Chapter 23Chapter 23

Microbial Diseases of the Microbial Diseases of the Cardiovascular and Lymphatic Cardiovascular and Lymphatic

SystemsSystems

The Cardiovascular SystemThe Cardiovascular System

Figure 23.1

The Lymphatic SystemThe Lymphatic System

Figure 23.2

The Cardiovascular System and Lymphatics System

Blood Blood —Transports nutrients to and wastes —Transports nutrients to and wastes

from cellsfrom cells White blood CellsWhite blood Cells —Defend against —Defend against

infectioninfection LymphaticsLymphatics —Transport interstitial fluid to —Transport interstitial fluid to

bloodblood Interstitial fluid (lymph) is blood plasma that has Interstitial fluid (lymph) is blood plasma that has

filtered out of the capillaries into spaces filtered out of the capillaries into spaces between tissue cells (interstitial spaces)between tissue cells (interstitial spaces)

Lymph nodesLymph nodes —Contain macrophages that —Contain macrophages that clear pathogens from the lymphclear pathogens from the lymph

Sepsis Bacteria growing in

the blood Fever, chills,

increased heart rate and breathing

Severe sepsis Results in drop in

blood pressure , affects organs

Septic shock Low blood pressure

cannot be controlled by addition of fluid

Sepsis and Septic ShockSepsis and Septic Shock

Gram-Negative Sepsis Endotoxins caused blood pressure

decrease Antibiotics can worsen condition by killing

bacteria

Gram-Positive Sepsis Nosocomial infections

Puerperal Sepsis (Childbirth fever) Streptococcus pyogenes Transmitted to mother during childbirth

by attending physicians & midwives Rx penicillin

SepsisSepsis

BrucellosisBrucellosis Brucella abortusBrucella abortus Gram - rodGram - rod Cattle, swineCattle, swine Direct contact, milk products.Direct contact, milk products. Infects uterus- mesoerythritol requirement. ( a Infects uterus- mesoerythritol requirement. ( a

carbohydrate produced in the fetus )carbohydrate produced in the fetus ) Chills, fever, malaise, heavy sweating.Chills, fever, malaise, heavy sweating. UndulatingUndulating- fever rises in evening 104˚C.- fever rises in evening 104˚C. Animals secrete bacteria in milk.Animals secrete bacteria in milk. Pasteurization process tailored for this Pasteurization process tailored for this

pathogen.pathogen. Organism survives phagocytosis, grows Organism survives phagocytosis, grows

intracellularly.intracellularly. RRxx ~ tetracycline + streptomycin -long ~ tetracycline + streptomycin -long

treatment.treatment.

Gas GangreneGas Gangrene

Clostridium Clostridium perfringensperfringens

Produces toxins that Produces toxins that travel down muscle travel down muscle bundles.bundles.

Many proteolytic Many proteolytic enzymes, enzymes, hyaluronidase, hyaluronidase, collagenase, lipases. collagenase, lipases.

P. aeruginosaP. aeruginosa can co- can co-infect.infect.

Treatment - remove Treatment - remove necrotic tissue, necrotic tissue, amputation, surgical amputation, surgical maggots.maggots.

Hyperbaric OHyperbaric O22 - - internal tissuesinternal tissues

RRxx ~ penicillin. ~ penicillin.

Gas GangreneGas Gangrene

Clostridium perfringensClostridium perfringens Gram + rod, anaerobe Gram + rod, anaerobe

(not strict), sporeformer.(not strict), sporeformer. Ischemia -lack of blood Ischemia -lack of blood

supply.supply. Necrosis -tissue death.Necrosis -tissue death. Gangrene -death of soft Gangrene -death of soft

tissue.tissue. Diabetes, injury, cancer.Diabetes, injury, cancer.

Bacterial Infections of the Bacterial Infections of the HeartHeart

Endocarditis Inflammation of the

endocardium ( inner heart muscle lining)

Rapid destruction of the heart valves leads to death

Can be caused by Stapylococcus aureus and Streptococci

Rx penicillin

Rheumatic FeverRheumatic Fever Repeated infections Repeated infections

with with S. pyogenesS. pyogenes -strep -strep throat. throat.

Ages 4 - 18.Ages 4 - 18. Joint pain.Joint pain. Streptococal antigens Streptococal antigens

(M protein) cross react (M protein) cross react with heart antigens. with heart antigens.

Antibody response to Antibody response to kill organisms damages kill organisms damages heart.heart.

Initial signs, arthritis and fever followed by nodes

AnthraxAnthrax Bacillus anthracis, gram-positive, endospore-

forming aerobic rod, found in soil Cutaneous anthrax

Endospores enter through minor cut, 20% mortality

Skin infection begins as a raised itchy Skin infection begins as a raised itchy bump that resembles an insect bite. Has a bump that resembles an insect bite. Has a necrotic area in the center.necrotic area in the center.

Gastrointestinal anthrax Ingestion of undercooked food

contaminated food, 50% mortality Inhalational anthrax

Inhalation of endospores, 100% mortality

Inhalation Anthrax cont.Inhalation Anthrax cont. Initial symptoms may resemble a Initial symptoms may resemble a

common cold – sore throat, mild fever, common cold – sore throat, mild fever, muscle aches and malaise. After muscle aches and malaise. After several days, the symptoms may several days, the symptoms may progress to severe breathing problems progress to severe breathing problems and shock. and shock.

Pulmonary form most serious, enters Pulmonary form most serious, enters lungs then to bloodstream, leads to lungs then to bloodstream, leads to septicemia; usually fatal.septicemia; usually fatal. Pathogenic factors Pathogenic factors include:include:

1.1. Anti-phagocytic capsule (poly-Anti-phagocytic capsule (poly-DD-glutamic acid) -glutamic acid) 2.2. A potent exotoxin.A potent exotoxin.

A.A. EF- edema factorEF- edema factorB.B. PA- protective antigen - binding factorPA- protective antigen - binding factorC.C. LF- lethal factorLF- lethal factor

RRxx ~ penicillin, docycycline; ciprofloxacin. ~ penicillin, docycycline; ciprofloxacin.

What Disease ?What Disease ?Ring around the rosyRing around the rosy11

A pocketful of posiesA pocketful of posies22

"Ashes, Ashes" "Ashes, Ashes" 33

We all fall down!We all fall down!

1 1 rosy red rash in the shape of a ring on the rosy red rash in the shape of a ring on the skin- flea bite.skin- flea bite.2 2 Pockets and pouches were filled with sweet smelling herbs ( or posies) which were carried due to the belief that the disease was transmitted by bad smells.3 The term "Ashes Ashes" refers to the cremation of the dead bodies!

Vector Borne Diseases - Vector Borne Diseases - PlaguePlague Ysernia pestisYsernia pestis Gram - rod.Gram - rod. Zoonoses, disease of Zoonoses, disease of

rodents (squirrels, rodents (squirrels, prairie dogs) spread by prairie dogs) spread by rat flea.rat flea.

14 -15th Centuries killed 14 -15th Centuries killed 1/41/4thth to 1/3 to 1/3rdrd of entire of entire European population.European population.

The Black DeathThe Black Death

Vector Borne Diseases - Vector Borne Diseases - PlaguePlague Ysernia pestisYsernia pestis Gram - rod.Gram - rod. Pathogenic factors:Pathogenic factors:

9.5 kb plasmid that codes 9.5 kb plasmid that codes for a plasminogen for a plasminogen activator that is necessary activator that is necessary for systemic spread.for systemic spread.

Another plasmid that Another plasmid that codes for an anti-codes for an anti-phagocytic capsule.phagocytic capsule.

Organism enters blood via bite and can grow in phagocytes.

RRxx ~ streptomycin, ~ streptomycin, tetracyclinetetracycline..

Vector Borne Diseases - Vector Borne Diseases - PlaguePlagueSymptoms: Symptoms:

1.1. 8 days post infection8 days post infectionFever, chills, Fever, chills, headache, then headache, then vomiting and nausea.vomiting and nausea.

2 6-8 days later 6-8 days later bubosbubos form in lymph glands,form in lymph glands,sensitive and painful.sensitive and painful.Ysernia pestis

Septicemia causes septic shock.Death occurs in a week.50-75% Mortality if untreated.Some cases can go pneumonic form of the disease -death can occur in 15 -24 hours.Only pneumonic form can be spread person to person.Pneumonic form produces a blood tainted sputum.

Relapsing FeverRelapsing Fever Borrelia recurrensis Borrelia recurrensis

or hermsiior hermsii Spirochete - no Gram Spirochete - no Gram

reaction. reaction. Spread by soft ticks.Spread by soft ticks. Fever, jaundice, rose-Fever, jaundice, rose-

colored skin spots.colored skin spots. Fever breaks after 3-4 Fever breaks after 3-4

days and patient days and patient appears to recover.appears to recover.

Relapsing FeverRelapsing Fever Borrelia recurrensis or Borrelia recurrensis or

hermsiihermsii Fever reappears due to surface Fever reappears due to surface

antigens changing.antigens changing. RRxx ~ penicillin. ~ penicillin.

Lyme’s DiseaseLyme’s Disease Borrelia burgdorferiBorrelia burgdorferi Spirochete - no Gram Spirochete - no Gram

reaction. reaction. Spread by hard ticks.Spread by hard ticks. Organisms infects tick Organisms infects tick

salivary glands.salivary glands. 10,000 cases annually -10,000 cases annually -

most prevalent ABD.most prevalent ABD. Rodents reservoir. Deer Rodents reservoir. Deer

in life cycle of tick.in life cycle of tick.

Lyme’s DiseaseLyme’s Disease Borrelia burgdorferiBorrelia burgdorferi Bull’s -eye rash -Bull’s -eye rash -

erythema migrans erythema migrans around bite.around bite.

Flu-like symptoms Flu-like symptoms follow.follow.

Later stages similar to Later stages similar to syphilis - heart and syphilis - heart and neurological neurological involvement.involvement.

Joint degeneration.Joint degeneration. RRxx ~ penicillin. ~ penicillin.

Lyme’s DiseaseLyme’s Disease

Chapter 24Chapter 24

Microbial Diseases of the Microbial Diseases of the Respiratory SystemRespiratory System

BreathingBreathing It starts at the nose. About 20 times a It starts at the nose. About 20 times a

minute. minute. When you do, you inhale air and pass it When you do, you inhale air and pass it

through your nasal passages where the through your nasal passages where the air is filtered, heated, moistened and air is filtered, heated, moistened and enters the back of the throat. enters the back of the throat.

Interestingly enough, it's the esophagus Interestingly enough, it's the esophagus or food pipe which is located at the back or food pipe which is located at the back of the throat and the windpipe for air of the throat and the windpipe for air which is located at the front.which is located at the front.

When we eat, a flap -- the epiglottis -- When we eat, a flap -- the epiglottis -- flaps down to cover the windpipe so that flaps down to cover the windpipe so that food doesn't go down the windpipe. food doesn't go down the windpipe.

what happens to the what happens to the carbon dioxide? carbon dioxide?

It goes through the lungs, back It goes through the lungs, back up your windpipe and out with up your windpipe and out with every exhale. every exhale.

It's a remarkable feat, this It's a remarkable feat, this chemical exchange and chemical exchange and breathing in and out. breathing in and out.

You don't have to tell your lungs You don't have to tell your lungs to keep working. Your brain does to keep working. Your brain does it automatically for you.it automatically for you.

FactoidsFactoids Your lungs contain almost 1500 miles of Your lungs contain almost 1500 miles of

airwaysairways and and over 300 million alveoli.over 300 million alveoli. Every minute you breathe in 13 pints of Every minute you breathe in 13 pints of

air. Plants are our partners in breathing. air. Plants are our partners in breathing. We breathe in air, use the oxygen in it, We breathe in air, use the oxygen in it,

and release carbon dioxide. Plants take in and release carbon dioxide. Plants take in carbon dioxide and release oxygen.carbon dioxide and release oxygen.

People tend to get more colds in the People tend to get more colds in the winter because we're indoors more often winter because we're indoors more often and in close proximity to other people. and in close proximity to other people.

When people sneeze, cough and even When people sneeze, cough and even breathe -- germs go flyingbreathe -- germs go flying

Upper respiratory normal microbiota may Upper respiratory normal microbiota may include pathogensinclude pathogens

Upper Respiratory SystemUpper Respiratory System

Figure 24.1

Microbial Diseases of the Upper Respiratory System

Laryngitis Infection of the larynx, affects speaking

ability Tonsillitis

Inflammed tonsils Sinusitis

Mucous membranes become inflammed Epiglottitis

Inflammation of the epiglottis, most dangerous

Steptococcal PharyngitisSteptococcal Pharyngitis Streptococcus pyogenesStreptococcus pyogenes Gram + cocci, chainsGram + cocci, chains -hemolytic, M protein -hemolytic, M protein

makes resistant to makes resistant to phagocytosis.phagocytosis.

Streptokinase, Streptokinase, streptolysin.streptolysin.

Culture from throat swab.Culture from throat swab. Local infection, sore Local infection, sore

throat, fever. throat, fever. Can progress to otidis Can progress to otidis

media.media. RRxx ~ penicillin. ~ penicillin.

Scarlet FeverScarlet Fever Streptococcus Streptococcus

pyogenespyogenes Invades upper respiratory Invades upper respiratory

tract.tract. Erythrogenic toxin Erythrogenic toxin

produces small “goose produces small “goose bumps” on skin - spreads bumps” on skin - spreads over entire body except over entire body except face, palms, and soles to face, palms, and soles to make red rash.make red rash.

High fever, chills, nausea, High fever, chills, nausea, vomiting, abdominal pain, vomiting, abdominal pain, and malaise.and malaise.

Scarlet FeverScarlet Fever

Streptococcus Streptococcus pyogenespyogenes

While the rash is still While the rash is still red, the patient may red, the patient may develop Pastia's lines, develop Pastia's lines, bright red coloration bright red coloration of the creases under of the creases under the arm and in the the arm and in the groin. groin.

RRxx ~ penicillin. ~ penicillin.

DiphtheriaDiphtheria

Corynebacterium Corynebacterium diphtheriaediphtheriae

Gram + pleomorphic Gram + pleomorphic rodsrods Club shaped, chinese Club shaped, chinese

characters.characters. Colonizes throat.Colonizes throat. Produces potent toxin Produces potent toxin

that inhibits protein that inhibits protein synthesis.synthesis.

DiphtheriaDiphtheria Corynebacterium Corynebacterium

diphtheriaediphtheriae Produces pseudomembrane Produces pseudomembrane

on back of throat.on back of throat. Can block breathing.Can block breathing. Diphtheria means “leather” Diphtheria means “leather”

for the texture of the for the texture of the pseudomembrane.pseudomembrane.

Produces potent toxin that inhibits protein synthesis.Give anti-toxin

First developed by Von Behring* in 1890.Rx ~ penicillin, erythromycin.Vaccine DTaP -2, 4, 6 months.

Otidis mediaOtidis media Earache.Earache. S. pneumoniaeS. pneumoniae 35% 35% H. influenzaeH. influenzae 20-30% 20-30% M. catarrhalisM. catarrhalis 10-15% 10-15% S. pyogenesS. pyogenes 8-10% 8-10% S. aureusS. aureus 1-2% 1-2% 85% under age of 385% under age of 3

Eustacian tube “S-shaped”.Eustacian tube “S-shaped”. RRxx ~ amoxicillin, sulfa drugs. ~ amoxicillin, sulfa drugs.

Lower Respiratory SystemLower Respiratory System Is nearly sterile, does not typically have normal Is nearly sterile, does not typically have normal

microbiotamicrobiota

Bacteria, viruses, & fungi cause: Bronchitis Bronchiolitis Pneumonia

Microbial Diseases of the Microbial Diseases of the Lower Respiratory SystemLower Respiratory System

PertussisPertussis (Whooping (Whooping cough)cough)

Bordetella pertusisBordetella pertusis Gram - obligate aerobe, Gram - obligate aerobe,

capsulated, capsulated, coccobacillus.coccobacillus.

Destroys cillary cells.Destroys cillary cells. Cytotoxin. Cytotoxin. Whoop comes from Whoop comes from

sound of patient sound of patient gasping for air between gasping for air between coughs.coughs.

Vaccination -DPT has Vaccination -DPT has reduced number from reduced number from 250,000 to 7000.250,000 to 7000.

Immunity lasts ~12 yrs.Immunity lasts ~12 yrs. RRxx ~ erythromycin. ~ erythromycin.

Mainly a childhood Mainly a childhood diseasedisease

Violent coughing, Violent coughing, can result in broken can result in broken ribs in childrenribs in children

Tuberculosis Tuberculosis (consumption)(consumption) Mycobacterium Mycobacterium

tuberculosistuberculosis Acid -fast rod, in filaments Acid -fast rod, in filaments

(myco -fungus).(myco -fungus). Air-borne, sputum.Air-borne, sputum. Enters lung, reaches Enters lung, reaches

alveoli.alveoli. Macrophages wall off into a Macrophages wall off into a

tubercle in healthy people.tubercle in healthy people. When immune system When immune system

weakens or fails they can weakens or fails they can reinfect lungs.reinfect lungs.

TuberculosisTuberculosis

TuberculosisTuberculosis

TuberculosisTuberculosis Symptoms include coughing, Symptoms include coughing,

rusty (blood) sputum, weight rusty (blood) sputum, weight loss.loss.

DiagnosisDiagnosis X-ray, tuberculin testX-ray, tuberculin test Tuberculin indicates exposure , Tuberculin indicates exposure ,

not necessarily active disease.not necessarily active disease. Culture, PCR faster.Culture, PCR faster.

MAIS - AIDS patients.MAIS - AIDS patients. RRxx ~ isoniazid, rifampicin, ~ isoniazid, rifampicin,

streptomycin.streptomycin.

Bacterial pneumoniasBacterial pneumonias Streptococcus Streptococcus

pneumoniaepneumoniae Gram + diplococcus, Gram + diplococcus,

capsulated.capsulated. Infects bronchi and alveoli.Infects bronchi and alveoli. High fever, difficulty High fever, difficulty

breathing, chest pains.breathing, chest pains. Lungs fill with fluid.Lungs fill with fluid. Sometimes progresses to Sometimes progresses to

septicemia and meningitis.septicemia and meningitis. RRxx ~ penicillin. ~ penicillin.

Bacterial pneumoniasBacterial pneumonias Hemophilus influenzaeHemophilus influenzae

RRxx ~ cephalosporins. ~ cephalosporins. Mycoplasma pneumoniaeMycoplasma pneumoniae

Atypical “walking” pneumoniaeAtypical “walking” pneumoniae No cell wallNo cell wall Low grade fever, headache, coughLow grade fever, headache, cough Colonies “fried egg”appearance.Colonies “fried egg”appearance. RRxx ~ tetracycline. ~ tetracycline.

Chlamydia pneumoniaeChlamydia pneumoniae OIP, needs ATP.OIP, needs ATP. Associated w atherosclerosisAssociated w atherosclerosis RRxx ~ tetracycline. ~ tetracycline.

Legionaires DiseaseLegionaires Disease Legionella pneumophilaLegionella pneumophila Gram - rod, aerobic, non-Gram - rod, aerobic, non-

sporeformer.sporeformer. Occurs in nature, water. Occurs in nature, water.

Resistant to chlorine.Resistant to chlorine. Enters lung via aerosol.Enters lung via aerosol. High fever, other symptoms High fever, other symptoms

of pneumonia.of pneumonia. RRxx ~ erythromycin. ~ erythromycin.

Legionaires DiseaseLegionaires Disease

NORMALNORMAL

LegionellaLegionella

TuberculosisTuberculosis

Mycobacterium tuberculosisMycobacterium tuberculosis: Acid-fast rod. : Acid-fast rod. Transmitted from human to humanTransmitted from human to human Treatment by prolonged use of multiple Treatment by prolonged use of multiple

antibioticsantibiotics Major problem in treating due to lack of Major problem in treating due to lack of

patient compliancepatient compliance Vaccines: BCGVaccines: BCG

PneumoniaPneumonia Pneumococal PneumoniaePneumococal Pneumoniae Streptococcus pneumoniaeStreptococcus pneumoniae: :

Gram-positive with capsuleGram-positive with capsule Diagnosis by culturing Diagnosis by culturing

bacteriabacteria Penicillin is drug of choicePenicillin is drug of choice

Haemophilus influenzaeHaemophilus influenzae PneumoniaePneumoniae Alcoholism, poor nutrition, Alcoholism, poor nutrition,

cancer, or diabetes are cancer, or diabetes are predisposing factorspredisposing factors