SHIMBERG LIBRARY PRESENTS

Created by: Lauren Adkins

NECROTIZING FASCIITIS

1871Confederate army surgeon Joseph Jones first described the disease during the Civil War.

1918Cause of the disease was identified as a bacterial infection.

1980s – 1990sWorldwide increase .

1952Named "necrotizing fasciitis“Necrosis: death of a portion of tissueFascia: fibrous tissues that enclose and connect the muscles.

19th – 20th Centuryoccurred sporadically and usually remained restricted to military hospitals during wartime, although some civilian population outbreaks also occurred.

1991 – 1995Increase in group A streptococcus (GAS) from0.085 to 0.4 per 100,000.

1990 and 20060.18 to 1.68 per 100,000 increase in New Zealand.

2006-2013600 cases of NF annually in the United States.

Deep tissue infection spreads along fascial planes caused by bacteria.Top 3 bacteria: polymicrobial, group A streptococcal, and gas gangrene.

Sym

pto

ms

(24

ho

urs

) 1. Skin trauma.

2. Pain grows.

3. Flu like symptoms.

4. Severe dehydration.

Ad

van

ced

Sym

pto

ms

(3-4

ho

urs

) 1. Swelling, purple rash.

2. Large dark marks, filled

with black fluid.

3. Bluish, white, or dark,

mottled, flaky

appearance.

Cri

tica

l Sym

pto

ms

(24

ho

urs

) 1. Blood pressure drops.

2. Body goes into toxic

shock.

3. Unconsciousness.

Courtesy University of California San Diego Catalog of Clinical Images, 2005

A 23 year-old woman developed a left facial cellulitis which progressed relentlessly with necrosis. Debridement was performed on several occasions to halt the spread of the necrosis. The Ophthalmology Unit, Universiti Malaysia Sarawak (UNIMAS).

Anterolateral thigh flap. A and B, After serial radical débridements and amputation of the index and middle fingers for severe necrotizing fasciitis following a spider bite, soft tissue coverage of both the dorsal and palmar aspects of the left hand was required.

Wolfe: Green's Operative Hand Surgery, 6th ed.Copyright © 2010 Churchill Livingstone, An Imprint of Elsevier.

Courtesy of MD Consult.

Necrotizing fasciitis in a later stage with skin necrosis. In early stages the patient may have only pain, swelling, and erythema. (From White G, Cox N: Diseases of the skin: a color atlas and text, London, 2000, Mosby.) via MDConsult

NODDING disease

(SyNDROME)

1960sAn epidemic illness characterized by head nodding associated with onchocerciasis has been described in Tanzania, by L. Jilek-Aall.

2003Term Nodding Disease was first applied in Southern Sudan.

2001-2002World Health Organization starts investigations into the disease in Sudan.

2000 HN attacks were mentionedexplicitly in an area highly endemic for O. volvulusin West Uganda.

2009CDC led multifaceted investigation to assess epidemiological and clinical illness, 14 children with the disease. Findings: Nodding syndrome is an epidemic epilepsy associated with encephalopathy, with head nodding caused by atonic seizures.

2013A clinical trial to investigate the effects of therapeutic levels of vitamin B6 among children with the syndrome is set to launch in 2013.

2013Cause remains unknown.

Nodding Syndrome

Over 3,000 people have beeninfected; Mortality rates growing.

Believed to be a new type of epilepsy.

Symptoms include: nodding of head, mental retardation, and stunted growth.

Mainly effects children 5-15 years old.

Present in Uganda, South Sudan, and Tanzania.

Treatment: Sodium Valproate.

Cause remains unknown.

The smaller patient has Nodding syndrome and is the same age as the taller adolescent who is of the same age, but does not havenodding syndrome. (Photograph by courtesy of Stella Chungong) Afr Health Sci. 2012 September; 12(3): 242–248.

Children such as 12 year old Nancy Lamwaka of Uganda, are tied to trees because their diminished mental capacity makes them prone to wandering and accidents such as drowning. CMAJ, August 7, 2012, 184(11).

Magnetic resonance image of a 13-year-old boy in Uganda with nodding syndrome. Image shows prominent cortical atrophy. Courtesy CDC 2013.

Methicillin-resistant

Staphylococcus aureus

(MRSA)

1959Methicillin, the first beta-lactamase-resistant penicillin, was licensed in England.

Late 1980s–1990sInfrequent hospital outbreaks of MRSA in Western Europe and Australia.

1960First MRSA isolates identified in a British study.

1968–mid 1990sMRSA gradually recognized as an endemic pathogen in hospitals, especially in large urban university hospitals.Percent of Staphylococcus aureus infections in hospitalized patients that were caused by MRSA increase.

1960-1967Infrequent hospital outbreaks of MRSA in Western Europe and Australia.

2001Shift from USA400 to USA300 as predominant strain of CA-MRSA in the United States

Mid-1990sScattered reports of CA-MRSA infections in children in the United States.

200795,000 invasive MRSA infections occurred in the United States in 2005. 19,000 deaths.

2012MRSA infections cause people to go to hospitals; hospital stays less commonly cause MRSA infections.

Nose

Armpits

Groin

Psoriasis

Colonized is when a person carries the bacteria but shows no signs of infection.

Average HospitalStay

MRSA Hospital Stay

Symptoms• Rash• Small bumps• Lesions• Open skin leaking pus• Swollen, tender.• Fever• Chills• Low blood pressure• Joint pain• Headaches

• Hospitals• Athletic settings• Military Barracks• Prisons• Schools

DRUGS

Penicillin

Methicillin

Dicloxacillin

Oxacillin

Amoxicillin

Nafcillin

Cephalosporin

Vancomycin

Magnified 20,000X, this colorized scanning electron micrograph (SEM) depicts a grouping of methicillin resistant Staphylococcus aureus (MRSA) bacteria. (CDC, 2013).

Cutaneous abscess caused by MRSA. (CDC, 2013).

Cutaneous abscess located on the thigh of a prison inmate. A clinician had lanced the lesion in order to allow the pus to drain. (CDC, 2013).

Vibrio vulnificus

1976Vibrio vulnificus was first discovered .

1988 and 2006,CDC received reports of more than 900 V. vulnificus infections

1992-2007459 U.S. cases reported by the FDA. 51.6% Mortality rate.

1981–1993.690 Vibrio infections reported in Florida.

1996Vibrio vulnificus outbreak in Israel fish market

1995Vibrio vulnificus documented on southern coast of Sweden.

1985V. vulnificus infection in a patient with septicemia and leg gangrene in Kaohsiung County, Taiwan.

2011207 cases in the U.S.35 cases 10 deaths. Florida.

2012207 cases in the U.S.35 cases 10 deaths. Florida.

201326 cases have been reported since January in Florida. 9 have resulted in death.

Vibrio Vulnificus

• V. vulnificus lives in warm seawater. Contaminated seafood and open wounds that areexposed to seawater can lead to infection.

• Sepsis can occur. With progression to sepsis-associated organ failure (ie, severe sepsis)or hypotension (ie, septic shock) mortality increases.

• Treatment: tetracycline and third-generation cephalosporin.

(Am Fam Physician 2007;76:539–44,546.) Copyright © 2007 American Academy of Family Physicians.

(A)

Cellulitis and hemorrhagic bullae.

(B)

In Vibrio vulnificus

infection.

Am Fam Physician. 2007 Aug 15;76(4):539-44.

A. Skin lesions in patient with liver cirrohosis septic shock developed. B. V. vulnificus bacteremia developed one day after a fish bone injury.C. Gram-negative curved bacilli isolated from a blood sample.

CDC Emerging Infectious Diseases Volume 10, Number 8, August 2004.

Hand under attack by an infestation of Vibrio Vulnificus bacteria. The cross cuts were performed to relieve pressure resulting from the swelling hand.

Photos by Dr. Russell Romero. Copyright © 1996-2013 Loyola University New Orleans. Loyola Center for Environmental Communication.

Post infection.

Naegleria fowleri(Primary Amoebic Meningoencephalitis)

1909Specimen in museum histologically indistinguishable from published cases.

1962 - 1965 16 cases of amebic meningoencephalitisoccurring between 1962 and 1965 in northern Bohemia.

1965First report of naturally occurring infection by free-living amoebae by Fowler and Carter from the Adelaide Children’s Hospital in South Australia .

1937Case in Northern Ireland.

19664 cases reported in the U.S.

1970 Named N. fowleri

1962First infections in U.S . In Florida.

1962-2012128 cases of PAM. Only one survivor

July 201312 year old girl contracts parasitic menegitis. Arkansas.

August 201312 year old boy contracts primary amoebic meningoencephalitis. Florida.

October 2013Naegleria fowleri amoeba have been reported this year in water in Louisiana.

The feeding structures of the amoeba Naegleria fowler.D.T. John & T.B. Cole, Visuals Unlimited. National Geographic 2013.

A cytospin of fixed CSF showing a Naegleria fowleri trophozoite (arrow) stained with Giemsa-Wright amidst polymorphonuclearleukocytes and a few lymphocytes. Within the trophozoite, the nucleus and nucleolus can be seen. Magnification: 1000x. CDC

2013

Contrast-enhanced CT brain scan shows right basal ganglia infarction. (Arrowhead, B) Enhancing exudates in the perimesencephaliccistern. CT: computed tomography; PAM: primary amebic meningoencephalitis.

Amebic meningoencephalitis: Spectrum of imaging findings. Am J Neuroradiol 2006; 27:1217;

Extensive hemorrhage and necrosis is present in the brain, mainly in the frontal cortex. Due to Naegleria Fowleri.

CDC 2013. Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

Treponema pallidum

(syphilis)

1492 (Syphilis)Origin unknown. Hypothesized Columbus brought it back from voyage to the Americas. Or it was already in Europe and became prevalent after that year.

1932–1972Tuskegee Study of Untreated Syphilis in the Negro Male.

1999National Syphilis Elimination Plan11,181

201113,970 diagnosed.National Syphilis Elimination Plan

201355,400 people in the United States contract syphilis every year.

200713,970 diagnosed.

Spirochete Bacteria.Hazel Appleton, Centre For Infectionshealth Protection Agency. 2013.

Primary syphilis manifesting as a painless tongue ulcer with indurated raised borders and clean base. Logical Images 2012 via MD Consult

Multiple slightly scaly erythematous papules are present on the trunk of this patient with papular secondary syphilis.

Maculopapular rash on the palms, which rarely can be pustular, in a patient with secondary syphilis. Patients can be quite contagious at this stage.

The Skin and Infection: A Color Atlas and Text, Sanders CV, Nesbitt LT Jr (Eds), Williams & Wilkins, Baltimore, 1995.

Tertiary SyphilisErythematous plaqueswith well-defined

ulcers with crusted surfaces on the face.

European Journal of Dermatology. Volume 9, Number 5, 371-3, July - August 1999, Cas clinique

ACKNOWLEDGEMENTS

I would like to thank the following for their support.

Rose bland

Samantha Stewart

Larry Cramer

Rick haley

Jeffrey honker

SHIMBERG LIBRARY 2013