National License: Infectious disease

PAGE 27NMLE step I: Infectious Diseases

NL: Infectious disease II Bacterial infection.. (MED26)Encoded and proof by 32 MED34

Term Bacteremia clinical syndrome sepsis

Sepsis bacteremia sepsis Melioidosis Burkholderia pseudomallei BP drop Clinical signs and symptoms bacteremia

Sepsis BP < 90/60 mmHg Septic shock pathophysiology vascular leakage

SIRS (Systemic Inflammatory Response Syndrome) inflammatory cytokine Sepsis Sepsis = Infection + SIRS

SIRS tachycardia, tachypnea, hyperthermia (Body temperature > 38 C) inflammatory cytokine acute pancreatitis leakage lipase fat necrosis inflammation cytokine cytokine target organs SIRS non-infectious SIRS Infection 3 host factors? host defense predisposing conditions (Immunocompromised) Atypical infection 20 pneumonia infectious pneumonia Streptococcus pneumoniae immunocompromised patient opportunistic infections PCP (Pneumocystis carinii jiroveci) 20 Streptococcus pneumoniae Mycoplasma pneumoniae 60 Gram negative Klebsiella pneumoniae identify organism prognosis Drug resistance identify organism Timing 7 virulence Virus Gram positive Gram negative bacteria Timing Slow growing Mycobacteria TB, fungus, Actinomyces Pattern Plasmodium falciparum pattern Plasmodium vivaxPast medical history (P. falciparum) melioidosis Endemic area Travellers diarrhea E. coli Tetanus , Chronic renal disease, Thalassemia B. Pseudomallei Melioidosis Alcoholic cirrhosis Klebsiella pneumoniae steroid, glucocorticoid, incidence Nocardia sp. Review Staphylococcus aureus

Gram +ve cocci incluster

Clinical manifestations Most common chief complaint: Skin and Soft tissue infection ( Anatomy skin soft tissue ) Hair follicle Folliculitis () Carbuncle impetigo Soft tissue cellulitis

FolliculitisCarbuncle

Impetigo Cellulitis

dermis subcutaneous layer deep fascia necrotizing fasciitis Treatment: Cloxacillin (Dicloxacillin: absorption ), 1st gen cephalosporin ( Gram +ve) warm and tender lesion cellulitis cellulitis Staphylococci Streptococci Skin lesion Staph. Strep. Lymphangitis ( distribution ) Streptococcal cellulitis Staphylococcal cellulitisStreptococcal cellulitis

Staphylococci Osteomyelitits

Septic arthritis Staphylococcus aureus Synovial fluid Double dose Cloxacillin Dicloxacillin Bones Joints Dose Site of infection duration Joint infection Synovial fluid Pathogenesis of septic arthritis

1. (Haematogenous spread)

2.

Staphylococcal Pneumonia Liquefactive necrosis neutrophil empyema

Lobar pneumonia Staphylococcus aureus

Hospital-acquired: Catheter () Staphylococci Normal Flora attach Acute infective endocarditis antibiotic double dose Staphylococcal toxic shock syndrome exotoxin (TSST-1) SIRS superantigen cytokine : (Erythroderma), hypotention, multiple organ failure (Acute renal failure, ARDS) Desquamation plaque syndrome DIC Staphylococcal Scald Skin Syndrome (SSSS): exfoliative toxin foci of infection Treatment: Cloxacillin + Clindamycin ( 50S ribosomal subunit exotoxin exotoxin ) immunoglobulin neutralize exotoxinStreptococcus pyogenes ((-hemolytic streptococcus Group A)

exudative Gram +ve cocci in chain

Clinical manifestations

Pharyngitis, pyoderma, erysipelas, cellulitis, necrotizing fasciitis

exudative Acute rheumatic fever Autoimmune reaction cell epitope M protein Basal ganglia glomerulus subcutaneous nodule ( Acute rheumatic heart fever) Poststreptocoocal glomerulonephritis Acute glomerulonephritis ( Strain Acute rheumatic fever strain Poststreptococcal glomerulonephritis) 10 Viral pharyngitis Streptococcal pharyngitis exudates ulcer Viral pharyngitis Corynebacterium diphtheria White patch Viral pharyngitisDiphtheria

Necrotizing fasciitis gangrene S. pyogenes Flesh-eating bacteria Bleb Deep fascia

Treatment: PGS high dose + Clindamycin + surgical removal of dead tissue Clindamycin : exotoxin Necrotizing fasciitis Stationary phase (-lactams Protein systhesis inhibitor Erysipelas Skin poor lymphatic drainage

ErysipelasScarlet fever

[Scarlet fever Erythrogenic toxin glossitis ]