I&I Bacteria, Inflammatory Diseases & SIRS
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- Definition of SIRS
-
widespread inflammatory response
abnormal temp, High HR &/or RR (also low PaCO2), Left shift &/or abnormal WBCs (nrml is 4000-12,000) - Sepsis
- SIRS + evidence of infection
- Severe Sepsis
-
SIRS + evidence of infection + end organ failure
(CV, Renal, Pulm, GI, Renal) - Septic Shock
- SIRS + evidence of infection + end organ failure + hypotension
- Pathogenesis of SIRS
-
Cytokines (TNF & IL-1)
Bacterial Factors (endotoxin or staph enterotoxin or TSS)
Complement Activation
Cellular injury (ischemia, less surface area, apoptosis, hypoxia b/c rigid RBCs & poli adhesion, cytotoxicity b/c endotoxin, TNF, NO) - Cytokines in SIRS
- TNF alpha & IL-1
- Bacterial factors in SIRS
- LPS, Staph enterotoxin, TSS
- Cellular injury in SIRS
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ischemia b/c poor perfusion
decreased surface area for O2 exchange
apoptosis
hypoxia b/c RBC rigid & PMN sticky
direct cytotoxicity from endotoxin, TNF & NO - Cause of Acute Renal Failure
-
48% can be attributed to SIRS
mortality is higher if SIRS - Patients at Risk for SIRS
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bacteremic
Comorbidities- AIDS, Renal/Liver Failure, CA, middle age/elderly - Useful treatment for SIRS
-
manage fluids
Glycemic ctrl (insulin)- PMNs need
ABs
Ionotropes
Activated Protein C- avoid clots
Hydrocortisone (for renal insuff) - Failed Treatments for SIRS
-
High Dose Corticosteroids
TNF alpha inhibitors
Anti-endotoxin ABs
Ibuprofen - Two types of diarrhea & bugs
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Inflammatory- usually bacteria (salmonella, campylobacter, shigella)
Non-inflammatory- bacillus cereus, viral, giardia, cholera - Signs/Symptoms of Inflammatory Diarrhea
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Abdominal pain & fever
Positive stools- WBC & RBC, possibly toxin - Mechanism of Inflammatory Diarrhea
- direct inflammation of gut wall
- Mechanism of Non-inflammatory diarrhea
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Secretory:
disrupted homeostasis
1. Change in gut villi (blunting)- Bacillus Cereus (reheated rice), Giardia
2. Viral- direct effect on endos
3. Toxin- cholera - Organisms in Viral Diarrhea
-
Rotavirus
Norwalk
Enteric adenovirus- Ad40 &41
small children/infants
Enterovirus- echovirus, may cause meningitis
Coronavirus- astro - Rotavirus
-
most common cause diarrhea in children
sudden onset, low fevers
villous changes
watery diarrhea, +/-URI
SEVERE DEHYD w/in 1 HOUR
(member of Reo) - Treatment of Rotavirus Diarrhea
- tx: fluids, possible hospitalization
- Norwalk
-
seen in all age groups
especially outbreaks in winter
cramps, NV watery diarrhea, HA, malaise, myalgias, lw fever
(member of Calcivirus) - Treatment of Norwalk Diarrhea
- fluids, prevent spread, antiemetics
- Common Bacteria Causing Diarrhea
-
Listeria & Clostridium- only G+ (bacilli)
Salmonella-enterobacter (G- bacilli) (Non-motile)
Shigella- enterobacter (has PS capsule)
E Coli- enterobacter (ferments lactose)
Cholera- G- vibrio
Vibrio Vulnificus- vibrio, shellfish - Characteristics of Cholera
-
G- vibrio
pandemics
classical biotype is E1
emerging biotype is 0139
Does NOT invade-colonize & multiply in gut - Treatment of Cholera
- doxycycline, Bactim (0139 is resistant), quinolones
- Signs & Symptoms of Cholera
- Rice Water Diarrhea, rushing, fullness, vomiting
- 0139
- bactim resistant emerging Cholera biotype
- Characteristics of Salmonella
-
G- bacillus (enterobacter)
Invades & multiplies in M cells of Peyers Patches
typhimurium & enteriditis are most common
DT104 is emerging & resistant - Risk Factors for Salmonella
- animals fed w/antibiotics, reptiles, PPI & H2 blocker, sickle cell
- S&S of Salmonella
-
N/V, fever, myalgias, HA
loose/watery
secondary sites b/c hem spread - Treatment of Salmonella
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Quinolones, PCN (extended), 3rd gen Cephalosporins
NO ABs in Healthy Adults (increases shedding time) - Characteristics of Shigella
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Enterobacter, non-motile, fecal/oral trnsmission
most communicable bacterial diarrhea
shiga toxin highly contagious
RNAase
endotoxin causes watery diarrhea - S & S of Shigella
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summer/fall, refuge camps
fever, cramps, watery diarrhea
bloody mucous or stool - Toxic megacolon
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complication of shigella
also septicemia, keratoconjunctivitis, reiters like autoimmune, Ikari syndrome in kids - treatment for shigella
- fluids & ABx
- Characteristics of E Coli
-
G- bacilli
ferment lactose
Vero toxin (sim to shigella toxin) - S & S of E Coli
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persistant, relapsing, watery diarrhea
bloody stool but no WBCs - Treatment for E Coli
-
Supportive only
NO ABx! - Characteristics of Listeria
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G+
found in herd animals - S & S of Listeria
-
self limiting gastroenteritis
fetal toxicity
bacteremia
CNS - Treatment of Listeria
- High Dose Ampicillin (+/- gentomycin or bactrim)
- Clostridium
-
dificile- from ABx, assocd w/ colitis
Perfringens- gas gangrene
Botulinum- preformed toxin, spores - Vibrio Vulnificus
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G- rod
"hazzard of halfshell"
skin infection - Cause of Food Poisoning
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Staph Aureus b/c ingest preformed enterotoxin
Bacillus Cereus from reheated rice - Red Currant Jelly diarrhea
- Entamoeba Histolytica
- Protazoa associated with AIDS
- cryptosporidium
- Bug in dental caries
- strep mutans
- characteristics of normal flora in mouth
-
gingival crevice has higest number (along with colon)
low O2 tension so anaerobes - Strep Mutans is normal flora in ...
- dental caries (gingival crevice)
- Prevotella intermedia is normal flora in ...
- gingivitis
- veillonella parvula is normal flora in ...
- saliva- common infection from human bite
- Normally Sterile sites
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Airway below larynx
Eustacian Tube
Sinus
Uterus
Fetus
Bladder
GI & Vagina until birth
Male GU (UTI implies underlying pathology) - Normal Bugs in oro/nasopharynx
-
GAS most common
strep pneumo, staph aureus, HIB, HSV (80% of adults) - Normal Bugs in UR tract
-
Anaerobes- veillonella, actinomyces, peptostrepto, fuso
Aerobes- HIB, Strepto, staph, neisseria
Fungi- candida - Normal Bugs in stomach
- lactobacillus & H Pylori
- Lactobacillus
-
important normal flora in stomach (with H pylori)
homeostasis - Normal Bugs in small intestine
-
peptostrepto, prevotella
produce volitile FAs that protect (salmonella)
candida
giardia