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Questions and Answers
What is a common characteristic of dry gangrene?
Which bacterium is primarily associated with causing atheromas?
What condition is characterized by severe infection leading to CNS issues or endocarditis?
Which of the following symptoms is common across multiple zoonotic infections, including Tularemia and Brucellosis?
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How is Cat Scratch Disease primarily transmitted?
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What characterizes gas gangrene specifically?
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Which zoonotic disease is most commonly transmitted through unpasteurized dairy products?
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What is a defining symptom of Rat-Bite Fever?
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Which vector is primarily responsible for the transmission of Lyme Disease?
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What condition can develop from poor public health standards regarding animals?
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What is the most common cause of infective endocarditis?
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Which of the following is a symptom of myocarditis?
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What condition is characterized by the inflammation of the outer layer of the heart?
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Bacteremia may frequently occur due to which of the following?
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Which symptom is commonly associated with septicemia?
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What serious condition can progress from untreated septicemia?
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Rheumatic fever is primarily a complication of which type of infection?
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What is a significant treatment for gangrene?
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What is the primary risk factor for bloodborne infectious diseases in certain occupations?
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What might cause Microbemia in a patient?
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Which disease is primarily transmitted through mosquito bites and can also be contracted via blood transfusion?
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What is the main cause of severe illness in babesiosis?
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How is Toxoplasmosis primarily transmitted to humans?
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Which symptom is commonly associated with severe cases of malaria?
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What factors increase the risk of severe illness from Babesiosis?
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What treatment is commonly used for malaria, despite decreasing effectiveness?
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How can Toxoplasmosis be particularly dangerous for pregnant women?
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What is a common complication of infections in the circulatory system?
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What is the primary transmission method of Rocky Mountain Spotted Fever?
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What is a significant symptom of Ehrlichiosis?
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What type of bacteria causes Bubonic Plague?
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What is the first stage symptom of Lyme Disease?
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Which bacterial agent is responsible for Infectious Mononucleosis?
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What is the characteristic effect of untreated Epidemic Typhus?
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What increases the risk of severe outcomes in systemic mycoses?
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Which of the following is considered a viral hemorrhagic fever?
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For which condition is the primary treatment typically focused on symptomatic relief rather than a cure?
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What type of parasite is associated with Scrub Typhus?
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What is a common early symptom of Cytomegalovirus Infections?
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What is a known consequence of untreated Lyme Disease?
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Which infectious disease primarily affects children and adolescents?
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What is a unique feature of relapsing fever?
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Study Notes
The Circulatory System
- Consists of the cardiovascular and lymphatic systems.
- Microorganisms can quickly spread throughout the body when they gain access to either system.
Endocarditis
- Inflammation of the endocardium, the inner lining of the heart or the heart valves.
- Can be infective or noninfective.
- Infective endocarditis symptoms include fatigue and weakness, fever and chills, weight loss, blood in urine, muscle aches and pains.
- High mortality rate for infective endocarditis (25%).
- Most commonly caused by bacteria, but can also be caused by fungi.
Myocarditis
- Inflammation of the myocardium, the muscular portion of the heart.
- Primarily caused by viral infections, but can also be caused by bacteria, protozoa, helminths, and fungi.
- Can result in heart failure.
- Symptoms include chest pain, fever, shortness of breath, leg swelling, arrhythmias, and congestive heart failure.
Pericarditis
- Inflammation of the pericardium, the saclike membrane surrounding the heart.
- Usually a complication of a viral infection, but can also be caused by bacteria and fungi.
- Symptoms include chest pain, difficulty breathing when reclining, dry cough, anxiety, fatigue, and fever.
Bloodborne Infectious Diseases
- Spread by contaminated blood or bodily fluids.
- Risk of exposure is greater for certain occupations, such as healthcare, emergency response, public safety, and teaching.
- Pathogens of primary concern (per CDC): HIV, Hepatitis B, Hepatitis C, and those causing viral hemorrhagic fever.
Microbemia
- Infections caused by microorganisms that enter the circulatory system through lymphatic drainage.
- Can be asymptomatic, symptomatic, transient, continuous, or intermittent.
- Symptoms include fever, chills, rigors, sweating, malaise, and fatigue.
- Treatment involves intravenous broad-spectrum antibiotics.
Bacteremia
- Presence of bacteria in the bloodstream.
- Caused by dental procedures, surgical procedures, indwelling medical devices, wound infections, and other factors.
- Typically elicits a strong immune response.
- Can lead to sepsis if the immune system fails to sufficiently defend.
Septicemia (Sepsis)
- Toxic condition caused by the spread of bacteria or bacterial toxins from the site of infection.
- A medical emergency requiring immediate treatment.
- Can progress to septic shock; death rate can be as high as 50% depending on the organism.
- Common symptoms include loss of appetite, fever, chills, tachypnea and tachycardia, lethargic or agitated behavior.
Rheumatic Fever
- Inflammatory disease that can develop as a rare complication after a group A streptococcal infection.
- Affects the heart, joints, brain, spinal cord, and skin.
- Generally occurs in children between 4 and 18.
- Common symptoms include joint pain, fever, chest pain, carditis, rash, and nodules under the skin (which occur several weeks after resolution of strep throat symptoms).
- Treatment involves long-term antibiotics and limiting physical activity.
- Permanent heart damage can occur and may not be discovered for decades.
- Low-dose antibiotics may be administered for 3-5 years after symptom onset.
Gangrene
- Complication of necrosis, the decay and death of tissue often related to wounds.
- Ischemia, the restriction of blood supply, can lead to gangrene.
- Mostly affects extremities, but can occur in muscle tissues and organs.
- Treatment entails removal of necrotic tissue; antibiotics alone are not effective.
- Hyperbaric oxygen therapy can also be used.
- Clostridium perfringens (an anaerobe) is the most frequent species involved.
- Types:
- Dry gangrene: Due to ischemia, generally begins at distal portions of a limb (e.g., feet).
- Internal gangrene (White gangrene): Bleaching of internal tissue, generally contracted after surgery or trauma.
- Wet gangrene: Occurs in organs lined by mucous membranes, such as the mouth, lower intestines, lungs, and cervix.
- Gas gangrene: Bacteria produce gas within infected tissue, fatal without treatment.
Atherosclerosis
- Plaques (atheromas - consisting of lipids, fibrin, and cell debris) in blood vessels.
- Form primarily in large arteries (aorta, iliac arteries, coronary arteries, carotid arteries).
- Bacteria and viruses have been linked to atheromas.
- Chlamydia pneumonia is the primary bacterial cause.
- Other causative organisms include Staphylococcus, Mycoplasma, Helicobacter, Streptococcus, and Enterobacter species.
Zoonotic Bacterial Infections
- Diseases or infections that can be transmitted from vertebrate animals to humans.
- Over 200 zoonoses have been described; not all affect the circulatory system.
- Can be caused by bacteria, viruses, parasites, and unconventional agents like prions.
Brucellosis (Undulant Fever)
- Infectious disease caused by various Brucella species (gram-negative aerobic coccobacilli).
- Most common in areas with insufficient standards for public health and domestic animal programs.
- Bacteria primarily affect sheep, goats, cattle, deer, elk, pigs, and dogs.
- Person-to-person spread is rare, but may occur through breastfeeding.
- Presents with fever, chills, headache, fatigue, dizziness, muscle aches, and joint pain.
- Severe infections of the CNS or endocardium can occur.
- Treatment with antibiotics is possible.
- High-risk groups include butchers, animal handlers, veterinarians, meat inspectors, and lab technicians.
- Most common route of infection for people not in a high-risk group is the ingestion of unpasteurized milk or dairy products.
Tularemia (Rabbit Fever)
- Caused by Francisella tularensis, a gram-negative bacillus.
- Infects the blood and lymph nodes.
- Transmitted by contact with infected animals, usually rabbits and squirrels (not person to person).
- Most common entry site is through a minor skin abrasion, where an ulcer will occur.
- Symptoms include fever, chills, headache, fatigue, dizziness, muscle aches, and joint pain.
- Can lead to sepsis if not contained.
- Symptoms appear in 5-14 days.
- Only 10-50 organisms are required to cause an infection.
- Potential bioweapon.
Cat Scratch Disease
- Bartonella henselae, an aerobic, gram-negative bacillus.
- Transmitted by cat scratches, bites, or even by exposure to saliva on broken skin or contact with the eye (40% of cats may be carriers).
- Initial symptoms typically involve local lymph nodes.
- Symptoms include fever, fatigue, malaise, and headache.
- Not spread by person-to-person contact.
- Treatment is typically not required unless immunocompromised.
- Simple contact with cat saliva, then a skin wound or touching one's eyes can result in infection.
Rat-Bite Fever
- Rare, systemic, infectious disease developing after being bitten or scratched by an infected rat/rodent, handling an infected rat/rodent, or ingestion of food or water contaminated by rat/rodent excreta.
- Symptoms include abrupt onset of chills and fever, vomiting, pain in the back and joints, and headache.
- Can cause pericarditis and endocarditis.
- Treatable with antibiotics, usually penicillin, erythromycin, or tetracycline; fatal if untreated.
- Rash develops 2-4 days after fever onset.
- More severe complications can lead to death if not treated.
Vector-Transmitted Diseases
- Vectors are animals capable of transmitting infectious disease, including flies, ticks, mites, fleas, and rats.
- Insects are major causes of human mortality and morbidity due to the transmission of infectious pathogens by blood-feeding species.
Plague
- Infectious disease caused by Yersinia pestis.
- Contracted after being bitten by a flea carrying bacteria from an infected rodent or handling an infected animal.
- Typically causes swelling of lymph nodes in the groin and armpits (buboes).
- Early antibiotic treatment is highly effective, but if left untreated, septicemic plague is fatal.
- Recovery provides immunity.
- Vaccines are available.
- Types:
- Bubonic
- Septicemic (can lead to septic shock)
- Pneumonic
Rocky Mountain Spotted Fever
- Caused by Rickettsia rickettsii.
- Transmitted by ticks.
- Severe disease; symptoms include fever, nausea and vomiting, severe headache, muscle pain, and lack of appetite.
- Later signs include rash, abdominal pain, joint pain, and diarrhea.
- Immediate antibiotic treatment is required.
- Despite treatment, 3% to 5% die from the condition.
- Pleomorphic (able to change shape) gram-negative bacterium.
- Incubation period is 5-10 days after the tick bite; symptoms are typically nonspecific.
- 35- 60% of infected patients develop a rash.
Lyme Disease
- Caused by Borrelia burgdorferi.
- Transmitted by the bite of an infected blacklegged tick.
- Early symptoms include skin rash, fever and fatigue, headache and stiff neck, and muscle pain.
- Early-stage treatment with antibiotics is effective.
- If untreated, can spread to the joints, heart, and nervous system.
- Third stage results in repeated and severe arthritic attacks.
- Gram-negative spirochete.
Ehrlichiosis
- Caused by several species of the genus Ehrlichia.
- Reservoir: Deer, rodents.
- Transmission primarily by the Lone Star tick.
- Initial symptoms include fever, headache, malaise, and muscle aches.
- Severe cases may result in prolonged fever, renal failure, disseminated intravascular coagulation (DIC), meningoencephalitis, respiratory distress, seizures, and coma.
- Immediate antibiotic treatment is necessary.
- Ehrlichia chaffeensis was the first cause of human disease discovered in 1987.
- Initial symptoms are nonspecific.
Typhus
- Epidemic typhus:
- Caused by Rickettsia prowazekii.
- Transmitted person-to-person by body lice.
- Symptoms include headache, backache, joint pain, high fever, nausea, vomiting, hacking dry cough, and abdominal pain.
- Causes localized blockage of blood vessels.
- If untreated, 20% mortality rate; as high as 60% for the elderly or immunocompromised.
- Obligate intracellular parasites.
- Endemic typhus:
- Caused by Rickettsia typhi.
- Transmitted by rat fleas.
- Similar symptoms, but less severe than epidemic typhus.
- Most people recover fully.
- Scrub typhus:
- Caused by Orientia tsutsugamushi.
- Found in areas of heavy brush vegetation (Far East).
- Transmitted by chiggers.
- Symptoms include fever, headache, muscle pain, and cough.
Relapsing Fever
- Caused by Borrelia recurrentis.
- Transmitted by body lice or ticks.
- Epidemics prevalent in overcrowded populations with poor hygiene.
- Tick- and louse-borne types.
- Symptoms include relapsing fever in 2-14 day intervals.
- Treatment involves antibiotics.
- Lice (plural)= louse (singular) - “piojo”
Viral Infections
- Viruses can cause a number of cardiovascular and lymphatic infections.
- Children and adolescents are more susceptible.
- Recovery typically occurs in 2-4 weeks but can last longer.
- Avoid sports – increased risk of spleen rupture.
Infectious Mononucleosis
- Caused by Epstein-Barr virus (EBV).
- EBV is also called human herpesvirus 4.
- Symptoms include sore throat, fever, fatigue, swollen lymph nodes; occasionally causes a swollen spleen or liver problems.
- Transmission requires contact with the saliva of an infected person (including water bottles, utensils).
- No specific treatment; symptoms are addressed with bed rest and adequate fluids.
Cytomegalovirus Infections
- Human herpesvirus 5.
- Direct contact transmission (present in various body fluids).
- Crosses the placenta.
- Permanent disabilities in infant CMV infections (20%).
- Healthy immune systems prevent damaging infections (most people have been exposed).
- No specific cure.
- Symptoms include fever, chills, extreme fatigue, headache, splenomegaly.
- Can lead to developmental disabilities, hearing loss.
- Present in urine, blood, saliva, and breast milk.
Viral Hemorrhagic Fevers
- Febrile illnesses ranging from relatively mild to life-threatening.
- Transmission by contact with the host (e.g., handling infected animals, their remains, fecal matter, urine, or secretions).
- Symptoms include fever, overall vascular system damage, and bleeding disorders (which can progress to extremely high fever, shock, and death).
- Regionally specific, but global in distribution.
- Some are associated with arthropod vectors.
- Can be transmitted from an infected person.
Fungal Infections
- Systemic mycoses:
- Capable of affecting all internal organs.
- Immunocompromised individuals are at higher risk.
- Treatment includes reducing or discontinuing immune-suppressing medications or administering systemic antifungal medications.
- Prognosis depends on the patient's immune function.
- May be fatal for people with HIV, cancer patients, people with neutropenia, organ transplant recipients, following surgery for pancreatitis or splenectomy, persons with poorly controlled diabetes mellitus, ICU patients, and the very young or very old.
Protozoan Infections
- Present unique challenges for treatment and control.
- Once the infection reaches the circulatory system, treatment becomes problematic due to toxic drug therapies.
- Protozoa are eukaryotic single cells.
Malaria
- Most common vector-borne infectious disease.
- Widespread in tropical and subtropical regions.
- Caused by Plasmodium species.
- Transmission through mosquito bites; also through blood transfusion from an infected donor or sharing needles.
- Wide range of symptoms depending on age and immune status.
- Uncomplicated and severe types.
- The severe type causes over 1 million deaths per year.
- Treated with antimalarial drugs (chloroquine, but it has become less effective).
- North American cases typically involve travel to warm regions.
- Grows inside erythrocytes (red blood cells), killing them.
Babesiosis
- Vector-borne, malaria-like illness caused by Babesia.
- Usually transmitted by ticks.
- Infections may be asymptomatic or cause mild nonspecific illness; some cases go unnoticed.
- Can cause severe illness, especially in the young, very old, or immunocompromised; symptoms include high fever, chills, and anemia.
- Human-to-human transmission only occurs through blood transfusions.
Toxoplasmosis
- Caused by Toxoplasma gondii.
- Organisms carry out their reproductive cycle in members of the cat family only.
- Treatment is not usually required, but it is available for pregnant women and immunocompromised individuals.
- Symptoms are uncommon in people with intact immune systems.
- Very dangerous to the fetus.
- Trimethoprim/sulfamethoxazole (Bactrim) is a possible treatment.
- Transmission occurs through the following:
- Raw or undercooked meat.
- Untreated water.
- Fecal-oral route.
- Mother-to-fetus.
- Organ transplant or blood transfusion.
Summary
- The circulatory system consists of the cardiovascular and lymphatic systems.
- Infective endocarditis is generally caused by bacterial or fungal infections.
- Myocarditis is generally caused by viruses but can be caused by other microbes.
- Pericarditis is caused by bacteria and viruses and rarely by fungi.
- Bloodborne infections often occur as a result of exposure to infected blood or body fluids.
- Infection of the circulatory system can be caused by bacteria, viruses, fungi, and protozoa.
- Bacteria and their toxins can cause sepsis, and bacteria multiplying in the blood cause septicemia.
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