Tags: Endometritis

Chlamydia

General Considerations Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae are among the most prevalent microbial pathogens in humans worldwide. C trachomatis is responsible for a variety of sexually transmitted disease (STD) syndromes in both sexes. In addition, certain serotypes of C trachomatis are responsible for trachoma, the most common infectious cause of blindness in humans. C psittaci is a zoonotic pathogen associated with atypical pneumonia. C pneumoniae infects approximately one-half of the world’s human population and is a cause of upper and lower respiratory tract disease. It has also been associated with atherosclerotic cardiovascular disease. A. Epidemiology. In the United States, genital infections by C trachomatis serovars D through K occur …

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Actinomyces

Essentials of Diagnosis “Sulfur granules” in specimens and sinus tract drainage: hard, irregularly shaped, yellow particles measuring from 1 to 5 mm in size Gram-positive branching filaments arranged in ray-like projections under the microscope Colonies with characteristic “molar tooth” appearance Production of extensive fibrosis with “woody” induration No specific antibody or antigen detection tests General Considerations A. Epidemiology. The Actinomyces species are facultative anaerobes that commonly inhabit the oral cavity, the gastrointestinal tract, and the female genital tract, where they exist as commensals. Diversity within this genus is broad, which has led to taxonomic revision and reclassification of some species as members of the Arcanobacterium genus, eg, Actinomyces pyogenes. Disease occurs …

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Important Anaerobes

Essentials of Diagnosis • Foul odor of draining purulence. • Presence of gas in tissues. • No organism growth on aerobic culture media. • Infection localized in the proximity of mucosal surface. • Presence of septic thrombophlebitis. • Tissue necrosis and abscess formation. • Association with malignancies (especially intestinal). • Mixed organism morphologies on Gram stain. General Considerations A. Epidemiology and Ecology. Anaerobic bacteria are the predominant component of the normal microbial flora of the human body. The following sites harbor the vast majority of them: • Skin: Mostly gram-positive bacilli such as Propionibacterium acnes • Gastrointestinal tract: In the oral cavity Prevotella spp., Porphyromonas spp., Peptostreptococcus spp., microaerophillic streptococci, and …

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Important Anaerobes: Clinical Syndromes

Box 1 summarizes different clinical syndromes associated with anaerobic bacteria. The sections that follow describe the various syndromes, including clinical findings. For some syndromes, specific diagnosis and treatment information is included as well. For other syndromes, see summary diagnosis and treatment sections at the end of the chapter. HEAD & NECK 1. EAR & PARANASAL SINUSES The flora in as many as two-thirds of chronic sinusitis and otitis cases includes B fragilis, Prevotella spp., Peptostreptococcus spp., and Porphyromonas spp. It is not surprising that ~50% of patients with chronic otitis media are infected with anaerobic bacteria, B fragilis being the most common. Mastoiditis may arise as a complication in some of …

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Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). 1. MENINGITIS Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old. …

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Streptococcus Dysgalactiae Subspp. Equisilimis & Streptococcus Zooepidemicus:Clinical Syndromes

1. PHARYNGITIS The symptoms of pharyngitis caused by these organisms mimic those of S pyogenes pharyngitis (Box 50-1; see also site). Poststreptococcal glomerulonephritis has been described following S dysgalactiae subspp. equisimilis and S zooepidemicus pharyngitis. Notably, however, no antistreptolysin O antibody response will be detected as these organisms do not produce streptolysin O. S dysgalactiae subspp. equisimilis pharyngitis has been associated with sterile reactive arthritis. Acute rheumatic fever, however, has not been described in association with S dysgalactiae subspp. equisimilis and S zooepidemicus pharyngitis. 2. SKIN & SOFT TISSUE INFECTIONS Cellulitis, wound infections, pyoderma, erysipelas, impetigo, and cutaneous ulcers can be caused by these organisms (see site). Breaches in skin integrity …

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Group B Streptococcus (S Agalactiae) Clinical Syndromes

1. EARLY-ONSET GROUP B STREPTOCOCCAL NEONATAL INFECTION Early-onset group B streptococcal neonatal infection has three major clinical expressions: bacteremia with no identifiable focus of infection, pneumonia, and meningitis (Box 1). Signs and symptoms of early-onset group B streptococcal neonatal infection include lethargy, poor feeding, jaundice, abnormal temperature, grunting respirations, pallor, and hypotension. In most infants with pneumonia, symptoms of respiratory distress are present at or within a few hours after birth. Signs of respiratory distress associated with pneumonia include apnea, grunting, tachypnea, and cyanosis. The radiographic findings in infants with pneumonia may be indistinguishable from those of hyaline membrane disease. Infants with meningitis have a clinical presentation that initially cannot be …

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Other Gram-Positive Cocci

VIRIDANS GROUP STREPTOCOCCI, INCLUDING ABIOTROPHIA DEFECTIVA & ABIOTROPHIA ADJACENS Essentials of Diagnosis • Facultatively anaerobic gram-positive cocci, catalase negative, coagulase negative. • a or ? hemolytic on blood agar. • Abiotrophia defectiva and Abiotrophia adjacens require pyridoxal or thiol group supplementation. • Streptococcus milleri group organisms often exhibit Lancefield antigens A, C, F, or G and often have a butterscotch odor. General Considerations A. Epidemiology. Viridans streptococci are part of the normal microbial flora of humans and animals and are indigenous to the upper respiratory tract, the female genital tract, all regions of the gastrointestinal tract, and, most significantly, the oral cavity. Clinically significant species that are currently recognized as belonging …

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Enterococci: Clinical Syndromes

URINARY TRACT INFECTION Urinary tract infections, including uncomplicated cystitis, pyelonephritis, prostatitis, and perinephric abscess, are the most common type of clinical infections produced by enterococci (Box 1). Most enterococcal urinary tract infections are nosocomial and are associated with urinary catheterization or instrumentation. BACTEREMIA & ENDOCARDITIS Nosocomial enterococcal bacteremias are commonly polymicrobial. Portals of entry for enterococcal bacteremia include the urinary tract, intra-abdominal or pelvic sources, wounds (especially burns, decubitus ulcers, and diabetic foot infections), intravascular catheters, and the biliary tree. Metastatic infections other than endocarditis are rare in enterococcal bacteremia. Enterococci account for ~5-10% of all cases of infective endocarditis (see site). Most cases are caused by E faecalis, but E …

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Streptococcus Pneumoniae

Essentials of Diagnosis • Most common infections include pneumonia, meningitis, sinusitis, and otitis media. • Predisposing factors include extremes of age (ie, infants and elderly) and underlying host defects in antibody, complement, and splenic function. • Transmission is human to human both in the community and nosocomially. • Pneumonia: productive cough, fever, chills, sweats, and dyspnea; lobar or segmental consolidation on chest x-ray; lancet-shaped gram-positive diplococci on Gram stain of sputum or growth of S pneumoniae from sputum, blood, or pleural fluid. • Meningitis: headache, stiff neck, fever, chill, and photophobia; nuchal rigidity, Kernig’s or Brudzinski’s sign; lancet-shaped gram-positive diplococci on Gram stain of cerebrospinal fluid (CSF), growth of S pneumoniae …

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