The Common Cases of Infectious Disease

8/7/2019 The Common Cases of Infectious Disease

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The Common Cases of Infectious Disease :The Common Cases of Infectious Disease : An Approach to Diagnosis An Approach to Diagnosis

Doni Priambodo Wijisaksono

Subdivision of Tropical Medicine and Infectious Disease Internal Medicine Department

Dr Sardjito General Hospital/ Faculty of Medicine Gadjah Mada University Yogyakarta



Some infectious diseases found only in focalSome infectious diseases found only in focalgeographic regions or in isolatedgeographic regions or in isolated

population:population:

past centuriespast centuries lack of interactionlack of interactiontodaytoday biologic and geoclimaticbiologic and geoclimatic

constraintsconstraints

In general :In general :

Infection is associated with residence in orInfection is associated with residence in ortravel through the endemic regiontravel through the endemic region



Clinical manifestationClinical manifestation

Fever (hyperthermia?), rash, pain,Fever (hyperthermia?), rash, pain,headache, dyspnea, cough, rhinorrhea,headache, dyspnea, cough, rhinorrhea,nausea, vomiting, diarrhea, jaundice, etcnausea, vomiting, diarrhea, jaundice, etc



Diagnosis: historyDiagnosis: history

Specific: feverSpecific: fever

Incubation periodIncubation period

Underlying illnessUnderlying illness TravellingTravelling

JobJob

Previous medicationsPrevious medications

Duration of illnessDuration of illness

Systemic reviewSystemic review





Diagnosis: laboratory examDiagnosis: laboratory exam

Gram stain, Giemsa stain, H & EGram stain, Giemsa stain, H & E

SerologySerology

CultureCulture

BiopsyBiopsy

RadiologyRadiology





Viral Infection: Viral Infection:

DENGUEDENGUE









Yip, 2009 Yip, 2009



BACTERIAL SEPSISBACTERIAL SEPSIS



Definition

11. SIRS. SIRS, caracterized with two or more following symptom, caracterized with two or more following symptom ::

a.a. Hyperthermia/ Hypothermia (> 38,3Hyperthermia/ Hypothermia (> 38,3 00C / < 35,6C / < 35,6 00C )C )

b.b. Tachypnoe ( resp > 20 / mnt )Tachypnoe ( resp > 20 / mnt )

c.c. Tachycardia ( pulse > 100 / mnt )Tachycardia ( pulse > 100 / mnt )

d.d. Leucocytosis >12000/mm atau Leucopenia < 4000/mmLeucocytosis >12000/mm atau Leucopenia < 4000/mm

e.e. 10% > immature cell10% > immature cell

2. SEPSIS2. SEPSISSIRS that has a proven or suspected infectionSIRS that has a proven or suspected infection

3. SEVERE SEPSIS3. SEVERE SEPSIS

Sepsis with one or more sign of Multi Organ Disfunction syndrome (MODS)/ MultiSepsis with one or more sign of Multi Organ Disfunction syndrome (MODS)/ Multiorgan Failure (MOF), Hypotension, oligouria or anuria.organ Failure (MOF), Hypotension, oligouria or anuria.

4. SEPSIS with Hypotension4. SEPSIS with Hypotension

Sepsis with hypotension ( systolic blood Pressure (SBP) < 90 mmHg or reduced SBPSepsis with hypotension ( systolic blood Pressure (SBP) < 90 mmHg or reduced SBP> 40 mmHg).> 40 mmHg).

5. SEPTIC SHOCK5. SEPTIC SHOCK

septic shock as subset of severe sepsis difined as sepsisseptic shock as subset of severe sepsis difined as sepsis--induced hypotensioninduced hypotensionpersistently despite adequate fluid resuscitation along with the presence of tissuepersistently despite adequate fluid resuscitation along with the presence of tissue

hypoperfusion.hypoperfusion.



ENDOENDO -- EXOTOXINEXOTOXIN

IMMUNOCOMPETENT CELLIMMUNOCOMPETENT CELL

CYTOKINESCYTOKINES

CELLULAR DAMAGECELLULAR DAMAGE

MODSMODS

MOFMOF

SEPTIC SHOCKSEPTIC SHOCK

DEVELOPMENT OF SEPSISDEVELOPMENT OF SEPSIS

(Guntur 2000)(Guntur 2000)



Common bacterial infections that cause sepsisCommon bacterial infections that cause sepsis

y UTI

y LRTI

y

IAIy PID

y Oral abcess

y ENT infections

y SSSI

y Bone and joint infections

y Bacteriemia



Bacterial Sepsis:Bacterial Sepsis:

((SIRSSIRS + proven/strongly suspe

cted b

acteri

al + proven/strong

ly suspe

cted b

acteri

al infection)infection)

General parameter: consciousness, vital sign,General parameter: consciousness, vital sign,body fluid state, routine blood & urine exambody fluid state, routine blood & urine exam

Inflammation parameter: leukocyte, CRP,Inflammation parameter: leukocyte, CRP,procalcitoninprocalcitonin

Source of infection: Specimen bacterial culture,Source of infection: Specimen bacterial culture,imaging, bedside ultrasonograf imaging, bedside ultrasonograf



Parasitic Infection:Parasitic Infection:MALARIAMALARIA



Approach to diagnosis Approach to diagnosis

Anamnesis : Anamnesis :

Complaint Complaint

Travelling to endemic areaTravelling to endemic area

Living in endemic areaLiving in endemic area

History of suffering malariaHistory of suffering malaria History of blood transfusionHistory of blood transfusion



CLINICAL FEATURESCLINICAL FEATURES

Clinical symptoms include the following: Fatigue,,Clinical symptoms include the following: Fatigue,,Shaking chills, Arthralgia, Myalgia, Paroxysm of fever,Shaking chills, Arthralgia, Myalgia, Paroxysm of fever,shaking chills, and sweatsshaking chills, and sweats

The classic paroxysm begins with a period of shiveringThe classic paroxysm begins with a period of shiveringand chills, which lasts for approximately 1and chills, which lasts for approximately 1--2 hours, and2 hours, and

is followed by a high fever. Finally, the patient is followed by a high fever. Finally, the patient experiences excessive diaphoresis, and the bodyexperiences excessive diaphoresis, and the bodytemperature of the patient drops to normal or belowtemperature of the patient drops to normal or belownormalnormal

Less common symptoms include the following:Less common symptoms include the following:

Anorexia and lethargy Anorexia and lethargy Nausea and vomitingNausea and vomiting DiarrheaDiarrhea HeadacheHeadache



SignsSigns

Anemia Anemia

SplenomegaliSplenomegali

Signs of severe malariaSigns of severe malaria

Acute renal failure Acute renal failure

Delirium/comatousDelirium/comatous

Jaundice, black water feverJaundice, black water fever

HaemoptoeHaemoptoe

Shock, etcShock, etc



Laboratory examinationLaboratory examination

GiemsaGiemsa--stained thick and thin peripheral blood smearsstained thick and thin peripheral blood smears

These smears are the criterion standard for malariaThese smears are the criterion standard for malaria

detection and should be sent to the laboratorydetection and should be sent to the laboratoryimmediately, since malaria is a potentially lifeimmediately, since malaria is a potentially life--threatening infection.threatening infection.

Rapid diagnosis test Rapid diagnosis test

PF test, ICT test, paracheck, OptiMALPF test, ICT test, paracheck, OptiMAL



Fungal InfectionFungal Infection



Martin et al, NEJM 2003; 348:1546



Organ TransplantOrgan Transplant

KidneyKidney 55--14%14%

HeartHeart 55--32%32%

LungLung 11--36%36%

PancreasPancreas 1818--38%38%

LiverLiver 77--42%42%

Bone Marrow TransplantBone Marrow Transplant 1515--25%25%

Intensive Care UnitIntensive Care Unit 17%17%



Candidemia Relative RiskCandidemia Relative Risk

Broad spectrum Antibiotics 1,7Broad spectrum Antibiotics 1,7

CVC 7,2CVC 7,2

ICU stay 9,8 ICU stay 9,8

Candida Colonisation 10,4Candida Colonisation 10,4 Hemodialysis 18,1Hemodialysis 18,1



The Action of Therapy:The Action of Therapy:

IDSA Guidelines 2009IDSA Guidelines 2009



SummarySummary

Infection is generally associated with residence in orInfection is generally associated with residence in or

travel through the endemic regiontravel through the endemic region The most important thing in diagnostic approach of The most important thing in diagnostic approach of infectious disease: historyinfectious disease: history

The most important clinical manifestation: feverThe most important clinical manifestation: fever

History of disease and physical exam guide clinician toHistory of disease and physical exam guide clinician tochoose an appropriate laboratory test choose an appropriate laboratory test



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The Common Cases of Infectious Disease