CHAPTER 8 Microbiological Diseases:

Non-Respiratory Infectious Diseases

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Introduction

• This chapter includes a discussion of infectious diseases of systems of the body (except respiratory system)

• Includes• Diseases• Symptoms• Diagnostic procedures• Treatments

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• Meningitis– Inflammation of meninges (viral or bacterial)– Signs/Symptoms (S/S): fever, nuchal rigidity,

fatigue, headache, decline in mental status– Diagnostics: blood culture, lumbar puncture,

gram stain, CSF culture– Transmission: respiratory droplets– Treatment: antibiotics (if bacterial)

(Continues)

Infectious Diseases of Head and Neck

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• Encephalitis– Inflammation of brain tissue– S/S: fatigue, headache, abnormal brain

function, seizures, paralysis, abnormal movements

– Diagnostic: lumbar puncture– Treatment: acyclovir – Prognosis: death (if untreated)

(Continues)

Infectious Diseases of Head and Neck

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• Otitis media– Inflammation of middle ear– S/S: irritability, ear tugging, decreased energy and

appetite, fever, vomiting– Treatment

• Antibiotics/topical steroids/analgesics/NSAIDs• Myringotomy• No ASA due to possibility of Reye syndrome

(Continues)

Infectious Diseases of Head and Neck

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• Parotitis─Infection of parotid gland─S/S: localized redness, swelling, firmness,

and pain; difficulty swallowing; high fever; chills

─Treatment• Antibiotics

Infectious Diseases of Head and Neck

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• Conjunctivitis– Inflammation of sclera– Acute: noninfectious (allergies)– Bacterial: usually contagious– Viral: contagious, often preceded by URI– Treatment

• Bacterial: topical antibiotics• Viral: antihistamines/decongestants

(Continues)

Infections of the Eye

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• Keratitis– Inflammation of cornea– Due to: viruses, bacteria, parasites, fungi– Can cause blindness; refer to ophthalmologist

immediately– Diagnostic: culture– Treatment: antibiotics if bacterial (medication

is compounded by pharmacist, since not commercially available), antivirals if due to Herpes simplex

Infections of the Eye

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Cardiovascular Infections

• Endocarditis– Infection in one or more heart valves– S/S: dyspnea; fever; edema of legs/feet;

petechiae/lesions of skin, hair, nails– Diagnostic: echocardiogram– Treatment

• Valve replacement• IV antimicrobials

– Prognosis: death if not properly treated

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Catheter-Related Bloodstream Infections (CRBIs)

• Types of catheters (based on infusion site)– Central (subclavian, internal jugular, femoral)

• S/S: localized redness and purulent drainage, fever, hypotension, change in mentation

• Diagnostic: culture from catheter and from a peripheral vein

• Treatment: antimicrobials, removal of catheter

– Peripheral (arms/hands), rarely infected

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• Cellulitis– Infection of lower dermis/fat tissue– S/S: flat, red area on skin; difficult to

distinguish border; possible drainage– Slow development– Risk factors: non-intact skin; chronic edema of

extremities– Treatment

• Antibiotics (Continues)

Infectious Diseases of Skin and Soft Tissues

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Infectious Diseases of Skin and Soft Tissues

• Erysipelas– Infection of upper dermis and lymphatics of

skin– S/S: redness with swelling of tissue above

level of skin, fever, chills– Abrupt onset– Treatment

• Antibiotics

(Continues)

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Infectious Diseases of Skin and Soft Tissues

• Necrotizing skin and soft tissue infections (including necrotizing fasciitis)– Serious, rapid destruction of skin/fascia– Anaerobic or aerobic– S/S: edematous, fluid-filled blisters at site;

fever; tachycardia; hypotension; confusion; decreased urine output

– Treatment• Debridement, antibiotics

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Intra-Abdominal Infections

• Appendicitis– S/S: abdominal pain, radiating from navel to

right lower abdomen; nausea; vomiting; loss of appetite

– Treatment• Surgery• Antibiotics, if required

(Continues)

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Intra-Abdominal Infections

• Acute cholecystitis– Presence of stone blocking bile flow– S/S: fever, right upper abdominal pain

radiating to back or right shoulder, nausea; vomiting; lack of appetite, onset of pain one hour after eating fatty meal

– Diagnostic: gallbladder ultrasound– Treatment: surgery, antibiotics, if required

(Continues)

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Intra-Abdominal Infections

• Diverticulitis– Inflammation of diverticula– Rupture can cause localized abscess, diffuse

peritonitis (or death if not treated)– S/S: pain in left lower abdomen, nausea,

vomiting, constipation or diarrhea– Treatment

• Antibiotics

(Continues)

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Intra-Abdominal Infections

• Clostridium difficile colitis– Mild to severe and/or life-threatening– Usual history of antibiotic therapy

10 weeks prior to onset of symptoms– S/S: diarrhea, abdominal pain with cramping,

low-grade fever, leukocytosis– Diagnostic: symptoms, history of antibiotics– Treatment: contact isolation, combination

therapy (Continues)

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Intra-Abdominal Infections

• Infectious diarrhea– Associated with consumption of contaminated

food, travel, or exposure to pets– S/S: abdominal cramps, diarrhea that might

be bloody– Treatment: self-limiting, replacement fluids– Source: usually food, not water– Prevention: handwashing, cautious food and

beverage consumption

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Genitourinary Tract Infections

• Sexually transmitted diseases• Preventable with safe sex practices

– Chlamydia• Incubation period 7–21 days• Males: asymptomatic (or) painful urination, mucoid

discharge from penis• Females: cervicitis, urethritis, salpingitis, endometritis,

PID• Treatment: doxycycline or azithromycin

(Continues)

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Genitourinary Tract Infections

• Sexually transmitted diseases– Gonorrhea

• Asymptomatic (or) urogenital, pharyngeal and rectal infections (males and females)

• Conjunctivitis (young children and adults)• Coinfection with chlamydia is common• Treatment: ceftriaxone, cefixime, azithromycin

(Continues)

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Genitourinary Tract Infections

• Herpes simplex 1 or 2– Type 2 usually causes genital herpes– S/S: asymptomatic (or) blisters around

rectum/genitals– Outbreaks may recur since viruses cannot be

eliminated from the body– Treatment

• Antivirals

(Continues)

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Genitourinary Tract Infections

• Human immunodeficiency virus (HIV)– If untreated, progresses to AIDS– Risk factors: STD, injection drug use,

receiving blood products, needle stick of health care workers

– S/S: similar to common cold– Treatment

• Antiretrovirals• Lack of treatment leads to opportunistic infections

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Bone and Joint Infections

• Osteomyelitis– Infection in one or more bones of the body– S/S: localized pain, redness, warmth and

edema at site; fever; chills– Treatment

• Debridement• Antibiotics• Surgery to remove necrotic bone

(Continues)

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Bone and Joint Infections

• Septic arthritis– Infection in one or more joints of the body– Risk factors: diabetes, steroid use, surgery or

trauma to joint, rheumatoid arthritis, IV drug use, advanced age

– S/S: painful, swollen joint; warmth at site; fever with chills; pain with movement of joint

– Treatment • Antibiotics

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Summary

• Clinical presentation, diagnosis, treatment of common non-respiratory infections– Infectious diseases of the head and neck– Infections of the eye– Cardiovascular infections– Infectious diseases of the skin and soft tissues– Intra-abdominal infections– Genitourinary tract infections– Bone and joint infections

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Summary

• Treatment– Empiric therapy if required– Appropriate anti-infective when microbe is

targeted

• Refer to text/tables for expanded information related to diseases, treatments

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