hi everyone welcome back this is the second module for infectious disease where we will move on with bacterial infections the first one up is CI this um bacterial infection is anerobic meaning it does not need oxygen in its environment to survive um and it can actually live up to months um and then usually it's feal oral root and it's a usually C is noal infection so this is one of those that we are on the lookout for in the hospital and manifestations are diarrhea but can lead to fatal inflammation of the colon so it's important that when we have symptoms of persistent diarrhea very watery and loose stool that we run a culture to see if C dip is the culprit so we can start treatment immediately our risk group is anyone who's on antibiotics those who are older than 65 and then if you're dieing in a room or a house with someone who has ciff because the patient may have it for 10 to 14 days prior and you are not aware and perhaps you um contract that it's a contact precaution so remember those contact precautions that we talked about in the first module and treatment for this is usually uh probiotics and some sort of antibiotic one thing to note with CI and I apologize it's not on the slide but it's very very important to know we talked about standard precautions and cleaning your equipment well with SEI um just wiping down your equipment with soap and water will not do it you actually need bleach and so usually at the hospital they'll have commercial disinfectant wipes available or if there's bleach wipes but you need to wipe down your equipment for example your stethoscope or your gate belt or anything that you brought into the room with you needs to be thoroughly wiped down with bleach or commercial disinfectant wipes and then you need to let air dry for at least 2 minutes so you're not wiping it and then wiping it off with a paper towel you're letting it air dry um and that's the proper way to clean your equipment if you were exposed to a patient who may have cff next is staff infections this is also one of the most common noal and community acquired infections again this one is also anerobic meaning it does not need to have oxygen to survive usually it's through direct transmission and the risk group for this is anyone who is again in the older population um those who have a surgery or Burns those open wounds insulin dependent diabetes metis if anyone has chronic diseases um if anyone is neutropenic which just means um low nutrifil counts and nutrifil are a type of white blood cells so if that's particularly low in a patient they'll be less likely to fight off these staff infections and then we want to make sure especially because it's contact precaution we want to make sure sure that we're sanitizing and washing our hands and educating our patients looking at pathogenesis of staff infections again usually um it can be invaded through secretions of membranes things like that or traumatic inoculation so if there's something that disrupts our barriers of protection for example maybe we had surgery something of that nature and then um a staff infection gets in that site and now we have a problem um you might see a local abscess form with p andac IIA at that site which will then lead to some sort of infection into the bloodstream and at that point you know that's bacteremia and that's a severe problem because once it's in the bloodstream it can now travel anywhere in our body including our joints or kidneys lung hearts and then we have a lot more to worry about um than just the local infection symptoms to look out for fever chills pain swelling over an affected area and cellulitis which we'll talk about later but you'll see um significant swelling and pain and oozing of the exity um one of the most common staff infections that we'll see um in the hospital is MRSA or also known as Mera treatment for any sort of staff infection is usually antibiotics to fight the particular strain so when we talk about fighting a certain strain usually when someone has some sort of infection they'll take a sample of that and they'll basically grow it in a Peet tree dish and they'll be able to tell what sort of bacteria is growing and depending upon what type of bacteria is growing they'll choose they the doctor will choose an appropriate antibiotic to fight that particular strain of bacteria um and Mera however um is a little bit resistant to most antibiotics but vasin is usually the antibiotic choice for Mera here are just a few pictures for you to kind of give you an idea what it looks like with a local infection with a staff infection um on a patient moving to strepto cacal infections group a also known as as gas these are usually transmitted via contact with respiratory droplets signs and symptoms of these type infections depend upon the location of their infection so here's a little list of all of the different types of group a strepto cocy infections that we're going to go over first up is fitis also known as strep throat there's an incubation period of 1 to five days possible presentation of a fever sore throat really red fairing swollen tonsils lace possible abdominal pain these folks do not like to swallow it hurts oftentimes you see this with kiddos um and adults too uh treatment for this is antibiotics to avoid post-rep syndromes which can include rheumatic fever and glal nefritis which is inflammation and damage of the kidneys scarlet fever usually Um this can happen if there's strut throat or wound that is untreated usually this is most common in into the 10-year-old so the younger population and it's transmitted through inhalation or contact with oral secretions and the patient will have fever sore throat what they call that strawberry tongue I've got a picture of that for you there and then that rash sandpaper like skin on the chest and extremities will also be apparent imp Pedigo this is um another form of strep and staff species again it's usually the younger population now two to five orus previous we're talking about 2 to 10 so this is mainly your toddlers here um in hot and humid weather risk of this is close contact overcrowding poor skin hygiene uh or possible minor skin trauma now that kind of opens up that barrier for that bacteria to kind of go in and grow good hygiene is the best defense um to prevent colonization and usually it presents with these small mules that end up developing into vesicles that contain the pus patients might scratch and spread the infection or with a scratching um the infection as it gets worse can develop lymp Andis or cellulitis usually patients with impetigo don't have a fear or pain it's just itchy and they have these little small vesicles everywhere aerosis is also caused by strepto Coco bacteria it's usually a superficial cellulitis with fever and chills uh it will usually appear on the face and the legs and unfortunately it's more common in women than men for whatever reason the skin is red shiny and swollen and then you'll start to see Bulet form after a couple of days this is usually treated with antibiotic so again you can see the extremity in this photo the redness um and then it's a little hard to see the shininess there is a little bit of a shine and it will be more swollen compared to the uninvolved limb and then truce uh stto Coco cellulitis is inflammation of the skin and subcutaneous tissue usually at a wound sight but entry of sight may not always be noted so you may not have a wound of Entry it may occur internally and this results in imp paral lymphatic drainage and so you have lympha dtis and you'll see the red linear streaks from the affected area the patient will be very tender to palpation usually they don't want their limb touched it's very sore and you'll see the swollen lipn as well and so here you can see the significant difference from the infected leg versus the non-infected leg then there's something called necrotizing fasciitis there's type one and type two um both of them um can cause the same sort of sequel of events but usually type one is from uh by mouth which is the p/ O that's what that stands for symptom onset is used usually pain and fever and things look okay on the outside but they just kind of don't feel good and there's a increased temperature in pain and then as the infection rapidly spreads you'll start to see edema and tenderness in the area that is affected and then developing later you'll see clotting of the blood vessels and they'll start to develop dark and red skin and then eventually the skin becomes es schic and that's where the skin turns black and necrotic so those who are a little queasy in the stomach I apologize for these photos but um this is what it is patients with necrotizing fitis will also have hypotension nausea vomiting or possible delirium there is a high mortality rate because of the rapid progression of the disease um and the effects on the system so toxic shock kidney or liver failure and Pulmonary infiltrates are also possible treatment for this is aggressive debr of the infected area and use of IV antibiotics streptococ pneumonia or pneumonia sorry um can lead to sepsis um or maybe it was started by otitis media or menitis um it's usually from direct contact or inhalation of a respiratory secretion this is the common community acquired bacteria and it can cause death um quite often in those who are compromised um but this is one of the most most preventable diseases um out there or not disease bacteria rather continuing on um vaccinations are recommended for pneumonia and those that are greater than 65 anyone with chronic diseases are compromised immunity so thinking about those patients that are more at risk the patient will likely have a fever have cloritis with pain dpia productive cough purulent sputum which is a thick opaque yellowish or sometimes can be green FL that contains pus elderly often end up developing delirium and there's likely a slight cough um associated with pneumonia right um you all know people with walking pneumonia that have that cough going on complications would be EMA which is defined as a collection of pests in the plural cavity bacteria which is blood in the excuse me bacteria in the blood which can then lead to sepsis which is the body's response um that responding improperly to the infection menitis can occur which is inflammation of the menes surrounding the brain and the spinal cord um so it can become very detrimental very quickly if it's not treated usually there's a culture taken of the fluid if it's in the portal space or um other testing depending on where it's at to select the appropriate antibiotic so they're trying to look at the gram positive negative and what type of bacteria is causing this pneumonia because different types of bacteria can cause pneumonia um and then treat appropriately with antibiotics gas gain green so this is rare but it's very painful and again it's one of those that are anerobic it does not need oxygen to survive um usually it's the muscles and subcutaneous tissue that fill with gas and exudate exudate is a fluid that kind of leaks out of the blood vessels into nearby tissues as often seen as the oozing from the cuts with an infection um and so you're for these um kind of grotesque limbs that have been infected with this kind of bubbling effect and I have a picture for you on the next slide this can follow trauma or surgery and this spreads quite rapidly and death can follow within hours so this is something if you notice any signs and symptoms of this it's an immediate alert to The Physician and the nursing staff um it's usually uncommon and healthy human tissue unless devitalized tissue with severe trauma present so maybe someone had a traumatic event and they're there for multiple traumas skin lesions are open things of that nature um it's also found in deep [Music] wounds so here's your grotesque picture of kind of what it looks like um and this is something that you want to again notify if this was the patient when you walked in you would hope that the nursing staff and the doctors would be aware this should be treated at this point uh this is pretty severe so if you're noticing the start of any of these signs or symptoms you want to make make sure you get help but the skin is kind of dark it starts to thicken there's a foul odor um and these little bubbles that start to present themsel and resurface to the skin prevention of this is cleaning the wound Surgical debrit and antibiotics so sometimes um prophylactically patients might be on antibiotic postop but not always um and then there is an incubation period of Less Than 3 days after the injury so um it might be kind of brewing and you don't know it for up to 3 days um before things start to really unfold moving on to pomonis pomonis is an opportunistic bacteria these are more associated with acute exacerbations of COPD versus the streptococcal pneumonia is more commonly seen as true pneumonia um but this can cause pneumonia um and lead to wound infections UTI and sepsis again this likes this particular bacteria likes moist environmental surfaces it can be resistant to many antibiotics um ciproflaxin is an example of an antibi that works well with this type of bacteria um and it is an aggressive growth and so again if someone has pseudomonas if you're basically detecting some sort of infection in your patient things tests need to be done right is it bacterial is it viral what's going on and if it's bacterial they run a battery of tests they take a sample as I mentioned before they let it grow in a petri dish and they try to find the type of bacteria that is involved so then they can find the specific antibiotic for that particular bacteria that can help kill it off okay uh transmission of pomonis it you want to make sure you have hand hygiene proper cleaning of your equipment and then sterile techniques with wounds so maintaining those standard precautions um when dealing with your patients uh continuing on with camonis um it can lead to respiratory tract infection and bacteremia which remember as I said bacteria is the infection in the bloodstream and once it hits the bloodstream it's fair game to kind of go anywhere so you can have a gamut of symptoms depending upon where it travels the hearts the lungs connective tissue Etc so um this is something that you want to be on top of right away because once it gets into the bloodstream it can be very fetal um CNF central nervous system infections can occur you'll see soft tissue infections so the picture there kind kind of shows you a infection of the skin and soft tissue and then again if it's in the bone or the joints um we'll call it osteomyelitis that is the end of the bacterial infectious disease module please come to class with any questions you may have and thank you for your time