Infectious diseases

Transmission

• 1st trimester- rubella• 3rd trimester – toxoplasmosis• Syphilis – after 20 weeks• Congenital herpes – risk of transmission at

child birth

• Appearance of Rash with Fever = VeRy Sick Person MaRy Takes Double Tablets

• Day 1 = Varicella & RubellaDay 2 = Scarlet FeverDay 3 = PoxDay 4 = Measles/ Roseola infantumDay 5 = TyphusDay 6 = DengueDay 7 = Typhoid

Number Other names for the disease Etiology(ies)

First disease Rubeola, Measles, Hard measles, 14-day measles, Morbilli Measles virus

Second disease Scarlet Fever, Scarlatina Streptococcus pyogenes

Third disease Rubella, German measles, 3-day measles Rubella virus

Fourth diseaseFilatow-Dukes' Disease,

Staphylococcal Scalded Skin Syndrome, Ritter's disease

Some say the disease does not exist1.

Others believe it is due

toStaphylococcus aureus strains that

make epidermolytic (exfoliative) toxin2,3

Fifth disease Erythema infectiosum Erythrovirus (Parvovirus) B19

Sixth diseaseExanthem subitum, Roseola

infantum, "Sudden Rash", rose rash of infants, 3-day fever

Human Herpes Virus 6B or Human Herpes

Virus 7

• 1st day - measles• 2nd day – scarlet fever• 3rd day – rubella/ german measles• 4th day – staph scalded skin syndrome• 5th day – erythema infectiosum• 6th day – exanthem subitum/ roseola

infantum• 8th day - tetanus

• Horder’s spots – Psittacosis – facial macules

• Koplik’s spots – measles – bluish gray buccal nodules

• Nagayama spots – roseola infantum

• Rose spots – truncal rash in typhoid patients

• Roth spots – pale centred retinal infarcts in SABE

• Inf mononucleosis – ampicillin inc incidence of rash

• Roseola infantum – rash appears when fever abates

• Erythema infectiosum – slapped cheek appearance, Aplastic crisis

Measles

• Paramyxovirus- RNA• Four C's of Prodrome

Measles: Cough, Conjunctivitis, Koplik's Spots, and Coryza

• Rash begins at hairline and descends downwards leaves behind a browny or furfuraceous desquamation.

• Warthin-Finkeldey Giant Multinucleated Cells• Giant cell pneumonia/ Hecht’s pneumonia• Koplik Spots (Red spots with blue-white centers seen

on buccal mucosa)

Measles

• 10th day – fever• 12th day – koplik’s spots• 14th day – rash – for 7 days

• MC complication bronchopneumonia/ LRTI

• MC complication in children otitis media, diarrhea, Vit A deficiency, least common is SSPE

SSPE/ Dawnson encephalitis

• After 3-8 years of measles. Can also occur after measles vaccine.

• Jabour Stage 1 – abnormal behaviour, poor school performanceStage 2 – seizuresStage 3 – decerebration/ comaStage 4 – EEG findings, no myoclonus

• EEG = burst suppression pattern

• Rx: Isoprinosine, intrathecal interferon

Rubella

1. cardiac PDA, Pulmonary Artery Stenosis, VSD 2. Cataracts3. Mental Retardation4. SNHL

• Maculopapular Rash first on face, then mostly on trunk• Red Tonsils with exudate• Cervical Lymphadenopathy (post occipital, retro auricular,

post cervical lymph nodes)• Fever, Arthralgias• Myocarditis, meningoencephalitis• IUGR• Salt and pepper retina, chorioretinitis, cataract,

microphthalmia

Diagnosis: Rubella-specific IgM 2-3 days after rash starts

Blueberry muffin – rubella; also in neuroblastoma, CMV

• Forscheimer’s spots – soft palate lesions in rubella

Roseola infantum

• Roseola/ exanthem subitum/ 6th disease• Cause – HHV 6• After defervescence of fever rash appears• Centripetal – trunks to extremities

Erythema infectiosum

• 5th disease• Cause – Parvovirus B

19• Slapped cheek• Reticular lacy pattern –

extremities• May have aplastic

crisis

• Arthritis, Myocarditis• Non immune hydrops• Papular purpuric glove stock syndrome• Rx: IVIg (if immunocompromiseed)

Scarlet fever

• Group A streptococci• Sandpaper texture – first on flexor – most

intense on neck, shoulders, axilla, popliteal skin folds

• Pharyngitis, tonsillitis, strawberry tongue

Strawberry tongue

• Strawberry tongue is the appearance of tongue with inflamed red papillae, giving an appearance suggestive to a red strawberry.

Associated conditions:• It is seen in Kawasaki disease, toxic shock

syndrome, and scarlet fever.• It may mimic glossitis or Vitamin B12 deficiency.

Hand, foot and mouth disease

• Coxsackie A 16 (enterovirus 71)• Palmar, plantar pustules• Haemorrhagic papules

• Acute hemorrhagic conjunctivitis – coxsackie A 24, Enterovirus 70

• Herpangina – Entero 71

Varicella/ Chickenpox

• Centripetal rash – trunk first• Prodromal symptoms precede by 1 day• a/c cerebellar ataxia• Cowdry type A• Tzanck Smear (Syncytia - Giant Mulitnucleated

cells)• Breakthrough varicella – varicella in

immunized patient

• MC complication – secondary bacterial infection

• Avoid aspirin – Reye’s syndrome• Acyclovir for immunocompromised

• Varicella embryopathy:6-12 weeks limbs affected16-20 weeks eye and brain affected

Varicella fetopathy

• If mother had varicella in 1st 20 weeks of pregnancy 2% develop fetopathy

• LMN signs• Sensory nerves – scars• Cerebrum – microcephaly, hydrocphalus, intracranial

calcification• Optic stalk and Lens vesicle investment

Chorioretinitis, optic atrophy, cataract, micro ophthalmia

• Congenital varicella syndrome:• Maternal infection near delivery – 5 days

before or 48 hours after• Scarring of skin• Cutaneous lesion - cicatrix

Impetigo

• Group A strep• Bullous lesions caused by Staph• Complication – PSGN

Acute bacterial meningitis

• 0-2 months : E coli, Group B strep, Listeria

• 2 months – 12 years: S. pneumoniae, N. meningitides, H. influenzae type B

• In alteration of host defence – P. aeruginosa, S. aureus, L. monocytogenes, CoNS, Mycoplasma

Mumps

• Paramyxovirus, rubula virus

• Parotitis • Orchitis (infertility rare as it is mostly u/l)• Aseptic Meningitis• Meningoencephalitis can precede parotitis• Congenital mumps --> Noncommunicating

Hydrocephaly due to Aqueductal Stenosis of Midbrain• During preg child will have endocardial fibroelastosis

CMV

• Owl Eye Inclusions (Cowdry Type A Body Intranuclear Inclusion Bodies)

• Binds Beta2-Microglobulin (Required for MHC I)• Only Herpesvirus that crosses Placenta• Use Ganciclovir to treat Retinitis/Infection• MC complication of acquired CMV bleeding diathesis• Congenital CMV -

Thrombocytopenic Purpura, Jaundice, Hepatosplenomegaly, Intracerebral Calcifications, Retinal Infections

CMV

• "MRDICS":- Microcephaly — vs. macrocephaly secondary to hydrocephalus in congenital toxoplasmosis- Mental Retardation- Deafness (sensorineural) — also seen in congenital rubella- Itracranial Calcifications (periventricular) — vs. the intracranial calcifications distributed throughout the cortex and basal ganglia in congential toxoplasmosis- Seizures (likely due to the intracranial calcifications)

Toxoplasmosis• Most common opportunistic CNS infection in those with HIV

(Reactivates in them - so see no/nonreactive IgM, and low IgG titers) or major Immunosuppression

Presentation: Triad• 1. Chorioretinitis• 2. Hydrocephalus• 3. Intracranial Calcifications (diffuse, punctate and periventricular) • Headache, Nausea, Vomiting for several days• IUGR• Thrombocytopenia and bleeding manifestations

Diagnosis:• Ring-Enhancing

Lesion type Brain Lesion

Treatment:• Sulfadiazine + Pyri

methamine

Syphilis

• Treponema Pallidum can easily pass maternal-fetal barrier• Test for this during First and Third Trimesters• Can cause Abortion, Stillbirth, Birth Defects

•Presentation: Hutchinson's Triad: Deafness, Interstitial Keratitis, Notched Incisors

• Saber Shins (Outward Bowing of Anterior Tibias)• Saddle Nose (Flattened Nose)• CNS Damage like CN VIII Deafness

• Hutchinson's Teeth (Notched Incisors)• Mulberry Molars• Perforated Palate• Maculopapular Bronzing Rash• Interstitial Keratitis (Vascularization of Cornea)• Neonate + stuffy nose = syphilis (snuffles)

SYMPTOM/SIGN DESCRIPTION/COMMENTS

Olympian brow Bony prominence of the forehead due to persistent or recurrent periostitis

Clavicular or Higoum?naki sign

Unilateral or bilateral thickening of the sternoclavicular third of the clavicle

Saber shins Anterior bowing of the midportion of the tibia

Scaphoid scapula Convexity along the medial border of the scapula

Hutchinson teethPeg-shaped upper central incisors; they erupt during 6th yr of life with abnormal enamel, resulting in a notch along the biting surface

Mulberry molars Abnormal 1st lower (6 yr) molars characterized by small biting surface and excessive number of cusps

Saddle nose* Depression of the nasal root, a result of syphilitic rhinitis destroying adjacent bone and cartilage

 LATE MANIFESTATIONS OF CONGENITAL SYPHILIS

Diphtheria• Neuro triad:

palatal palsy – 2nd weekneuropathy – 4th weekloss of accomodation – 5th week

• Cardiomyopathy – any time• Bull neck, membrane over tonsils

• Descending paralysis

• Rx: DOC – erythromycin; prophylaxis - penicillin

Pertussis

• Bordetella pertussis – Gm –ve coccobacilli• Whooping Cough (Residual Cough after

Treatment)• 100 day cough• Lymphocytosis is Prevalent• Incubation period 2-4 weeks Prodrome

catarrhal Paroxysmal Convalescent

• MC complication - Pneumonia

• Plate on Bordet-Gengou Agar

• Most easy to isolate during Catarrhal Stage (Most Infectious Period)

Tetanus

Cause: Clostridium Tetani – anaerobic bacterium

• Tetanus bacilli spread through nerves only• Tetanus toxin can spread through blood,

lymphatics

• Incubation period 2-14 days

• TETanus has TETanic Paralysis - Block Glycine release from Renshaw Cells in Spinal Cord - causes Spastic Paralysis, Trismus (Lockjaw) and Risus Sardonicus

• Hyperpyrexia• Laryngeal spasms

• Rx: human tetanus Ig

Polio

• 1% non paralytic polio – meningeal irritation – neck stiffnes:1. tripod posture2. kiss the knee test3. head drop sign4. Rope sign

• 0.1% paralytic polio – asymmetric, areflexia preceded by fever and diarrhea

• Descending paralysis• Sup reflexes lost DTR lost weakness

• Poliovirus destruction of Anterior Horn of Spinal Cord leading to Lower Motor Neuron Lesion.

• Bulbar lesion – CN 9,10,11,12 • Often die of Suffocation (Diaphragm stops)

Diagnosis:• Lymphocytic Pleocytosis with slight elevation of

protein in CSF with Lumbar Puncture - no change in Glucose

• Find virus in stool or throat

• Treatment:Ventilation, Kenny packs

• Any child under 15 years with acute flaccid paralysis – reported

• Fecal samples collected and transported to lab within 72 hours of collection at 4-8 degree celsius

• This is called reverse cold chain

• Natural polio – type 1• VAPP- type 3• Post polio syndrome – weakness with muscle pain

(cramps)

Descending paralysis

• Polio• Botulism• Diphtheria

PCP

• No prodrome, very acute onset• Severe hypoxia, cyanosis• Diffuse Bilateral Interstitial Pneumonia

• CXR – ground glass appearance

• Biopsy shows Honeycomb Exudate with Silver Staining Cysts in Alveolar Lavage

• Most Common Infection in HIV positive patients with < 200 CD4

• PCP presents as Fluffy Infiltrates

• DOC for PCP is Sulfonamide/Trimethoprim (TMP-SMX)

Paediatric HIV2 major + 2 minor Criteria

MAJOR: Weight loss of failure to thriveChronic diarrhoea > 1 month}Prolonged fever > 1 month } Major

MINOR SIGNS:• Generalised lymphadenopathy• Oropharyngeal candidiasis• Recurrent common infections• Generalised dermatitis• Recurrent invasive bacterial infection• Confirmed maternal HIV infection

Paed AIDS

• MC tumor in children NHL• Recurrent bacterial infection• 3 Ps Parotid enlargement, polyclonal

hyperglobulinemia, lymphocytic interstitial pneumonitis

• ELISA – only after 18 months

• Prevent MTCT – NVP, Zidovudine combination therapy ??

• Prophylaxis P. carinii – cotrimoxazoleTB- INHAtypical mycobacterium – Clarithromycin

• BCG, OPV can’t be given in AIDS. BCG given in HIV + mothers.

ATT and side effects

• INH – peripheral neuritis, optic neuritis, hepatitis, aplastic anemia, hypersensitivity

• Rifampicin – hepatotoxic, dermatitis, flu like syndrome, thrombocytopenia, hemolytic anemia

• Pyrazinamide – hepatotoxic

• Ethambutol- retrobulbar neuritis, color blindness

• Streptomycin – auditory or vestibular dysfunction

HBV

• Infant born to HBsAg +ve women vaccine at birth, 1-2 months and 6 months of age + immunoglobulins HBIg 0.5 ml at first dose

• Vaccine – Recombivax HB, Engerix B at first dose

Infectious mononucleosis

• Cause: EBV (Inc risk of NP Cancer)

• Blood Smear Commonly shows B Cells (put rarely shows T Cells)

• Hyperemia of Pharynx, Tonsillar Exudates, Splenomegaly, Cervical Lymphadenopathy,

• Penicillin (Ampicillin) causes Maculopapular Rash

Diagnosis:• Heterophile Antibody• Paul Bunnel test +• Atypical Lymphocytes, Lymphocytosis• EBV Serology (EBV Antibody Titers)• Monospot test for screening

Variant:• Heterophil-Negative Mononucleosis (No Antibodies) -

caused by CMV, Toxoplasma Gondii, Listeria

Dengue• Dengue Fever Virus:

-Dengue Fever: “breakbone fever” (flu-like + severe joint/muscle pain)-Dengue Hemorrhagic Fever (Dengue Fever + Hemorrhage, shock)

• If second infection by different serotype -> antibodies against 1st serotype increase -> cross-react to form immune complexes -> type III hypersensitivity reaction -> hemorrhage, shock (Dengue Hemorrhagic Fever)

Listeria

• Neonatal meningitis• Low protein, sugar and high chloride in CSF

• Tumbling motility, umbrella type formation below surface

Infant botulism

• Botulinum toxin• causing paralysis by blocking the release of

acetylcholine at the neuromuscular junction.• floppy infant• Bulbar palsies, generalized weakness,

hypotonia• Symmetric, descending, flaccid paralysis

IMNCI

• Diarrheal disease• ARI• Malaria

SIRS

Systemic inflammatory response syndromeFinding Value

Temperature <36 °C (96.8 °F) or >38 °C (100.4 °F)

Heart rate >90/min

Respiratory rate >20/min or PaCO2<32 mmHg (4.3 kPa)

WBC<4x109/L (<4000/mm³), >12x109/L (>12,000/mm³), or 10% bands

• Risus sardonicus – tetanus• Rope sign – polio• Coma vigil, organomegaly, acute abdomen –

enteric fever

• Mumps – acute pancreatitis

• Delayed umbilical cord detachment with purulent discharge, leukocytosis, recurrent infections leukocyte adhesion defect, lazy leukocyte sybdrome

• Polyoma virus - hemorrhagic cystitis

• JC Virus - causes PML with HIV

• Vaccine predisposing to malignancy – hep B

• EBV – NHL

• EBV complication Perceptual distortions of sizes, shapes, and spatial relationships, known as the Alice in Wonderland syndrome (metamorphopsia)

Stains

• Acid fast – ziel neelson, Kinyoun, Auramine Rhodamine

• Acridine orange – DNA

• Methanamine silver – pneumocystis cysts

• Wright and giemsa – blood parasites (plasmodium, babesia, leishmania)

• Trichome – stools for parasites

• agar disk diffusion method (Bauer-Kirby method) antibiotic susceptibility

• E test – for MIC

• Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis – Marshall syndrome

• Relative tachycardia – toxins, non infectious disease

• Relative bradycardia – typhoid, brucellosis, leptospirosis

• Fever with petechiae – meningococcus, Hib

• SIRS, CARS (compensated anti inflammatory response syndrome), MARS (mixed anti inflammatory)

• Hyper Ig E – combined B and T whereasHyper Ig M – antibody deficiency

• Ecthyma gangrenosa is a necrotic ulcer covered with a gray-black eschar. It is usually a sign of P. aeruginosa sepsis and usually occurs in LAD patients (immune compromised)

• CGD – defect in NADPH oxidase function of neutrophils

• T. gondii – complicates heart transplants

• Antibiotic lock or dwell therapy, with administration of solutions of high concentrations of antibiotics or ethanol that remain in the catheter for up to 24 hr, may improve outcome when used as an adjuvant to systemic therapy.

• peritoneal cavity (ventriculoperitoneal [VP] shunt) or right atrium (ventriculoatrial [VA] shunt)

• Chronic VA shunt colonization may cause hypocomplementemic glomerulonephritis due to antigen-antibody complex deposition in the glomeruli, which is commonly called shunt nephritis; clinical findings include hypertension, microscopic hematuria, elevated blood urea nitrogen (BUN) and serum creatinine levels, and anemia.

Staphylococcal Scalded Skin Syndrome

• Staphylococcal Scalded Skin Syndrome (Ritter Disease)

• 7 'S' of SSSS

1. Staphylococcal – group 22. Skin tenderness3. Scarlatiform diffuse erythema4. Sign : Nikolsky 5. Sterile intact bulla ( non contagious ) 6. Subcorneal granular split of epidermis (BIOPSY)7. Skin moistened and cleaned with isotonic saline & antibiotics (Rx)

• TSS - Staphylococcus Aureus TSST-1 Superantigen bullous impetigo

• Strep - non bullous impetigo, quellung’sexotoxins of strep pyogenes – super antigens;

PANDAS

• Pneumococcal polysaccharide vaccines- conjugated to CRM 197

• Quinupristin/dalfopristin – for vancomycin resistant enterococci

• Actinomycosis – yellow sulfur granules3 sites – cervicofacial (lumpy jaw), abdo, pelvic, pulmonary

• Pseudo appendicitis – yersinia enterocolitis

• Modified kinyoun’s – Nocardia – beaded pattern

• Madura foot- actinomadura madurae

• GBS – assoc with meningococcal vaccination

• Gonococcus - Dissemination from the fallopian tubes through the peritoneum to the liver capsule results in perihepatitis (Fitz-Hugh–Curtis syndrome).

• H. influenzae is a fastidious, gram-negative, pleomorphic coccobacillus that requires factor X (hematin) and factor V (phosphopyridine nucleotide) for growth.

• Chancroid- buboes, painful, Rx: azithro

Pertussis

• filamentous hemagglutinin (FHA), some agglutinogens (especially fimbriae [Fim] types 2 and 3), and pertactin (Pn) are important for attachment to ciliated respiratory epithelial cells. Tracheal cytotoxin, adenylate cyclase, and PT appear to inhibit clearance of organisms.

• Stainer-Scholte broth or Regan-Lowe semisolid transport medium

• showing perihilar infiltrate or edema (sometimes with a butterfly appearance) and variable atelectasis.

• Lymphocytosis (T and B cells) in Pertussis

Bartonella

• Both B. henselae and B. quintana cause vascular proliferative disease called bacillary angiomatosis (BA) and bacillary peliosis in severely immunocompromised persons, primarily adult patients with AIDS or cancer and organ transplant recipients.

• Subcutaneous and lytic bone lesions are strongly associated with B. quintana, whereas peliosis hepatis is associated exclusively with B. henselae.

• neuroretinitis with papilledema and stellate macular exudates, encephalitis

• development of granulomatous osteolytic lesions

• Warthin-Starry and Brown-Hopps tissue stains

• Leukocytoclastic vasculitis

Gianotti-Crosti syndrome

• also known as papular acrodermatitis of childhood: • immunologic reaction to viral infections and immunizations • initially associated with primary liver infection by hepatitis

B virus. • seen in children after immunizations (hepatitis A, others)

and in patients infected with Epstein-Barr virus (most common association), coxsackievirus A16, parainfluenza virus, and other viral infections.

• Lines of papules (Koebner phenomenon) may be noted on the extremities. skin lesions appearing on lines of trauma

Rickettsia

• TRIAD OF HEADACHE, FEVER, RASH.

• Rickettsia Rickettsii (Rocky Mountain Spotted Fever) with Tick Vector

• Rickettsia Akari - Vesicular Rash (like Chickenpox) esp on Trunk, Smaller Eschars at site of Mite Bite

• Rickettsia Typhi (Endemic Typhus) with Flea vector• Rickettsia Prowazekii Epidemic Typhus with

Human Body Louse

• Erlichia (Ehrlichiosis) via Tick• Pneumonia with Coxiella• Ricketsia Japonicum, R. Slowaki – spotted fever

• Coxiella Burnetii (Q Fever) via Inhaled Aerosols - Queer since it has no rash, no vector and negative Weil-Felix and its causative organism can live outside for along time and is not called a Rickettsia, Can cause Atypical Pneumonia, can be inhaled with dust, or from Ticks.

• Shigella – reiter’s, Ekiri syndrome or “lethal toxic encephalopathy”, pseudomembranous colitis

• E. coli – HUS (O157: H7)due to shiga toxin; fecal leucocyte positiveTraveller’s diarrhea - ETEC

• Campylobacter – GBS;C. fetus – extraint manifestation

• Y. pseudotuberculosis - gm –ve coccobacilli, is associated with a Kawasaki disease–like illness (coronary aneurysm)

• Psudomonas – CF more prone to infection; Phenacin – blueFlurosin – redcause ecthyma gangrenosum,

Burkholderia• Glanders is a severe infectious disease of horses and other

domestic and farm animals due to Burkholderia mallei.

• Burkholderia cepacia is a filamentous gram-negative rod. requiring an enriched, selective media oxidation fermentation base supplemented with polymyxin B–bacitracin-lactose agar (OFPBL)common in CF

• Burkholderia Pseudomallei (Melioidosis) Diabetes mellitus is a risk factor for severe melioidosis. traveler or immigrant from south east asia, pneumonia like symptoms. may present as a single primary skin lesion (vesicle, bulla, or urticaria).

• grown on Ashdown's medium

Francisella tularensis

• Purulent conjunctivitis with ipsilateral preauricular or submandibular lymphadenopathy is referred to as Parinaud oculoglandular syndrome.

• Ulceroglandular disease• Pneumonia• Typhoidal tularemia

• Needs cysteine to grow

Brucella

• Brucella Suis -Pigs• Brucella Melitensis - Goats• Brucella Abortus - Cattle

• Unpasteurized Milk Intermittent Fever, Profound Muscle Weakness, GNB in blood, BM- Microgranuloma, Serum agglutination test +ve

• Brucellosis/Undulant Fever• Bang's Disease• Malta Fever

Legionella

• Legionaire’s disease - Severe Atypical Pneumonia - stays IC in macrophages - Spreads with Air Conditioning Exposure with Fever, (Common in those over 50 yrs old, Smoking,Alcoholism) - Dx: Direct Fluorescent Antibody = Tx: Erythromycin

• Pontiac disease – flu like illness

• Diarrhea + decreased PO4 + decreased Na + Renal dysfunction + abnormal LFT

Bartonella bacilliformis

• Oroya fever, a severe, febrile hemolytic anemia, and verruca peruana (verruga peruana), an eruption of hemangioma-like lesions.

• Bartonellosis is also called Carri?n disease

• Trench fever – bartonella quintana

• Relapsing fever – borellia recurrentis• Louse-borne (epidemic) relapsing fever is caused by

Borrelia recurrentis and is transmitted from person to person by Pediculus humanus

• Tick-borne (endemic) relapsing fever is caused by several species of Borrelia and is transmitted to humans by Ornithodoros ticks.

Borellia burgdorferi

• Lyme disease

• Erythema migrans• Jarish herxheimer reaction• papilledema, cranial neuropathy (especially

cranial nerve VII) • Conduction block

• Vincent angina, also known as acute necrotizing ulcerative gingivitis or trench mouth, is an acute, fulminating, mixed anaerobic bacterial-spirochetal infection of the gingival margin and floor of the mouth. It is characterized by gingival pain, foul breath, and pseudomembrane formation. Fusobacteria + spirochetes

• Ludwig angina is an acute, life-threatening cellulitis of dental origin of the sublingual and submandibular spaces. Infection spreads rapidly in the neck and may cause sudden airway obstruction.fusobacteria

• Lemierre syndrome, or postanginal sepsis, is a suppurative infection of the lateral pharyngeal space, of apparent increasing prevalence, that often begins as pharyngitis. It may complicate Epstein Barr Virus or other infections of the pharynx. It usually manifests as a unilateral septic thrombophlebitis of the jugular venous system with septic pulmonary embolization. Clinical signs include unilateral painful neck swelling, trismus, and dysphagia culminating with signs of sepsis and respiratory distress. Fusobacterium necrophorum is the most commonly isolated organism, although polymicrobial infection may occur.

Clostridium

• Clostridial necrotizing enteritis (CNE), also called enteritis necroticans and pigbel, is an often fatal type of food poisoning caused by a β-toxin of Clostridium perfringens Type C.

• Clostridium perf A – food poison myonecrosis

• Clostridium septicum - rapidly fatal gas gangrene

• M. marinum – fish tank/ swimming pool granuloma

• M. ulcerans – Buruli ulcers

Rx: azithro, rifampicin

Leptospirosis

• Weil's Disease (Acute Icteric Disease) – fulminant hepatic failure

• Non icteric disease• Fever, Headache and Vomiting 1 week after

camping on Island (Hawaii)• Animal Urine gives lesser disease

• Warthin-Starry silver staining

• Mollaret’s meningitis – Herpes simplex

• Eosinophilic meningitis - Angiostrongylus cantonensis

• Shipyard conjunctivitis – Adenovirus, enterovirus

• Pleurodynia (bronholm disease) – coxsackie B1- B5 thoracic pain

• Myocarditis – Coxsackie B5/ Entero 71

Enterovirus – Rx of choice – Pleconarin

rhombencephalitis involving the midbrain, pons, and medulla

dermatomyositis-like syndrome, hepatitis, arthritis, myocarditis, or disseminated infection