Introduction to Infection and Infectious Diseases PDF

INTRODUCTION INFECTION AND INFECTIOUS DISEASES Anak Agung Ayu Yuli Gayatri Tropical Infectious Disease Division of Internal Medicine Department Medical Faculty of Udayana University/RS Ngoerah 2  INFECTION A pathological process caused by invasion of normally sterile...

INTRODUCTION INFECTION AND INFECTIOUS DISEASES Anak Agung Ayu Yuli Gayatri Tropical Infectious Disease Division of Internal Medicine Department Medical Faculty of Udayana University/RS Ngoerah 2  INFECTION A pathological process caused by invasion of normally sterile tissue or fluid or body cavity by pathogenic or potentially pathogenic micro-organisms. It is important to point out that, frequently, infection is strongly suspected without being microbiologically confirmed. TRIANGLE OF INFECTION The chain of Infection BREAKING THE CHAIN OF INFECTION Who is at Risk to Infectious disease? Host Factors Age, gender, genetics, comorbidities Elderly account for 60-85 percent of all cases of severe sepsis Immunosuppression o Disease related, medications related Exposure risk o Health care associated: invasive devices, secondary infections and skin breakdown CAUSATIVE MICROORGANISMS of INFECTIONS Bacterial infections are the most common Fungal, parasitic or viral infections may occur in patient with comorbid conditions and immune supression Unknown (1/3 of all cases)  BACTERIA  Common Gram-positive organisms include coagulase negative Staphylococci, Staphylococcus aureus, Streptococcus species, and Enterococcus species (e.g. faecalis, faecium).  Of al HAI associated pathogens, C.difficile accounts for the most commonly reported pathogen in US hospitals (15% of al infections with a reported pathogen).  Common Gram-negative organisms include species of the Enterobacteriaceae family, including Klebsiella pneumoniae and Klebsiella oxytoca, Escherichia coli, Proteus mirabilis, and Enterobacter species; Pseudomonas aeruginosa, Acinetobacter baumanii, and Burkholderia cepacian. Acinetobacter baumanii is associated with high mortality within the intensive care setting owing to its inherent multi-drug resistant properties. Increased of antimicrobial resistance (AMR)  FUNGI  Usually associated with opportunistic infections in immunocompromised patients & those with indwelling devices, such as central lines or urinary catheters.  Candida species, such as C. albicans, C. parapsilosis, C.glabrata are the most commonly encountered fungal organisms associated with HAI  Candida auris poses a serious problem as a globaly emerging multidrug-resistant organism with high morbidity and mortality due to difficulty with diagnoses and high rates of treatment failure.  Altogether, Candida species make up the fourth most common pathogen across al types of HAIs  Aspergillus fumigatus may be acquired by airborne environmental contamination in areas of healthcare construction.  VIRUSES viral pathogens are the least reported, making up 1-5% of all HAI pathogens Healthcare-acquired hepatitis B and C and human deficiency virus (HIV) has been implicated in unsafe needle practices Globally 5.4% of al HIV infections are healthcare-associated and frequently occur in developing countries Other reported viral pathogens include rhinovirus, cytomegalovirus, herpes simplex virus, rotavirus, and influenza Common sites of infection and causative microorganisms The process of infection 1. Attachment microbes to the target cell 2. Entry into the host cell (intra cellular pathogen ) 3. Development of infection Local multiplication of the pathogen Spread of the microorganism to distant site 4. Shedding of the organism and transfer to a new host  Non INFECTION Infection Bacteria Mechanical Trauma Virus, Neoplastic Diseases Hematopoetic Yeast, disorders Parasites Vascular accidents Immune diseases Acute metab disor CLINICAL DIAGNOSTIC PROCEDURE OF INFECTION 1. ANAMNESIS 2. PHYSICAL EXAMINATION 3. LABORATORIUM 4. RADIOLOGY/ IMAGING  ANAMNESIS (1) Personal history Underlying Diseases: Age  Splenectomy Occupation  Surgical Implantation of Prosthesis Place of origin, Travel History  Immunodeficiency Habits Sexual Practices  Chronic Diseases: Injection Drug Abuse Cirrhosis Excessive Alcohol Use Chronic Heart Diseases Consumption of Unpasteurized Dairy Products Chronic Lung Diseases ANAMNESIS (2) Drug history Associated symptoms: Antipyretics  Shaking chills Immune suppressants  Ear pain,Ear drainage,Hearing loss Antibiotics  Visual and Eye Symptoms  Sore Throat Family History:  Chest and Pulmonary Symptoms TB in the Family  Abdominal Symptoms  Back pain, Joint or Skeletal pain Recent Infection in the Family PHYSICAL EXAMINATION Vital Signs Neurological Exam. Skin Lesions,Mucous Membrane Eyes ENT Lymphadenopathy Lungs and Heart Abdominal Region (Hepatomegaly,Splenomegaly) Musculoskeletal Sign and symptoms of infection Local Systemic Fever Fever Pain Aches Redness Chill Swelling Nausea Less of function Vomiting Foul odor discharge weakness Pus LABORATORY STUDIES Assess the extent and severity of the inflammatory response to infection Determine the site(s) and complications of organ involvement by the process Determine the etiology of the infectious disease LABORATORY EXAMINATION PANEL  CBC (Flowcytometri)  Urine (Refractometri)  Malaria (Microscopy, rapid)  Widal and Gaal culture  IgG & IgM anti Dengue (Immunochromatography)  Serum Transaminase (IFCC)  CRP (Immunoturbidimetry)  LABOATORY INVESTIGATIONS MICROBIOLOGY PARASITOLOGY PATHOLOGY ANATOMY ULTRASONOGRAPHY CT-SCAN MRI  Pemeriksaan untuk diagnosis demam akut Darah Lengkap Urine Lengkap (Flowcytometri) (Refraktometri) hsCRP RADIOLOGY Malaria (Immunoturbidimetri) IMAGING IgM dan IgM anti DHF Serum Transaminase (Immunochromatography) (IFCC) Widal atau IgM anti Salmonella Typhi dan Gaal Cultuur 25 Clinical Spectrum of Infection Infection Bacteremia Sepsis Severe Sepsis Septic Shock PROGRESSION OF SEPSIS  SIRS Systemic Inflammatory Response Syndrome SEPSIS Severe Sepsis Septic Shock A Worldwide Problem Sepsis is a major, world-wide health care problem Although mortality has decreased in the last decade, it remains over 25 percent → 1 in 4 Severe sepsis incidence and mortality This alarming increase in incidence can be attributed to different factors:  the advanced average age among patients  the increased number of invasive procedures;  the wide usage of immunosuppressive drugs and chemotherapy; and antibiotic resistance  IDENTIFYING ACUTE ORGAN DYSFUNCTION AS A MARKER OF SEVERE SEPSIS Altered Tachycardia Consciousness Hypotension Confusion  CVP Psychosis Oliguria Tachypnea Anuria PaO2< 70 mm Hg  Creatinine SaO2 < 90% Jaundice  Platelets  Enzymes  PT/APTT  Albumin  Protein C  PT  D-dimer How do we recognize the patient? Sepsis is a medical emergency Hour-1 Bundle Most Common Infection Sources https://www.cdc.gov/vitalsigns/sepsis/index.html What are antimicrobials?  Antimicrobial Therapy  Empiric antimicrobial therapy be narrowed once pathogen identification and sensitivities are established and/or adequate clinical improvement is noted  Antimicrobial treatment duration of 7- 10 days is adequate for most serious infections associated with sepsis and septic shock.  Antibiotic Antibiotics are the life-saving treatment for an infection Every hour antibiotic initiation is delayed increases the risk for mortality by more than eight percent. Antibiotics should be given as soon as possible after blood cultures are drawn. If more than one antibiotic is ordered, give the broadest- spectrum antibiotic first. Infuse multiple antibiotics concurrently, if appropriate. Antibiotics The MOST important thing you can do for your septic patient For every hour delay in antibiotic administration, mortality increases 4% KESIMPULAN Infeksi berat dengan sepsis adalah kondisi yang mengancam jiwa dan bergantung pada waktu yang masih disertai dengan prognosis yang buruk secara keseluruhan. Sepsis dan syok septik menjadi tantangan bagi dokter darurat dalam praktik sehari-hari, karena alas an sbb (i) permulaan klinisnya yang berbahaya; (ii) kesalahan diagnosis yang menyebabkan tertundanya pengobatan dan selanjutnya memperburuk hasil klinis dan kualitas hidup; dan terakhir (iii) penatalaksanaan multidisiplin dan menantang dengan aspek terapeutik berbeda yang masih diperdebatkan, misalnya waktu hingga pengobatan antimikroba, resusitasi cairan yang adekuat, pemberian vasopresor dini, dan target oksigen Pengobatan yang diatur dengan cepat dan tepat berdasarkan antimikroba tertentudapat meningkatkan hasil akhir pasien.  Terimakasih Thankyou Matur suksma