Bacterial infectious diseases

Anthrax

- an acute infectious disease caused by the bacteria Bacillus anthracis
- Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous).

1. Pulmonary (pneumonic, respiratory, or inhalation) anthrax

Respiratory infection initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse.

A lethal dose of anthrax is reported to result from inhalation of 10,000-20,000 spores. This form of the disease is also known as Woolsorters' disease or as Ragpickers' disease.

2. Gastrointestinal (gastroenteric) anthrax

Gastrointestinal infection often presents with serious gastrointestinal difficulty, vomiting of blood, and severe diarrhea. Untreated intestinal infections result in 25-65% mortality.

3. Cutaneous (skin) anthrax

Cutaneous infection often presents with large, painless necrotic ulcers (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection.

Treatment

- large doses of intravenous and oral antibiotics, such as penicillin, ciprofloxacin, doxycycline, erythromycin, and vancomycin.
- Antibiotic prophylaxis is crucial in cases of pulmonary anthrax to prevent death.

Cholera

- a water-borne disease caused by the bacterium Vibrio cholerae, which are typically ingested by drinking contaminated water, or by eating improperly cooked fish, especially shellfish.

Symptoms

- general GI tract upset: profuse diarrhea (eg 1L/hour), abdominal cramping, fever, nausea and vomiting.

- Dehydration

- severe metabolic acidosis with potassium depletion, anuria, circulatory collapse and cyanosis

- Death is through circulatory volume shock (massive loss of fluid and electrolytes)

Treatment

- rehydration and replacement of electrolytes

- Tetracycline antibiotics may have a role in reducing the duration and severity of cholera

Diphtheria

- Diphtheria is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane (a pseudomembrane) on the tonsil(s), pharynx, and/or nose

Signs and symptoms

- Incubation time of 1-4 days

- Symptoms include fatigue, fever, a mild sore throat and problems swallowing

- Children infected have symptoms that include nausea, vomiting, chills, and a high fever,

Treatment

- Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others

- Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or

- Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).

- Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

- In more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult throat may require intubation or a tracheotomy

Pertussis

- Pertussis, also known as "whooping cough", is a highly contagious disease caused by certain species of the bacterium Bordetella—usually B. pertussis

- The disease is characterized initially by mild respiratory infections symptoms such as cough, sneezing, and runny nose (catarrhal stage).

- After one to two weeks the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound (paroxysmal stage)

- Other complications of the disease include pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection.

- The disease is spread by contact with airborne discharges from the mucous membranes of infected people.

- Laboratory diagnosis include; Calcium alginate throat swab, culture on Bordet-Gengou medium, immunofluorescence and serological methods.

-Treatment of the disease with antibiotics (often erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole)

- Vaccination in children as preventive measure . The immunizations are often given in combination with tetanus and diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years

Tetanus

Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani.

Symptoms

-The incubation period for tetanus is 3 days to as long as 15 weeks

- For neonates, the incubation period is 4 to 14 days, with 7 days being the average

- The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen.

- Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate

Treatment

- Penicillin and metronidazole

- Human anti-tetanospasmin immunoglobulin should be given.

- Diazepam and DPT vaccine booster are also given

Syphilis

- a sexually transmitted disease (STD) that is caused by a spirochaete bacterium, Treponema pallidum

- The route of transmission for syphilis is almost invariably by sexual contact

Stages of syphilis

1.Primary syphilis

Chancres on penis due to primary syphilitic infection

Primary syphilis is manifested after an incubation period of 10-90 days (the average is 21 days) with a primary sore.

During the initial incubation period, individuals are asymptomatic.

The sore, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the bacterium, often on the penis, vagina or rectum.

 Local lymph node swelling can occur. The primary lesion may persist for 4 to 6 weeks and then heal spontaneously.

2. Secondary syphilis

characterized by a skin rash that appears 1-6 months (commonly 6 to 8 weeks) after the primary infection

This is a symmetrical reddish-pink non-itchy rash on the trunk and extremities , nvolves the palms of the hands and the soles of the feet

in moist areas of the body the rash becomes flat broad whitish lesions called condylomata lata. Mucous patches may also appear on the genitals or in the mouth

common other symptoms include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes

3. Tertiary syphilis

occurs from as early as one year after the initial infection but can take up to ten years to manifest

This stage is characterised by gummas, soft, tumor-like growths, readily seen in the skin and mucous membranes, but which can occur almost anywhere in the body, often in the skeleton

Other characteristics of untreated syphilis include Charcot's joints (joint deformity),

Clutton's joints (bilateral knee effusions).

The more severe manifestations include neurosyphilis and cardiovascular syphilis.

Cardiovascular complications include aortic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation, and are a frequent cause of death

Syphilitic aortitis can cause de Musset's sign

4.Congenital syphilis

Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with secondary or tertiary syphilis.

Manifestations of congenital syphilis include abnormal x-rays; Hutchinson's teeth (centrally notched, widely-spaced peg-shaped upper central incisors);

mulberry molars (sixth year molars with multiple poorly developed cusps);

frontal bossing; saddle nose; poorly developed maxillae; enlarged liver; enlarged spleen; petechiae;

other skin rash; anemia; lymph node enlargement; jaundice; pseudoparalysis; and snuffles, the name given to rhinitis in this situation.

Rhagades, linear scars at the angles of the mouth and nose result from bacterial infection of skin lesions.

Death from congenital syphilis is usually through pulmonary hemorrhage.

Diagnosis

First effective test for syphilis, the Wassermann test

Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) test are not as effective

Newer tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum haemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific, but are still unable to rule out non-syphillis Treponomal infections such as Yaws and Pinta.

Microscopy of chancre fluid using dark ground illumination can be extremely quick and effective.

Treatment

first choice treatment for syphilis remains penicillin, in the form of benzathine penicillin G or aqueous procaine penicillin G injections

oral tetracyclines. In patients allergic  to penicillins

Typhoid fever

- Typhoid fever (Enteric fever) is an illness caused by the bacterium Salmonella typhi

Symptoms

After infection, symptoms include:

a high fever from 39 °C to 40 °C (103 °F to 104 °F) that rises slowly

chills

bradycardia (slow heart rate)

weakness

diarrhea

headaches

myalgia (muscle pain)

lack of appetite

constipation

stomach pains

in some cases, a rash of flat, rose-colored spots called "rose spots"

extreme symptoms such as intestinal perforation or hemorrhage, delusions and confusion are also possible.

Diagnosis

Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar)

Treatment

Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, are commonly used to treat typhoid fever in developed countries

Usage of Ofloxacin along with Lactobacillus acidophilus is also recommended.

Histoplasmosis

Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. Its symptoms vary greatly, but the disease primarily affects the lungs.

Occasionally, other organs are affected—this form of the disease is called disseminated histoplasmosis, and it can be fatal if untreated.

H. capsulatum grows in soil and material contaminated with bat or bird droppings. Spores become airborne when contaminated soil is disturbed. Breathing the spores causes infection.

Symptoms

they will start within 3 to 17 days after exposure.

The acute respiratory disease is characterized by respiratory symptoms, a general ill feeling, fever, chest pains, and a dry or nonproductive cough.

Chronic lung disease resembles tuberculosis and can worsen over months or years

Treatment

Antifungal medications are used to treat severe cases of acute histoplasmosis and all cases of chronic and disseminated disease

Candidiasis

Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is probably the most common.

candidiasis can usually only be found in exposed and moist parts of the body, such as:

the oral cavity (oral thrush)

the vagina (vaginal candidiasis or thrush)

folds of skin in the diaper area (diaper rash)

the most common cause of vaginal irritation or vaginitis

can also occur on the male genitals, particularly in uncircumcised men.

Symptoms

itching and irritation of the vagina and/or vulva, and a whitish or whitish-gray discharge that may have a "yeasty" smell like beer or baking bread

Diagnosis

KOH (potassium hydroxide) preparation can be diagnostic

Aspergillosis

Aspergillosis is an infection or an allergic response caused by a fungus of the Aspergillus type. It may play a role in allergy, but is best known for causing serious pulmonary infections in immunocompromised patients

It causes illness in three ways:

as an allergic reaction in people with asthma

as a colonization and growth in a lung injury (such as from tuberculosis or lung abscess)

as an invasive systemic infection with pneumonia, nasal necrosis or aural inflammation and necrosis that is spread to other parts of the body by the bloodstream (pulmonary aspergillosis - invasive type).

Symptoms

Allergic aspergillosis

Fever

Malaise

Coughing

Coughing up blood or brownish mucous plugs

Wheezing

Weight loss

Recurrent episodes of lung obstruction

Invasive infection

Fever

Chills

Headaches

Cough

Shortness of breath

Chest pain

Increased sputum production, which may be bloody

Bone pain

Blood in the urine

Decreased urine output

Weight loss

Symptoms involving specific organs

Brain: meningitis

Eye: blindness or visual impairment

Sinuses: sinusitis

Heart: endocarditis

Signs and tests

Abnormal chest X-ray or CT scan

Sputum stain and culture showing Aspergillus

Tissue biopsy (see bronchoscopy with transtracheal biopsy) for aspergillosis

Aspergillus antigen skin test

Aspergillosis precipitin antibody or galactomannan positivity

Elevated serum total IgE (immunoglobulin)

Peripheral eosinophilia with allergic disease

Treatment

intravenous amphotericin B, an antifungal medication.

Itraconazole can also be used, or its newer counterpart voriconazole.

Caspofungin may be tried when other drug therapy has failed.

Endocarditis caused by Aspergillus is treated by surgical removal of the infected heart valves and long-term amphotericin B therapy.

Allergic aspergillosis is treated with oral prednisone.

1. Anaphylaxis 

    - Adrenaline (epinephrine) injection 1:1000, 1 mg/ml
    - Intramuscular adrenaline (0.5 ml of 1 in 1000 solution) 
    - Repeat at 5 minutes if needed

2. Hypoglycaemia

    - Oral glucose solution/tablets/gel/powder 
    - Glucagon injection 1 mg  Intramuscular
    - Proprietary non-diet drink or 5 g glucose powder in water     

3. Acute exacerbation of asthma

    - (Beta-2 agonist) Salbutamol aerosol inhaler 100  mcg/activation
    - Salbutamol aerosol Activations directly or up to six into a spacer
    
4. Status epilepticus
    - Buccal or intranasal midazolam 10 mg/ml
       
5. Angina
    - Glyceryl trinitrate spray 400 mcg/metered activation   
    
6. Myocardial infarct

    - Dispersible aspirin 300 mg