Meningitis
inflammation of the meninges of the brain and spinal cord
1. Streptococcus pneumonia (actually gram positive)
2. Neisseria meningiditis
3. Hemophilius influenza
4. Listeria monocytogenes (actually gram positive)
What bacteria cause meningitis?
Meningococcal meningitis
An inflammation of the meningeal coverings of the brain and spinal cord; can be highly contagious.
Neisseria meningitidis
-serotype C most common
What causes Meningococcal meningitis?
Transmitted by droplets
How is Meningococcal meningitis transmitted?
1. Classic triad= fever, nuchal rigidity, and a change in mental status
2. Chills, headache, photophobia, N, V, and neck/back pain very common
3. Petechial rash beginning at lower extremities
4. May develop seizure and coma
Clinical presentation of Meningococcal meningitis
1. Brudzinski sign
2. Kernig sign
Physical exam of Meningococcal meningitis
1. Blood culture and lumbar puncture immediately
-CSF may appear purulent, high protein, low glucose, many WBCs, gram - diplococci seen
2. Order a CT before the lumbar puncture if increased intracranial pressure is suspected
3. May see papilledema with fu
Diagnostics of Meningococcal meningitis
1. Antibiotics ASAP
- 2 to 50= vancomycin + 3rd generation cephalosporin
- >50= vancomycin + ampicillin + 3rd generation cephalosporin
2. IV dexamethasone if S. Pneumonia revealed on SF
3. Prophylaxis for close contacts
-rifampin 2 doses, or ciprofloxacin
Treatment of Meningococcal meningitis
1. 10-15% mortality rate
2. 11-19% have serious long term sequelae including hearing loss, loss of limb, brain damage, and CNS damage
*best prognosis with early detection and initiation of antibiotics
Meningococcal meningitis prognosis
1. Quadrivalent conjugate vaccine for adults
2. MenB vaccine for younger patients
Meningococcal meningitis prevention
Neisseria gonorrheae
Co-pathogen= Chlamydia trachomatis
Most commonly seen in teens and young adults
What causes gonnococcal/chlamydial infections?
Sexual contact- invasion of mucus membranes
How are gonnococcal/chlamydial infections spread?
1. Dysuria (serous or milky discharge)
2. Over 1-3 days, pain increases, discharge becomes profuse, yellow, and creamy
3. May have primary infection of pharynx or rectum
4. May be asymptomatic in chlamydia
Clinical presentation of gonnococcal urethritis
Cervicitis
What is gonnococcal urethritis most frequently associated with?
1. May progress to prostatitis
2. May progress to epididymitis
3. Long standing disease may cause urethral stricture
gonnococcal urethritis prognosis
1. Dysuria
2. Urinary frequency and/or urgency
3. Purulent urethral or vaginal discharge
4. May be asymptomatic
*most often symptomatic after menses
*uterine cervix is the most common site
Clinical presentation of gonnococcal cervicitis
1. Chorioamionitis
2. Premature rupture of membranes
3. Preterm birth, low birth weight, small for gestational age infants
4. Spontaneous abortion
What can gonnococcal cervicitis cause?
1. Neonatal conjunctivitis
2. Pharyngitis
3. Gonococcemia
4. Arthritis
What diseases can a mother with gonnococcal cervicitis pass on to her child during birth?
1. Triad= rash, arthralgia, tenosynovitis
2. Purulent arthritis
-monoarticular, larger joints, less common form
Clinical presentation of disseminated gonococcal
1. Profuse, purulent discharge
2. Conjunctival infection
3. Rapid progression to panophthalmitis and loss of eye
* may be transmitted to infant during vaginal delivery
Clinical presentation of gonococcal conjunctivitis
1. Gold standard= culture (gives sensitivities)
2. Cervical or urethral smear looking for gram negative diploccoci
3. Nucleic amplification tests
4. Chlamydia, gonorrhea, HIV, and syphilis tests
Diagnostics for gonococcal infections
1. All sexual partners within the past 60 days must be treated for gonnorrhea and chlamydia and tested for HIV and syphilis
2. Ceftriaxone 250mg IM + azithromycin 1g PO x 1 OR doxycycline 100mg PO bid x7 days
3. If disseminated gonococcal infection= Ceftr
Treatment for gonococcal infections
Moraxella catarrhalis
Most commonly seen in children with significance decreasing with age
What causes Moraxella catarrhalis
Respiratory droplets and fomites
How is Moraxella catarrhalis spread?
1. Otitis media (one of the top three causes of it in children)
2. Acute exacerbation of COPD
3. Acute bacterial rhinosinusitis
Clinical presentation of Moraxella catarrhalis
Typically only culture if non-responsive to first line treatments
Diagnostics of Moraxella catarrhalis
1. Depends on site of infection
2. Typically treated empirically
3. Almost all strains produce beta lactamase and are thus resistant to penicillin, ampicillin, amoxicillin, clindamycin, and vancomycin
-use a macrolide instead (clarithromycin)
Treatment of Moraxella catarrhalis
non-contagious- typically transmitted to humans via inhalation of aerosols derived from water or soil
How is Legionella bacterium spread?
Bacterial, atypical pneumonia caused by Legionella species- most commonly Legionella pneumophilia
What causes Legionnaire's disease?
1. High fever
2. Low pulse (bradycardia)
3. N, V, D
Clinical presentation of Legionnaire's disease
1. Hyponatremia
2. Elevated hepatic transaminases
3. C reactive protein levels >100mg/L
4. Failure to respond to treatment for pneumonia with beta lactam monotherapy
Diagnostic results of Legionnaire's disease
1. Macrolides
2. Quinolones
3. Tetracyclines
*no vaccine for prevention
Treatment of Legionnaire's disease
Legionella species
What causes Pontiac fever?
1. Headache
2. Fever
3. Muscle aches
4. Fatigue
*easily mistaken with the flu
Clinical presentation of Pontiac fever
Usually an acute self limited febrile illness (3-5 days)
Why are diagnostic tests and treatments not needed for Pontiac fever?
Pseudomonas aeruginosa
Opportunistic pathogen
What causes Pseudomonas skin disease (aka. Hot tub folliculitis), ecthyma gangrenosum, burn and wound infections, and nail infections?
Contact with infected water (most commonly from hot tubs)
How is Pseudomonas skin disease spread?
1. Malaise
2. Low grade fever
3. Erythematous pustules in occluded areas
Clinical presentation of Pseudomonas skin disease
1. Usually self limited
2. Fluoroquinolones for persistent disease or if very bothersome to patient
Treatment of Pseudomonas skin disease
Ulcerative lesion that extends through the epidermis and deep into the dermis
-appears as a punched out ulcer covered in crust surround by a raised violaceous margin
Clinical presentation of ecthyma gangrenosum
perivascular bacterial invasion of the media and adventitia of arteries and veins with secondary ischemic necrosis
What causes ecthyma gangrenosum?
1. Discoloration of scar
2. Erythema of tissue
3. May have a blue/green tinted drainage often with a sweet smell
Clinical presentation of burn and wound infections
Require surgical debridgement + multi drug treatment
Treatment of burn and wound infections
Green discoloration of finger or toe nail
Clinical presentation of nail infections
1. Confirm with culture before possible removal of nail
2. Bacitracin ointment 2-4 times a day for 1-2 months
Diagnostics and treatment of nail infections
1. Bronchitis/pneumonia (patients with cystic fibrosis)
2. Bacteremia (from medical intervention)
3. Endocarditis (prosthetic valves)
4. Malignant OE
5. Meningitis and brain abscess
6. Keratitis or endophthalmitis of eye
7. Osteomyelitis
8. GI infections
Clinical presentation of pseudomonal diseases
1. Gram stain
2. Culture of blood, urine, and/or sputum
Diagnostics of pseudomonal diseases
1. Varies with type of infection
2. Beta lactam antibiotics with an aminoglycoside
3. 2 antipseudomonal drugs from two different classes
4. Fluoroquinolones
Treatment of pseudomonal diseases
Brucella species
What causes brucellosis?
Ingestion of contaminated meat or milk, direct inoculation, or inhalation while animal is giving birth
How is brucellosis spread?
Cattle and other animals (this is a zoonotic infection)
What are some reservoirs of brucellosis?
Category B bioterrorism weapon
What are brucellosis and tularemia classified as?
1. Has a broad clinical spectrum ranging from asymptomatic disease to severe and/or fatal illness
2. Fever, myalgia, fatigue, headache, night sweats with strong odor, and depression are common
Clinical presentation of brucellosis
1. Isolation of organism on culture of blood or bone marrow
2. Serological testing
Diagnostics of brucellosis
1. Doxycycline
2. Rifampin
3. Streptomycin or gentamicin
*difficult to treat so you actually need to prescribe all three
Treatment of brucellosis
Francisella tularensis
What causes tularemia (aka. Rabbit fever)?
Infection through tick bite, food or water contamination, handling infected animal tissue, and/ or inhalation of aerosols
*no human to human transmission
How is tularemia spread?
1. Rapid onset of fever, chills, myalgia, anorexia, and dry cough
2. May have abdominal pain and D
Clinical presentation of tularemia
1. Ulceroglandular tularemia- most common
2. Glandular tularemia
3. Oculoglandular tularemia
4. Oropharyngeal tularemia
5. Pneumonic tularemia
6. Typhoidal tularemia
Specific manifestations of tularemia
1. High index of clinical suspicion
2. Specimen sent to Biosafety level 3 lab
3. Polymerase chain reaction and immunofluorescence testing of tissue samples
*poor yield with culture
Diagnostics of tularemia
1. Streptomycin or gentamicin for 7-14 days
2. Prophylaxis/mild disease= 14 day course of doxycycline or ciproflaxacin
Treatment of tularemia
Yersinia pestis
What causes plague?
Rodents with a vector (usually a flea)
-zoonotic
How is plague spread?
1. sudden onset of fever and chills
2. weakness
3. headache
4. followed by intense pain and swelling of lymph nodes
Clinical presentation of bubonic plague
1. disseminated intravascular coagulation
2. possible organ failure
3. blackening of the finger tips
Clinical presentation of septicemic plague (Black Death)
1. sudden onset of dyspnea
2. high fever
3. pleuritic chest pain
4. cough
5. may be accompanied by a bloody sputum
Clinical presentation of pulmonic plague (red death)
Primary= inhalation of respiratory droplets
Secondary= homogenous spread
How does pulmonic plague spread?
1. Gram stain of material from buboes
2. PCR on tissues
3. Serology- will see a rise in antibody titer to Y. Pestis
4. Cultures are slow growing so notify lab of suspicion
Diagnostics of plague
1. Immediate treatment for 10 days
-gentamycin loading dose then every 8hrs IV or streptomycin 1g every 12hrs IV
-if unable to tolerate, use doxycycline or tetracyclines
2. Prophylaxis= doxycycline 100mg bid for 7 days
* keep isolated until sputum is clea
Treatment of plague
Recketsia Rickettsii
What causes Rocky Mountain Spotted Fever?
Tick bite (American dog tick)
How is Rocky Mountain Spotted Fever spread?
1. Fever, malaise, headache, and arthralgia very common
2. Rash occurs in 90% of patients between days 3-5
-blanching erythematous rash with macules 1-4mm in size that become petechial
3. May present with abdominal pain, bleeding, and edema with CNS findi
Clinical presentation of Rocky Mountain Spotted Fever
1. Serological testing
2. Use of special stains on a skin biopsy preferably before antibiotics are started
*can not be cultured in most clinical labs
Diagnostics of Rocky Mountain Spotted Fever
Doxycycline 100mg daily IV or PO continued for 3 days after patient is afebrile
Treatment of Rocky Mountain Spotted Fever
Campylobacter jejuni or Campylobacter coli
What causes Campylobacter jejuni infection?
Largely food borne
-live in intestines of animals (especially chickens)
How is Campylobacter jejuni infection spread?
Late onset reactive arthritis or Guillain-Barr� syndrome
Clinical presentation of Campylobacter jejuni infection
1. Usually self limited with no need of antibiotics
2. Severe cases= azithromycin or Fluoroquinolones
Treatment of Campylobacter jejuni infection
1. Wash hands after handing raw chicken
2. Clean surfaces
3. Cook thoroughly
Campylobacter jejuni infection prevention
Salmonella
What causes Salmonellosis?
1. Typhoid
2. Nontyphoid
Types of Salmonellosis
Ingestion of poultry, eggs, milk, meats, and other food stuff or contact with pets (especially reptiles)
How is nontyphoid Salmonellosis spread?
Enteric fever
Clinical presentation of typhoid Salmonellosis
1. Generally self limited
2. Severe cases= ceftriaxone or Fluoroquinolones
Treatment of Salmonellosis
Shigella
What causes shigellosis?
1. High fever
2. Abdominal cramps
3. Frequent small bloody bowel movements
Clinical presentation of shigellosis
Typically self limited
Treatment of shigellosis
If severe, should do susceptibility testing as increase in resistant strains
Diagnostics of shigellosis
Vibrio cholerae
What causes cholera?
Contaminated water or food (most commonly rice and vegetables)
How is cholera spread?
1. Severe watery diarrhea that is white and fishy smelling
2. Severe fluid loss
3. Electrolyte imbalances
Clinical presentation of cholera
1. Aggressive fluid resuscitation (IV or PO)
2. Antibiotics for severe cases= tetracyclines, macrolides, Fluoroquinolones based on resistance patterns
Treatment of cholera
1. Clean water consumption
2. Vaccine
cholera prevention
Gonorrhea
What is the most common cause of urethritis in men under 30?
Gonorrhea
What is the second most common cause of reported communicable disease?
Chlamydia
What is the most common bacterial cause of STI?
Uterine cervix
What is the most common site of mucosal infection with Neissaria gonorrheae?