SEMİOLOGY OF İNFECTİOS DİSEASES

Prof. Dr. Yaşar Küçükardalı Yeditepe UniversityFaculty of Medicine

Department of Internal Medicine

Semiology ; science of the findings and symtoms of the deseases

Subjective and Objective information

subjective objective

What the patient says (chief complaint etc.)

Physician‘s physical examination

Laboratory findings

Radiological findings

INFECTİON

Infection: The invasion and multiplication of microorganisms such as bacteria, viruses,fungus and parasites that are not normally present within the body and the reaction of host tissues to these organisms and the toxins they produce .

An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.

An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic .

Microorganisms that live naturally in the body are not considered infections. For example, bacteria that normally live within the mouth and intestine are not infections.

transmissible diseases communicable diseases

HOW BACTERIA AND VIRUSES ENTER THE BODYPathogenic bacteria must gain access into the body. The range of access routes for bacteria includes: Cuts Contaminated food or water Close contact with an infected person Contact with the faeces of an infected person Breathing in the exhaled droplets when an

infected person coughs or sneezes Indirectly, by touching contaminated

surfaces – such as taps, toilet handles, toys and nappies.

VIRUSES ARE SPREAD FROM ONE PERSON TO ANOTHER BY:

Coughs Sneezes Vomits Bites from infected animals or insects Transfusion of the contaminated blood

products Exposure to infected bodily fluids through

activities such as sexual intercourse or sharing hypodermic needles.

Forgetting to wash your hands after handling pets and animals is another way for germs to be taken in by mouth.

Primary pathogens cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic  virulence

Opportunistic pathogens can cause an infectious disease in a host with depressed resistance. 

such as pathogenic bacteria or fungi in the gastrointestinal or the upper respiratory tract,

An opportunistic disease requires impairment of host defenses, which may occur as a :

result of  genetic defects (such as Chronic granulomatous disease),

exposure to antimicrobial drugs or immunosuppressive chemicals (as might occur following poisoning or cancer chemotherapy),

exposure to ionizing radiation, 

FEVER > 37.5 C oral, > 38.2

rectal

Endogen pirogens : IL-1, TNF, INF

Eksogen pirogens: Gr+, - , bacterial endo or egzo toxins,

Daily physiologic alteration may occur 1 C

20-30 % elderly patients may not have fever during th infection episode

HYPERPYREXIA Hyperpyrexia is a fever with an extreme elevation of

body temperature greater than or equal to 41.5 °C (106.7 °F). Such a high temperature is considered a medical emergency

The most common cause is an

intracranial hemorrhage

sepsis,

Kawasaki syndrome,

neuroleptic malignant syndrome,

drug effects,

serotonin syndrome,

thyroid storm.

Heatstroke

malignant hyperthermia

Infections commonly associated with hyperpyrexia include: rubeola and enteroviral infections

in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point due to an outside source.

CAUSES OF FEVER İnfectious diseases Solid and hematologic malignancies Vasculitis and collageneous diseases Outoimmun Granulamatous Endocrin and metabolic Primary neurologic Other: FMF, allergic rx, alcoholic hepatitis,

hemolysis, histiositosis -X, drug fever, Kikuchi diseases, pancreatitis, Sweet syndrome, pulmonary emboli, hyperimmungloubulin D syndrome

Continuous fever: Temperature does not fluctuate more than 1 °C in 24 hours, e.g. lobar pneumonia, urinary tract infection, brucellosis, or typhus. Typhoid fever may show a specific fever pattern, with a slow stepwise increase and a high plateau.

Intermittent fever: The temperature elevation is present only for a certain period, later cycling back to normal, e.g. malaria, kala-azar, pyaemia, or septicemia

Remittent fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours, e.g., infective endocarditis.

Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high for one week and low for the next week and so on

MOST COMMON SYMPTOMS RELATED TO SİDE OF THE İNFECTİON Systemic Head and Neck Pulmonary

FeverFatigueAnorexiaWeaknessExtensive pain

HeadacheSore throatDifficulty on swollow

DyspneaCoahingChest pain

Cardiovasculary Hepatobiliary Gastrointestinal

PalpitationChest pain DyspneaSencopCloudicatio intermit.

Right upper guadrant pain , Right/left upper quadrant dullnessNausiaVomitingİcterusPuriritis

Abdominal painNausiaVomitingDiarea , mucoid, ..Abdominal bloatingPerirectal puriritisPain during the defecation

MOST COMMON SYMPTOMS RELATED TO SİDE OF THE İNFECTİON

Urogenital Musculosceletal Santral and peripheric nervous system

Burning during the urinationPollacuriaFlunk painDificulty on urinationReferred painUreteral discharge

Muscle / joint painDiminish ROM

Loss of memoryMental disordersNausia, vomitingParestesia

Skin

PururitisBurning

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation

Percussion

Palpation

Head and Neck

Discharge of ear, Post nasal dischargeHyperemic conjonctivaIcteric sclereHyperemic apperence of pharenxExuda on tonsil

LymphadenomegalyTenderness of sinusNeck stiffnessTenderness of thyroid

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation Percussion

Palpation

Chest TacipneaBradipneaVesiculary lesions

RalesRoncusDiminish lung sound

Matite Axillary lymphadenomegaly

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation Percussion Palpation

Cardio-vasculary

Slinter hemoragiaJaneway lesionHyperemic vasculary line

Altered murmurDiminished heart sounds

Matite Weak radial pulse

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation Percussion Palpation

Hepatobiliary

İcterusAbdominal distansionVomitingDark urineWhite stool

HapatomegalySplenomegaly

Murphy signReboundTenderness

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation Percussion Palpation

Gastrointestinal Abd distantionCullenTurnerBloody stool

Hyperactive bowel soundsSilent abdomen

Sonorite

Matite

TendernessReboundMc Burney

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation

Percussion Palpation

Urogenital system

Urethral dischargeGlob vesicaleGenital herpetic lesionsPiuria

Costa vertebral angle tenderness Suprapubic dullness

Testiculary tendernessInguinal LAMPelvic tendernessProstat tenderness

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation

Percussion Palpation

Muscle and sceletal system

Milky synovial fluid apperenceBrown urineFoot ulcerChronic discharge

Hot jointDiminish ROMBallotmanBone tendernessPain point of on axial system

MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON

İnspection Oscultation

Percussion Palpation

Central and peripheral nervous system

Loss of memoryNeurologic deficitVomitingDificulty on swollowAbnormal talking

Neck stiffnessLoos of sensationParestesiaPlegiaAbnormal reflexes

CHARACTERİSTİCS OF VİRAL İNFECTİONS In general, viral infections are systemic.

This means they involve many different parts of the body or more than one body system at the same time; i.e. a runny nose, sinus congestion, cough, body aches etc.

They can be local at times as in viral conjunctivitis or "pink eye" and herpes. Only a few viral infections are painful, like herpes.

The pain of viral infections is often described as itchy or burning.

Reye syndromeReye syndrome is sudden (acute) brain damage and liver function problems of unknown cause.The syndrome has occurred in children who have been given aspirin when they have chicken pox or the flu. Reye syndrome has become very uncommon since aspirin is no longer recommended for routine use in children.

DİAGNOSİS OF VİRAL DİSEASES Clinical presentation is used to detect viral disease

by looking for history of severe muscle and joint pains

before fever also detect skin rash lymph gland swelling

Laboratory investigations is not necessary to detect viral infections, because no increase in the white blood cells, the laboratory investigation is done to find other bacterial infections, if it is suspected.

Viruses commonly have self-limited life, so treatment is usually reduce the symptoms only and antipyretic and analgesicdrugs

CHARACTERİSTİCS OF BACTERİAL İNFECTİON The classic symptoms of a bacterial infection

are:localized redness, heat, swelling and pain.

One of the hallmarks of a bacterial infection is local pain, that occurs at the site of the infection.

Bacterial throat pain is often characterized by more pain on one side of the throat.

An ear infection is more likely to be diagnosed as bacterial if the pain occurs in only one ear. 

Bacterial infections produces pus and milky-colored liquid

FEVER WİTHOUT LOCALİSE SYMPTOMS

Tuberculosis Endocarditis Micotic anevrisma Septic thrombophlebitis Spondilitis Osteomyelitis Pneumonia Intraabdominal abces Pyelonephritis Viral: CMV , mononucleosis, HIV, early

hepatitis

MAJOR SYMPTOMS MAY COEXİST WİTH FEVER Eruption Joint and bone pain Lymphadenopathy Face and neck swelling Headache and neck stiffness Neurological disturbances Cold ang flu like symptoms Coughing and chest pain icterus Splenomegali Diarea Abdominal pain Disuria Sepsis Heart diseases

FEVER AND PATECHİA / PURPURA

Bacteria, ricethsia, virus DİC Gram negative sepsis Endocarditis Meningococcemia Tiphus, Rocky Mountain

Fever, Rubella, rubeola,

mononucleosis, hepatitis, hemoragic fever

A petechia is a small (1 - 2 mm) red or purple spot on the skin, caused by a minor hemorrhage (broken capillary blood vessels).

NON INFECTİOUS CAUSES OF PATECHİA / PURPURA

Henoch schlein purpura SLE, ANCA related vasculitisPANChurg Strause Wegener Granulomatosis

MACULOPAPULARY EXANTEM

Rubella, rubeola, coxacie, ecovirus, mononucleosis, parvovirus

Streptococ,(erizipel,scarlet fever), staphylococ, ( TSS) , sec. Siphylis

Drug rx, serum sickness, lupus, Steven Johnson S, dermatomysotis,

Sweet Syndrome, Etiology ? leucocytosis, skin lesions, neutrophilic infiltration, myalgia, headache, fever, (infection, malignity, IBS vb )

An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.

VESİCULARY AND PUSTULARY LESİONS

Varisella, zoster, herpes symplex, coxachie A16, hand, foot, mouth diseases,

Spahpylococ sepsis Disseminated gonococ

infection ( distal)

Drug eruption, allergic dermatitis, Sweet S, Steven Johnson S,

Vesicles are small, fluid-filled sacs that can appear on skin

NODULARY SKİN LESİONS

Treponema pallidum; Nocardia; and atypical mycobacteria, particularly Mycobacterium marinum and Mycobacterium chelonae, as well as Mycobacterium tuberculosis itself.

Fungal infections, including blastomycosis, coccidioidomycosis, sporotrichosis, and aspergillosis,

All these infectious disorders are due to Staphylococcus aureus or opportunistic bacteria such as Nocardia, Legionella or Aspergilli.

ULCERUOS SKİN LESİONS

Ulcerated skin lesions may result from Staphylococcus infections

The necrotic ulcer of anthrax is often surrounded by edema

Rarely, a painless destructive ulcer with undermining edges may result from infection with Mycobacterium ulcerans (Buruli ulcer).

cutaneous leishmaniasis. The lesion is a chronic, usually painless ulcer,

skin dephteria,tularemi, ectima gangrenosum ( pseudomonas aeroginosa) , ricetsia

Peripheral vasculary disease, Behçet diseases, vasculitis, cholesterol embolism, lymphoma, erithema multiforme major,

Stomatitis is an inflammation inside the mouth, such as a small sore or ulcer. Multiple blisters in the mouth can be a sign of herpetic stomatitis.

FEVER AND BONE/ JOİNT PAİN İnflammatory joint diseases together

with % 15-20 infectious pathogen Bacterial artritis: gonococ / rubeola,

hepatitis, mumps, polyarticulary , others monoarticulary

Cardinal findings of inflammation No fever / mycobacterium, fungal

infection Most common: Knee, hip, scholder,

elbow

Gram stain positive % 30-50 , staph,

Viral: rubeola, hepatitis B, Reactive artritis: Chlamidia, Shigella,

Camphylobacter, Salmonella, Yersinia, Gonococ

FEVER AND DİSSEMİNETED LAM

FEVER AND LOCALİSED LAM

Servical LAM: upper respiratory tract infections Virus, Group A streptococ, Ebstain Barr Virus, Diphteria, Toxoplasmosis, tbc lymphadenitis

Oxipital LAM: Rubella, rubeola, non -spesific infections of scalp

Axillary, İnguinal LAM: Group A streptococ

Inguinal LAM with pain: herpes symplex, lymphogranuloma venerum ( chlamidia) Soft chankır ( Haemophilus ducrei), granuloma inguinale

FEVER AND FACE / NECK SWOLLEN

Mumps, pürülan parotitis

Parotis , salivary gland lenfamatosis, Sjogren S, Warthin TM

Neck: Lemierre S Actinomicosis: Lemierre's syndrome (or Lemierre's disease, also known as postanginal shock including sepsis and human necrobacillosis) refers to thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteremia or septic emboli.

FEVER, HEADACHE AND NECK STİFNESS

İnfectious origine Drug Rx Allergic Rx, Leucemia SNS metastasis Subaracnoid hemoragia SVA ( emboli , trombosis)

MENİNGİTİS

Bacterial meningitis and viral encephalitis are two life-threatening causes of infection and inflammation within the central nervous system (CNS).

Evaluation in the acute care setting is focused on identifying patients who require urgent diagnostic testing and/or empiric treatment.

Meningitis affects patients of all ages, but those who are very young, elderly, or immunosuppressed are at increased risk.

MENENGİSM Neck stiffness Headache Fever Nousia Vomiting Photophobia Diplopia Hyperestesia Generalise convulsion

MENENJİTİS LİKE CONDİTİONS Purulan proceses near the meninxBrain abceses, mastoiditis, otitis, osteomyelitis, sinusitis, ………may caouse meningial irritation

İNFLUENZA There are two main types of influenza

(flu) virus: Types A and B. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year.

Fever* or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (tiredness) Some people may have vomiting and

diarrhea, though this is more common in children than adults.

Acute respiratory diseases ( upper end lower tract)

Sec bacterial infections may occur ( staph., pneumococ, H influenza)

FEVER AND FLU LİKE İNFECTİONS

Bacterial tonsillitis and pharangitis Streptococal: odinophagia, LAM,

leucocytosis, scarlet; high fever with fast klinical course skin lesions may appear 2-5 day later

Dihpteria Plaunt vincent angina

Non Bacterial pharangitis: Mycoplasma, Ebstain Bar virus,

adenovirus, coxachie virus, CMV, herpes virus,

COLD: İNFLUENZA LİKE İNFECTİONS

Virus 90%, ( rhinovirus, coxachie virus, Mycoplasma, Chlamidia

Rhinitis, tosillopharengitis, larengotraceitis, trakeobronchitis, bronchopneumonia

In the absence of outbreak, influenza may be diffucult to differentiate from acut respiratory illness caused by other viruses or mycoplasma

Severe streptecocal pharangitis or early bacterial pneumonia may mimic acute influenza

SİNUSİTİS Sinus infections are caused by

infections from a pathogenic microorganism (virus, bacterium, or fungus), which grows within a sinus and causes intermittent blockage of the sinus ostium.

Sinus infection symptoms may include sinus headache, facial tenderness, pressure or pain in the sinuses, fever, cloudy discolored drainage, and feeling of nasal stuffiness, sore throat, and cough, and on rare occasions, associated with facial swelling.

OTİTİS

Otitis is a general term for inflammation or infection of the ear,

It is subdivided into the following: Otitis externa, or "swimmer's ear" involves the

outer ear and ear canal. Otitis media or middle ear infection involves the

middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space.

Otitis interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, vertigo is a common symptom.

The eustachian tube is shorter in children than adults which allows easy entry of bacteria and viruses into the middle ear, resulting in acute otitis media. Bacteria such as Streptococcus pneumoniae (strep) and Haemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media and viruses the remaining 15%.

pus within the middle ear causes pain , there is usually transient hearing loss during the infection, Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal.

BRONCİTİS

Bronchitis is an inflammation of the bronchial tubes,

People who have bronchitis often cough up thickened mucus, which can be discolored.

Often developing from a cold or other respiratory infection, acute bronchitis is very common.

Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and flu (influenza). The most common cause of chronic bronchitis is smoking cigarettes. Air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition.

Viruses cause about 90% of acute bronchitis cases, whereas bacteria account for about 10%

Mycoplasma pneumoniae, Chlamydophila pneumoniae,Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae

FEVER, COAHİNG, THORAX PAİN : PNEUMONİA

Pneumonia is a common lung infection caused by bacteria, a virus or fungi

Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites.

In bacterial pneumonia, your temperature may rise as high as 38 degrees . This pneumonia causes profuse sweating, and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.

Bacteria are the most common cause of community-acquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases. Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases;[20] Staphylococcus aureus; Moraxella catarrhalis; Legionella pneumophila and Gram-negative bacilli

The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips.

In adults, viruses account for approximately a third[6] and in children for about 15% of pneumonia cases.[22] Commonly implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and

parainfluenza.

BREATHING SOUNDS:disease chest

inspection

palpation (thoracic vibration)

percussion

character of breathing

sounds

patological sounds

pneumonia

normal/dyspnea

increased normal/matitiy

decreased/bronchiolar/

bronchovesicular

inspiratory rales

atelectasis

depression

of onehemithor

ax

decreased matity decreased or absent

inspiratory rales

pneumothorax

increase of one

hemithorax

decreased hypersonority

decreased or absent

-

emphysema

increased thoracic

index

normal/decreased normal/hyperson

or

decreased -

COPD normal/dyspneic

normal normal normal/increased

wheezing/rhoncus

pulmonary fibrosis

tachypnea/

dyspnea

normal normal normal velcro rales

asthma dyspnea normal normal normal/decreased/silent

wheezing/rhoncus

cardiac failure

dyspnea normal/increased normal normal inspriatory rales/rhoncus

pleural effusion

increase of one

hemithorax

decreased matitiy decreased -/Frotman

FEVER AND İCTERUSPrehepatic

Clostridium perfiringens, M pneumonia may cause hemolysis ( low hgb, reticulosis, high LDH)

Sicle cell anemia, G6PD deficiency, PNH,

Hepatic

Acute viral hepatitis, mononucleosis, CMV,

Sepsis: pneumococ, klebsiella, Salmonella, Bacterides fragilis E Coli, Streptococ,

Milier tuberculosis

Intrahepatic abceses

Posthepatic

Chlangitis and choledecolitiasis

FEVER AND SPLENOMEGALY

Lymphoproliferative disorders İnfections Hemolitic anemia

Non infectious Felty Syndrome Still Diseases Lupus Diseases

The causes of massive splenomegaly (spleen >1000 g) are fewer, and include:visceral leishmaniasis (kala-azar)chronic myelogenous leukemiamyelofibrosismalariaprimary lymphoma of spleen

FEVER AND DİAREA

Diarrhea may be accompanied by fever (temperature greater than 100.4ºF or 38ºC), abdominal pain, or cramping

Viral diarrhea are typically associated with mild-to-moderate symptoms with frequent, watery bowel movements, abdominal cramps, and a low-grade fever.

The following are the common causes of diarrhea caused by viral infections:

rotavirus is a common cause of diarrhea in infants;

norovirus (for example, Norwalk virus, caliciviruses) is the most common cause of epidemics of diarrhea among adults and schoolage children (for example, cruise ship infection, schools, nursing homes, day care facilities, and restaurants); and adenovirus infections are common in all age groups.

Bacterial infections cause the more serious cases of diarrhea. Typically, infection with bacteria occurs from contaminated food or drinks (food poisoning). Bacterial infections also cause severe symptoms, often with vomiting, fever, and severe abdominal cramps or abdominal pain. Bowel movements occur frequently and may be watery.

The following are examples of diarrhea caused by bacterial infections: 

In more serious cases, the stool may contain mucus, pus, or blood. Most of these infections are associated with local outbreaks of disease. Family members or others eating the same food may have similar illnesses.

Campylobacter, salmonellae, and shigella organisms are the most common causes of bacterial diarrhea.

Less common causes are Escherichia coli Yersinia, and listeria.

Use of antibiotics can lead to an overgrowth of Clostridium difficile (C diff) bacteria in the intestines.

Parasites cause infection of the digestive system by the use of contaminated water. Common parasitic causes of diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.

Intestinal disorders or diseases including inflammatory bowel disease, irritable bowel syndrome (IBS), diverticulitis, microscopic colitis, and celiac disease can cause diarrhea.

Reaction to certain medications can cause diarrhea. Common medications include antibiotics, blood pressure medications, cancer drugs, gout medications,weight loss drugs, and antacids (especially those containing magnesium).

Intolerance to foods such as artificial sweeteners and lactose (the sugar found in milk) can cause diarrhea.

ORGANIC VERSUS FUNCTIONAL PAINHISTORY ORGANIC FUNCTIONAL

Pain character Acute, persistent pain Less likely to changeincreasing in intensity

Pain localization Sharply localized Various locations

Pain in relation to sleep Awakens at night No affect

Pain in relation to Further away At umbilicus umbilicus

Associated symptoms Fever, anorexia, Headache, dizziness,vomiting, wt loss, multiple system

com-anemia, elevated ESR plaints

Psychological stress None reported Present

Definition LocationWork-upAcute pain

syndromesChronic pain

syndromes

Definition LocationWork-upAcute pain

syndromesChronic pain

syndromes

FEVER AND ABDOMİNAL PAİN

Intraabdominal infectionsTime to antimicrobial therapy importantHistory and clinical findings are gold standart for diagnosis Primary peritonitis: 1% ,chrosis with ascites,

nephrotic syndrome, monomicrobial, E.Coli, pneumococ, group A streptococ,

Secondary peritonitis : necrotizing lesion of GI tract, traumatic perforation, perforation during the invasive procedure, aerobic ( E coli, enterobacter, enterococus, streptococ, pseudomonas) and anaerobic ( Bacteroides fragilis, Clostridium ) polymicrobial

INTRAABDOMİNAL ABCESES

Progression of diffuse peritoitis Spontan and travmatik perforation of GI

tract Leakega of surgical anastomos line

Tendency of intraabdominal abcessesCrohn: intraperitoneal, retroperitoneal, bacterial endocarditis Gallbladder diseases: liver abcessesPancreatitis: pancreatic abcesses

Rigor:

UROGENİTAL İNFECTİONS

FEVER, DİSURİA AND POLLAKURİA Üretritis: burning,discharge, leucocyturia,

gonococus, chlamidia, tricomonas, mycoplasma, uroplasma , no fever,

Uncomplicated urinary system infection in womens: disuria, pollacuria, lower abdominal pain E coli, Staph saprophiticus, short term antibiotic

Asemptopmatic bacteriuria: pregnancy, diabetes, transplantation, should be treated

Uncomplicated pyelonephritis: fever, chill, lomber pain, costa vertebral tenderness

Blood and urine culture +, 100000 mo / ml E Coli

Complicated pyelonephritis: plus, present complicated urologic diseases

MalformationRenal stoneProstat hyperplasiaDesensus uteri Diabetes

FEVER AND SEPSİS

Sepsis is a potentially life-threatening complication of an infection.

If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death.

To be diagnosed with sepsis, you must exhibit at least two of the following symptoms:

Body temperature above 101 F (38.3 C) or below 96.8 F (36 C)Heart rate higher than 90 beats a minuteRespiratory rate higher than 20 breaths a minuteLeucocyt count >12000 or < 4000/ ulProbable or confirmed infection

While any type of infection — bacterial, viral or fungal — can lead to sepsis, the most likely varieties include: Pneumonia Abdominal infection Kidney infection Bloodstream infection (bacteremia)

INFECTIVE ENDOCARDITIS

– inflammatory process on-going inside endocardium – due to infection after endothelium damage– most often involving aortic and mitral valves

3-10/100 000/year Maximum at the age of 70-80 More common in women Staphylococcus aureus is the most common

pathogen Streptococcal IE is still the most common

in developing countries

Fever – over 90% of patients New intra-cardiac murmur - about 85% of patients Roth spots, petechiae, glomerulonephritis – up to 30% of

patients• When we suspect? • Sepsis of unknown origin• Fever coexsisting with:

– Intracardiac implantable material– IE history– Congenital heart disease or valve disease – IE risk factors– Congestive heart failure symptoms– New heart block– Positive blood cultures– Focal neurological signs without known aetiology– Periferal abscesess (kidney, spleen, brain, vertebral column)

DUKE CRITERIA

Major criteria

1. Blood culture positive for typical IE-causing microorganism

2. Evidence of endocardial involvement

Minor criteria

1. Predisposition – heart condition or i.v. drug abuse

2. Fever – temp. >38 °C3. Vascular phenomena –

arterial emboli etc.4. Immunologic phenomena

– glomerulonephritis, Osler’s nodes, Roth’s spots

5. Microbiological evidence – positive blood cultures but do not meet major criteria

Diagnosis• 2 major criteria• 1 major and 3 minor• 5 minor criteria

PALPATION OF THE LIVER: