RESPIRATORY VIRAL INFECTIONS

the most common infectious illness in humans Adults average ~2 to 4 colds1,2 and children average 3 to 8 colds3 per year

RESPIRATORY INFECTIONS CAUSED BY VIRUSES Clinical syndrome

Epidemic influenza

Usual cause (other causes in parentheses)

Influenza A and B

Influenza-like' ' illness

Sore throat Common cold )(coryza Feverish' cold' Croup Bronchitis

)Adenoviruses, rhinoviruses (enteroviruses

Adenoviruses (enteroviruses, parainfluenza viruses, influenza A )and B in partially immune Rhinoviruses (coronaviruses, enteroviruses, adenoviruses, )respiratory syncytial virus Rhinoviruses, enteroviruses (influenza A and B, parainfluenza )viruses, respiratory syncytial virus )Parainfluenza 1, 2, 3 (rhinoviruses, enteroviruses )Rhinoviruses, adenoviruses (influenza A and B

Bronchiolitis
Pneumonia

)Respiratory syncytial virus (parainfluenza 3

Influenza A and B, chickenpox (respiratory syncytial virus, )parainfluenza, measles and adenoviruses

BACTERIAL INFECTIONS OF THE SKIN AND SOFT TISSUES

STAPHYLOCOCCAL INFECTIONS

Staphylococci are imprtant human pathogens.( staph. Aureus)

They are capable long-standing association with the human body,

colonise skin, body cavities and the gut lumen They are dangerous if they gain access to the blood stream cellulitis or its occurrence in the mid-facial region indicates the need for urgent antistaphylococcal antibiotics to prevent secondary sepsis.

SKIN AND SOFT TISSUES

Staphylococcal infections :

Impetigo , Ecthyma, folliculitis, furuncles (Boils) and carbuncles Wound infections Cannula-related infection :Staph. epidermidis associated with cannula
sepsis

Staphylococcal scalded skin syndrome and bullous impetigo

Staphylococcal toxic shock syndrome (TSS)

Folliculitis

Furuncle

Impetigo

Wound infection

Staphylococcal scalded skin syndrome

Staphylococcal toxic shock syndrome (TSS) serious and life-threatening disease commonly seen in young women during, or after menstruation and is associated with the use of intravaginal tampons

associated with toxin-producing staphylococcal infections. The toxin acts as a 'super-antigen', triggering T-helper cell activation and very high peripheral polymorphonuclear leucocyte numbers .

Staphylococcal toxic shock syndrome (TSS)

high fever generalised systemic myalgia headache, sore throat and vomiting generalised erythematous blanch rash Hypotension rapidly progresses over hours to multisystem involvement with cardiac, renal and hepatic compromise, leading to death in 10-20%. Recovery is accompanied at 7-10 days by desquamation

.Full-thickness desquamation after toxic shock syndrome

Management
mmediate and aggressive fluid resuscitation

an intravenous antistaphylococcal antibiotic (flucloxacillin or vancomycin) is required.

The rapid progression of symptoms and signs may require intensive care.

Cannula-related infection Skin staphylococcal ( Staph. Epidermidis) associated with cannula infection and sepsis Staph. Epidermidis have a predeliction for plastic, forming a biofilm which remains as a source of bacteraemia. common reason for morbidity following hospital admission.

antibiotic treatment with benzylpenicillin and flucloxacillin is necessary if there is any spreading infection .

Cannula-related infection

.Skin abscesses in an injection drug-user

MRSA
Staph. aureus has shown the ability to develop resistance to antibiotic Resistance to meticillin due to the production of an additional penicillin-binding protein MRSA are a major health care- pathogen in Hospitals

recently : resistance to vancomycin/teicoplanin ( glycopeptide intermediate Staph. aureus( (GISA) rarely, vancomycin-resistant (VRSA) MRSA now accounts for up to 40% of staphylococcal bacteraemia
appropriate

infection control measures

STREPTOCOCCAL skin INFECTIONS

STREPTOCOCCAL INFECTIONS

Strep. pyogenes

Skin and soft tissue infection (erysipelas, impetigo, necrotising fasciitis ( Streptococcal toxic shock syndrome Scarlet fever
Bone and joint infection Tonsillitis Puerperal sepsis Glomerulonephritis Rheumatic fever

Strep. mitis, sanguis, ( Alpha-haemolytic streptococci )mutans, salivarius

Endocarditis Septicaemia in immunosuppressed Group B streptococci

Neonatal infections including meningitis Female pelvic infections

Enterococcus faecalis

Endocarditis Urinary tract infection

Anaerobic streptococci ).spp Peptostreptococcus(

Peritonitis Dental infections Liver abscess Pelvic inflammatory disease .All streptococci can cause septicaemia

scarlet fever
Group A and occasionally group C and G streptococci The source is streptococcal pharyngitis or tonsillitis. Common in school-age children

fever strawberry tongue diffuse erythematous rash

The disease lasts about 7 days the rash disappearing in 7-10 days followed by a fine desquamation. Residual petechial lesions in the antecubital fossa may be seen ('Pastia's sign .Treatment (benzylpenicillin or orally penicillin plus symptomatic measures.

Streptococcal toxic shock syndrome

impetigo

erysipelas

Cellulitis an infection of the dermis and the subcutaneous tissue

Necrotising fasciitis

Type 1: polymicrobial infection with Enterobacteriaceae and anaerobic organisms.

often occurs following surgery or in diabetic or immunocompromised patients .

Type 2 ( streptococcal gangrene) is caused by Strep. pyogenes (group A)

. a severe, rapidly progressive and destructive inflammation of the dermis

subcutaneous tissues, subcutaneous fat including the deep fascia.

often arising from an apparently minor breach in skin integrity.

The affected area is erythematous, hot, shiny and exquisitely tender. The central area of skin involvement becomes anaesthetic due to cutaneous nerve damage. surrounded by necrotising fasciitis.

associated with profound toxaemia and multisystem failure.

high fever, marked leucocytosis and often hypocalcaemia due to subcutaneous fat necrosis.

Subcutaneous gas may be present in type 1 necrotising fasciitis.

.Excision following necrotising fasciitis in an injection drug-user

Management
urgent and extensive surgical dbridement

appropriate antibiotic therapy against Gram-positive, anaerobic and Gram-negative organisms. Usually intravenous benzylpenicillin and a quinolone, plus either clindamycin or metronidazole.

Clostridial soft tissue infections

Gas gangrene or myonecrosis

acute clostridial invasion of healthy living muscle (Clostridia perfringens)

(70% of cases) develops following deep penetrating injury sufficient to create an anaerobic environment

Cl. tetani and Cl. botulinum contaminating can cause 'wound tetanus' and 'wound botulism'.

Severe pain at the site of the injury progresses rapidly ( 18-24 hours( Skin colour changes from pallor to bronze/purple to blue-black color .

the skin is tense and exquisitely tender.

Gas in tissues with crepitus on clinical examination or visible on X-ray or ultrasound.

low-grade fever
Signs of systemic toxicity (Tachycardia ,apathetic mental status hypotension multi-organ dysfunction( renal failure) high leucocytosis, raised creatine kinase and evidence of disseminated intravascular haemolysis

Management high-dose intravenous penicillin, clindamycin, cephalosporins and metronidazole.

aggressive surgical dbridement of the affected tissues.

hyperbaric oxygen

Bacteroides infection Bacteroides fragilis are commonly found in the gastrointestinal tract and can cause skin and soft tissue infections and bacteraemia. often associated with mixed infections in compromised hosts such as diabetics frequently linked to rectal or colonic surgery or pelvic disease. Antimicrobial resistance is widespread in this group are usually sensitive to -lactam--lactamase inhibitor combinations, metronidazole or carbapenems .

SEVERE NECROTISING SOFT TISSUE INFECTIONS Necrotizing fasciitis

Clostridial anaerobic cellulitis (confined to skin and subcutaneous tissue (

Non-clostridial anaerobic cellulitis Progressive bacterial synergistic gangrene( Staph. aureus + microaerophilic streptococcus ( Pyomyositis (discrete abscesses within individual musclegroups ( Clostridial myonecrosis (gas gangrene ( Anaerobic streptococcal myonecrosis (non-clostridial gas gangrene (

Group A streptococcal necrotising myositis