Irresistible Diseases

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Sepsis. SIRS

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Irresistible Diseases 2008

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Sepsis SIRS – systemic reaction Temp >38C (<36C) HR >90bpm, RR >20bpm (Pa CO2 <32mmHg) WBC >12k or >10% groups Sepsis = SIRS + Infection Severe Sepsis = Sepsis + Organ Dysfunction Septic Shock = Sepsis + Hypotension PIRO seriousness organizing TLR 4 – LPS (Gm-) TLR 2 – PGN, LTA (Gm+) Fever, aggravation, DIC, ARDS, azotemia , olyguria , cellulitis , purpura , GI dying, jaundice Procalcitonin analytic? Tx : ATB, strong, Activated Protein C ( Xigris )

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Fever/Hyperthermia Fever Hyperthermia Hypothalamic setpoint unaltered Does not react to NSAIDS Heat stroke, hyperthyroidism, atropine, happiness, threatening hyperthermia, serotonin disorder Hypothalamic setpoint moved up by PGE 2 invigorating EP-3 Pyogenic cytokines Pneumonia, drugs, PE, DVT, C. difficile, parasitic disease, MI, NG tubes, IV catheters

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Bioterrorism Anthrax ( Cutaneous ) Bacillus antracis Botulism (Inhalation) Bacillus antracis Inhaled spores, no individual to-individual transmission Incubation: 1w to 2 months Mediastinal augmenting, pleural emission, penetrates Initial manifestations enhance, unexpected onset of fever/ARDS, stun/demise inside 24-36h Tx: Penicillin or Cipro/Doxy Direct contact with spores Jet dark injuries (eschars) on skin inside 7-10d Incubation 1d Tx: Cipro or Doxy q 60d Vaccine: constricted Ag

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Bioterrorism Anthrax (GI) Bacillus antracis Botulism Clostridium botulinum Most harmful poison on earth Not infectious, spread by vaporized/nourishment 12-72 h brooding N/V, diff see, swallow, speak Muscle shortcoming/loss of motion Ingested spores, no individual to-individual transmission N/V, serious abd torment, bleeding looseness of the bowels, perhaps mediastinal broadening, bounce back delicacy, ascites Incubation: 1-7d Tx: Penicillin or Cipro/Doxy

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Bioterrorism Cholera Vibrio cholerae Glanders Burkholderia mallei Affects stallions, donkeys, jackasses Enters cut skin, mucous films, inward breath Rice-water the runs, lack of hydration, stun Incubation 12h-5d Food/water spread

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Bioterrorism Plague Yrsinia pestis Q Fever Coxiella burnetii Nonspecific febrile disorder, pneumonia Hepatitis, endocarditis, granulomatous intricacies Tx: Doxycycline 14-21d "Dark Death", tainted insects Bubonic – 1-10 cm buboes on skin w/edema, influenza like side effects w/abd torment Septicemic - auxiliary septicemia, thromboses in acral v. prompting to rot Penumonic – intense fulminant side effects, almost 100% death rate Tx : Streptomycin or Doxycycline

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Bioterrorism Smallpox Variola real Tularemia Francisella tularensis One of most irresistible microorganisms in world Tick/bug chomps Incubation 10-14d Fever, chills, HA, hack, torpidity, skin ulcers, lymph-adenopahty Officially killed Incubation 10-14d High fever, HA, spinal pain, spewing, rash on palm/sole Highly infectious No tx, antibody inside 3-5d

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Bioterrorism GB Sarin VX 1000x more poisonous than GB Persists in soil for 6d Binary weapon Inhibits ACHe, phosphonate esters, light cocoa oil If serious: quit breathing, loss of motion, seizures, LOC Binary weapon – two non-deadly reagents blend to frame sarin gas Inhibit ACHe, phosphonate esters, light chestnut oil If mellow: diminish vision, salivation, trunk snugness Tx: Atropine and 2PAMCl

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Bioterrorism Ricin Waste extra from preparing castor beans V/D, parchedness, hypotension, fantasies, seizures, hematuria, different organ brokenness No tx accessible

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Bioterrorism Needs Immediate Treatment, Suspect … Respiratory Symptoms Acute: Cyanide Also nerve operators, mustard, lewisite, phosgene, SEB Delayed: Anthrax, Plague, Tularemia Also Q Fever, SEB, ricin , mustard, lewisite, phosgene Neurological Symptoms Acute: Nerve specialists Also cyanide Delayed: Botulism Also VEE-CNS

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Bioterrorism "Dynamic" Research Algeria Egypt India Iran Israel N. Korea Pakistan Syria Taiwan "Subtly" Developing China Russia "Previous" Programs Canada France Germany Japan S. Africa UK, US

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Immunocompromised Deficiencies in Complement IG/B-Cell Phagocyte T-cell Clues Recurrent Neisseria inf Recurrent pneumonia Severe introduction Pneumocystis jiroveci Burkholderia cepacia Non-TB Mycobacteria Aspergillus

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Complement Deficiency Hereditary angioedema C1 inhibitor lack Overactive supplement Minor stressors trigger assaults C5-9 Deficiency MAC lysis deformity Neisseria bacteremia DAF and CD59 Paroxymal nighttime hemoglobinuria C1, C3, C4 insufficiency Recurrent pyogenic sinus and respiratory disease C1q inadequacy 90% have SLE

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Ig/B-Cell Deficiency ( Bruton's ) X-Linked Agammaglobulinema Btk imperfection, no B-cells, Ig Multiple pyogenic contaminations No live antibodies! Tx : IvIg Hyper IgM Syndrome X-connected, ordinary B-cell Low Ig yet high IgM Pneumocystis diseases T-cells need CD40L CVID Low Ig , typical B-cell Recurrent sinus, respiratory contaminations Chronic diseases with Giardia , Campylobacter Tx : ATB, IVIg IgA lack Associated with CVID Compensated by others Secondary Ig insufficiencies Multiple myeloma, leukemia, skin copies

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Neutrophil Deficiency Neutropenia Causes Blacks have bring down tallies Chemotherapy patients Post-contamination, sepsis Sulfa-drugs, β - lactams Infections Mucositis Ecthyma gangrenosum Disseminated candidiasis Aspergillosis Hereditary Cyclic N. Promotion, ELA2 transformation Predictable cycles Aphtous stomatitis Tx : G-CSF, steroids Chediak - Higashi Syndrome AR, LYST change Giant lysosomes , insufficient granulopoiesis Oculocutaneous albinism

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Neutrophil Deficiency Job's Syndrome Hyper IgE, debilitated chemotaxis STAT3 quality change Facies, scoliosis, skin abscesses, sinusitis Myeloperoxidase (MPO) Makes discharge green Converts H 2 O 2 to HOCl Deficiency hinders this CGD Defective NADPH oxidase, no respiratory burst, no executing Infections with catalase positive life forms NBT test

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Spleen "Lack" Splenectomy Trauma, ITP, Hairy cell leukemia, boil Hyposplenism Autoimmune (Graves, Hashimoto, SLE) Neoplasia (Hodgkin, CML, Sezary ) Amyloidosis Alcoholism, elderly, Crohn's , Sickle cell Decrease in flowing initiated B-cells (75%) Risk of thalassemia > hodgkins > sphero-cytosis > ITP > sepsis Infections S. Pneumoniae (generally) Haemophilus , GNR, Neisseria (less normal)

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T-Cell Deficiency DiGeorge's Deletion 22q11.2 No T-cells, hypocalcemia , velocardiofacial abandons SCID Combined B/T-cell insufficiency, lymphopenia , hypogammaglobulinemia ADA, PNP, RAG1/2, Jak3 quality inadequacies CD4 T-cell Deficiency HIV, <300 CD4+/mL Wiskott - Aldrich WASP protein Pyogenic diseases, purpura , dermatitis High IgA , IgE , low IgM Infections Mycobacteria , norcardia , legionella , cryptococcus , histoplasma , pneumocystis , herpesvirus , cryptosporidium, toxoplasma

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Food Safety Milk sanitization: 72C for 15s or 63C for 30m Botulism spores: kill with high warmth + acidic Preservatives: feeble acids, nitrites, sulfites, flavors Radiation: γ - illumination for flavors, meats Survival: Cold – Listeria ; Chlorine – Giardia , Cryptosporidum growths; Anything home prepared Outbreaks: Listeria ( microwaved sausage), Cyclospora (raspberries), Salmonella, ETEC

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Tuberculosis Mycobacterium tuberculosis, bovis, africanum Acid-quick, high-impact non-motile bacillus, diminish nitrates, create niacin, moderate developing BACTEC blood culture, DAT tests utilizing PCR PPD ( Mantoux ) is killed tuberculin, positive if >15 mm, shows earlier contamination (LTBI), require CXR Risks: (typical) 1 st year: 3-4%, lifetime: 5-15% (HIV tainted) 1 st year: 40%, +10% consistently Tx : test weakness, give numerous medications INH + RIF + ETH (+ PZA), INH prophylaxis, hepatotoxicity

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Tuberculosis Mycobacterium tuberculosis, bovis, africanum Infected aerosolized beads, drain (M. bovis), recreates in center/bring down projections alveolar space, Rasmussen's aneurysm (aspiratory a.), pleural radiation, sputum with PMNs Spread to hilar lymph hubs in macrophages Reactivate in upper flaps, pits frame Can scatter through blood (military TB), skin injuries, HA, abd torment, osteomyelitis

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Leprosy Mycobacterium leprae Lepromatous Leprosy Tuberculoid Leprosy Strong T H 1 reaction Small # of microbes Self-restricting Form granulomas Poor T H 1 reaction Large # of microscopic organisms in tissue Infectious, non self-constraining Tx : rifampicin (month to month) and dapsone (every day) - FREE Thickened fringe nerves Loss of sensation, sores, fringe nerve harm, male pattern baldness, distortion

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AIDS HIV disease Lenti - retrovirus, diligent viremia , contaminates T-cells and macrophages (CD4 + CCR5/CXCR4) CD4 >500 asymptomatic, 200-500 expanded thrush, shingles, <200 crafty contaminations, <50 MAI, CMV CD4 drops 10/month all things considered Transmitted by bosom drain (intense), blood, semen Risk: blood 95%, pregnancy 20-33%, MSM 10%, needlestick 1 in 300 (1 in 2400 with treatment) Acute contamination "mono"- like w/rash, ulcers, and w/o tonsil hypertrophy and exudate .

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AIDS HIV disease Presents with unexplained weakness, leukopenia , intermittent pneumococcal pneumonias, Kaposi's sarcoma, thrush, squandering, STD, fever Screen: ELISA, Confirm: Western Blot, Viral Load: PCR, Severity: CD4 Count HAART Treatment: NRTI (AZT, 3TC), NNRTI ( nevirapine , efavirenz ), protease inhibitors ( ritonavir , nelfinavir ) Opportunistic Infections: CMV, MAC, PCP, Toxoplasmosis, Cryptococcosis , Candida, PML

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Gonorrhea Neisseria gonorrhoeae Gm-diplococci Infect columnar/cuboidal epi, PMN reaction, pharynx, anorectal, conjunctivitis Spread by means of sex and perinatally Dysuria w/o recurrence or desperation, torment, release, cervicitis (PID entanglement) Dx by refined swab for diplococci Tx with Ceftriaxone IM/cefixime PO

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Chlamydia C. trachomatis , psittaci , pneumoniae Intracellula