Contributors
David Adkins, md Department of Internal Medicine, University of Kentucky, Lexington, KY Janet Arno, md Division of Infectious Diseases, Department of Internal Medicine, Indiana University, Indianapolis, IN Andrea L. Benin, md Epidemic Intelligence Service, Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA Joseph...
Pelvic Inflammatory Disease
Pelvic inflammatory disease PID remains a diagnostic and treatment challenge. It is typically defined as an infection of the female genital tract above the cervix and may include salpingitis, endometritis, tubuloovarian abscess TOA , and or frank peritonitis 64 . Long-term sequelae of PID are severe and include ectopic pregnancy, infertility, and chronic pelvic pain 64 . In the United States, the population most commonly affected by PID appears to be the young, nonwhite, unmarried urban dweller...
Cystitis
Clinical Description, Epidemiology, and Etiology Cystitis connotes infection limited to the urinary bladder. It is a clinical syndrome characterized by irritative voiding symptoms e.g., dysuria, frequency, and urgency and bacteriuria pyuria, in the absence of flank pain or fever to suggest renal or systemic involvement 1 . In children too young to report voiding symptoms, cystitis All practice suggestions are followed by quality of evidence assessments A supported by randomized trial,...
Infections In The Cancer Patient
Clinical Description and Epidemiology Infections remain a common cause of morbidity, and in some cases mortality, in patients with cancers, both hematologic malignancies and solid tumors. Risk factors for infection in this population are related to humoral and cellular immune defects that are inherent to the primary disease process, as well as the immunosuppression caused by therapy. Patients with hematologic malignancies may have immunologic defects related to the primary disease process even...
References
1. Radestsky M. The discovery of penicillin. Pediatr Infect Dis J 1996 15 811-818. 2. Centers for Disease Control and Prevention. Control of infectious diseases. MMWR 1999 48 621-629. 3. Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA 1999 281 61-66. 4. Pinner RW, Teutsch SM, Simonsen L, Klug LA, Graber JM, Clarke MJ, Berkelman RL. Trends in infectious disease mortality in the United States. JAMA 1996 275 189-193. 5....
Antibiotic Control Policies
Many infectious disease societies have published clinical guidelines to control the use of antibiotics in hospital systems 19 . Antibiotic control programs are implemented in an effort to optimize antibiotic use while minimizing antibiotic costs 32 . The success of these programs depends on cooperation of multidisciplinary teams, including hospital administrators, clinicians, infectious diseases specialists, infection control teams, microbiologists, and hospital pharmacists 18 . All team...
References Lwo
1. Saddick NS. Current aspects of bacterial infections of the skin. Dermatol Clin 1997 15 342-350. 2. Deery HG. Outpatient parenteral anti-infective therapy for skin and soft-tissue infecitons. Infect Dis Clinic North Am 1998 12 936-950. 3. Lewis KT, Stiles M. Management of cat and dog bites. Am Fam Phys 1995 52 479-485. 4. Darmstadt GL, Lane AT. Impetigo an overview. Pediatr Dermatol 1994 11 293-303. 5. Barnett BO, Frieden IJ. Streptococcal skin diseases in children. Semin Dermatol 1992 11...
Uncomplicated Upper Respiratory Infectioncommon Cold
Uncomplicated upper respiratory infections URIs are characterized by rhinorrhea, nasal congestion, sneezing, sore or scratchy throat, and cough 1 . The incubation period varies between 48 and 72 h. In some cases a low-grade fever is present, but temperature elevation in adults is rare. The early symptoms may be minimal and limited to malaise and nasal symptoms. The nasal discharge is initially clear and watery. There is a subsequent transition period where the nasal discharge becomes viscous,...
O
change implementation in health care system, 293 contributing factors to overuse, economics, 292 education, 292, 332 expectations, 292 experience, 292, 332 hospital policy, 292, 293, 332 respiratory tract infection, 291, 292, 331, 332 importance, 291 regulation around the world, 333, 334 resistance reduction, 291, 332, 337 strategy implementation, administrative interventions, 294 antibiotic control programs, 295, 296 audit and feedback, 299, 300 clinical guidelines, 298, 299 computer-assisted...
Specific Inanimate And Animate Vectors
It is important to recognize inadequate handwashing and the contaminated hand as the major factor responsible for the transmission of resistant pathogens in the hospital setting. One must not, however, unduly downplay the role of other vehicles in such transmission. It is often difficult to demonstrate the importance of environmental contamination in causing nosocomial infections, but there are sufficient examples in the literature of such occurrences to remind us that in certain settings...
Types Of Infections
Candida spp. can cause superficial mucocutaneous or deep infections 17 . Candi-dal infections are extremely common, ranging from oral thrush to disseminated disease. Thrush most often occurs in patients on steroids or chronic antibiotics and in immunocompromised patients, especially those with HIV infection. In addition to the classic creamy white coating of the tongue and oral mucosa, oral candidiasis can present as an atrophic form, as angular cheilitis, or as Candida leukoplakia. In...
Acute Otitis Media
Acute otitis media is one of the most common pediatric conditions seen in primary care. In 1990 there were 12.8 million episodes of acute otitis media in children lt 5 yr old in the United States, with total estimated costs of 3.5 billion including 240 million spent on antibiotics 49 . Despite the extensive clinical experience in the management of otitis media, there is no consensus regarding which antibiotics are most appropriate for initial or recurrent therapy, the optimal duration of...
Resistant Pathogens As A Cause Of Nosocomial Infections
The observation that infections acquired in the hospital tend to be caused by pathogens that are more resistant to antimicrobials than organisms causing similar infections originating in the community was made decades ago. Two factors seem to account for this difference. First, nosocomial infections tend to be caused by pathogens that are intrinsically more resistant to antimicrobials than pathogens that cause community-acquired infections 4 . While community-acquired pneumonia is most often...
Info Kvh
delivery. Prevalence of viral shedding varies from 0.5 to 1 for all women at the time of delivery, irrespective of past history of HSV infection 17 . Transmission of HSV depends on intimate, personal contact between a susceptible individual and an individual who is excreting the virus. For infection to be initiated, the viruses must come into direct contact with mucosal surfaces or abraded skin. Following exposure to HSV I vesicular lesions on an erythematous base appear after an incubation...
Sexually Transmitted Proctitis Proctocolitis And Enteritis
Infection of the GI tract may occur from anal intercourse proctitis or sexual activity that includes fecal-oral contact enteritis . Proctocolitis may occur with either route. Proctitis is characterized by anorectal pain, tenesmus, and rectal discharge and may be caused by GC, C. trachomatis including LGV strains or serovars, HSV, or T. pallidum 2 . Patients with acute proctitis who practice receptive anal intercourse should be examined with anoscopy to make a specific diagnosis. Although...
Chronic Encephalitis
Most chronic encephalitis syndromes have characteristic neurological manifestations that help distinguish one another. Chronic encephalitis due to HIV infection commonly manifests as a dementing illness. These symptoms are usually recognized in the later stages of the illness when the CD4 counts are lt 100 cells mm3. The symptoms of HIV dementia affect three main categories cognitive, motor, and behavioral. The primary cognitive symptom is forgetfulness, associated with impaired concentration...
Treatment
Consensus guidelines are available to guide therapy of HIV-infected individuals 15,16 . Currently three different classes of antiretroviral medications are available for use Table 1 . Each of these medications acts to inhibit at least one key step in the HIV replication cycle. Zidovudine was the first drug indicated for the management of HIV infection. Subsequently, many agents have been added to the HIV armamentarium 1 . Concentrated efforts by virologists and clinicians have made HIV...
Hepatitis B
Hepatitis B is produced by a DNA virus classified as a hepadnavirus type 1 40-42 . There are multiple serotypes. More than 300 million people suffer from chronic hepatitis B virus HBV infection more than 75 of affected individuals live in Asia or are of Asian origin. The usual incubation period is 2-3 mo but may be as short as 45 d and as long as 6 mo. The frequency of clinical illness with jaundice is different at different ages. Fewer than 10 of the patients acquiring infection when younger...
Mechanisms of Action and Mechanisms of Antifungal Resistance
Amphotericin B Binds to ergosterol in fungal membrane pore formation leakage of intracellular contents Azoles Binding to the enzyme lanosterol 14a-demethylase which is required for ergosterol synthesis Azole-induced changes in cell membrane also interfere with other membrane-bound enzymes such as those required for chitin synthesis Interference with other enzymes required for synthesis of ergosterol surrogates Altered ergosterol content in fungal membrane Altered p-1, 3-glycan composition in...
Folliculitisfurunclescarbuncles
Folliculitis is an infection of the pilosebaceous unit and involves only minor inflammation of an individual hair follicle. This infection is associated with minimal pain and surrounding erythema. Gram-negative folliculitis most often develops as a superinfection in people who have undergone prolonged oral antibiotic therapy. It is characterized by pustules in the area of the nose. The pathogens in the superficial form of this infection are usually Klebsiella or Enterobacter species. A deep...
Respiratory Syncytial Virus
Respiratory syncytial virus RSV is highly infectious and easily transmitted from person to person by close contact. The primary modes of transmission include direct contact with large droplets of secretions small particle aerosol is not a significant mode of transmission and self-inoculation of eyes and nose by hands made infectious by touching contaminated objects. For example, RSV can be isolated from countertops more than 6 h after contact with an infected source such as nasal secretions....
Infections In The Solid Organ Transplant Recipient
Clinical Description and Epidemiology The course of solid organ transplant recipients is often complicated by infectious processes, owing to defects in both cellular and humoral immunity. However in the past several decades, improvements in graft and patient survival and a decline in infection-related mortality have been observed, probably related to better regulation of chronic immunosuppressive therapy, better selection of transplant candidates, improved antimicrobial prophylaxis, and...
Esophageal Infections
Esophageal infections have increased in frequency over the last decade, in part as a result of the growing numbers of patients with acquired immunodeficiency syndrome AIDS and organ transplantation requiring immunosuppressive therapy. Patients with esophageal infections may be asymptomatic however they more commonly present with symptoms of dysphagia difficulty in swallowing or odynophagia painful swallowing . Rarely does esophageal infection progress to more serious complications such as...
Holmes Kk Ryan C. Std Care Management. In Holmes Kk Sparling Pf Mardh P-a Et
1. Eng TR, Butler WT. The Neglected Health and Economic Impact of STD's. The Hidden Epidemic Confronting Sexually Transmitted Diseases. Washington DC National Academy Press, 1997, pp. 28-67. 2. CDC. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR 1998 47 1-116. 3. Cohen MS. Sexually transmitted diseases enhance HIV transmission no longer a hypothesis. Lancet 1998 351 S5-7. 4. Curtis JR, Holmes KK. Individual-level risk assessment for STD HIV infections. In Holmes KK, Mardh...
Overuse And Misuse Of Antibiotics
Patient expectations for receiving antibiotics play an important role in the overuse of antibiotics. For example, discolored nasal discharge is a normal self-limited phase of a viral upper respiratory tract infection URI . Randomized placebo-controlled trials From Management of Antimicrobials in Infectious Diseases Edited by A. G. Mainous III and C. Pomeroy Humana Press Inc., Totowa, NJ have shown no significant effect of antibiotics on purulent rhinitis or discolored nasal discharge 2 . The...
Impetigo
Impetigo is a skin infection commonly found in children of preschool age, but may also occur in adults. Impetigo accounts for about 10 of all pediatric skin problems 4 . It typically spreads from one part of the body to another through scratching and is a highly communicable disease. Impetigo has two classic forms nonbullous and bullous. The nonbullous form is more common and accounts for approx 70 of cases. This form is commonly associated with a honey-colored crusted discharge. As intact skin...
Diseases Characterized By Urethritis And Cervicitis
Neisseria gonorrhoeae and Chlamydia trachomatis cause the majority of urethritis and cervicitis. The etiology of most nongonococcal, nonchlamydial urethritis is unknown. Other agents that may cause urethritis include Trichomonas vaginalis and Herpes simplex. Ureaplasma urealyticum and possibly Mycoplasma genitalium also have been implicated as causes of urethritis. Urethritis refers to inflammation of the urethra in men or women and is manifested by dysuria, pyuria, or discharge. Discharge may...
Classification of Lactamases from Jacoby and Archer
Common plasmid-mediated -lactamase Many Gram-negative Ampicillin, ticarcillin, Cefotetan, cefoxitin, Chromosomal -lactamases produced constitutive Extended-spectrum -lactamases related to AmpC Carbapenem-hydrolyzing chromosomal -lactamase Plasmid-mediated extended-spectrum -lactamases related to the TEM or SHV family Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae Pseudomonas aeruginosa, Enterobacter cloacae, Serratia marcescens Stenotrophomonas maltophilia, Bacteroides fragilis...
Enterococcus
Members of the genus Enterococcus were formerly classified with the Lancefield group D streptococci. Growth at extremes of temperature, salinity, and alkalinity as well as hydrolysis of esculin in the presence of bile characterize these organisms. More recently genetic techniques have been used to clarify the taxonomy. These facultatively anaerobic Gram-positive cocci are usually found in the gastrointestinal and biliary tracts, vagina, and male urethra. Historically not considered pathogenic...
Fungal Uti
Clinical Description, Epidemiology, and Etiology Fungal UTI, an increasingly frequent problem, is generally limited to hosts with an obvious predisposing factor such as diabetes mellitus, antibiotic therapy, and or indwelling bladder catheter use 53 . Candida species predominate overwhelmingly as the causative agents, with Aspergillus and other fungi only rarely causing UTI, and then only in profoundly immunocompromised hosts. The great majority of fungal UTIs are asymptomatic and, like...
Epq Antibiotics
Rising antibiotic resistance is a global problem emanating from human activities. Successful strategies to curb this trend will require cooperation and coordinated strategies. Several factors play key roles in the trend of rising antibiotic resistance including a lack of regulation of antibiotic use, failure of infection control procedures in hospitals and other sites such as nursing homes, expanding use of antibiotics in medical settings for diseases not traditionally viewed as infections,...
Respiratory Syncytial Virus Infection Control Guidelines
General control measures to prevent nosocomial RSV transmission Educate hospital staff about RSV epidemiology, modes of transmission, and means of prevention. Use contact and droplet isolation for RSV-positive patients including gloves and gown. Maintain good handwashing procedures following any contact with RSV-infected patients or fomites, even if gloves are used. Limit visitors. Do not allow visitors with who have symptoms of respiratory infection to visit uninfected pediatric,...
Key Points Obn
Treatment of common skin infections should be based primarily on clinical indications. Human and animal bites are not uncommon and management should include antimicrobial therapy that will cover the oral flora of the animal, the skin flora of the victim, and likely environmental contaminants. Osteomyelitis can result in severe morbidity. Acute osteomyelitis can be effectively treated with antibiotics. Long-term parenteral antibiotics, many times administered on an outpatient basis, have become...
Subacute Or Chronic Meningitis
Subacute or chronic meningitis is characterized by a gradual onset, often without any predisposing factor. These syndromes run their course over weeks, months or years. The clinical signs include headache, fever, stiff neck, and altered consciousness. Lower cranial nerve palsies may accompany basilar meningitis. Of the treatable conditions, crytococcosis and syphilis can be easily diagnosed on the basis of serology and antigen detection. Lyme disease Borrelia burgdorferi with nervous system...
References 1
1. Lee C, Banks SD, Li JP. Virulence, immunity and vaccine related to Streptococcus pneumoniae. Crit Rev Microbiol 1991 18 89-114. 2. Tuomanen EI, Austrian R, Masure HR. Pathogenesis of pneumococcal infection. N Engl J Med 1995 332 1280-1284. 3. Rubins JB, Janoff EN. Pneumolysin a multifunctional pneumococcal virulence factor. J Lab Clin Med 1998 131 21-27. 4. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow...
Diseases Characterized By Vaginal Discharge
Vaginitis and vaginal discharge are common complaints prompting women to visit their health care providers. The differential diagnosis is extensive and should include physiologic discharge, chemical or irritant vaginitis, atrophic vaginitis, and vaginitis due to the infectious agents discussed in the following sections. Many over-the-counter products, such as topical antifungals, are widely available and allow women to self treat, often inappropriately. This makes diagnosis even more difficult...
Varicellazoster Virus
Like the herpes simplex viruses, varicella-zoster virus VZV is an enveloped, dou-ble-standed, DNA virus of the herpesvirus family. VZV causes two distinct clinical syndromes. Primary exposure to VZV results in varicella chickenpox , a usually benign, highly contagious infection of children. Reactivation of latent VZV results in herpes zoster shingles , an illness most commonly seen in adults over the age of 45 yr. VZV is spread from person to person by direct contact, as an aerosol from skin...
Diseases Characterized By Genital Ulcers
Genital lesions can be divided into ulcerative and nonulcerative lesions. In most parts of the United States, syphilis and genital herpes are the usual causes of ulcerative lesions 2 . In developing countries, the differential broadens to include chancroid, donovonosis, and lymphogranuloma venereum LGV . Other causes of ulcerative lesions that should be considered are trauma, malignancy, fixed drug eruption, and Behcet's and Reiter's syndromes. Multiple studies have shown that genital ulcer...
References Tts
1. Berger JR. Benign aseptic Mollaret's meningitis after genital herpes. Lancet 1991 337 1360-1361. 2. Fiore AE, Moroney JF, Farley MM, et al. Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance. Clin Infect Dis 2000 30 71-77. 3. Balkundi DR, Murray DL, Patterson MJ, Gera R, Scott-Emuakpor A, Kulkarni R. Penicillin-resistant Streptococcus mitis as a cause of septicemia with meningitis in febrile neutropenic children. J Pediatr Hematol Oncol...
Alice C Thornton David Adkins and Janet Arno INTRODUCTION
Sexually transmitted diseases STDs are a complex set of syndromes involving more than 25 pathogens acquired through sexual activity. A majority of the 12 million Americans infected with STDs each year are not treated in a public STD clinic 1 . This emphasizes the need for all clinicians to be aware of and provide management for STDs according to the Center for Disease Controls' CDC STD Treatment Guidelines 2 . In an era of emerging antimicrobial resistance and incurable viral STDs, prevention...
Acute Pyelonephritis
Clinical Description, Epidemiology, and Etiology Pyelonephritis connotes infection of the renal pelvis and or parenchyma, and is defined clinically by the presence of flank pain and or tenderness, usually accompanied by fever, in a patient with bacteriuria and pyuria 7 . Pyelonephritis exhibits many of the same epidemiological associations as cystitis, but is approx 20-fold less common. Patients with pyelonephritis usually feel systemically ill and may have nausea and vomiting, abdominal pain,...
References Xbn
1. Gwaltney JM Jr, Hendley JO, Simon G, et al. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA 1967 202 494. 2. Gohd RS. The common cold. N Engl J Med 1954 250 687-691. 3. Schappert SM. National Ambulatory Medical Care Survey, 1991 Summary. Vital Health Stat 13 116 . Hyattsville, MD National Center for Health Statistics, 1994. 4. Woodwell DA. National Ambulatory Medical Care Survey, 1995 Summary. Advance Data from Health and Vital...
Hepatitis C
Hepatitis C is caused by an RNA virus that has many features similar to the fla-viviruses 35 39 . Hepatitis C represented 16 of the cases of acute hepatitis in the sentinel study from the CDC from 1982 to 1993. Despite this, hepatitis C represents more than half of all the cases of chronic viral hepatitis in the United States. The incubation of the infection is from 2 to 26 wk. Clinical illness occurs in 30-40 of the patients, but only 20-30 of all the patients will develop jaundice. There are...
Literatureb
Bacteria Percent of Isolates that Produce the -Lactamase Data from University of Kentucky Hospital Antibiogram 1998. ESBLs. For confirmation, a disk containing ceftazidime can be placed on a lawn of the bacteria next to an amoxacillin-clavulanic disk. Susceptibility will be restored zone-of-inhibition on the side of the ceftazidime disk that is closest to the amoxacillin-clavulanic disk Fig. 2 . Alternatively, an E-test strip containing on one end ceftazidime alone, and on the other end...
Info Hsd
work, need to return child to day care crucial to controlling overuse and resistance 1 . In the United States, 75 of all antibiotics prescribed in the outpatient setting each year are for respiratory tract infections 7 . Overuse of antibiotics may relate to misinformation on the part of the practitioner and patient. For example, when presented scenarios consistent with an upper respiratory tract infection with discolored nasal discharge, physicians, pharmacists, and patients were likely to...
Ivda
Methicillin-resistant Native valve Prosthetic valve Enterococci native and prosthetic valve PCN-sensitive PCN-resistant PCN G 12-18 MU d x 2 wk gentamicin 1 mg kg q8h x 2 wk PCN G 18 MU d x 4-6 wk gentamicin 1 mg kg q8h x 2 wk Nafcillin 12 g d x 4-6 wk gentamicin Nafcillin 12 g d x 2wk gentamicin 1 mg kg q8h x 2 wk Nafcillin 12 g d x 6 wk rifampin 900 mg d x 6 wk gentamicin 1 mg kg q8h x 2 wk Vancomycin 30 mg kg d x 4-6 wk Vancomycin 2 g d x 6 wk rifampin 900 mg d x 6 wk gentamicin 1 mg kg q8h...
Treatment 1
Antifungal agents are much more limited in number than are antibacterial drugs 22-24 . Unfortunately, many of the available agents have significant cost and toxicity. Currently available drugs for the treatment of fungal infections are amphotericin B and the newer liposomal forms of amphotericin, flucytosine, and the azole drugs 25,26 . The polyene amphotericin B is the mainstay of therapy for serious fungal infections and remains the most broad-spectrum antifungal agent available. Its broad...
Staphylococcus
Staphylococcus is a member of the family Micrococcaceae. These Gram-positive cocci, 0.7-1.2 mm in diameter, take their name from their tendency to grow in grapelike clusters in solid media although they may appear singly, in pairs, or in chains of fewer than five organisms. Staphylococcus is characterized by a positive test for cata-lase, and S. aureus is characterized by the presence of coagulase enzymes. Coagulase-negative species are quite numerous and include the frequently isolated S....
Human Papilloma Virus
Human papilloma virus HPV infections have two important clinical manifestations external genital warts EGWs and squamous intraepithelial lesions 30 . A discussion of these neoplasms is beyond the scope of this chapter but screening and treatment issues can be found elsewhere 2 . The majority of newly acquired HPV infections are asymptomatic. EGWs are diagnosed when visible warts occur in the genital area they can be discrete or coalesce into confluent plaques 30 . The acetowhite test has not...
Introduction Hno
The role of the hospital microbial flora as pathogens responsible for nosocomial infections has been an area of much debate over the centuries. In early hospitals, established prior to the development of the germ theory, scant attention was paid to any measures aimed at avoiding contamination of wounds, hands, or instruments. These facilities, referred to by Nightingale and others as pest houses, often failed to meet standards of simple cleanliness. With the general acceptance of the microbial...