PACKET 1: Gastroenteritis

- Gastroenteritis: refers to an inflammation of the lining of the stomach and intestines and is predominantly
manifested by the following symptoms: Nausea, Vomiting, Anorexia, diarrhea, abdominal discomfort.
- Traveler’s diarrhea: refers to gastroenteritis in travelers usually caused by bacteria endemic to the local
water.
- Traveler’s diarrhea may be caused by any of several bacteria, viruses, or parasites. However,
enterotoxigenic E. coli is the most common cause. E. coli organisms are commonly present in the water
supplies of areas that lack adequate water purification.
- Infection is common in persons traveling to some areas in Mexico and Latin America, the Middle East,
Asia, and Africa.
Symptoms:
- Nausea, vomiting, abdominal cramps, and diarrhea begin 12 to 72 hours after ingesting contaminated food or
water. Severity is variable. Some people develop fever and myalgias.
Prevention:
- Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street
vendors.
- They should consume only cooked foods that are still hot, fruit that can be peeled and carbonated beverages
without ice.
- avoid eating uncooked vegetables.
- Antibiotics generally are not recommended for mild diarrhea in patients without fever or blood in the stools
as they may alter intestinal flora adversely and promote resistant organisms.
- for more severe diarrhea (three or more loose stools over 8 hours), antibiotics may be indicated, especially if
vomiting, abdominal cramps, fever, or bloody stools are present.
Note: Ciprofloxacin is contraindicated in children less than 16 years of age.
- Escherichia coli 0157:H7 Infection: This infection is a syndrome typically characterized by acute bloody
diarrhea, which may lead to the hemolytic-uremic syndrome.
- E. coli 0157: H7 and similar strains of E. coli (enterohemorrhagic E. coli) produce high levels of toxins that
are indistinguishable from the potent cytotoxin produced by Shigella dysenteriae. These Shiga toxins are
produced in the large intestine after ingestion of enterohemorrhagic E. coli.
- Although over 100 serotypes of E .coli produce Shiga toxin, E. coli serotype 0157: H7 is the most common
in North America.
- both outbreaks and sporadic cases of hemorrhagic colitis occur after ingestion of undercooked beef
(especially ground beef) or unpasteurized milk.
Symptoms
- E. coli 0157: H7 infection typically begins acutely with severe abdominal cramps and watery diarrhea that
may become grossly bloody within 24 hours.
- Some patients report diarrhea as being “all blood and no stool.” Fever is usually absent or when present is
usually low grade, occasionally reaching 102.2 F. In uncomplicated cases the diarrheal illness may last 1 to 8
days.
- About 5% of cases are complicated by the hemolytic-uremic syndrome (HUS)
Diagnosis
- E. coli 0157: H7 infection should be distinguished from dysentery and from other infectious diarrheas with
bloody stools by isolating the organism from stool cultures.
Treatment
- Although E. coli is sensitive to most commonly used antimicrobials, antibiotics have not been shown to
alleviate symptoms, or prevent HUS.
- Patients at risk for developing HUS should be observed for early signs. Patients who develop complications
are likely to require intensive care

The onset of foodborne botulism is abrupt. not by staphylococcal itself.Home-canned foods are the most common sources. trouble seeing. however the incubation has been shown to vary from 4 hours to 8 days. Constipation is common after neurologic impairment appears.Onset is usually abrupt.Type A and B toxins are highly poisonous proteins resistant to digestion by our gastrointestinal enzymes. Symptoms and Signs: Infant Botulism: . .Diagnosis relies on recognizing the clinical syndrome. . and toxin production in vivo. are readily destroyed by heat. Severe nausea and vomiting begin 2 to 8 hours after eating food containing the toxin. Symptoms . Treatment . weakness. exposure to moist heat at 120 C (248 F) for 30 minutes will kill the spores. Diagnostic confirmation. but there are no GI symptoms or evidence implicating food as a cause. . Symptoms and Signs: Wound Botulism: . Other symptoms may include abdominal cramps. It results from the ingestion of C. although some have been traced to the ingestion of honey. . . diarrhea.Constipation is present initially in 90% of cases and is followed by neuromuscular paralysis .Symptoms such as Dysarthria.Wound botulism is manifested by neurological symptoms. C.fever is absent. but commercially prepared foods have been identified in about 10% of outbreaks. .Infant botulism occurs most often in infants less than 6 months. .Symptoms of staphylococcal food poisoning are caused by staphylococcal enterotoxin. .Staphylococcal Food Poisoning: an acute syndrome of vomiting and diarrhea caused by eating food contaminated by staphylococcal enterotoxin. and many cases may be caused by the ingestion of microscopic dust. it is usually non-bloody. Symptoms .Major complications include respiratory failure caused by diaphragmatic paralysis and pulmonary infections. botulinum spores. constituting a point source out break. Usually several persons are similarly affected. and trouble speaking . Careful food preparation is essential for prevention. and occasionally headache and fever. . .. their colonization in the large intestine.Botulism: type on neuromuscular poisoning from Clostridium botulinum toxin . botulinum spores are common in the environment. Muscles of the extremities and trunk and of respiration progressively weaken in a descending pattern. Approximately 50% of foodborne outbreaks in the USA are caused by Type A toxin.A history of a traumatic injury or a deep puncture wound in the preceding 2 weeks may suggest the diagnosis.Because the toxin does not cause mucosal ulceration. and cooking food at 176 degrees F for 30 minutes safeguards against botulism.Most cases if infant botulism are idiopathic.Unlike foodborne botulism. although rarely required. as in foodborne botulism. feeling tired.honey should not be given to infants younger than 1 . botulinum spores are highly heat-resistant and may survive boiling for several hours at (212 degrees F). infant botulism is not caused by ingestion of a preformed toxin. usually 18-36 hours after ingestion of the toxin. .This is then followed by neurological symptoms. Gram stain of specimens of vomit may show staphylococci. . dysphagia. These symptoms are characterized by bilateral descending weakness and paralysis . entails isolating coagulase staphylococci from the suspected food.C. dysphonia develop. however.Toxins on the other hand. followed by type B and E.

and Diagnosis . Infections occur year-round with an increase during the summer. . Vomiting occurs in most patients and a low grade fever occurs in about 30% of cases. congenital muscular dystrophy. with onset of symptoms 6 to 24 hours after ingestion of contaminated food.incubation (8-10 days) Astrovirus: infection may affect persons of all ages.The greatest threat to life is respiratory impairment and its complications. Person to person transmission also occurs because the virus is highly contagious. or hypothyroidism. Patients should be hospitalized and closely monitored with serial measurements of vital capacity.In wound botulism. Symptoms typically resolve within 24 hours. Symptoms. When meat contaminated with C.Infant botulism may be confused with sepsis.Viral gastroenteritis is the most common cause of infectious diarrhea in the USA. . and infections occur year-round.The majority of infections caused by viral enteropathogens are asymptomatic. . Prevention and Treatment .Diagnosis is based on evidence of eating contaminated foods and the isolation of organism from suspected food and stool of affected persons. watery diarrhea is the most common symptom.C. and water. botulinum organism on anaerobic culture of the wound confirms the diagnosis. cramps.incubation (1-3 days) Norwalk virus: commonly infects older children and adults. . . . . the pattern of neuromuscular disturbances and ingestion of a likely food source are important diagnostic clues. Perfringens is widely distributed in feces. The simultaneous presentation of at least two patients who ate the same food simplifies the diagnosis which may be confirmed by demonstrating C. Perfringens is left at room temperature. Progressive paralysis prevents patients from showing signs of respiratory distress while their vital capacity decreases.To prevent disease.In foodborne botulism. Finding C. and most infections occur via the fecal-oral route. . Adults may be infected after close contact with an infected infant. Transmission is via fecal-oral route. diarrhea . Symptoms and Signs: . dehydrating diarrhea in young children (peak incidence 315 months). Signs. finding toxin in serum or isolating the C. but usually infect infants and young children Infection is most common in the winter. Children less than 2 years of age are primarily affected.Infants and young children with rotavirus gastroenteritis may develop severe watery diarrhea lasting 5 to 7 days. soil. .Mild gastroenteritis is most common.Intestinal flu is caused by infection with one of several viruses. and transmission occurs from person to person by the fecal-oral route. air. botulinum toxin in the serum or feces or by isolating the organism from the feces. . botulinum toxin in the feces establishes the diagnosis. The most common symptoms are water diarrhea and abdominal cramps. C.Diagnosis . waterborne and foodborne outbreaks are well documented. Contaminated meat has caused many outbreaks. Norwalk virus is the principal cause of epidemic viral gastroenteritis. but the illness in adults is generally mild. In symptomatic infections. Four categories of viruses are known to cause gastroenteritis: Rotavirus: is the most common cause of severe. usually characterized by the following: vomiting. Rotavirus is highly contagious. the organism multiplies. Vomiting is unusual. . Incubation 1 to 3 days. Perfringens: causes and acute gastroenteritis when eating foods contaminated by this organism. leftover cooked meat should be refrigerated promptly and reheated thoroughly before serving.incubation (1-3 days) Adenovirus: serotypes 40 and 41 are the second most common cause of childhood viral gastroenteritis.

. It is major causes of cirrhosis and a major cause of post-transfusion hepatitis. complicate acute hepatitis B infection but is seen more commonly as a “super infection” with an increase in abnormal liver function tests in a patient with chronic hepatitis B . abdominal cramps. .Hepatitis B (HBV): is a DNA hepadnavirus that can cause acute or chronic hepatitis. Within the envelope you will find the double-stranded DNA. most patients can be effectively rehydrated with oral rehydration solutions. For rotavirus outbreaks in child care facilities. In children. however.. Asia.Hepatitis: is an acute or chronic liver inflammation due to a variety of agents.Viral gastroenteritis is often diagnosed clinically. antiHBcAg are not protective. whereas in adults. This viral antigen is found in the serum. Low-grade fever occurs in about 50% of the cases. HBV is a major cause of hepatocellular carcinoma worldwide. . diarrhea usually predominates . The core is also antigenic and antibodies form against the core. and is a marker for active disease. .IgM antibody is a marker of acute infection. The Dane particle has an envelope and an icosahedral capsid containing protein spikes. It can. stool. and liver only during acute infection. Daignosis .Norwalk virus typically causes acute onset of vomiting.HBeAg is found dissolved in the serum. vomiting is more prominent than diarrhea. . all children should be tested for excretion of the organism Treatment: -The mainstay of therapy is appropriate fluid resuscitation. . several of which are available OTC. and diaperchanging areas should be disinfected with diluted household bleach or 70% alcohol.Hepatitis E (HEV): a small RNA virus that has been described in cases of acute hepatitis in Mexico.adenovirus gastroenteritis is diarrhea lasting 1 to 2 weeks. therefore. with symptoms lasting only 1 to 2 days. IV rehydration is necessary only for patients with severe dehydration. unlike antiHBsAg. whereas IgG anti-HA merely indicates previous exposure to HAV and immunity to recurrent infection. It is spread via the fecal-oral route. HBV is spread by blood and other body fluids. Even if vomiting.Hepatitis A is a single-stranded RNA picornavirus. .Hepatitis D (Delta): is caused by a small. defective RNA virus (delta agent) that is infectious only in the presence of hepatitis B infection because it relies on hepatitis B proteins for replication. It is often associated with IV drug abuse and is spread by blood-borne transmission . HAV is spread by fecal-oral route and can lead to epidemics.HCV is an RNA virus and may cause acute or chronic hepatitis.Astrovirus causes a syndrome similar to a mild rotavirus infection.The core of the virus is called the Hepatitis B core antigen (HBcAg). . most notably viral infection by one of the hepatitis viruses or alcohol use. . . .Caregivers should wash their hands thoroughly with soap and water after changing diapers. Rotavirus and enteric adenovirus infections can be diagnosed rapidly using commercially available assays that detect viral antigen in the stool. Affected infants and children may have mild vomiting that typically starts 1 to 2 days after the onset of diarrhea.having anti-HBsAg means that the patient is immune against HBV. including saliva. PACKET 2: Hepatitis .Sports drinks and carbonated beverages are not appropriate rehydration for children less than 5 years of age. and Africa. and diarrhea. .The intact HBV is called the Dane particle. It normally causes self-limited disease but can be fatal in (10%-20%) pregnant women.

WBCs and RBCs are seen at various stages of disintegration. . The most important pathogen is Klebsiella pneumoniae.Recommended therapy is penicillinase-resistant penicillin .Vancomycin has been preferred for severely ill patients. Positive blood cultures are definitive evidence of pneumococcal infection. with an episode of chills.morality rate 10% Staphylococcal pneumonia: S. fatigue. .S. .Gram stain of the sputum typically shows gram-positive lancet-shape diplococci. It occurs most commonly in persons at age extremes. preferably cephalothin or cefamandole .Gray hepatization: is characterized by an accumulation of fibrin and inflammation. . vascular engorgement and bacterial proliferation.Congestion: earliest stage of lobar pneumonia and is characterized by extensive serous exudation. cirrhosis). and initiate an inflammatory process that begins in the alveolar spaces with an outpouring of protein-rich fluid . The onset is often sudden. .Red hepatization: reflects the liver-like appearance of the consolidated lung. neutropenia.Chronic hepatitis usually gives rise to symptoms indicative of chronic liver disease (jaundice.Acute hepatitis often starts with a viral prodrome of nonspecific symptoms (malaise. vascular congestion occurs.Chest x-ray shows a pulmonary infiltrate.Pneumococcal pneumonia generally occurs sporadically but most frequently in winter. and difficulty breathing) . and sputum production Diagnosis: . PACKET 3: Pneumonia (Typical symptoms include a cough. proliferate. For HCV you may treat with alpha-interferon and ribavirin.Pneumococci usually reach the lungs by inhalation or aspiration. .Vancomycin is preferred when methicillin resistance is suspected.Pseudomonas aeruginosa is a common pathogen in patients with cystic fibrosis. . Positive . advanced AIDS. joint pain.Gram negative bacilli should be suspected in a patient with pneumonia with risks factors discussed. . cough. . dyspnea.Pneumococcal pneumonia is often preceded by an upper respiratory infection. changes in bowel habits followed by jaundice. Symptoms: . pneumoniae is the most common identifiable cause of bacteria pneumonia and accounts for 2/3 of bacteremic community-acquired pneumonias.Alpha-interferon and lamivudine have proven efficacy for chronic HBV infection. Pneumonia caused by Gram-Negative Bacilli: Gram negative bacilli account for less than 2 % of community acquired pneumonias. The chill is ordinarily followed by fever. Diagnosis: . The alveolar spaces are packed with inflammatory exudate.The major alternative is a cephalosporin.Symptoms and signs generally parallel those of pneumococcal pneumonia .The mortality rate is generally 30 to 40 % in part due to the serious associated conditions the patients have Treatment . although findings may be minimal Treatment: .Penicillin G or V 250 to 500mg po q 6 h is the preferred treatment for patients not severely ill.Blood tests usually show leukocytosis. nausea. and extravasation of RBCs causes a reddish discoloration on gross examination. . chest pain. pain with breathing on the effected side (pleurisy). fever. aureus accounts for about 2% of community-acquired pneumonias and 10 to 15% of nosocomial pneumonia. They lodge in bronchioles. Airspaces are filled with polymorphonuclear cells (neutrophils). . There are more than 80 different serotypes. . vomiting. .Resolution is characterized by resorption of the exudate. which causes Friedlander’s pneumonia.Symptoms and treatment: Acute Hepatitis: .

influenzae.H.Nearly all patients recover with or without treatment.Mycoplasmal pneumonia is also called primary atypical pneumonia. 4. flu-like illness without pneumonia sometimes called Pontiac fever . This agent may be responsible for epidemics that spread slowly because it has an incubation period of 10-14 days. especially hospitals and hotels. mortality is about 15% or greater in community acquired cases and is higher among immunosuppressed or hospitalized patients. gram-negative coccobacilli. . or a transtracheal aspirate obtained before treatment are considered diagnostic. this disease progresses gradually.Hib pneumonia usually occurs in children (average age one year). characterized by pneumonia . is a relatively common cause of bacterial pneumonia . which may resemble influenza. Person-to-person transmission has not been shown. the military. The most preferred drug regimen includes a cephalosporin Pneumonia caused by Haemophilus Influenzae: . Acute symptoms usually persist for 1 to 2 weeks followed by gradual recovery.The mortality for gram-negative bacillary pneumonia is about 25 to 50% despite the availability of effective antibiotics.cultures from blood. pleural fluid. malaise.Legionaires disease has a predilection for late summer and early fall. . of these the most common agent is L. Prognosis and treatment . Because mycoplasmas do not have a cell wall. headache. and families.Gram stain of expectorated sputum shows numerous.Prophylaxis with H. including meningitis. Most patients have a prodromal phase. Symptoms and Signs: . L. sore throat. pneumophilia .The usual incubation period is 2 to 10 days. At least 19 species have been implicated as agents of pneumonia in humans. which increase in severity as the disease progresses. . Treatment: . and dry cough. Spread may involve close contacts or closed populations in schools. and 6 months of age.There are more than 30 proposed species of Legionella. and epiglottitis.A self-limited. Symptoms and Signs . pneumonia outbreaks tend to occur in buildings. with malaise. Unlike typical pneumococcal pneumonia. fever. Prognosis and Treatment: . Prognosis and Treatment .Mycoplasma pneumoniae: is a common pathogen of lung infection in persons 5 to 35 years of age.Initial symptoms resemble influenza.Strains containing the type b (Hib) polysaccharide capsule are the most virulent and most likely to cause serious disease. Pneumonia of Legionaires Disease: . . small. .Even with appropriate treatment.Investigation of an outbreak of acute febrile respiratory illness among members of the American Legion in Philadelphia in 1976 led to the discovery of the bacterium Legionella pneumophilia. influenzae type b (Hib) vaccine is advocated for all children to be given in three doses at 2. they do not respond to antibiotics that interfere with cell wall structure.The preferred drugs are tetracycline or erythromycin . they develop cough that is initially nonproductive and subsequently productive of mucoid sputum.Erythromycin is usually the drug of choice. or in certain geographic areas when a water supply becomes contaminated and aerosolized organisms are spread from evaporative condensers of air conditioner systems Symptoms and Signs . . and myalgias.Legionaires disease the most serious form.

Diagnosis .C. of red. it progresses through a primary.Syphilis. less often in poultry. secondary. and a dry. carinii pneumonia when the CD4 cell count is less than 200/u/L. and is enclosed by a fibrous capsule. . dapsone 100 mg/day po or aerosolized pentamidine 300 mg monthly can be used. lovebirds). The lesions are usually widespread and are symmetric in distribution.Patients with HIV infection become vulnerable to P. . Tertiary syphilis: is the destructive stage of the disease and can be crippling. They are often pink. and anorexia. pigeons. psittaci is found principally in psittacine birds (parrots. . The face is often spared except around the mouth. The temperature rises gradually rises . and tertiary stages. This persists for 2 to 6 weeks and then heals spontaneously. Symptoms and Signs After a 1 to 3 week incubation period.Mortality may reach 30% in severe untreated cases. They are commonly found in the . patients typically develop lesions of secondary syphilis.Psittacosis is an infectious atypical pneumonia caused by Chlamydia psittaci and transmitted to humans by certain birds. . parakeets. rubbery. flat flat-topped papules may coalesce to form condylomata lata Latent Syphilis: is that stage in which there are no clinical signs of syphilis and the cerebrospinal fluid is normal. with the exception of congenital syphilis. coppery. including anogenital and orogenital intercourse. dyspnea.P. moist areas such as the perineum. . a painless papule develops and gradually breaks down to form a clean-based ulcer with raised margins. sore throat. . nonproductive cough.In warm. fever.The drug of choice is trimethoprim-sulfamethoxazole (TMP-SMX) 20 mg/kg/day. newly recognized cases of late syphilis have been declining steadily in the Unites States since World War II. Latency begins with the passing of the first attack of secondary syphilis and may last for a lifetime. The chest x-ray characteristically shows diffuse bilateral perihilar infiltrates. They may complain of malaise. but 20 to 30% of patients have normal X-rays. and Diagnosis: . If untreated. Pneumonia caused by Pneumocystis carinii: . Signs. strict patient isolation should be instituted when the diagnosis is suspected on clinical and epidemiologic grounds. Symptoms. . Treatment -Because other persons may become infected by inhaling cough droplets and sputum. PACKET 4: STD's ..Psittacosis is suggested by a history of exposure to birds and is confirmed by recovery of the agent or by serology.On of the most complication of late syphilis is the appearance of GUMMA A gumma is a soft. It is usually acquired by sexual contact with another infected individual. who may transmit infection to her fetus after many years. .At least 80% of patients with secondary syphilis have cutaneous lesions or lesions of the mucocutaneous junctions. headache. malaise. is acquired almost exclusively by intimate contact with the infectious lesions of primary or secondary syphilis.Early latency in the United States is defined as the first year after infection. chills.Most patients have fever.The incubation period averages approximately 21 days Primary Syphilis: Following the incubation period. and canaries. This is usually through sexual intercourse. noncancerous grow with a necrotic center. large. . with fever. Secondary Syphilis: Approximately 4 to 8 weeks following the appearance of the primary chancre. onset may be insidious or abrupt. If this treatment is not tolerated. .Late latent syphilis is ordinarily not infectious except for the case of the pregnant woman. carinii is considered a fungus and causes disease only when defenses are compromised.Syphilis: is a subacute to chronic infectious disease caused by the bacterium Treponema pallidum. Fortunately.

a member of the Herpesviridae family of viruses.T. It is more difficult to perform than the VDRL test. . and progressive ataxia Darkfield Examination: The most definitive means of making a diagnosis is finding spirochetes of typical morphology and motility in lesions of syphilis. are frequently used for the screen of syphilis.Gonorrhea is the most common reportable infectious disease in the United States. Treatment: . They are highly autolytic and die rapidly when outside their normal human environment. testis. . trachomatis is a sexually transmitted disease that often coexists with or mimics N. Nonspecific Tests: The standard test in use today for detection of anticardiolipin antibody is the Venereal Disease Research Laboratories (VDRL) test. gonorrhoeae is a gram negative. . skin. The FTA-ABS test is used as a confirmatory test. while males become infected only 20-25% of the time after sex with an infected female. The darkfield examination is almost always positive in primary syphilis and in the moist mucosal lesions of secondary syphilis.Gonorrhea is very easily transmitted to women during sexual intercourse. brain. 80-90% of women who have a single encounter with an infected individual contract the disease. .Condoms are effective prophylaxis Chlamydia Trachomatis:C. Diagnosis: . Cardiovascular syphilis usually begins with 5 to 10 years after the initial infection but may not become clinically apparent until 20 to 30 years after infection. The incubation period is 2-7 days. Meningovascular Syphilis: is an acute to subacute aseptic meningitis and may occur at any time after the primary stage but usually within the first year of infection. . Many similar tests. Specific Treponemal Tests: fluorescent treponemal antibody absorption (FTS-ABS) test. resulting in a progressive loss of peripheral reflexes. Herpes genitalis is caused by the herpes simplex virus. HSV type 1 as been implicated in about 13 %. bone. . gonorrhoeae are humans.liver.The only natural hosts for N.N. pallidum is highly susceptible to penicillin G Neisseria gonorrhoeae: is a common sexually transmitted organism that causes anterior urethritis in males and endocervicitis and urethritis in females. Tabes dorsalis: is a slowly progressive degenerative disease involving the posterior columns and posterior roots of the spinal cord. usually of the ascending aorta. myalgia. . Diagnosis: Thayer-Martin medium (80-95 sensitivity). . and headache. with about one million reported cases annually.Seventy to 90% of cases of herpes genitalis are caused by HSV type 2.Transmission is through direct contact with someone who is actively shedding virus from skin or mucous membrane lesions. Death may eventually result from congestive heart failure.Sixty-85% of women with antibodies to HSV-2 have never had a recognized genital ulcer. IT is sensitive and has a high degree of specificity. impairment of vibration and position sense. . It is positive in 85% of patients with primary syphilis and 99% positive in patients with secondary syphilis. aerobic diplococcus. gonorrhoeae infection. and other tissues Cardiovascular Syphilis: The primary cardiovascular complications of syphilis are aortic insufficiency and aortic aneurysm.presumptive diagnosis of herpes genitalis can be made on physical examination when typical lesions are .Primary infection is often associated with systemic “flu-like” symptoms of malaise. including the rapid plasma regain (RPR) test and the unheated serum regain (USR). Treatment/Prevention: IM ceftriaxone. heart.

.The vaginal flora play a critical role in vaginal defenses by maintaining the normally acidic pH (pH 3.Cone biopsy of the cervix . . New organisms that may be introduced into the vagina also affect the microenvironment.Treatment: Treatment does not eradicate the virus.If glycogen levels are decreased. This is helpful in detecting latent or associated precancerous lesions caused by HPV .Normal estrogen levels are necessary for a normal vaginal environment and resistance to infection.Hormones.present.Its acidic environment . Incubation time is between 6 weeks – 18 months . . . These organisms play a critical role in maintaining the normal vaginal environment.Foreign bodies. thus affecting the microenvironment of the vagina. aerobic and anaerobic bacteria that inhabit the vagina.Common Symptoms: Burning/Itching Bacterial vaginosis is the most common vaginal infection in the United States today. .Approximately 2%-4% of pap smears demonstrate the pathognomonic cell—the koilocyte (halo cell). .2) of the vagina. poor diet. treatment modalities include . .Lactic acid and hydrogen peroxide produced by lactobacilli are toxic to anaerobic bacteria in the vagina.Antiviral therapy: Acyclovir is an antiviral drug that is effective against herpesvirus. .More than 40 million sexually active adults in the US harbor HPV.8-4. . necessary for lactobacillus metabolism. often . . This involves a magnified inspection of lower genital tissues after staining with a weak acetic acid solution.Antibiotics alter the microbiology of the vagina and can increase the risk of infection.Intercourse.Laser vaporization .The treatment of latent HPV infections without dysplasia is not recommended. . . Douching or the use of intravaginal medications can alter the vaginal pH affecting the vaginal flora.Bacterial vaginosis is caused by an overgrowth of a variety of bacterial species. E.Intravaginal preparations.Catheterization may be necessary for acute urinary retention. . . . .Estrogen: stimulates proliferation and maturation of the vaginal epithelium. . .Lactobacillus acidophilus: is the dominant bacteria in a healthy vaginal ecosystem. . A mature epithelium provides glycogen. reduces re-occurrence up 75% HPV is a double-stranded DNA virus responsible for a variety of mucocutaneous genital lesions. It can be applied topically or taken orally for the primary episode of HSV-2 infection .Stress.Loop electrode excision of the transformation zone. HSV-2 should be suspected Treatment: sitz baths and topical anesthetic creams .risk of contracting warts for women whose sexual partners have obvious genital warts is 60% to 85%. and fatigue.A thick protective epithelium . As mentioned decreased levels of estrogen increases risk for infection. It is also known to be associated with lower genital tract cancers. .Surgical excision of vulvar or vaginal lesions Gynecological Infections: The vagina is usually resistant to infections for two major reasons: . providing a physical barrier to infection. Semen has an alkaline pH. coli).Oral acyclovir decreases the time of viral shedding. duration of symptoms. HPV-related precancerous conditions. lactobacillus counts decrease as well. affecting both men and women.The acidic environment of the vagina is maintained through the production of lactic acid.Colposcopy. The following are several factors that alter the vaginal environment. particularly anaerobes. .There are normally 5-15 different bacterial species (group B Streptococcus. .

. . which influence the immune system. . . Classic evidence of trichomoniasis includes the following: .Fifty percent of women with bacterial Vaginitis are asymptomatic.Tight clothing. warm moist environment. . Diagnosis: The diagnosis is based on finding three of the following four criteria.Because of the multiple sites of infection.5 . an abundance of bacteria. malodorous discharge.normally found in the vagina.Patients should be warned of a disulfiram-like reaction and told to abstain from alcohol with treatment. . and systemic agents are necessary.Organisms most often included Bacteroides. .. green. homogenous. Both appear to be quite effective. birth control pills and vaginal spermicides.Contraceptive practices (e. because yeast thrive in a dark. The clue cell is a squamous cell in which coccobacillary bacteria have adhered to the cell surface. Trichomoniasis is the third most common vaginitis.Use of antibiotics. . frothy discharge. . both partners require therapy.Several factors have been identified that can lead to symptomatic infection. Gardnerella vaginalis (most common!!) .Undiagnosed or uncontrolled diabetes. vaginal therapy alone is ineffective. Metronidazole can be used after the first trimester. . . Trichomonas vaginitis is therefore an STD.5.The vaginal pH is usually greater than 4.Saline wet mount of the vaginal discharge reveals numerous leukocytes and the highly mobile.Application of 10% KOH to the wet mount specimen produces a fishy odor. indicating a positive “whiff” test. Treatment: . These include the following: . flagellated trichomonads in up to 75% of cases.Wet mount preparation showing minimal or no leukocytes. and the characteristic “clue” cell. usually Candida albicans . which influence the vaginal pH).Use of systemic steroids. panty hose.A vaginal pH greater than 4.The etiologic agent for this infection is a yeast (fungi) organism. Clindamycin can be used throughout pregnancy.Treatment during pregnancy is critical because data suggest an associated of adverse and maternal and fetal outcomes with bacterial Vaginitis. .Because the causative agent is sexually transmitted. Treatment Treatment is based on the use of agents with anaerobic activity and uses both topical and systemic agents.The trichomonad can be recovered from 70% to 80% of the male partners of the infected patient.g.Copious. and bathing suits. . . Candida Vaginitis is the second most common vaginal infection in the United States. .The presence of gray. gray discharge. accounting for 1-3 million cases a year.Cure rates of 90% are achieved with treatment with metronidazole. The most common presentation is a malodorous. accounting for 25% of cases. 25-70% of women report yeast infections after antibiotic use. . . which alters the microbiology of the vagina.

and fish provide media where coagulase-positive staphylococcal grow and provide enterotoxin. . diarrhea. groin. . . diabetics injecting insulin. Toxic shock syndrome caused by staphylococcal exotoxin.The most effective technique for stopping transmission of staphylococci from person to person.Penicillinase: This is a secreted form of beta-lactamase. Microbial Virulence: . only staphylococci can anaerobically to ferment glucose to produce acid. Usually several persons are similarly affected.Coagulase:This enzyme leads to fibrin formation around the bacteria. skin rash.Exfoliatin is a diffusible exotoxin that causes the skin to slough off (scalded skin syndrome) . macrophages. which often accumulates on the surface of our body. They destroy red blood cells. intermittent confusion. . aureus. Drug addicts. . After widespread publicity of the role played by tampons and diaphragms.Patients who regularly use needles have an increased rate of carriage of S. diarrhea. aureus follow ingestion of foods containing a preformed toxin. . of which there are two genera of clinical importance.Diagnosis relies on recognizing the clinical syndrome.). processed meat. .Enterotoxins are associated with food poisoning. so it lives harmlessly as part of the normal flora. and S. aureus predominantly in the nasopharynx. while lipase is capable of degrading fats and oils. cream-filled pastry. and platelets.Onset is sudden. .Normally. hypotension. and delta). with fever (102-105 degrees F. is to wash one’s hands meticulously immediately before and after examining each patient. milk. Other symptoms may include abdominal cramps. Severe nausea and vomiting begin 2 to 8 hours after eating food containing the toxin. beta. the micrococci and the staphylococci. .Hyaluronidase: is a protein that breaks down proteoglycan in connective tissue. and other foreign bodies should be removed at once.Onset is usually abrupt.Patients suspected of having toxic shock syndrome should be hospitalized immediately and treated intensively: tampons.Hemolysins: There are four types of hemolysins (alpha. .TSST-1 has been associated with Toxic shock syndrome Staphylococcal Gastroenteritis: Most cases of gastroenteritis caused by S. neutrophils. or shock. and occasionally headache and fever. But given the chance.Humans carry S. Leukocidins destroy leukocytes (white blood cells).PACKET 5: Staph Infections . constituting a point source outbreak. nonpurulent conjunctivitis. headache. . . patients on hemodialysis.Leukocidins: As the name implies. gamma. profound lethargy. aureus . .Toxic shock syndrome occurred predominantly in menstruating women who used tampons. Exotoxins released from Staphylococci include the following: . especially in the hospital setting. . .Staphylococci may colonize almost all animal species. epidermidis is universally present on the human skin .These two genera are both catalase positive. .Custards. although some individuals can be heavily colonized in the axillae. This protein has the ability to bind immunoglobulins through interaction with the heavy chain. sore throat. Diagnostic confirmation. it can cause a variety of disease. Fluid and electrolyte replacement must be given to prevent hypovolemia. vomiting. and perineal region.Protein A is a surface protein found in the cell wall of Staphylococcus aureus. vomit. and even patients receiving brief courses of allergy shots all have increased rate of nasal carriage of S. a healthy immune system wards off Staphylococcus aureus. diaphragms. protecting it from phagocytosis. although rarely required. The toxin itself is not produced within the gastrointestinal tract.Staphylococci are members of the family Micrococcaceae. resulting in vomiting and diarrhea. is characterized by the following: high fever. By disrupting the beta-lactum portion of penicillin it inactivates it Proteins that tunnel through tissue may include the following: .

. often with an infiltrated surface resembling the skin of an orange Treatment: For streptococcal cellulitis. Topical antibiotics and antiseptics . Itching is common and scratching may cause spread. but healing is rapid and is related to how promptly the peripheral site has been treated. Furuncles: are acute. Diseases Related To Direct Invasion and Systemic Spread of Staphylococci: . erythema. ear or fingers) .SSSS is another toxin-mediated disease produced by certain strains of S. and edematous.Cellulitis is a spreading. .Furuncles occur most frequently on the neck. infected hairs may be easily removed. mycobacteria. as in the bearded area .. and fungi. swelling. Osteomyelitis is an inflammation and destruction of bone caused by aerobic and anaerobic bacteria. WBC infiltration. -The arms. red. legs and face are more susceptible to impetigo and ecthyma than unexposed areas Treatment: Application of mupirocin ointment 3 times daily has been effective in treating impetigo caused by S.The rash proceeds rapidly to desquamation. ringworm like lesions.Carbuncles occur most frequently in males and most commonly occur in healthy persons. and edema without cellular necrosis and suppuration (formation of pus) -Streptococcus pyogenes (group A Beta-hemolytic streptococcus) is the most common cause of superficial cellulitis.Ecthyma is an ulcerative form of impetigo. perifollicular inflammatory nodules resulting from infection by staphylococci.Impetigo is a superficial vesiculopustular infection. brown-black crusts and surrounding erythema. Folliculitis is a superficial or deep bacterial infection and inflammation of the hair follicles. aureus. . aureus but occasionally caused by other organisms such as P. acute inflammation within solid tissues characterized by hyperemia.A single furuncle is treated with intermittent hot compresses to allow the lesion to point and drain spontaneously. breasts. shallow.g.Impetigo may occur on normal skin. Diabetes mellitus. especially on the legs of children.In this condition.Treatment of acute folliculitis is similar to that of impetigo. Folliculitis may become chronic where the hair follicles are numerous or deep in the skin. Lesions vary from a pea-sized vesicopustule to large. DNASE. and outbreaks of this syndrome have occurred in nurseries after introduction of a toxin producing strain. .The skin is hot. . . Infants are most commonly involved. resulting in deep suppuration.Ecthyma is characterized by small. aqueous penicillin is indicated.Vertebral osteomyelitis produces localized back pain with paravertebral muscle spasm that is unresponsive to conservative treatment.The skin is often tender and very erythematous. punched-out ulcers with thick. on the nose. Symptoms .The Staphylococcal Scalded Skin Syndrome (SSSS): . aureus and group A Beta hemolytic streptococci. . usually caused by S. face. . penicillin is the drug of choice . purulent. and a large scar. and buttocks but are most painful when on skin closely attached to underlying structures (e. and have localized warmth.For severe cases which require hospitalization. . and tenderness .Osteomyelitis occurs in vertebrae and in bones of the feet in patients with diabetes or at sites of bone penetrated by trauma or surgery.Patients with acute osteomyelitis of peripheral bones are usually febrile.A patient with a furuncle in the nose or central facial area and patients with multiple furuncles should be treated with systemic antibiotics Carbuncles: are a cluster of furuncles with subcutaneous spread of staphylococcal infection. but new papules tend to develop. producing a sunburn-like rash during the initial phase. and hyaluronidase—enzymes produced by the organism . slow healing. diffuse infection occurs because streptokinase. debilitating diseases and old age are predisposing factors. have had weight loss and fatigue. . often extensive local sloughing. aeruginosa .

congenital heart disease. . initial antibiotic treatment should include penicillinase-resistant penicillin (nafcillin or oxacillin) Staphylococcal Endocarditis: This condition follows staphylococcal bacteremia during which a nidus of infection becomes established on one or more heart valves. . which often contain 100 plus nuclei. and the individual at first has the feeling of developing a very bad flu. Its single antigenic serotype has been remarkably stable throughout the world for many years with no variations noted.Diagnosis: X-rays become abnormal after 3-4 weeks. CT scan can define the abnormality . are a characteristic find in rubeola. requiring no treatment. soft tissue swelling. Koplik spots (small.Complications are rare.Incubation 12-19 Congenital rubella: most commonly results in deafness. and myalgias. an RNA virus that is classifieds as a togavirus. Prevention of rubella is effected by a live attenuated vaccine. Prevention: Measles is part of the MMR (measles. .Disease at 1-3 months gestation is associated is associated with a 30%-60% risk of multiple congenital defects . Clinical manifestations are absent in many cases of rubella. . and rubella) vaccine. highly contagious viral disease that occurs chiefly in young children living in densely populated areas.Secondary bacterial otitis media (most common complication) Rubella (German measles): is an acute. usually benign infectious disease characterized by a 3-day rash. -Therapy is mainly supportive. The word subacute refers to the clinical manifestations. Definitive diagnosis of rubella requires either virus isolation or serologic confirmation. .Rubella is caused by rubella virus. generalized lymphadenopathy. epidermidis is the most common cause. Postnatal rubella.In a patient with localized bone pain. . irregular red spots with central gray or bluish white specks) . Exanthems are rashes that arise as cutaneous manifestations of infectious diseases. night sweats. cough. cataracts.Within 2 or 3 days after the onset of symptoms. .Disease at 5-9 months gestation occasionally is associated with a single defect. which is a live attenuated vaccine. . chills.Disease at 4 months gestation is associated with a 10% risk of a single defect. The fever is often quite high (103 to 105 Fahrenheit).An incubation period extends for 8-12 days after initial exposure to the virus . Endocarditis consists of two clinical syndromes. but may occur. which is usually given at age 15 months . showing bone destruction. myalgias. and weight loss. fever and malaise suggests osteomyelitis. and minimal or no prodromal symptoms. however. often with back pain or some gastrointestinal symptoms.S.In children and adults. . and mental retardation. Treatment of congenital rubella is supportive.Measles is caused by an RNA paramyxovirus. Diagnosis: Warthin Finkeldy giant cells. mumps. Postnatal rubella usually is mild and self-limited. .An erythematous maculopapular rash erupts about 5 days after the onset of symptoms. and loss of vertebral height. glaucoma.subacute bacterial endocarditis the patients present with a history of days to weeks of low-grade fever with or without chills. . They include the following: Measles (rubeola): is an acute. of endocarditis occurring in association with prosthetic heart valves Acute Bacterial Endocarditis: The word acute refers to the clinical presentation of the patient who experiences the rapid onset of fever. and conjunctivitis.Antibiotics should be selected to cover gram-positive and gram negative organisms until culture results are available. This disease is characterized by fever. especially in malnourished of immunocompromised children .

. which is caused by human herpesvirus 6. which usually occurs 1 week after the onset of the rash. . . most notably in hospitals.Varicella is caused by VZV. Because it is highly contagious. atrophic limb.Oral acyclovir is given to adolescents and adults with increased risk of serious disease Erythema infectiosum: is a mild.Bacterial infections of the skin are the most common complication of chickenpox in childhood.The illness usually begins with an abrupt fever characterized by temperatures of 103-104 F. . with low grade fever. . acute disease and young children. It is a double stranded DNA virus. . . although adults may also be affected.Roseola infantum (exanthema subitum): is a common. fatalities have been reported. .The major complications of varicella in adults are encephalitis and pneumonia. .disease is known to be spread by direct contact. accompanied by fever and malaise.Uncomplicated cases of varicella are treated with antipruritic medication and daily bathing to reduce secondary bacterial infections.Herpes zoster is due to reactivation of varicella-zoster virus (VZV). which gives a “slapped cheek” apperance . although these symptoms are more common in adults than in children. The prognosis is generally good.Infectious period: Patients are infectious beginning approximately 24 hours before the appearance of the rash until all lesions are crusted. .The incubation period is usually about 14 days .Complications are uncommon.Immunocompromised children with varicella or disseminated zoster should be treated with intravenous acyclovir. early in the course of the illness Therapy: . a member of the herpes virus family. for example those with AIDS or leukemia who have not had varicella and who are exposed to someone with the disease should received prophylaxis with varicella-zoster immune globulin within 96 hours of exposure . Varicella or chickenpox: is an acute communicable disease characterized by a generalized vesicular rash.Varicella in pregnant women is believed to be more serious than in nongravid females.It begins as a marked erythema of the cheeks. If the diagnosis is unclear.This stage usually last 2-3 weeks. most individuals contract it in childhood. .This is following by an erythematous maculopapular rash that involves the arms and spreads to the trunk and legs. The human is the only known natural host of this virus. although febrile convulsions may occur. . Diagnosis: of both varicella and zoster usually is obvious from the clinical presentation.Parvovirus B-19 is the cause of the illness the rash progresses through three stages: . Attacks of zoster may begin with pain along the affected sensory nerve. Airborne spread also has been demonstrated. self-limited systemic illness accompanied by a distinctive rash.Parvovirus B-19 infection during pregnancy can cause fetal hydrops and death. It occurs primarily in epidemics involving children.varicella embryopathy: These infants are born with cerebral damage and a variety of ocular findings and characteristically have a scarred.occurring primarily in children younger than 10 years of ag . The fever persists for 1-5 days . . . but may persist for several months.therapy is supporive .Immunocompromised children. . a Tzanck test should be performed on scrapings take from the base of a vesicle.

anemia. . Intermittent swelling and pain occur in a few large joints. vivax because their RBCs lack the Duffy blood group.fever. the knees.Malaria results from infection with any of the four different species of Plasmodia. and rash. and an erythematous rash.Younger children are treated with amoxicillin. . . which is the wood tick that is found in the West and is most active in the spring.Lyme disease: is a multisystem infection caused by the spirochete.incubation period that averages about 5-10 days Diagnosis is made primarily on the basis of clinical appearance and history Antibiotic therapy includes either chloramphenicol or tetracycline given 5-7 days LYME DESIASE .” Aside from the rash the patient may also experience malaise.The principle vectors of Rocky Mountain spotted fever are Dermacentor andersoni. myalgia.Scarlet fever: is an acute illness characterized by fever. causing periodic periods of chills.Vector born illness: usually Ixodes ticks . . or CNS disease warrant parenteral therapy with high-dose penicillin G or ceftriazone. headache. confusion .Lyme disease is a clinical diagnosis. fever.Phase III: consists of monoarticular (oligoarticular) arthritis which develops in 605 of patients. . which is transmitted by a tick bite. The disease may be severe. . diaphoresis. ovale. life threatening. particularly. cardiac. pharyngitis. *The four important Plasmodium species are: P falciparum. Borrelia burgdorferi.Phase II: involves the heart (conduction abnormalities. MALARIA . -The face is flushed.Almost two-thirds of the cases of Rocky Mountain spotted fever occur in patients who are younger than 15 years of age. and a mild fever. . and there is increased erythema in the skin folds (Pastia lines). and splenomegaly. similar to sand paper. *A new onset of Bell’s palsy (paralysis of cranial nerve VII) should suggest the possibility of Lyme disease. malariae *Plasmodium falciparum: most severe. chills.A strawberry tongue and pharyngeal erythema with exudate may be present. leading to shock and death in 57% of patients . vivax. P.Severe or persistent arthritis. arrhythmias) or the nervous system (cranial or peripheral neuropathies or aseptic meningitis).Phase I: is characterized by an enlarging erythematous rash (erythema migrans) at the site of the original tick bite. mental confusion.Rocky Mountain spotted fever is a tick-borne illness caused by Rickettsia rickettsii .Most blacks in West Africa are resistant to P.Children older than 8 years of age should receive oral doxycycline for 14 days .10 days of orally administered penicillin Rocky Mountain spotted fever: is an acute febrile illness characterized by the sudden onset of fever. headache. . . P. The skin may feel rough. P. . *The rash resembles a “bull’s-eye. . . *Lyme disease is the most common tickborne illness in the United States. which is required for the invasion of RBCs. It is rare in infancy and may occur more than once in a single patient. based on suggestive history and the characteristic rash on physical examination. headache.

. When the mosquito feeds on a human.P. it inoculates sporozoites.Streptococcus pneumoniae (pneumococcus) . and chloroquine sensitive P. .. epigastric tenderness. During the following 1 to 2 weeks. however. falciparum: causes the most severe disease and can be fatal if untreated. and severe thrombocytopenia may also occur. Those at risk include the following: alcoholics. *Renal disease may result from volume depletion.P. 5. a separate cycle of development results in the formation of gametocytes in the RBCs. falciparum exists. falciparum and P. The trophozoites grow and develop into schizonts. . falciparum and P.The basic elements of the life cycle are the same for all four species. .Meningitis: refers to an inflammation of the meninges of the brain or spinal cord. those with closed head injuries with CSF leaks. . MENINGITIS . retinal hemorrhages. Transmission begins when a female Anopheles mosquito feeds on a person with malaria and ingests blood containing gametocytes. The merozoites invade RBCs and there transform into trophozoites. diarrhea. . coli. influenzae type b is an uncommon cause unless there is a predisposing factor (eg. They appear as rings in stained RBCs. . The trophozoite stage represents the activated feeding stage in the cycle.Factors such as age. Klebsiella. 3. compromised immunity).trophozoite stage: is a feeding stage . . malariae is the most common cause of transfusion malaria. individuals with chronic otitis. .Chloroquine-resistant P.A large variety of bacteria can cause meningitis. head trauma. vivax is treated with oral quinine sulfate. ovale.Pneumococcus is the most common cause of meningitis in adults.H.Mefloquine is recommended for travel to areas where chloroquine-resistant P. history of head trauma with CSF leaks. vivax and P. or Enterobacter) can occur in immunocompromised persons or after CNS surgery or trauma. 2. the plugging of blood vessels. P. ovale: rarely compromise the function of vital organs. which rupture the RBC. falciparum schizonts adhere to vascular endothelium *Patients with cerebral malaria may develop symptoms ranging from irritability to coma. bacteremia . RBCs containing P.Chloroquine is the drug of choice against P. . Simultaneously.Doxycycline should not be given during pregnancy. malariae. *Finding Plasmodium in the blood is diagnostic. Prevention & Treatment .Meningococci exist in the nasopharynx of approximately 5% of the population and spread by respiratory droplets and close contact. P. vivax. Neisseria meningitides (meningococcus) 2. Schizogony occurs within infected hepatocytes. and immune status are helpful in determining the causative agent. Schizogony is a form of asexual reproduction. in which the nucleus divides many times before the cytoplasm divides to form the daughter cells (merozoites). but low-grade parasitemia may persist for decades and lead to immune-complex mediated nephritis. 6. gametocytes inside the mosquito reproduce sexually and develop into infective sporozoites. 4. the two most common are the following: 1. immune complex deposition. which quickly infect hepatocytes. or blackwater fever (hemoglobinemia and hemoglobinuria resulting from intravascular hemolysis). sinusitis. 1. malariae: infections often cause no acute symptoms.Gram-negative meningitis (most often due to E. . Mortality is rare and is mostly due to splenic rupture or uncontrolled hyperparasitemia in asplenic persons. respiratory syndrome.Anopheles mosquito acts as malaria vector .P. and mastoiditis.

mouth. Normal glucose . and vascular collapse may lead to shock and the Waterhouse-Friderichsen syndrome. porcupines.. Blood tests may also reveal low white blood cell counts. . because pneumococcal strains resistant to ceftriaxone and cefotaxime are becoming increasingly prevalent. stiff neck (nuchal rigidity). the CSF is characterized as follows: *Elevated WBC. -Since people may handle these infected animals. bacteremia (eg. and high liver enzymes. low platelet counts. and the development of the Waterhouse-Friderichsen syndrome reduces the chances of survival. Waterhouse-Friderichsen syndrome is a massive usually bilateral hemorrhage into the adrenal glands. nose. is usually added. vomiting. irritability.Attempts to extend the knee from the flexed-thigh position are met with strong passive resistance (Kernig’s sign). . Symptoms and Signs: . vancomycin.In aseptic meningitis. Forrest antelopes.A third generation cephalosporin ( ceftriazone or cefotaxime) should be included . vomit. breast milk. shock. Elevated protein.The Ebola virus belongs to the viral family Filoviridae. and skin should be inspected for sources of infection. from endocarditis). sinusitis. antibiotics should be given immediately. or an organ transplant . stiff neck may be absent. and bulging or tight fontanelles are common. It is characterized by the following: hypotension. blood. by extension from nearby infections (eg. especially in meningococcal septicemia. delayed therapy. but only after a CT scan has excluded a mass lesion. chimps. Fever.The virus is known as a “zoonotic” virus because it’s transmitted to humans from animals: fruit-bats.A low peripheral WBC count is a bad prognostic sign.In bacterial meningitis. or broken skin . and vomiting that characterize acute meningitis. ear.Spinal tap . semen . widespread purpura. EBOLA .The head. convulsions. Treatment: . saliva. Abrupt neck flexion in a supine patient results in involuntary flexion of the hips and knees (Brudzinski’s sign). without waiting for diagnostic test results. Diagnosis: . with or without rifampin.Listerial meningitis can occur at all ages. These virus types cause hemorrhagic fever or profuse bleeding inside and outside the body accompanied by a very high fever.Dehydration is common. liver disease. symptoms and signs are less predictable. or neurosurgical procedures. . the virus can be transmitted via the animal’s blood and body fluids: sweat. .Staphylococcal meningitis can occur after penetrating head wounds. headache.If bacterial meningitis is suspected. gorillas. .However. Persistent leucopenia. the CSF is characterized as follows: *Mildly elevated WBC. . monkeys. Normal or lowered glucose level . Scientists also call it Filovirus.Bacteria reach the meninges by hematogenous spread.People can get Ebola when they come in contact with these fluids via the eyes.Lumbar puncture should be performed promptly. feces. .A prodromal respiratory illness or sore throat often precedes the fever.In infants between 3 months and 2 years of age.Blood tests can identify antibodies or the Ebola virus when people show the first symptoms of what could be Ebola. particularly in patients with chronic renal failure. urine. epidural abscess). a high-pitched cry. Normal or mildly elevated protein level. . .

In pregnant patients.. erythromycin .Mycoplasma pneumoniae: tetracycline or erythromycin for adults or erythromycin for children.Ebola case fatality rate is 50 percent.H. trachomatis: Doxycycline or azithromycin. Others prefer ciprofloxacin or azithromycin. .Pneumococcal pneumonia: Penicillin G or V 250 .Zaire and Sudan viral strains have a 90 percent fatality rate.Staphylococcal pneumonia: penicillinase-resistant penicillin (oxacillin of nafcillin) . influenzae: trimethoprim-sulfamethoxazole (TMX-SMX). . carinii: trimethoprim-sulfamethoxazole (TMP-SMX) .Psittacosis: Tetracycline .T.P. . .C.Herpes genitalis: Acyclovir is an antiviral drug that is effective against herpesvirus . pallidum: is highly susceptible to penicillin G .Trichomoniasis: metronidazole .Legionella pneumophilia: Erythromycin is usually the drug of choice. TREATMENT: .