Core Concepts in Clinical Infectious Diseases (CCCID)

Carlos Franco-Paredes

• Publisher: Academic Press
• Year: 2016
• Print ISBN: 9780128044230
• eBook ISBN: 9780128044803
• Topic: Medicine
• Subtopic: Immunology

Core Concepts in Clinical Infectious Diseases (CCCID) provides medical students and researchers, infectious disease fellows, and practicing clinicians with key clinical concepts in the differential diagnosis and workup of infectious diseases. With the use of tables, charts, and problem-oriented medical diagnosis, it will provide a way of organizing and thinking about commonly seen clinical presentations of infectious diseases. Instead of discussing each disease process or any particular infectious process, this book will assist clinicians in seeing the forest and not focusing on the leaf. Graphs and tables have been constructed over 14 years of taking notes, teaching clinical infectious diseases, and discussing real clinical cases. This book is not about acquiring the structure of infectious diseases that is presented in classic textbooks of infectious disease; instead, it is about refining the process of putting the pieces together in clinical thinking to achieve an accurate clinical diagnosis and thus improved patient care. - Assists the reader in connecting the dots (process of accumulating real-time knowledge) during the thinking process of clinical decision-making in the area of infectious diseases - Uses tables and charts for easy understanding and application - Contains a manual style that targets different audiences, such as medical students, hospital medicine specialists, outpatient internal medicine practitioners, infectious disease fellows in training, and practicing clinicians - Provides an up-to-date discussion of core concepts in clinical infectious diseases

Chapter 1

Sepsis

Abstract

Microorganisms are dynamic players in the ecology of the earth but some of them may wreak chaos on human welfare, affecting the lives of many individuals. Furthermore, these microbes interacting with the human host sculpt our genomes, shape and prune our sophisticated immunologic defenses, and ultimately, determine our biological destinies. In some individuals and under certain circumstances, in trying to respond to exposure to pathogens of foreign antigens, our inflammatory or immune responses may mount an exuberant reaction that may result in tissue damage.

Sepsis, the syndrome of infection complicated by vital organ dysfunction, represents one of these conditions. It is convenient to further divide sepsis into hospital-acquired and community-acquired forms since the causes and mechanism of sepsis may vary between the two categories. Sepsis is one of the world’s leading causes of death. Without prompt intervention including resuscitation and antibiotics, individuals may rapidly develop shock, multisystem organ failure, and death.

Keywords

necrotizing fasciitis

acute bacterial meningitis

acute endocarditis

Vibrio vulnificus

Aeromonas hidrophyla

Streptococcus pyogenes

Streptococcus pneumonia

sepsis

septic shock

multiorgan failure

Diagnostic approach to sepsis

We live in a world where nature rules. Man is irremediably embedded in nature with complex interactions with all living organisms. Ecologies vary across landscapes of built and natural environments, different geopolitical realities, and different access to health care and public health services.¹ Infectious pathogens do not rely on our anthropocentric spatial understanding for them to negotiate the negative spaces between human vision and the landscapes that afford them to reproduce and survive. This is true as it occurs in the dense jungle of the Amazonian river as well as in the modern setting of an intensive care unit in a highly specialized hospital.

In striving for self-transcendence and coexistence with other living organisms, our ancestors have experienced formidable molecular strife and have adopted ingenious adaptations.² As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, we are shared, occupied, or rented with viruses, bacteria, archaea, protozoa and fungi.³

Although there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some bacteria are able to cause a wide spectrum of diseases. Yet, despite effective antimicrobial interventions and subsequent elimination of the inciting pathogen, many patients die as a consequence of the exuberant and inadequately regulated immune response to the infection.⁴

Infection

This is the process whereby an infectious pathogen adheres and invades normally sterile tissues. When the infectious process affects the parenchyma of an organ it may lead to abscess formation, whereas when an infectious pathogen invades existing spaces it may cause an empyema, for example, when a bacterial pathogen reaches the pleural space or the subdural space.

When viable bacteria reach the bloodstream and detected by blood cultures, this is defined as bacteremia. Similarly, when a viral pathogen is detected in peripheral blood through culture or by molecular detection assays, the patient is considered to have viremia (eg, CMV). When fungi, particularly some of the dimorphic fungi are detected in blood cultures, this is defined as fungemia (eg, candidemia or cryptococcemia). Fungal blood cultures might rarely yield molds such as Aspergillus spp., particularly Aspergillus terreus, or Fusarium spp. Parasitemia may also be detected in peripheral blood in many protozoan infections such as in malaria, acute Chagas disease, babesiosis; or in helminthic infections (eg, filarial infections such as Loa loa) (Table 1.1).

Table 1.1

Infections Including Those Reaching the Bloodstream

Categories	Feature	Examples
Infection^a	Adherence and invasion of sterile human tissues with clinical consequences^b^,^c	Bacterial, viral, fungal, parasitic
Bacter...

Table of contents

• Cover
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Chapter 1: Sepsis
• Chapter 2: Bloodstream Infections
• Chapter 3: Central Nervous System Syndromes
• Chapter 4: Ocular Infections
• Chapter 5: Upper Airway Infections
• Chapter 6: Lower Airway Infections
• Chapter 7: Neck and Thoracic Infections
• Chapter 8: Abdominal/Pelvic Infections
• Chapter 9: Genitourinary Infections
• Chapter 10: Cutaneous, Subcutaneous, and Deep Tissue Infections
• Chapter 11: Osteoarticular Infections
• Chapter 12: Nonsuppurative Manifestations of Infections
• Chapter 13: Inflammatory and Autoimmune Syndromes Mimickers of Infection
• Chapter 14: Syndromes in Travel and Tropical Medicine
• Chapter 15: Infectious Syndromes Associated With Immunodeficiencies
• Chapter 16: Specific Organ Syndromes
• Chapter 17: Febrile Syndromes
• Subject Index