BACTERIAL INFECTIONS

MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
  Whooping  Cough                
  6-­‐WEEK  COUGH                
EPIDEMIC  Pertussis  (sole  
AKA                  
cause)  
SPORADIC  Pertussis  
               
(usual  cause)  
Corynebacterium  
Neisseria  Meningitidis   Pseudomonas  Aeruginosa   Haemophilus  influenza   Leptospira  interrogans   Streptococcus  pyogenes    
diphtheria:  
Requires  FACTORS  X  
(hematin)  &  V  
AGENT   Bordetella  pertussis   Clostridium  tetani      
SUBTYPES:  Mitis,  Gravis,   SEROTYPES:  A  (developing   (Phosphopyridine  
   
Intermedius   countries),B,C,W,  Y   nucleotide)  for  growth  
SEROTYPES:  A,B(MOST  
   
VIRULENT),C,D,E,F  
Gram  (+)  Bacilli   Gram  (-­‐)  COCOBACILLI   Gram  (+)   Gram  (-­‐)  DIPLOCOCCUS   Gram  (-­‐)  RODS   Gram  (-­‐)  COCOBACILLI   Spirochette   Gram  (+)  COCCI   Gram  (+)  COCCI  
AEROBIC     ANAEROBIC     strict  AEROBES          
BACTERIA  
Non-­‐sporeforming   Non-­‐sporeforming   SPORE-­‐FORMING   Non-­‐sporeforming   Non-­‐sporeforming   Non-­‐sporeforming        
CHARACTERISTICS  
Drumstick  or  Tennis  Racket  
    Biscuit  Shaped         pairs  or  short  chain   grape-­‐like  clusters  
appearance  
Coughing  adolescents  &   RAT  ,  dogs,  cats,  livestock,  wild  
RESERVOIR       HUMANS  (only  reservoir)          
adults   animals  
Skin                  
AREAS  AFFECTED  
mucous  membranes                  
INCUBATION  PERIOD   2-­‐4  days   3-­‐12  days   2-­‐14  days         7-­‐12  days      
INHALATION  of  respiratory  
AIRBORNE  droptlets   AIRBORNE  droptlets     aerosols     exposure  of  wound  by  URINE   Respiratory  droplet    
droplets  
MOT   DIRECT  CONTACT  of  
Exposure  to  rusty  metal,   walking  in  flood  waters  w/  
exudates  &  respiratory     nasopharyngeal  secretions     DIRECT  CONTACT   Skin  to  skin  (s.  pyoderma)    
animal  excreta,  soil   broken  skin  
secretions  
M  protein:  major  virulence  
ENDOTOXIN   Beta  Lactamase  
factor  
Hyaluronic  acid  capsule  
62KD  Polypeptide   Tetanus  Toxin   EXOENZYME  S    
nd (accessory)  
EXOTOXIN  (inhibits   (TETANOSPASMIN):  2  
Toxins/  Virulence  Factors   Pertussis  Toxin   ENDOTOXIN       SPE  B  (Streptococcal  Pyogenic  
PROTEIN  synthesis  &  LOCAL   most  poisonous  substance  
EXOTOXIN  A:  cause  LOCAL   Exotoxin)  
tissue  NECROSIS)   known  
necrosis  &  SYSTEMIC   Streptolysisn  O  &  S    
bacterial  invasion   DNAses  A-­‐D,  Hyaluronidase,  
Streptokinase  
INFECTIVITY     EXTREMELY  CONTAGIOUS                
 

 
 BACTERIAL INFECTIONS
MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
EPIDEMIOLOGY             affect  children  <  5  y.o        
important  cause  of  
NOSOCOMIAL  infection  in  
NEONATAL  UMBILICAL   children  w/  cystic  fibrosis,  
               
TETANUS:  MC   neoplastic  disease,  
extensive  burns,  prolonged  
Atb  tx  
SOURCES  of  nosocomial  
infection:  faucet  aerators,  
d/t  SEPTIC  delivery  
communal  soap  dispensers,  
      common  in  delivery  of            
disinfectatns,  improperly  
babies  at  home  
cleaned  ventilators,  infant  
intubators  
      NON-­‐NEONATAL  TETANUS              
      Penetrating  wounds              
      Illicit  drug  injections              
      Abscesses              
      Ear-­‐piercing              
      Tattoo              
PATHOGENESIS                    
Spores  enter  wound  !  
tetanus  toxin  released  &  
binds  at  the  NMJ  !  toxin  
endocytosed  by  motor  
Colonization  of  the  
nerve  !  RETROGRADE   damage  of  endothelial  lining  
nasopharynx  precedes  
axonal  transport  to  alpha   of  bv  !  vasculitis  !  
      infection  !  dissemination          
motor  neurons  !  exits  at   ischemic  changes  to  liver,  
into  the  bloodstream  !  
motor  neuron  in  SC  !   kidneys,  meninges  &  mm  
MININGOCOCCEMIA  
inhibit  spinal  inhibitory  
interneurons  !  prevents  
NTS  release  (GABA)  !  No  
GABA!  TETANUS  
 

 
 BACTERIAL INFECTIONS
MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
DISEASE  CHARCTERISTICS                    
Dry  Hacking,  Paroxysmal   Thumb  Sign  appearance  on   Aseptic  Menigitis  in  ANICTERIC  
PATHOGNOMONIC   PSEUDOMEMBRANE           ABSCESS  
COUGH   Neck  Xray  for  Suprag;ottitis   Leptospirosis  
VASCULITIS:   STREPTOCOCCAL  
PHARYNGEAL  DIPTHERIA:  
Other  Manifestations   CATARRHAL  STAGE  (2  wks)   GENERALIZED  TETANUS   endotoxin  interaction  2/   ENDOCARDITIS   MENINGITIS   ANICTERIC  LEPTOSPIROSIS   PHARYNGITIS  (M  types    
MC  
complement  system   1,3,5,6,12,18,19,24)  
Behavioral  problems,   Septicemic  Phase:  spirochetes  
NONSPECIFIC  PRODROME   language  disorders,   isolated  in  CSF  &  blood,  severe  
Trismus  (lockjaw,  masseter  
(cough,  HA,  &  sore  throat)   Impaired  vision,  mental   HA  &  Abdominal  pain,  body   Sore  throat  w/  BEEFY  RED  
  Sore  throat  (early)   lacrimation   muscle  spasm,  difficulty   PNA    
!  rapid  onset  FEVER,  chills,   retardation,  Hearing   malaise,  N&V,  mm  pain  &   TONSILS  
chewing,  dysphagia)  
arthralgias,  &  myalgias   impairment  (MC   tenderness,  conjunctival  
complication)   soffusion  
  MODERATE  GRADE  fever   LOW  GRADE  fever   HIGH  GRADE  fever   SUDDEN  ONSET  FEVER   CNS  INFECTION   CELLULITIS   FEVER  &  CHILLS   FEVER    
tosillopharyngeal  erythema,  
Risus  Sardonicus   red  edematous  uvula,  palatal    
Head  &  neck  MC  involved,  
(Sardonic  or  Satanic  smile,   FULMINANT   photophobia,  erythematous   petechial,  tender  anterior    
  malaise   sneezing   CHRONIC  MASTOIDITIS   can  spread  from  periorbital  
spasm  of  facial  &  buccal   MENINGOCOCCEMIA   maculopapular  rash   cervical  adenopathy,  enlarged    
!  orbital  !  meningitis  
mm)   &  erythematous  tonsils  w/    
patchy  exudates  
circulatory  collapse  w/   Phase  of  Apparent  Recovery:  
OPISTHOTONUS  (boardlike   ACUTE  EPIGLOTTITIS  OR  
Bull  neck  w/  brawny  edema   rhinorrhea   rapid  enlargement  of   OSTEOMYELITIS   brief  period  of  well  being,  fever   IMPETIGO  CONTAGIOSA   BULLOUS  IMPETIGO  
rigidity)   SUPRAGLOTTITIS  
petechial  &  purpuric  lesions   subsides  
  Immune  Phase:  antibody   PAINLESS  discrete  
Airway  Obstruction  &  
formation,  disappearance  of     papulovesicular  lesion  
LARYNGEAL  DIPHTHERIA   conjunctival  suffusion   Asphyxiation  (laryngeal  &   MENINGITIS   SEPTIC  ARTHRITIS   MEDICAL  emergency   VARNISH-­‐LIKE  coating  
organism  in  blood  &  CSF,   surrounded  by  localized  areas  
respiratory  mm  spasm)  
aseptic  meningitis,  uveitis   of  redness  
PAROXYSMAL  STAGE:  2  wks  
Tetanic  Seizure  (TONIC  type   HA,  neck  stiffness,  lethargy,  
  Stridor   (Pathognomonic  for   UTI   Cherry  RED  epiglottis   ANICTERIC  LEPTOSPIROSIS   HONEY  COLORED  CRUST    
seizure   drowsiness  
Pertussis)  
Dry,  Hacking  to  Paroxysmal   Dysuria  &  urinary  
PSGN  (M49  strain)    
COUGH:  (machine  gun  burst   RETENTION,  
of  uninterrupted  w/  chin  &  
chest  help  forward,  tongue   FORCED  DEFECATION   appears  like  a  cigarette  burn   appears  like  a  cigarette  burn  
maximally  protruded,  eyes   PNA,  SEPTIC  ARTHRITIS,  
!  mentation  &  coma  
bulging  &  watering,  face   OM,  PERICARDITIS,   Septicemis  Phase  &  Phase  of  
  CROUPY  COUGH     GIT  INFECTION  
reddened  &  purple,  ending   tachycardia  &  arrhythmias   NEONATAL  SEPSIS,  OTITIS   apparent  Recovery:  same   CELLULITIS    
 
with  INSPIRATORY   MEDIA,  SINUSITIS  
“WHOOP”)  
Post-­‐tussive  EMESIS  &   PAINFUL  
diaphoresis    
EXHAUSTION   INDISTINCT  BORDERS  
CONVALESCENT  STAGE:  2   Immune  Phase:  Hepatic  
  Hoarseness   NEONATAL  TETANUS:  MC   YOUNG  CHILDREN:   SKIN  INFECTION     ERYSIPELAS    
wks   Dysfunction  
number,  severity,  &   sudden  onset  fever,  
RENAL  DYSFUNCTION   skin  swollen,  red  &  exquisitely  
  Dyspnea   duration  of  coughing   3-­‐12  days  after  birth   vomiting  lethargy,        
(PRINCIPAL  CAUSE  OF  DEATH)   tender  
episodes  diminish   convulsions  
PROGRESSIVE  DIFFICULTY   SHARPLY  DEFINED  BORDERS  &  
  PRONE  TO  SUFFOCATION     FEEDING  (initial         Cardiovascular  Dysfunction   Slightly  elevated  w/  tendency    
manifestation)   to  creep  
paralysis,  diminished   NECROTIZING  FASCITIS  or  
  CUTANEOUS  DIPHTHERIA           Hemorrhagic  Manifestations    
movement   STREPTOCOCCAL  GANGRENE  
superficial  NON-­‐healing  
extensive  destruction  of  
  ulcer  w/  GRAY-­‐BROWN     spasms  &  stiffness  to  touch            
superficial  &  deep  fascia  
membrane  
 
PURPLE  SKIN  w/  yellow  or  
 
  OTITIS  EXTERNA   LOCALIZED  TETANUS           hemorrhagic  BULLAE  (48=72    
 
hours)  
 
 BACTERIAL INFECTIONS
MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
PURULENT  &  ULCERATIVE   spasms  occurring  at  the  
            TOXIC  SHOCK  SYNDROME    
CONJUNCTIVITIS   immediate  wound  site  
renal  impairment,  
coagulopathy,  liver  
PURULENT  &  ULCERATIVE   abnormalities,  acute  
               
VULVOVAGINITIS   respiratory  distress,  extensive  
tissue  necrosis,  erythematous  
rash  
      CEPHALIC  TETANUS              
spasms  involving  the  
                 
BULBAR  musculature  
retracted  eyelids,  deviated  
                 
gaze,  
      trismus  &  risus  sardonicus              
spastic  paralysis  of  the  
                 
tongue  &  pharyngeal  mm  
CNS:  deafness,  seizures,  
NONSUPPURATIVE  
COMPLICATIONS         paralysis,  impairment  of          
COMPLICATIONS  
intellectual  function  
  TOXIC  CARDIOMYOPATHY   Apnea     HYDROCEPHALUS:  VP  shunt         ARF  &  PSGN    
TOXIC  NEUROPATHY:  
neuritis  &  paralysis  of  soft   Secondary  Infection  (OTITIS   SUPPURATIVE  
    Extensive  Skin  necrosis          
aplate,  eye  mms  or   MEDIA,  PNA)   COMPLICATIONS  
extremities  
SEQUELAE  OF  FORCEFUL  
Sinusitis,  Otitis,  Mastoiditis,  
COUGHING  
Lymphadenitis,  PNA,  
    (conjunctival  Hemorrhage,     Loss  of  digits  or  extremities          
Empyema,  Septic  Arthritis,  
epistaxis,  pneumothorax,  
Meningitis  
umbilical  &  inguinal  hernia)  
    CNS  (seizures)     Intestinal  Hemorrhage            
        Late  adrenal  insufficiency            
WATERHOUSE-­‐
FREIDERICHSEN  
SYNDROME:  Fulminant  
                 
meningococcemia  w/  DIC,  
massive  skin  &  mucosal  
hemorrhages  &  shock  
DIAGNOSIS  made  by   DIAGNOSIS  made  by  CLINICAL  
LABORATORY  FINDINGS                
CLINICAL  grounds   &  HISTORY  
Isolation  of  B.  pertussis  in  
Isolation  of  organism  from   Isolation  of  organism  in   Blood  Agar:  Complete  
culture  of  nasopharyngeal  
CULTURE   LOEFFLER  AGAR  MEDIUM     sterile  sites:  BLOOD,  CSF,   BLOOD,  CSF,  URINE,  LUNG   Isolation  of  organism     hemolysis  in  Beta,  Partial    
secretions                (GOLD  
SYNOVIAL  Fluid   aspirate   hemolysis  in  Alpha  
STANDARD)  
CBC  
NORMAL  WBC   Leukocytosis   MILD  PMN  leukocytosis           Leukocytosis    
(Initial  Screening  Test)  
  Hemolytic  Anemia   ABSOLUTE  lymphocytosis                
  Thrombocytopenia                  
NORMAL  w/  MILD  "  of   "  CSF  pressure  w/  "  
CSF                
opening  pressure   protein  levels  &  !  glucose  
Rapid  antigen  detection  test,  
punch  biopsy  &  needle   ASO  titers  (>166  TODD  units),  
"  Serum  mm  enzymes,   Indirrect  Hemagglutination  
OTHERS       aspiration  specimens  of  skin       Anti-­‐DNAse  &    
Transient  ECG  &  EEG  Abn.   Test,  ELISA,  dot  ELISA  Test  
lesions,  PCR   antihyaluronidase  titers,  
Streptozyme  test  
 
  

BACTERIAL INFECTIONS
MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
TREATMENT                    
DIPHTHERIA  ANTITOXIN:  
Tetanus  Antitoxin:  
ANTITOXIN   MAINSTAY,  neutralize  free                
3000-­‐6000  U  IM  
toxin  
TETANUS  IMMUNE  
GLOBULIN  
IMMUNOGLOBULIN       INFANTS:  500  units  IM              
CHILDREN  &  ADULTS:  
3000-­‐6000  units  IM  
TOXOID       Tetanus  Toxoid              

ANTIBIOTICS   STOP  toxin  production                  

DOC  
METRONIDAZOLE                  
30-­‐50  m/k/d  
DOC:  
ONLY  drug  w/  proven   alternative  for  Penicillin  allergy,  
ERYTHROMYCIN   (40-­‐50mg/kg/D)  x  14  days   EFFICACY             30-­‐50mg/kg/D  PO  q  6-­‐8  hours  x    
(40-­‐50  mg/kg/D)  x  14  days   10  days  
(also  given  to  close  contact)  
st
DOC:    high  dose  in  1  48  
100,000  U/k/D  for  10-­‐14   hours  to  prevent  meningitis   Benzathine  Pen  G  (IM),  PEN  V  
PENICILLIN  G   50T-­‐100T  U/Kg/D         DOC:  50T-­‐100T  U/Kg/D    
days   (250000-­‐300000  U/k/D  IV  x   (ORAL),  Acqueous  PEN  G  (IV)  
7  days)  

DOC:  50-­‐100  m/k/d  for  7-­‐10  

AMPICILLIN                  
days  

Combination  of  any  2  

drugs:  Carbenicillin  (200-­‐
400  m/k/d),  Ticarcillin  (200   Alternative:  
DIAZEPAM:  anticonvulsant   Choramphenicol  (75-­‐ m/k/d)      
Chloramphenicol  
&  mm  relaxation   100mg/k/d)   Gentamycin  (5-­‐7.5  m/k/d)   Tetracycline  (>12  y.o):  10-­‐20  
OTHER  drugs       Ampicillin  Resistant:  
(0.1  –  0.2  mg/k/d  3-­‐6  hours   Cefotaxime  (200m/k/d)   Tobramycin  (3-­‐5  m/k/d)   m/k/d  
Cefixime,  Amoxicillin-­‐
IV)   Ceftriaxone  (100m/k/d)   Amikacin  (15-­‐25  m/k/d)   Clavulanate  
Can  be  used  alone:  
   
Ceftazidime  150-­‐200  m/k/d  
Respiratory  Isolation  for  at  
ISOLATION     least  5  days  after  starting                
Erythromycin  
 

 
  

BACTERIAL INFECTIONS
MENINGOCOCCAL  
CHARACTERISTICS   DIPTHTHERIA   PERTUSSIS   TETANUS   PSEUDOMONAS  INFECTION   INFLUENZA  INFECTION   LEPTOSPIROSIS   GROUP  A  STREPTOCCOCI   STAPHYLOCCOCAL  INFECTION  
INFECTION  
rodent  control  &  avoid  
PREVENTION                  
contaminated  water  
MENINGOCOCCAL  VACCINE  
ADULT:  (11-­‐55  yo)  
Hib  Vaccine  1  dose  at  15  
DPT,  DTaP  (<7yo),  Tdap   MCV  0.5  mL  IM  
IMMUNIZATION   DPT   DPT,  DT,  DTap,  Td,  Tdap     months,  or  2  doses  at  12-­‐14   immunize  pets      
(>7yo)   PEDIATRIC  (2-­‐10  y.o  &  >  
months  &  <  6  months  
55yo)  
MPSV  0.5  ml  IM  
Neither  natural  disease  nor  
vaccination  provide  lifelong  
immunity  
Protection  wanes  3-­‐5  years  
LIFELONG  IMMUNITY                  
postvaccination  
Can  become  RESERVOIRS  of  
pertussis;  hence  get  Tdap  
after  10  years  
if  completed  <  7y.o,  Booster  
BOOSTER  SHOT   Td  or  Tdap  after  10  years   every  5-­‐10  years       4  years  old        
shots  every  10  years  
EXPOSURE                    
For  Close  Contacts  
ERYTHROMYCIN   (40-­‐50mg/kg/D)  x  7-­‐10  days                
(40-­‐50  mg/kg/D)  x  14  days  
50T-­‐100T  U/Kg/D  single  
BENZATHINE  PENICILLIN  G                  
dose  IM  
ADULT:  600  mg  PO  BID  x  2  
0-­‐1  month:  10m/k/dose  
days  
above  1  month:  
RIFAMPIN         PEDIATRIC:  (<  1  mo)  5  m/k          
20m/k/dose  
PO  or  (>  1  mo)  10  m/k  PO  q  
 
12  hours  x  2  days  
200  mg  once/  week  in  endemic  
DOXICYCLINE                  
areas  
DIFFERENTIAL  DIAGNOSIS       RABIES              
Hydrophobia,  marked  
      dysphagia,  CLONIC  seizures,              
CSF  pleocytosis  
      HYPOCALCEMIA              
TONIC-­‐CLONIC  seizures,  NO  
                 
trismus  
      PHENOTHIAZINES              
Thorazine  causes  EPS:  
Pseudoparkinsonism,  
      Dystonia,  Akathisia,              
Irreversible  Tardive  
Dyskinesia  
POLIOMYELITIS,  BACTERIAL  
      MENINGITIS,  NARCOTIC              
WITHDRAWAL