Diseases of Cardiovacular and Lymphatic Systems

1
Diseases of Cardiovacular and Lymphatic Systems
2
Sepsis

• Septicemia, bacteremia, bacteria in the
• blood
• 500M cases in United States/annum
• 25 mortality rate
• 10 of patients with sepsis die of
• underlying disease or comorbidity
• 13th leading cause of death in the United
• States
• Cost 5-10 billion in annual healthcare
• expenditures

3
Sepsis
4
Sepsis

• 50 of all cases of sepsis are caused by gram
  negative rods
• other etiologies include
• CNS
• Staphylococcus aureus
• Enterococcus sp
• Fungi (yeast)
• The numbers of sepsis are predicted to
• increase
• larger numbers of immunocompromised patients
• more frequent use of invasive procedures or
  devices
• greater availability of life-sustaining
  technology
• higher infection rates of antibiotic resistant
  bacteria
• increase proportion of patients at the extremes
  of age

5
Bacterial Sepsis

• Among hospitalized in non-coronary intensive
• care units, sepsis has been reported to be the
• most common cause of death.
• The term systemic inflammatory response
• syndrome (SIRS)was developed to imply a
• clinical response from a non-specific etiology.
• SIRS is defined as two or more of the following
• temperature above 38 C or below 36 C
• heart rate above 90 beats/minute
• respiratory rate above 20/minute P CO2 less than
  32 mm Hg
• white blood count above 12M or below 4M
  cells/mm3
• presence of more than 10 immature neutrophils

6
Gas Gangrene

• A severe form of gangrene (tissue
• death) usually caused by Clostridium
• perfringens (see also necrotizing
• subcutaneous infection). It can also be
• from Group A Streptococcus.
• Staphlyococcus aureus and Vibrio
• vulnificus can also cause similar
• infections.
• Gas gangrene occurs as a result of
• infection by Clostridium bacteria.
• Under anaerobic (low oxygen)
• conditions, produce toxins that cause
• the tissue death and associated
• symptoms.

7
Gas Gangrene

• Gas gangrene generally occurs
• at the site of trauma or a recent
• surgical wound.
• Symptoms   
• moderate to severe pain around a skin injury
• progressive swelling around a skin injury
• moderate to high fever
• skin color initially pale, later dusky
  progressing to dark red or purple
• Vesicle (blister) formation, coalescent (combine
  into large blisters)
• blisters filled with brown-red fluid
• drainage from the tissues, foul-smelling
  brown-red or bloody fluid (serosanguineous
  discharge)
• increased heart rate (tachycardia)
• sweating
• subcutaneous emphysema (air under the skin)

8
Gas Gangrene

• Treatment   
• Prompt surgical removal of dead, damaged, and
  infected tissue (debridement) is necessary.
  Amputation of an arm or leg may be indicated to
  control the spread of infection.
• Antibiotics, preferably penicillin-type, should
  be given. Initially, this is given intravenously
  (through a vein). Analgesics may be required to
  control pain. Hyperbaric oxygen has been tried
  with varying degrees of success.
• Hyperbaric treatment
• Prognosis   
• Gas gangrene is progressive and often lethal.
  Immediate medical attention is required.

9
Plague

• Yersina pestis is the causative
• agent.
• Three clinical manifestations
• Pneumonic
• Septicemic
• Bubonic
• In early stages of bubonic there is
• fever, delirium, and swelling of
• lymph nodes. Septicemia develops
• and cause hemorragic blackened
• lesion therefore black death

10
Plague

• Plague is transmitted among
• rodents and to humans by flea bite
• or ingestion of the feces of fleas.
• It can also be transmitted human
• to human when a plague victim
• develops pneumonia and spreads
• infected droplets by coughing.
• An epidemic may be started this
• way.

11
Plague

• Symptoms 
•   
• Sudden onset of high fever
• Chills
• General discomfort, uneasiness, or ill feeling
  (malaise)
• Muscular pains
• Severe headache
• Smooth, oval, reddened, painful swellings of
  swollen lymph glands called buboes in the groin,
  armpits, neck, or elsewhere in the body. Pain may
  occur in the area before the swelling the most
  common area is in the groin
• Seizures

12
Plague

• Treatment   
• Immediate treatment with antibiotics such as
  streptomycin, chloramphenicol, or tetracycline is
  indicated. Oxygen, intravenous fluids, and
  respiratory support are additional treatments.
• Patients with pneumonic plague are strictly
  isolated from other patients.
• People who have had contact with anyone infected
  by pneumonic plague are observed closely and are
  given antibiotics as a preventive measure.

13
Plague

• Prognosis   
• Half of bubonic plague victims die if not
  treated, and almost all victims of pneumonic
  plague die if not treated. Treatment reduces the
  death rate to 5

14
Art Appreciation
15
Art Appreciation
16
Lyme Disease

• Borrelia burgdorferi is a species of Gram
  negative
• bacteria of the spirochete class of the genus
• Borrelia. B. burgdorferi is predominant in North
• America, but also exists in Europe, and
• is the agent of Lyme disease.
• It is a zoonotic, vector-borne disease
  transmitted
• by ticks and is named after the researcher Willy
• Burgdorfer who first isolated the bacterium in
• 1982.
• B. burgdorferi is one of the few pathogenic
• bacteria that can survive without iron, having
• replaced all of its iron-sulfur cluster enzymes
  with
• enzymes that use manganese, thus avoiding the
• problem many pathogenic bacteria face in
• acquiring iron.

17
Lyme Disease

• Borrelia burgdorferi infections have been
• linked to non-Hodgkin lymphomas.
• Lyme disease is diagnosed based on
• symptoms, objective physical findings
• (such as erythema migrans, facial palsy,
• or arthritis), and a history of possible
• exposure to ticks. Validated laboratory
• tests can be very helpful but are not
• generally recommended when a patient
• has erythema migrans.

18
Lyme Disease

• The Lyme disease bacterium, Borrelia
• burgdorferi, normally lives in mice,
• squirrels and other small animals.
• It is transmitted among these animals
• and to humans through the bites of
• certain species of ticks. In the
• northeastern and north-central
• United States, the black-legged tick
• (or deer tick, Ixodes scapularis)
• transmits Lyme disease.

19
Lyme Disease

• Antibiotics commonly used for oral treatment
• include doxycycline, amoxicillin, or cefuroxime
• axetil. Patients with certain neurological or
• cardiac forms of illness may require intravenous
• treatment with drugs such as ceftriaxone or
• penicillin.
• Patients treated with antibiotics in the early
  stages
• of the infection usually recover rapidly and
• completely.
• A few patients, particularly those diagnosed with
  
• later stages of disease, may have persistent or
• recurrent symptoms.
• Scientists have concluded that longer courses of
• antibiotic treatment are not beneficial.

20
Brucellosis

• Brucellosis is an infectious disease caused
• by the bacteria of the genus Brucella.
• These bacteria are primarily passed among
• animals, and they cause disease in many
• different vertebrates.
• Various Brucella species affect sheep, goats,
• cattle, deer, elk, pigs, dogs, and several other
• animals.
• Humans become infected by coming in contact
• with animals or animal products that are
• contaminated with these bacteria.

21
Brucellosis

• In humans brucellosis can cause a range of
• symptoms that are similar to the flu and may
• include fever, sweats, headaches, back pains, and
  
• physical weakness.
• Also known as undulating fever (higher at night),
  
• muscle aches, enlarged spleen and lymph nodes
• Severe infections of the central nervous systems
• or lining of the heart may occur. Brucellosis can
  
• also cause long-lasting or chronic symptoms that
• include recurrent fevers, joint pain, and
  fatigue.

22
Brucellosis

• Mainly an infection of livestock.
• Human cases are reported as
• 60 butchers, meat packers
• 30 ranchers and hunters
• 10 people who consume unpasteurized dairy
  products

23
Brucellosis

• Brucellosis is diagnosed in a
• laboratory by finding Brucella
• organisms in samples of
• blood or bone marrow.
• Also, blood tests can be done to
• detect antibodies against the
• bacteria.
• If this method is used, two blood
• samples should be collected 2 weeks
• apart.

24
Brucellosis

• Treatment can be difficult. Doctors can
• prescribe effective antibiotics.
• Usually, doxycycline and rifampin are used
• in combination for 6 weeks to prevent
• reoccuring infection.
• Depending on the timing of treatment and
• severity of illness, recovery may take a few
• weeks to several months.
• Mortality is low (lt2), and is usually associated
  
• with endocarditis.

25
Tularemia

• Francisella tularensis, the organism
• that causes tularemia, is one of the
• most infectious pathogenic
• bacteria known, requiring
• inoculation or inhalation of as few
• as 10 organisms to cause disease.
• It is considered to be a dangerous
• potential biological weapon because of
• its extreme infectivity, ease of
• dissemination, and substantial capacity
• to cause illness and death.
• Francisella tularensis is a hardy non-
• spore forming organism that is capable
• of surviving for weeks at low
• temperatures in water, moist soil, hay,
• straw or decaying animal carcasses.

26
Tularemia

• Tularemia is a zoonosis. Natural reservoirs
• include small mammals such as voles,
• mice, water rats, squirrels, rabbits and
• hares.
• Naturally acquired human infection occurs
• through a variety of mechanisms such as
• bites of infected arthropods handling
• infectious animal tissues or fluids direct
• contact or ingestion of contaminated
• water, food, or soil and inhalation of
• infective aerosols.

27
Tularemia

• F. tularensis is so infective that examining an
  open culture plate can cause infection.
• Humans can contract tularemia in the following
  ways
• direct contact with an infected animal or carcass
  via broken skin
• the bite of an infected flea, deer fly, or tick
• ingesting infected meat (rare)

28
Tularemia Sx

•  
• red spot on the skin, enlarging to an ulcer
• enlarged lymph nodes of groin or armpits
• headache
• muscle pains
• possible conjunctivitis
• shortness of breath
• fever
• chills
• sweating
• weight loss
• joint stiffness

29
Tularemia Tx

•  
• The goal of treatment is to eliminate the
  infection with antibiotic therapy. Streptomycin
  and tetracycline are commonly used in this
  infection.
• Tularemia is fatal in about 5 of untreated cases
  and in less than 1 with treatment.
• Complications   
• meningitis
• pneumonia
• pericarditis

30
Cat-Scratch Disease

• Cat scratch disease is an infectious illness
  caused by the bacteria Bartonella, believed to be
  transmitted by cat scratches, bites, or exposure
  to cat saliva.
• More than 40,000 cases occur annually in the US

31
Cat-Scratch Disease

• Symptoms   
• A history of contact with a cat
• Papule or pustule at site of injury
  (inoculation), usually the first sign
• Swelling of the lymph nodes (adenopathy) occurs
  in the area near where the skin was infected
  (bitten, scratched, etc.)
• Fever in approximately one third of patients
• Fatigue
• Malaise
• Headache

32
Cat-Scratch Disease

• Treatment   
• Generally, cat scratch disease is not serious.
  Treatment, other than reassurance, is not usually
  recommended. However, in severe cases treatment
  with antibiotics can be helpful.

33
Typhus

• Typhus is a rickettsial disease caused by one of
  two organisms, Rickettsia prowazekii (epidemic
  typhus and Brill disease) and Rickettsia typhi
  (murine or endemic typhus). Epidemic typhus and
  Brill disease are uncommon in the United States.
• Murine typhus occurs in the southeastern and
  southern states. There are less than 100 cases
  per year. Murine typhus is a milder form and is
  seldom fatal (less than 2).
• It is frequently seen in the summer and fall and
  typically lasts two to three weeks. Risk factors
  for murine typhus include exposure to rat fleas
  or rat feces, or exposure to other animals (such
  as cats, opossums, raccoons, skunks, and rats).

34
Typhus

• Epidemic typhus occurs in poor hygienic
  conditions (which is why it is sometimes called
  "jail fever"), usually when the temperature is
  cold.
• It is spread by lice. Although very rare in the
  United States, it has sometimes been spread by
  the lice and fleas of flying squirrels.

35
Symptoms Of Epidemic Typhus

• severe headache
• fever, high (104 degrees Fahrenheit)
• cough in 70 of patients
• arthralgia and myalgia, (muscle pain) severe
• chills
• falling blood pressure
• stupor
• delirium
• rash that begins on chest and spreads to rest of
  trunk and extremities, but not to palms and soles
  
• early rash is faint and rose colored and fades
  with pressure (Later the lesions become dull,
  red, and do not fade. People with severe typhus
  may also develop petechiae.)
• lights appear very bright, and exposure to light
  may hurt the eyes

36
Typhus Treatment

• Treatment   
• The goal of treatment is to eliminate the
  infection and to treat the symptoms with
  antibiotics (such as tetracycline, doxycycline,
  or chloramphenicol). For epidemic typhus,
  intravenous fluids and oxygen may be necessary to
  help stabilize the patient.
• Prognosis   
• Without treatment death may occur in 10 to 60 of
  patients with epidemic typhus. Patients over the
  age of 60 have the highest risk of death. With
  timely antibiotic therapy, the affected person is
  expected to recover completely.
• Less than 2 of untreated patients with murine
  typhus may die, and appropriate antibiotic
  therapy will cure virtually all patients.

37
Rocky Mountain Spotted Fever

• An infectious disease caused
• by Rickettsia rickettsii
• transmitted to humans by the
• bite of ticks.
• Symptoms   
• fever
• chills
• incubation period of 2 to 14 days
• severe headache
• muscle pain
• mental confusion
• rash, first appearing on wrists and ankles, then
  spreading to most of the body, usually starts a
  few days after fever starts up to 20 of people
  do not get a rash

38
Chagas Disease

• Chagas disease is caused by Trypanosoma cruzi, a
  parasite related to the African trypanosome that
  causes sleeping sickness.
• It is spread by reduvid bugs and is one of the
  major health problems in South America, where 20
  million people are infected.
• Due to immigration, approximately 500,000 people
  in the United States are believed to be infected.

39
Chagas Disease

• Chagas disease has two phases acute and
  chronic. The acute phase may have no symptoms or
  have very mild symptoms. Symptoms of the acute
  phase include swelling and reddening at the site
  of infection (where the blood-sucking insect
  caused the initial infection).
• This may be followed by swelling of one eye.
  Lymph nodes that drain the area of the insect
  bite may become swollen. As the parasite spreads
  from the bite site, the patient develops fever,
  malaise, and generalized swelling of the lymph
  nodes. The liver and spleen may become enlarged.
• The disease goes into remission after the acute
  phase and may become chronic with no further
  symptoms for many years. When symptoms finally
  develop, they appear as cardiac disease
  (cardiomyopathy) and digestive abnormalities.

40
Chagas Disease

• Patients may develop
• congestive heart failure.
• Swallowing difficulties may
• be the first symptom of
• digestive disturbances and
• may lead to malnutrition.
• Patients who have parasitic
• infection of the colon may
• experience abdominal pain and
• constipation. Death is usually
• caused by heart disease.

41
Chagas Disease Sx

•   
• history of exposure in an area where Chagas
  disease is known to occur
• swollen red area at site of previous insect bite
• enlarged lymph nodes
• swelling of one eye
• fever
• irregular heartbeat (arrhythmia)
• rapid heartbeat (tachycardia)
• swallowing difficulties

42
Chagas Disease

• Treatment   
• The acute phase should be treated. Benznidazole
  has been shown to be effective. Experimental
  treatment may include nifurtimox. Treating the
  chronic phase with antibiotics is not helpful.
  Instead, the symptoms of heart and intestinal
  disease should be treated.
• Prognosis   
• Approximately 30 of infected and untreated
  people will develop chronic or symptomatic Chagas
  disease. It may take more than twenty years from
  the time of the original infection to develop
  heart or digestive problems.
• Abnormal heart rhythms (arrythmias, ventricular
  tachycardia) may cause sudden death. Once
  congestive heart failure develops, death usually
  occurs within several years.

43
Leishmaniasis

• Leishmania are tiny protozoa. Their
• parasitic life cycle includes the
• sandfly and an appropriate host.
• Humans are one of those hosts.
• Leishmania infection can cause
• skin disease (called cutaneous
• leishmaniasis).
• It can affect the mucous membranes
• with a wide range of appearance, most
• frequently ulcers. It may cause skin
• lesions that resemble those of other
• diseases including cutaneous
• tuberculosis, syphilis, leprosy, skin
• cancer (basal cell carcinoma), and
• fungus infections.

44
Leishmaniasis

• Symptoms   
• history of exposure to the bite of sandflies
• history in being in an area known for
  leishmaniasis
• Systemic illness (visceral leishmaniasis)
• fever, persistent, long duration (weeks), may
  cycle irregularly
• night sweats
• fatigue
• weakness
• appetite loss (anorexia)
• weight loss
• abdominal discomfort, vague
• vomiting (children)
• diarrhea (children)
• cough (children)
• skin, scaly
• skin, gray, dark, ashen
• hair, thinning

45
Leishmaniasis

• Skin disease (cutaneous leishmaniasis) Symptoms
  on the skin include
• macule or papule, erythematous
• skin ulcer, forms at site of original lesion
• ulcer heals very slowly over a matter of months
• smaller lesions may form around the ulcer
  (satellite lesions)

46
Leishmaniasis

• Treatment   
• Antimony-containing compounds are the principal
  medications used to treat leishmaniasis. These
  include
• meglumine antimonate
• sodium stibogluconate
• Other drugs that may be used include
• pentamidine
• amphotericin B
• Miltefosine
• Plastic surgery may be required to correct
  disfigurement by destructive facial lesions
  (mucocutaneous leishmaniasis). Removal of the
  spleen (splenectomy) may be required in
  drug-resistant cases (visceral leishmaniasis).

47
Schistosomiasis

• Causes and risks   
• Schistosoma infections are contracted through
  contact with contaminated water. The parasite in
  its infective stages is called a cercaria. It
  swims freely in open bodies of water.
• On contact with humans, the parasite burrows into
  the skin, matures into another larval stage
  (schistosomula), then migrates to the lungs and
  liver (where it matures into the adult form).
• The adult worm then migrates to the anatomic area
  of its preference, depending on which species is
  involved. Likely areas include the bladder,
  rectum, intestines, liver, portal venous system,
  spleen, and lungs.
• Schistosomiasis is not usually found in the
  United States. However, it is prevalent in many
  tropical or subtropical areas, and it is a common
  illness thought to affect more than 200 million
  people.

48
Schistosomiasis

• Symptoms   
• Symptoms vary with the species of worm and the
  phase of infection.
• Initial invasion of the skin may cause itching
  and a rash (swimmer's itch).
• Heavy infestation may cause fever, chills, lymph
  node enlargement, and liver and spleen
  enlargement.
• Urinary symptoms may include frequency, painful
  urination (dysuria), and blood in urine
  (hematuria).
• Intestinal symptoms include abdominal pain and
  diarrhea (which may be bloody).

49
Schistosomiasis

• Treatment   
• Praziquantel
• With acute infection, corticosteroids may be
  given
• Prognosis   
• Treatment before significant damage or severe
  complications usually produces good results.

50
Toxoplasmosis

• Toxoplasmosis is caused by the protozoan parasite
  Toxoplasma gondii. In the United States it is
  estimated that 22.5 of the population 12 years
  and older have been infected with Toxoplasma.
• In various places throughout the world, it has
  been shown that up to 95 of some populations
  have been infected with Toxoplasma. Infection is
  often highest in areas of the world that have
  hot, humid climates and lower altitudes.

51
Toxoplasmosis

• Toxoplasmosis is not passed from
  person-to-person, except in instances of
  mother-to-child (congenital) transmission and
  blood transfusion or organ transplantation.
  People typically become infected by three
  principal routes of transmission.

52
Toxoplasmosis

• Foodborne transmission
• The tissue form of the parasite (a microscopic
  cyst consisting of bradyzoites) can be
  transmitted to humans by food. People become
  infected by
• Eating undercooked, contaminated meat (especially
  pork, lamb, and venison)
• Accidental ingestion of undercooked, contaminated
  meat after handling it and not washing hands
  thoroughly (Toxoplasma cannot be absorbed through
  intact skin)
• Eating food that was contaminated by knives,
  utensils, cutting boards, or other foods that had
  contact with raw, contaminated meat

53
Toxoplasmosis

• Cats play an important role in the spread of
  toxoplasmosis. They become infected by eating
  infected rodents, birds, or other small animals.
  The parasite is then passed in the cat's feces in
  an oocyst form, which is microscopic.
• Kittens and cats can shed millions of oocysts in
  their feces for as long as 3 weeks after
  infection. Mature cats are less likely to shed
  Toxoplasma if they have been previously infected.
  A Toxoplasma-infected cat that is shedding the
  parasite in its feces contaminates the litter
  box. If the cat is allowed outside, it can
  contaminate the soil or water in the environment
  as well.
• People can accidentally swallow the oocyst form
  of the parasite. People can be infected by
• Accidental ingestion of oocysts after cleaning a
  cat's litter box when the cat has shed Toxoplasma
  in its feces
• Accidental ingestion of oocysts after touching or
  ingesting anything that has come into contact
  with a cat's feces that contain Toxoplasma
• Accidental ingestion of oocysts in contaminated
  soil (e.g., not washing hands after gardening or
  eating unwashed fruits or vegetables from a
  garden)
• Drinking water contaminated with the Toxoplasma
  parasite

54
Toxoplasmosis

• People can accidentally swallow the
• oocyst form of the parasite. People
• can be infected by
• Accidental ingestion of oocysts after cleaning a
  cat's litter box when the cat has shed Toxoplasma
  in its feces
• Accidental ingestion of oocysts after touching or
  ingesting anything that has come into contact
  with a cat's feces that contain Toxoplasma
• Accidental ingestion of oocysts in contaminated
  soil (e.g., not washing hands after gardening or
  eating unwashed fruits or vegetables from a
  garden)
• Drinking water contaminated with the Toxoplasma
  parasite

55
Toxoplasmosis

• Most healthy people recover from toxoplasmosis
  without treatment. Persons who are ill can be
  treated with a combination of drugs such as
  pyrimethamine and sulfadiazine, plus folinic
  acid.
• Pregnant women, newborns, and infants can be
  treated, although the parasite is not eliminated
  completely. The parasites can remain within
  tissue cells in a less active phase their
  location makes it difficult for the medication to
  completely eliminate them.

56
Toxoplasmosis

• Persons with ocular toxoplasmosis are sometimes
  prescribed medicine to treat active disease by
  their ophthalmologist. Whether or not medication
  is recommended depends on the size of the eye
  lesion, the location, and the characteristics of
  the lesion (acute active, versus chronic not
  progressing).
• Persons with compromised immune systems need to
  be treated until they have improvement in their
  condition. For AIDS patients, continuation of
  medication for the rest of their lives may be
  necessary, or for as long as they are
  immunosuppressed.

57
(No Transcript)