What is peritonitis ?

INTRAABDOMINAL INFECTIONS 

PRIMARY ( SPONTANEOUS ) BACTERIAL PERITONITIS ( PBP ) 

Spontaneous bacterial peritonitis (SBP) is to develop peritonitis (infection of the abdominal cavity), although there is no obvious source of infection.It occurs almost exclusively in cases of portal hypertension of people (more of Increased portal vein pressure ), usually a result of cirrhosis of the liver and liver.It may also occur in nephrotic syndrome patients.

Primary bacterial peritonitis  is seen as the result of a combination of factors associated with cirrhosis and ascites, and prolonged bacteremia secondary to compromised host defenses, maneuvers intrahepatic blood colonized, and the defective bactericidal activity in the ascites fluid. Contrary to previous theories, transmucosal migration of bacteria in the intestine of ascites is no longer considered to play an important role in the etiology of SBP. With regard to the compromised host defenses, patients with chronic liver disease often have severe acute deficiency of the complement and possibly a system malfunction of neutrophils and the reticuloendothelial system.

ETIOLOGIES 

Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.

SIGN AND SYMPTOMS 

Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic   encephalopathy  could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.

MORTALITY / MORBIDITY 

The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.

DIAGNOSIS 

The diagnosis of  Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from  the cavity of abdomen .  If the fluid contains bacteria or a big amount  of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.

TREATMENT 

Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.

PREVENTION 

Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time. 

SECONDARY PERITONITIS 

Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

CLINICAL FEATURES 

Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .

DIAGNOSIS AND TREATMENT 

Studies marked leukocytosis with a left  shift to find the source of peritonitis are the main treatment.  Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.

PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS 

Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical  therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter  removal scheme should be considered if the patient does not improve within 48 hours ....... read more

Rheumatic fever symptoms - Leptospirosis -Listeria symptoms

SYSTEMIC / MULTISYSTEM INFECTIONS 

RHEUMATIC FEVER 

Rheumatic fever is an inflammatory disease that can develop after an infection with Streptococcus bacteria (such as strep throat and scarlet fever) and can involve the heart (especially the valves), joints, skin and brain. Rare in developed countries like Great Britain, USA and Australia. Incidence has dropped by 10% of children in 1920 to 0.01% of all children today. This reduction in the incidence reflect advances in infection control and treatment of streptococcal infections to antimicrobials. The disease is still prevalent in developing countries such as the Middle and Far East and Latin America.

Rheumatic fever is preceded by a throat infection with Streptococcus organsisms. After infection with group A streptococcal pharyngeal, usually in childhood (5-15And) is followed by a systemic syndrome I think it is caused by an autoimmune reaction triggered by an infection. Syndrome includes: 1) Arthritis (multiple join pain and swelling) 2), carditis (heart inflammation) 3) The cutaneous manifestations 4) manifestations5 nervous system), fever, joint pain 50% etc.About Patients who develop carditis during the initial phase of the disease will continue to develop long-term heart disease and rheumatic valvular disease.

1) Blood tests: ESF and CRP (non-specific inflammation), leukocytosis2) Studies in X-ray may be a sign of heart infection, pericarditis, pericardial effusion effusion.3) ECG may signs of inflammation of the heart (extended range PR) or, and pericarditis (saddle-shaped ST elevation). Parts of the acute clinical syndrome may recur after the first period. However, projected common disease, skin disease and nerve disease associated with rheumatic fever is excellent with no known long-term consequences. rheumatic heart disease has traditionally been hailed as an important causal factor of cardiac valvular disease and makes the associated morbidity and mortality.

LEPTOSPIROSIS 

Leptospirosis is a rare infection, serious and contagious caused by bacteria of several species of the genus Leptospira, a micro-organism spiral (spirochete). Leptospirosis is often called the swineherd's disease, swamp fever, or mud fever. The organism enters the body when mucous membranes or abraded skin comes into contact with contaminated environmental sources. The infection causes a systemic disease that can often lead to renal and hepatic failure as possible. 

 Leptospirosis is a zoonosis (animal care) infection with a worldwide distribution and incidence. The incidence varies from sporadic in temperate zones endemic in some tropical countries. The disease has a seasonal incidence. Most cases occur during the rainy season in the tropics and in western countries in late summer or early fall, when soil is moist and alkaline. Leptospirosis is usually associated with tropical countries and heavy rains, but most cases occur in temperate climates, probably due to underreporting in some countries.

In general, the prognosis associated with this disease is good, usually with full recovery after infection. more serious systemic infections (Weil's disease), can lead to renal (kidney) or hepatic (liver), myocarditis (heart inflammation), and can be potentially fatal.

Approximately 15-40% of patients are exposed, but do not become ill show serologic (blood or urine or saliva) evidence of a past existing infection. This statistic includes 15% of abattoir workers, home workers, and the incubation period is usually between 7-12 days veterinarians.The, with a range of 2-20 days. About 90% of patients experience a mild form of the disease,
and about 5-10% have the severe form with jaundice, also known as Weil's disease. The natural course of leptospirosis is divided into two very distinct phases, sepsis and immune systems. For a brief period of 1-3 days between the first and second phase, the patient shows some improvement.

LISTERIOSIS 

Listeriosis is an infectious disease caused by foodborne bacteria Listeria monocytogenes. The symptoms are the symptoms of upper respiratory tract and septiceamia. Listeriosis is of particular concern during pregnancy because it can cause miscarriage, stillbirth, premature delivery and sepsis (full body infection) and pneumonia in newborns.

It is an environmental organization that is ubiquitous in soil and rotting matter.It affect both animals and humans, the most common way of infection to humans in contaminated food. The organism can grow at temerature as low as 4 degrees Celsius, and the foods most frequently implicated are soft cheeses, unpasteurized, raw vegetables and the chicken heads. Listeriosis is a rare but serious infection that mostly affects infants, pregnant women, elderly and immunocompromised, L. monocytogenes has also been recently recognized as a cause of self-limiting gastroenteritis, foodborne healthy adults, but the incidence of this phenomenon is unknown....... read more

Lyme disease symptoms

SYSTEMIC / MULTISYSTEM INFECTIONS 

LYME DISEASE

Lyme disease, or other name is Lyme borreliosis, is an emerging clinical infection caused by at  three  type of species of bacteria ,that belong to the genus Borrelia.Borrelia burgdorferi sensu stricto is the major cause of Lyme disease in the U.S. while Borrelia afzelii andBorrelia garinii cause most of the  European cases. 


The disease name is given after the town of Lyme,Connecticut,  in United States of America , where a large number of cases were found in 1975. According to the  Allen Steere Lyme disease was a tick-borne disease in 1978, the main cause of this disease remained a mysterious until 1981, when B. burgdorferi was identified by another person Willy Burgdorfer.



Lyme disease is caused by a bacterial infection transmitted by ticks and the individual's immune response to infection later. It is characterized by arthritis, neurological and cardiac complications, which is a characteristic rash, which extends from the original tick bite. Lyme disease is caused by spirochete Borrelia burgdorferi, which is sent to Ixodes. Spirochete can be transmitted during the blood meal of an infected tick. Studies have shown that the transfer requires at least 24-48 hours of tick attachment. Ticks carrying the voles, moles, sheep and horses, and wide distribution in the U.S., the UK and Europe. They are particularly numerous in wooded areas along or pasture, ie farmers, loggers and bush walkers usually more at risk. Activities are seasonal and peak in spring, summer and early autumn.

Traditionally, the progression of Lyme disease is divided into three phases, but it is somewhat artificial as the progression from the beginning to a later stage is not inevitable, even in the absence of antibiotic treatment. The first, and in most cases the only clinical characteristic of Lyme disease is a rash of classic erythema migrans - an area of redness migrate outwards from the site of a tick bite might have happened anytime from 20-40 days earlier. The second stage of Lyme disease occurs weeks to months after initial infection and the results spread to more distant locations via the bloodstream and lymphatic system. many organs and tissues are potential targets, especially the skin, nervous system, heart and joints. The clinical signs depend on the system and the severity of injuries. Patients may complain of flu-like symptoms with night sweats and muscle aches.

Lyme disease should always be considered if there is a history of exposure to ticks. A negative history of tick bite does not develop the disease. The study was made to work, travel and leisure exposure and pets. Samples can be performed on blood or cerebrospinal fluid. The organism can be cultured in the laboratory for 3-4 weeks. DNA detection is also possible. The prognosis is generally excellent, and only a few deaths have been reported. Even without treatment, a tendency to recurrent episodes of Lyme arthritis to resolve over time. Children seem to have a better chance of complete recovery than adults.

Bone infection

BONE AND JOINT INFECTIONS 

 

Osteomyelitis is the name given to infections of the bone. This may be acute or chronic in nature. More than 90% of acute osteomyelitis caused by Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae but also cause an acute infection of Haemophilus inflenzae bone is rare due to the widespread use of Hib vaccine.

 

Bone has been infected by the bacteria move into the bloodstream, where seeds of infection. Acute osteomyelitis usually affects the long bones points higher, because blood flow is slow in these areas. This allows the possibility of bacteria in motion to resolve the infection and establish at these sites. Although rare, osteomyelitis more often in children and adolescents who are growing rapidly. Sometimes, acute osteomyelitis can cause the spread of infection to adjacent tissues. In such cases, the infection is likely to be polymicrobial.

The bacterium Mycobacterium tuberculosis is the most common cause of chronic osteomyelitis. This condition causes the secondary spread of a lung infection. Unlike osteomyelitis, which affects the growing points of long bones chronic osteomyelitis caused by Mycobacterium tuberculosis is most likely to affect the vertebrae. Other bones, including hip and knee and leg in your hands or feet, may be involved in chronic osteomyelitis. The pressure on the spinal cord due to chronic osteomyelitis may be enough to cause paralysis in the affected region.

 

A bacterial infection of a joint can cause serious and potentially destructive form of arthritis, often called septic arthritis. Common bacterial infections can be caused by a variety of organisms and can occur in natural and artificial joints (eg after total knee arthroplasty). The most frequent common infection caused by N. gonorrhea, sexually transmitted bacteria that cause gonorrhea, this is called a gonococcal joint infection. mixed infection with other types of bacteria called nongonococcal bacterial (septic) arthritis. Infection of an artificial joint is known that infection prosthesis.

 

People who have artificial joints are at risk of developing a common infection. Approximately 0.5 to 1 percent of the population with replacement joints to develop such an infection. Infections may occur during early recovery from hip replacement surgery (within the first two months) or much later. Unfortunately, artificial joint infections are difficult to treat. This is due, in part, the development of structures known as biofilms within the commune. Biofilm develops when bacteria are in accordance with the common artificial solid surface. Biofilm can act as a shield against some bacteria, making it difficult for bacteria to find and destroy the body's natural defenses or antibiotics.

 

Other bacteria that cause chronic osteomyelitis include salmonella and other coliform bacteria, Pseudomonas aeruginosa and the spirochetes Treponema pallidum. This can cause bone lesions in children with congenital syphilis. Also cause sensitization to gum formation of bone in patients suffering from tertiary syphilis. Recent archaeological evidence suggests that bone lesions caused by syphilis is evident in the bones of Europe before the discovery of America. These doubts about the theory that Christopher Columbus brought syphilis during his first return from the New

World.

 

Bone and joint infections occur when a bacterial infection spread from one part of the body for a bone or joint through the bloodstream. The infected bone begins to produce pus, which may cause an abscess or pocket of pus. Over time, the infection can disrupt the blood supply of bone. This can cause the bone to die. One of the most common bone and joint infection called osteomyelitis. Bone and joint infections can cause symptoms such as bone pain, swelling, fever and nausea. Several factors increase a person's risk of bone and joint infections, including trauma, diabetes, dialysis and the use of intravenous drugs. If you experience symptoms similar to those of a bone or joint infection, you should be seen by a specialist in infectious diseases.

 

Gram-positive organisms, particularly staphylococci and streptococci, which are responsible for most infections in bones and joints. The treatment of these infections can be difficult, usually associated with long-term course of antibiotics, often with surgery. The choice of antibiotics depends on the sensitivity profile, patient tolerance and long-term goals, such as the treatment or suppression, but only a few randomized controlled trial in patients compared the efficacy of different antibiotics. Varying degrees of bone penetration and clinical outcome of certain antibiotics, such as beta-lactams, clindamycin and quinolones, has been described, although the method of these studies are not standardized and results are not always be applied directly to patients.

 

The effect of achieving a minimum bactericidal concentration of serum in patients has also been studied, but no longer routinely recommended in clinical practice. Comparative clinical trials are few but have demonstrated the efficacy of oral fluoroquinolones in combination with rifampicin or fusidic acid for selected Gram-positive infections. In the last decade, more and more resistant organisms such as Staphylococcus aureus resistant to methicillin and vancomycin resistant enterococci have been recognized as causes of infection in orthopedics. Individual case reports describe successful treatment with new antibiotics, for example, linezolid and quinupristin / dalfopristin, but results of clinical trials are expected.

Systemic infection

SYSTEMIC / MULTISYSTEM INFECTIONS 

 

SEPTICAEMIA 

 

Sepsis is a serious condition characterized by inflammation in the body. It is caused by bacteria entering the bloodstream, which triggers an immune response, causing inflammation and a closing body systems slow to treat the infection. This disease can be fatal, especially if the patient is allowed to make progress in the shock phase and departure can be alarmingly quickly. If sepsis is suspected, a patient transported to hospital for immediate medical care.

SEPTICAEMIA 

 

The causes of sepsis are varied. Typically, the patient is vulnerable due to age or condition, and bacteria simply enjoy the situation. Surgery latent infections, and burns can all cause blood poisoning, which is a very good reason to keep any infections to ensure they do not spread. A case of sepsis begins with bacteria that produce toxins in the bloodstream, causing blood clotting, the body tries to fight against bacteria.

 

MENINGOCOCCAL SEPTICAEMIA 

 

Meningococcal septicemia (blood poisoning) - This is the most dangerous and deadly of the two diseases. It occurs when bacteria enter the bloodstream and multiply uncontrollably, damaging the walls of blood vessels and cause bleeding under the skin. The disease is called sepsis and meningitis is usually associated with the eruption of purple. Sepsis can cause death within hours, or permanent disabilities such as scars and amputations. See the animation below shows how it travels through the blood system. 

MENINGOCOCCAL SEPTICAEMIA 

 

The disease is carried in asmptomatically 50-20% of the population. It is found worldwide in the five major serogroups. Meningococcal group A causes epidemic disease in sub-Saharan Africa and parts of Asia. Groups Y and W also cause an infection outbreak. B and C tend to cause sporadic infections in Europe and North America. The disease occurs only in a small percentage of those colonized. It depends on both host and bacterial factors and are more likely following viral upper respiratory tract. Man is the only known reservoir of disease. Meningococcal disease occurs when bacteria invade the nasal mucosa and into the bloodstream.

 

TULAREMIA 

 

Tularemia, also known as "rabbit fever", is a disease caused by the bacterium Francisella tularensis. Tularemia is typically found in animals, especially rodents, rabbits and hares. Tularemia is a disease usually in rural areas and has been reported in all states of the United States except Hawaii. Typically, people infected by the bites of infected insects (most commonly, ticks and horseflies) by handling infected sick or dead animals, eating or drinking contaminated food or water by respiration bacteria from the air.

Tularemia

 

Its  a common  widespread disease in animals. About 200 human cases of tularemia are reported each year in the United States. In most cases occur in parts of south-central and western states. Almost all cases occur in rural areas, and those resulting from bites of ticks and biting flies or handling infected rodents, rabbits or hares. Cases the result of breathing the bacteria into the air and laboratory accidents. people develop symptoms depends on how they are exposed to tularemia. Possible symptoms include skin sores, swollen lymph nodes, painful, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If bacteria are inhaled, symptoms may include sudden onset of fever, chills, headache, muscle aches, joint pain, dry cough and progressive weakness. People with pneumonia can develop chest pain, difficulty breathing, spitting blood and respiratory failure. Rabbit fever can be fatal if the person has not been treated with appropriate antibiotics.

 

Francisella tularensis is highly contagious. A small number of bacteria (10-50 organisms) can cause disease. If Francisella tularensis were used as a bioweapon, the bacteria were probably made in the air to be inhaled. People who inhale the bacteria can experience severe respiratory diseases like pneumonia and systemic infection serious if not treated.

 

The incubation period (time to be exposed to fall ill) for tularemia is usually 3-5 days, but can vary from 1-14 days. If you think you have been exposed to tularemia bacteria, consult a doctor quickly. Treatment with antibiotics for a period of 10-14 days or more after exposure may be recommended. If you have any antibiotics, it is important to take following the instructions you receive. All medications you take, be taken.

 

 

Bacteremia

Bacteremia can follow surgery ,dental treatment and even tooth brushing .The transient presence of organisms in the blood can occur in healthy people 

SYSTEMIC / MULTISYSTEM INFECTIONS 

Many infections are limited to a body organ or system Especially because the body's metabolic needs that may route of infection, or infections defences.Other o host response may affect multiple systems, or whole body . Under unusual situations host immunity as amended, infections, usually related can become systemic. we are describing infections that typically cause systemic disease in an immunocompetent host.

BACTERAEMIA 

Bacteremia occurs when bacteria enter the bloodstream. This can occur through a wound or infection, or surgery or injection. Bacteremia may cause no symptoms and resolve without treatment or can cause fever and other symptoms of infection. In some cases, the bacteria leads to septicshock, potentially life-threatening condition.

Number of live bacteria on the skin or colonize the moist linings of the urinary tract, lower gastrointestinal tract and other internal surfaces. These bacteria are generally harmless, on how to control the body's natural barriers and the immune system. People in good health with strong immune systems rarely develop bacteremia. However, when bacteria directly from the circulatory system, particularly personwho is sick or aggressive treatment, maynot immune systems can cope with the attack, and symptoms of bacteremia may develop. For this reason, bacteremia is more common in people who have already or treat other medical problems. Furthermore, medical care can add a personal touch of new bacteria, which are invasive than those already residing in the human body, thus increasing the likelihood of bacterial infection.

The bacteria most likely to cause bacteremia include members of Staphylococcus, Streptococcus, Pseudomonas, Haemophilus and Escherichia coli (E. coli) genera. Bacteremia is diagnosed by blood culture for bacteria. The samples may be needed repeatedly tested for several hours. The blood test may also reveal elevated white blood cells. Blood pressure should be closely watched, a decrease of blood pressure may indicate an incipient septic shock. Antibiotics are the cornerstone of treatment and are often initiated before the positive identification of the bacteria are made. Careful observation is necessary to protect against septic shock. Since bacteremia is usually associated with infection from elsewhere in the body, detect and treat this infection is an  important part of treatment.