Microbial Diseases of Cardiovascular and Lymphatic Systems PDF

MANILA CENTRAL UNIVERSITY College of Pharmacy MICROBIAL DISEASES OF THE CARDIOVASCULAR AND LYMPHATIC SYSTEM At the end of the lesson the students will be able to: 1. Illustrate the anatomical structure of the cardiovascular and lymphatic systems. 2. Determine...

MANILA CENTRAL UNIVERSITY College of Pharmacy MICROBIAL DISEASES OF THE CARDIOVASCULAR AND LYMPHATIC SYSTEM At the end of the lesson the students will be able to: 1. Illustrate the anatomical structure of the cardiovascular and lymphatic systems. 2. Determine the etiological agents affecting the cardiovascular and lymphatic systems 3. Explain the drug of choice for a specific disease The Lymphatic System Functions of the Lymphatic System Removal of Fluid Interstitial fluid accumulates in the tissues, generally as a result of the pressure exerted from capillaries (hydrostatic and osmotic pressure) or from protein leakage into the tissues (which occurs during inflammation). These conditions force fluid from the capillaries into the tissues. One of the main functions of the lymphatic system is to drain the excess interstitial fluid that accumulates. The lymphatic system is a blunt-ended linear flow system, in which tissue fluids, cells, and large extracellular molecules, collectively called lymph, are drained into the initial lymphatic capillary vessels that begin at the interstitial spaces of tissues and organs. Fluid removal from tissues prevents the development of edema. Edema is any type of tissue swelling from increased flow of interstitial fluid into tissues relative to fluid drainage. Fatty Acid Transport During fat digestion, fatty acids are digested, emulsified, and converted within intestinal cells into a lipoprotein called chylomicrons. Lymph drainage vessels that line the intestine, called lacteals, absorb the chylomicrons into lymph fluid. The lymph vessels then take the chylomicrons into blood circulation, where they react with HDL cholesterols and are then broken down in the liver. Immune Cell Transport Most notably, highly-specialized white blood cells called lymphocytes and antigen -presenting cells are transported to regional lymph nodes, where the immune system encounters pathogens, microbes, and other immune elicitors that are filtered from the lymph fluid. The Cardiovascular System Functions of the Cardiovascular System Blood circulation Temperature regulation Structure of the Lymphatic System The lymphatic system is a collection of structures and vessels that drains lymph from blood and has several other functions. It is a circulatory system for lymph fluid and the site of many key immune system functions. Lymph node - Small oval bodies of the lymphatic system, distributed along the lymphatic vessels clustered in the armpits, groin, neck, chest, and abdomen. They filter through lymph fluid. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 1 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Lymph - A colorless, watery, bodily fluid carried by the lymphatic system, consisting mainly of white blood cells. The lymphatic system: This diagram shows the network of lymph nodes and connecting lymphatic vessels in the human body. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 2 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Bacterial Diseases of the Cardiovascular and Lymphatic Systems Sepsis and Septic Shock Endocarditis Rheumatic Fever Tularemia Brucellosis Anthrax Gangrene Sepsis and Septic Shock For patients in the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers). Symptoms of sepsis include either fever or low body temperature, rapid breathing, chills and shaking, rapid heartbeat, decreased urine output, and confusion or delirium. Severe sepsis often causes extremely low blood pressure, which limits blood flow to the body and can result in organ failure and death. This is known as septic shock. Sepsis is treated with antibiotics, fluids, and medicines to support blood pressure and prevent organ damage. Endocarditis Endocarditis occurs when bacteria grow on the edges of a heart defect or on the surface of an abnormal valve after the bacteria enter the blood stream, most commonly from dental procedures but also from procedures involving the gastrointestinal or urinary tract. The most important diagnostic test for endocarditis involves a positive blood culture. A blood culture is a small sample of blood drawn from the vein which is grown in a special solution so that bacteria can be detected. Symptoms and signs of endocarditis vary but include prolonged fever poor appetite, feeling weak or tired, joint pains, skin rashes, and changes in the nature of a previously present heart murmur. Treatment of bacterial endocarditis consists of a period of intravenous doses of appropriate antibiotics determined from blood tests under the supervision of an infectious disease specialist and cardiologist. Rheumatic Fever Rheumatic fever is a condition that is a complication of untreated strep throat. Strep throat is caused by a group A streptococcal infection found in the throat. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 3 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Healthy throat (left side) Throat with Streptococcal pharyngitis (right side) When the body senses the strep infection, it sends antibodies to fight it and sometimes these antibodies attack the tissues of your joints or heart instead. This is known as anitbody cross-reactivity which leads to rheumatic fever. Symptoms of rheumatic fever occur several weeks after initial throat problems have disappeared; and include chest pain, fever, heart problems, joint pain, nosebleeds, and skin rash. Rheumatic fever is treated using a combination of antibiotics and anti-inflammatory medications. Tularemia Francisella tularensis is a pathogenic species of gram-negative bacteria and the causative agent of tularemia or rabbit fever. The primary vectors are ticks and deer flies, but the disease can also be spread through other arthropods. The disease is named after Tulare County, California and most commonly occurs in North America and parts of Europe and Asia. Macrophage is a white blood cell that phagocytizes necrotic cell debris and foreign material, including viruses, bacteria, and tattoo ink. It presents foreign antigens on MHC II to lymphocytes. Part of the innate immune system. Tularemia is an infectious disease caused by the bacterium Francisella tularensis. The main clinical signs include fever, lethargy, anorexia, muscle pains and signs of septicemia. Although tularemia can be life-threatening, most infections can be treated successfully with antibiotics. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 4 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Tularemia Lesion: A Tularemia lesion on the dorsal skin of right hand. Tularemia is caused by the bacterium, Francisella tularensis. Symptoms vary depending on how the person was exposed to the disease and, as is shown here, can include skin ulcers. Brucellosis (Undulant Fever) Brucella: A genus of Gram-negative bacteria. They are small, non-motile, non-encapsulated coccobacilli, which function as facultative intracellular parasites. Species infecting domestic livestock are B. melitensis (goats and sheep), B. suis (pigs), B. abortus (cattle), B. ovis (sheep), and B. canis (dogs). B. abortus also infects bison and elk in North America. Brucella can infect cattle, goats, dogs, and pigs. The bacteria can spread to humans by ingesting unsterilized milk or meat from infected animals, or close contact with their secretions. Brucellosis, also called Bang’s disease, Crimean fever, Gibraltar fever, Malta fever, Maltese fever, Mediterranean fever, rock fever, or undulant fever, is a highly-contagious zoonosis caused by ingestion of unsterilized milk or meat from infected animals or close contact with their secretions. Brucellosis symptoms include fever, joint pain and fatigue. The infection can usually be treated successfully with antibiotics. People working in jobs where they often come in contact with animals or meat such as slaughterhouse workers, farmers, and veterinarians are at higher risk for contracting Brucellosis. Anthrax Bacillus anthracis is a Gram-positive, endospore-forming, rod-shaped bacterium, with a width of 1-1.2µm and a length of 3-5µm. It can be grown in an ordinary nutrient medium under aerobic or anaerobic conditions. Bacillus anthracis exists in the soil as spores. Spores are inactive forms of the bacteria and can survive for decades in this form. Humans can become infected through contact with the anthrax spores from infected animals. It is not contagious and cannot be spread from one infected person to another person. There are three ways one can become infected with anthrax: by inhalation of anthrax spores, entrance of spores through cuts in the skin, and by eating undercooked meat containing anthrax spores. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 5 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Anthrax can be successfully treated with early antibiotic treatment. An anthrax vaccine has been approved for use in humans and is effective in protecting against an anthrax infection. Gangrene Gangrene is the death of tissue due to reduced blood supply as a result of infection or a blocked blood vessel Gas gangrene is a bacterial infection that produces gas within tissues. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. Infection spreads rapidly as the gases produced by bacteria expand and infiltrate nearby healthy tissue. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency. Necrotizing fasciitis affects the deeper layers of the skin. Noma is a gangrene of the face. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 6 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Fournier gangrene usually affects the male genitals and groin. Dead tissue cannot be saved, and amputation is necessary in most cases. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 7 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Viral Diseases of the Cardiovascular and Lymphatic System Burkitt’s Lymphoma Infectious Mononucleosis Cytomegalovirus Infections Chikungunya Fever Viral Hemorrhagic Fever Burkitt’s Lymphoma Burkitt’s lymphoma is a very fast-growing form of non-Hodgkin’s lymphoma, a cancer in the lymphatic system. Burkitt’s lymphoma was first discovered in children in certain parts of Africa by surgeon Denis Parsons Burkitt, but also occurs in the United States. There are three types of Burkitt’s lymphoma: endemic, the sporadic and the immunodeficiency- associated. The endemic type is closely associated with the Epstein-Barr virus (EBV). Burkitt’s lymphoma usually develops in the abdomen and spreads to other organs, including the brain. It may first be noticed as a swelling of the lymph nodes (glands) in the neck, groin, or under the arm. Chemotherapy and various drugs are used to treat this type of cancer. Burkitt’s Lymphoma: Swelling of the jaw associated with Burkitt’s Lymphoma Infectious Mononucleosis Mononucleosis is an infectious disease caused by the Epstein-Barr virus (EBV) and results in flu-like symptoms. Infectious mononucleosis (also called mono or kissing disease) is spread orally and is characterized by symptoms such as fever, sore throat, and fatigue. Once infected, the virus lives dormantly in B lymphocytes in a person. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 8 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Cytomegalovirus (CMV) Infections Cytomegalovirus (CMV) is a viral genus of the viral family known as Herpesviridae or herpesviruses. CMV infections are frequently associated with the salivary glands CMV is found throughout all geographic locations and socioeconomic groups, and infects between 50% and 80% of adults in the United States CMV is generally transmitted from infected people to others through direct contact with body fluids, such as urine, saliva, vaginal secretions, and semen. Drugs of choice: Ganciclovir, Cidofovir, and Foscarnet Chikungunya Fever Chikungunya (CHIKV) is a mosquito-borne viral disease which causes fever and severe joint pain. The chikungunya virus is transmitted from human to human by the bites of infected female mosquitoes; the Aedes aegypti and Aedes albopictus mosquitoes. The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of CHIKV have spread to Europe and the Americas. There is no cure for CHIKV. Treatment is focused on relieving the symptoms which include fever and severe joint pain, muscle pain, headache, nausea, fatigue and rash. Dengue is an acute febrile disease of the tropics caused by a flavivirus, transmitted by mosquitoes, and characterized by high fever, rash, headache, and severe muscle and joint pain. Close up of Aedes aegypti mosquito: The Aedes aegypti mosquito is the principle vector responsible for transmitting the chikungunya virus to humans. Viral Hemorrhagic Fevers Viral hemorrhagic fevers (VHFs) are a group of illnesses that are caused by several distinct families of RNA viruses. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 9 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy VHFs are caused by viruses of four distinct families: arenaviruses, filoviruses, bunyaviruses, and flaviviruses. They are all RNA viruses covered, or enveloped, in a fatty coating. Viruses associated with most VHFs naturally reside in an animal host or arthropod vector. For the most part, rodents and arthropods are the main reservoirs for viruses causing VHFs. Symptoms include marked fever, fatigue, dizziness, muscle aches, loss of strength, exhaustion, and excessive bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears. Protozoan and Helminthic Diseases of the Cardiovascular and Lymphatic Systems Chagas Disease Toxoplasmosis Malaria Leishmaniasis Babesiosis Schistosomiasis Chagas Disease (American trypanosomiasis) Chagas disease is caused by the protozoan parasite Trypanosoma cruzi and transmitted via the reduviid bug. Chagas disease is prevalent in areas with reduviid bugs such as Central and South America. Chagas disease is transmitted via a vector, the reduviid bug, which becomes infected when it bites an already-infected individual. The life cycle of Trypanosoma cruzi requires two hosts, the reduviid bug and the human or animal host. Reduviid bug: In Chagas-endemic areas, the main mode of transmission is through an insect vector called a triatomine or reduviid bug.The bugs emerge at night, when the inhabitants are sleeping. Because they tend to feed on people’s faces, triatomine bugs are also known as “kissing bugs.” After they bite and ingest blood, they defecate on the person. Triatomines pass T. cruzi parasites (called trypomastigotes) in feces left near the site of the bite wound. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 10 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy The reduviid bud often bites the tender skin around the eyes, leaving a swollen bump called a chagoma or Ramona’s sign. Romaña’s sign: The most recognized marker of acute Chagas disease is called Romaña’s sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 11 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Toxoplasmosis Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii and its life cycle mandates a definitive host which are cats. Humans may become infected as a result of infected blood transfusions, organ transplants, ingesting contaminated soil, raw or undercooked meat, and most commonly from the careless handling of cat litter, which can lead to accidental ingestion of the parasite. Toxoplasmosis can also be passed from an infected mother to her baby via the placenta (transplacentally). Symptoms that may occur from toxplasmosis include: enlarged lymph nodes, headache, fever, muscle pain, and sore throat. Individuals with immunocompromised or weakened systems display more severe symptoms, such as: confusion, fever, headache, blurred vision and seizures. The three categories of toxoplasmosis include acute, latent, and cutaneous toxoplasmosis. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 12 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Malaria Malaria is a parasitic disease that is caused by the bite of an infected Anopheles mosquito. Malaria can be transmitted from mother to baby and by blood transfusions. The Anopheles mosquito transmits the parasites, called sporozoites, upon biting the hosts, into the bloodstream to the liver, where the parasites continue their life cycle. In the liver, the parasites mature and release another form called merozoites, which enter the bloodstream and infect the red blood cells. In the red blood cells, they develop into ring forms called trophozoites and schizonts that in turn, produce further merozoites. Upon infection of the red blood cells, the parasite is able to multiply within the cell, break open and continue infecting additional red blood cells. The symptoms occur in a cyclical manner every 48-72 hours. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 13 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy Malaria is characterized by the development of symptoms that include high fevers, shaking chills, flu-like symptoms, and anemia. The five types of malaria parasites include species of Plasmodium. The fives species include: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi. Plasmodium falciparum is responsible for the majority of deaths caused by infection and Plasmodium vivax, ovale and malariae cause a milder form of malaria. The species, Plasmodium knowlesi, commonly causes malaria in macaques but can also cause severe infections in humans. Leishmaniasis Leishmaniasis is transmitted by the bite of infected female phlebotomine sandflies which can transmit the infection Leishmania. The sandflies inject the infective stage, metacyclic promastigotes, during blood meals. Metacyclic promastigotes that reach the puncture wound are phagocytized by macrophages and transform into amastigotes. Amastigotes multiply in infected cells and affect different tissues, depending in part on which Leishmania species is involved. These differing tissue specificities cause the differing clinical manifestations of the various forms of leishmaniasis. Cutaneous leishmaniasis is characterized by infection of the skin and mucous membranes. The symptoms include skin sores which present at the site of the sandfly bite. Systemic or visceral leishmaniasis present as an infection of the entire body. There is a delay of symptoms, ranging from 2-8 months post bite, and the effects on the immune system can result in deadly complications. The parasites damage the immune system by targeting the disease-fighting cells. Babesiosis Babesia, the parasite, is capable of undergoing both sexual and asexual reproduction in its life cycle. A majority of individuals infected with babesiosis are asymptomatic but severe cases display malaria-like symptoms which include high fevers, chills, shakes, and hemolytic anemia. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 14 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh  MANILA CENTRAL UNIVERSITY College of Pharmacy A definitive characteristic of Babesia infection is the formation of a “Maltese Cross” (four merozoites asexually budding, but attached together) Schistosomiasis Schistosomiasis is a parasitic disease caused by various species of trematodes or “flukes,” which are of the genus Schistosoma. For parasites categorized as schistosomes, the snail is the intermediary agent between the mammalian hosts. Schistosomiasis is common in countries that lack the facilities to maintain proper water supplies and sanitation facilities. These supplies and facilities are often exposed to contaminated water that contains infected snails. Individuals infected with schistosomiasis display chronic illness that can result in the damage of internal organs and in children, affects target growth and cognitive development. PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 15 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh MANILA CENTRAL UNIVERSITY College of Pharmacy PHARMACEUTICAL MICROBIOLOGY WITH PARASITOLOGY 16 PREPARED BY: CHRISTINE MARIE S. TERRADO, RPh, MSPh