns of reactivity do not fall into the (+) or (-) categories - considered “indeterminate” - can be repeated in one month HIV RNA levels – determine the prognosis and assess the response to antiviral tx P24 antigen capture assay – detects viral protein p24 in blood PCR, Nucleic acid sequenced based assay

51. Influenza Virus

53. Types: * Influenza A - isolated in 1933 - most severe type causing pandemics - hosts are humans, swine, horses * Influenza B - isolated in 1939 - usually mild illness * Influneza C - isolated in 1950 usually no s/s

54. INFLUENZA A ~ classified by Hemagglutinin (H) & Neuraminidase (N) sub-types ~ Current circulating strains: H1N1 & H3N2 ~ Human subtypes include H1N1, H3N2, H1N2, & H2N2 ~ Avian subtypes: H1 to H15 & N1 to N9 ~ Bird  human H5N1, H9N2, H7N7, H7N2, H7N3

57. AVIAN INFLUENZA IN BIRDS ~ carry the viruses in their intestines ~ shed the virus in their saliva, nasal secretions, & feces ~ contact with contaminated secretions or excretions or w/ surfaces that are contaminated w/ secretions ~ Domestic birds infected w/ direct contact w/ infected waterfowl or poultry ~ contact w/ surfaces (dirt/cages) or materials contaminated w/ virus

58. AVIAN INFLUENZA IN HUMANS ~ Risk is low; usually do not infect humans ~ From contact with infected poultry or surfaces contaminated with secretions/excretions from birds ~ Spread of avian virus from one person to another has been very rare

67. SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

74. AMEBIASIS

81. MALARIA

90. FILARIAL INFECTIONS

97. SCHISTOSOMIASIS