Other Bacterial Infections
Scarlet fever:
Toxic Shock Syndrome (TSS):
• multiorgan systemic illness due to exotoxins of Staph. aureus – occur in women using some types of tampons, but can occur as a complication of staph infections
• Presents with fever, generalised erythematosus rash, hypotension and shock. May progress to renal failure
• Desquamation of palms and soles occurs 1-3 weeks after onset
• Management – fluid replacement (for hypotension); antibiotics; infection management (incision & drainage of abscess; removal of tampons)
Bacillary Dysentery/Shigellosis:
• due to Shigella dysenteriae, flexneri, boydii and sonnei
• endemic throughout world
• presents with bloody diarrhoea, abdominal pain – may have fever, headache, neck stiffness
• treatment – antibiotics
Diptheria:
• due to Corynebacterium diphtheriae in upper respiratory tract sore throat and tonsillitis
• now rare in developed countries
Typhoid and Paratyphoid (Enteric) Fevers:
• enteric fevers due to Salmonella typhi and S. paratyphi – spread by faecal-oral route when sanitation is inadequate; 3-21 day incubation
• typhoid – start with fever, headache, myalgias, bradycardia, constipation, vomiting. After 7 days ‘rose’ spots on trunk, splenomegaly, cough, diarrhoea. After two weeks and untreated dlirirum, coma, death
• paratyphoid similar to typhoid but more abrupt onset and milder symptoms
• treatment – antibiotics; fluid replacement; adequate nutrition
Brucellosis/Undulant fever/Malta fever/Abortus fever:
• Due to Brucella abortus – occupational hazard of veterinary surgeons, slaughterhouse workers, farmers etc
• acute onset with fever, sweating, weakness, joint aches, headache, rigors
• treated with tetracycline
Plague:
• due to Yersinia pestis spread by rodents from infected fleas (rare spread from cats); 1-7 day incubation
• now limited to sporadic human cases
• starts with lymphadenopathy and flu like illness progresses to cough with bloody sputum, septicaemia and a fatal haemorrhagic illness
Cholera:
• due to Vibrio cholerae serotype 01; incubation from 1-2hours up to 5 days; spread by faecal-oral route
• severe acute gastrointestinal infection with watery diarrhoea, vomiting, fever, dehydration
• treatment – barrier nursing; fluid replacement; tetracycline
Anthrax: (check Medscape website)
• serious infection due to gram positive, spore forming Bacillus anthracis.
• usually from handling of infected carcasses; also bioterrorism threat as a potential biological weapon (and be distributed through mail)
• several forms:
• cutaneous – after 1 – 12 day incubation papule vesicle necrotic ulcer, maybe with fever, malaise, headache and lymphadenopathy
• inhalation – after 2 – 60 day incubation fever, cough, fatigue, mild chest discomfort may rapidly progress to severe respiratory distress, cyanosis, meningitis may proceed to shock and death with 24-36 hours
• gastrointestinal – 1 – 7 day incubation nausea, anorexia, fever, severe abdominal pain, bloody diarrhoea.
• management:
• antibiotic prophylaxis for 60 days after exposure to spores (ciprofloxacin)
• cutaneous – antibiotics
• inhalation and GI – admission to critical care; ciprofloxacin IV (maybe also rifampin, vancomycin, penicillin)
Tetanus:
• due to exotoxin of Clostridium tetani. Spores in faeces and soil – enter by break in skin spore germinate release exotoxin causes muscle spasm and rigidity by travelling up peripheral nerves and interfering inhibitory synapses
• prodrome of fever, malaise, headache (varies from 1 day to several months after injury)
• classical feature is ‘locked jaw’
• treatment – wound care; immunoglobulin; ventilation support; diazepam for spasms
• prevention – immunisation
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