CLINICAL

INFECTIOUS
DISEASES
MUHAMMED NIYAS,MD(Internal Medicine)

 A 55 year old man presents to his primary care physician

with a 2 day history of cough and fever.His cough is
productive and thick with dark green sputum.His past
medical history is significant for hypercholesterolemia
treated with rosuvostatin

He does not smoke cigarettes and is generally quite healthy.He has no

ill contacts and do no recall the last time he was treated with
antibiotics.
On presentation his vitals were as follows.Temperature 102.1F,Blood
pressure 132/80mm Hg,respiratory rate of 2o breaths per minute,heart
rate of 87breaths per minute,oxygen saturation of 95% in room air.
Crackles are present in Right infraclavicular and mammary areas with
egophony.Chest radiograph demonstrates segmental

Which of the following is the likely pathogen?

A)Mycobacterium tuberculosis
B)Streptococcus pnemoniae
C)Mycoplasma pneumoniae
D)Influenza virus

 Healthcare-associated pneumonia (HCAP) is defined as pneumonia

that occurs in a non-hospitalized patient with extensive healthcare
contact, as defined by one or more of the following:
Intravenous therapy, wound care, or intravenous chemotherapy
within the prior 30 days
Residence in a nursing home or other long-term care facility
Hospitalization in an acute care hospital for two or more days within
the prior 90 days
Attendance at a hospital or hemodialysis clinic within the prior 30 day

SURGICAL TREATMENT
Emergent: (same day)
Acute aortic regurgitation plus preclosure of
mitral valve
Sinus of Valsalva abscess ruptured into right
heart
Rupture into pericardial sac

Urgent (within 12 days)

Valve obstruction by vegetation
Unstable (dehisced) prosthesis
Acute aortic or mitral regurgitation with heart failure (New York Heart
Association class III or IV)
Major embolus plus persisting large vegetation (>10 mm in diameter)
Septal perforation
Perivalvular extension of infection with or without new
electrocardiographic conduction system changes
Lack of effective antibiotic therapy

Elective (earlier usually

preferred)
Vegetation diameter >10 mm plus severe aortic or mitral valve
dysfunction
Progressive paravalvular prosthetic regurgitation
Valve dysfunction plus persisting infection after 710 days of
antimicrobial therapy
Fungal endocarditis

CNS Infections

Acute bacterial meningitis

An 18 year old boy presented with

complaints of fever,headache and
vomiting.Physical examination
revealed neck stiffness and a non
blanching rash.

Tuberculous
Meningitis
Total Leucocyte
Up to 1000/L
count
Predominant cells Lymphocytes

Bacterial
Meningitis

Viral Meningitis

>100 cells/L

25500/L

Neutrophils

Lymphocytes

Sugar

<45 mg/dl
(Low)

<40 mg/dl
(very low)

Normal

Protein

100800 mg/dL
(Very high)

>45 mg/dl
(High)

2080 mg/dL
(normal or slightly
elevated)

Acute viral meningitis

Subacute meningitis

 A 20 year old male patient presents with complaints of fever and

headache for 2 weeks duration.On examination the patient has neck
stiffness and Right lateral rectus palsy.The CSF examination shows a
TC of 300(all lymphocytes),Protein 300mg/dl,and Glucose 50mgdl.
CT scan is as given

What is the diagnosis?

A)Pyogenic meningitis
B)Viral meningitis
C)Tuberculous meningitis
D)Herpes Encephalitis

UTI

 A 65 year old Diabetic women presented with

complaints of fever associated with rigor and
chills,nausea,vomiting and right flank pain.

Physical examination showed tenderness in right

renal angle.
CT scan is shown.

Acute Infectious Diarrheal

Diseases

Prevention of Central Venous Catheter

Infections
Catheter insertion bundle:
Educate personnel about catheter insertion and care.
Use chlorhexidine to prepare the insertion site.
Use maximal barrier precautions and asepsis during catheter
insertion.
Consolidate insertion supplies (e.g., in an insertion kit or cart).
Use a checklist to enhance adherence to the insertion bundle.
Empower nurses to halt insertion if asepsis is breached.

 Catheter maintenance bundle:

Cleanse patients daily with chlorhexidine.
Maintain clean, dry dressings.
Enforce hand hygiene among health care workers.
Ask daily: Is the catheter needed? Remove catheter if not needed or
used.

 A neutropenic patient on cancer chemotherapy

developed a small macule over the abdomen which
rapidly turned to a gray-black eschar with surrounding
erythema.

 An AML patient who was recovering from

neutropenia developed persistent fever which was
unresponsive to antibiotics.On examination the
patient had abdominal tenderness.Serum alkaline
phosphatase levels were elevated.A CT scan of the
abdomen was done.

Drug of Choice
For acutely ill
Lipid formulation of amphotericin B for induction
Followed by oral fluconazole.
Alternative agent for induction:
Echinocandins
Clinically stable: Oral fluconazole.

 A 43 year old woman undergoes allogenic stem cell transplant for

AML.Two weeks after transplantation she is admitted to the hospital
with a temperature of 101.1 F.a pulse rate of 115 per minute,BP :
110/83mmHg and an oxygen saturation of 89% in room air

 Her white blood cell count is 500/cmm.Because of hypoxia and

infiltrates on chest radiograph a CT scan is ordered.

 Which of the following tests is most likely to diagnose her disease

A)Microscopic examination of buffy coat
B)Serum galactmannan assay
C)Sputum culture
D)Plasma CMV viral load
E)Urine legionella assay

Streptococcus
pneumoniae
Gram-positive
Grow in chains or pairs
-hemolytic
Capsulated
Optochin sensitive
Bile soluble

Staphylococcus
Gram positive
Grape like clusters
Non motile
Aerobic
Facultatively anaerobic
Catalase positive

GLYCOPEPTIDES

Vancomycin
Teicoplanin,
Telavancin
Dalbavancin,
Oritavancin

Oxazolidinone

Linezolid
Tedizolid

Streptococcal infections

Enterococci
Gram-positive organisms
Usually observed as single cells, diplococci, or
short chains
Hydrolyze esculin in the presence of 40% bile
salts
Grow at high salt concentrations (6.5%)
High temperatures (46C).

Corynebacterium
diphtheriae
Gram positive
Non encapsulated
Non motile
Non sporing
Characteritic club shaped
appearance

 A 42 year old man with HIV has been developing worsening disease
because of HAART resistance and worsening viremia.Over the past 6
months his CD4 count has fallen below 100/L.He has not been
taking prophylactic medication because he is tired of taking pills

 He comes to the clinic reporting 3 weeks of productive cough and low

grade fever.A chest radiograph shows upper lobe cavitory
lesion.Percutaneous needle biopsy shows some neutrophils and small
Gram positive coccobacilli that look like corynebacterium.

Rhodococcus equi

Listeria monocytogenes
Facultatively anaerobic,
Nonsporulating,
Gram positive rod
Grows over a broad temperature
range, including refrigeration
temperatures

Clostridium tetani
Gram-positive,
Spore-forming
Bacilli

Botulism

Gas Gangrene

A 60 year old male patient presents with

complaints of abrupt onset of pain and
swelling of the left shoulder and upper
arm.There is no history of trauma.On
examination the patient had edema of the
left upper limb with fluid filled
bullae.Palpation of the limb revelaed
crepitus.

Gram staining of the fluid revealed :

 A 25 year old female patient who had underwent an abortion 3 days

back now presents with complaints of lower abdominal pain.The
patient was looking sick,Her pulse rate was 110/mt and blood
pressure 80/60 mm Hg.She was afebrile.Examination revelaed
edema,bilateral pleural effusion and

 ascites.Blood investigations revealed a total leucocyte count of

60000/cmm and a hematocrit of 60.
Her condition soon worsened and she succumbed to her illness
Post mortem examination of the uterine specimen showed Gram
positive bacilli

 What is the possible etioogical agent?

A 64 year old male hospitalized patient who

was on treatment for Pneumonia complaints
of abdominal pain and multiple episodes of
watery diarrhea.He also had mild fever.

Blood investigations showed an elevated total

leucocyte count of 16,000/L.
Colonoscopy done showed the following
appearance.What is the diagnosis?

DIAGNOSIS
The diagnosis of CDI is based on a combination of clinical criteria:
(1) diarrhea (3 unformed stools per 24 h for 2 days) with no other
recognized cause plus
(2)Toxin A or B detected in the stool or
Toxin producing C.difficile detected in the stool by PCR or culture,
Pseudomembranes seen in the colon

Treatment
Ciprofloxacin + Doxycycline
Plus
Clindamycin/Rifampicin

Post exposure
Ciprofloxacin
Or
Doxycycline
Or
Amoxycillin

Category A

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum toxin)
Plague (Yersinia pestis)
Smallpox (Variola major)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers :
Arenaviruses: Lassa, New World (Machupo, Junin, Guanarito, and Sabia)
Bunyaviridae: Crimean-Congo, Rift Valley
Filoviridae: Ebola, Marburg

Neisseria meningitidis
Gram-negative
Aerobic
Diplococcus

Neisseria gonorrhoeae
gram-negative,
nonmotile,
non-sporeforming
organism that grows singly
and in pairs