Symptomatic meningitis (headache, stiff neck) occurs in up to 15% of patients and resolves without sequelae in 3-10 days. ... It may mimic appendicitis. ... source
Drug Induced Meningitis (DIAM)
Drug induced aseptic meningitis (DIAM) citations
Amoxicillin-induced aseptic meningitis Citation
Drug-induced aseptic meningitis
S aureus and S intermedius are coagulase positive. All other staphylococci are coagulase negative
Staphylococcus albus
most strains express a fibrin/fibrinogen binding protein (clumping factor) in aureus
Staphylococcus aureus and the coagulase negative staphylococci can be differentiated by their ability to coagulate blood plasma, with S. aureus being coagulase positive.
Gram-Negative Bacteria
Constitute the largest group of human pathogens
Due in part to the presence of lipid A in the bacterial cell wall
Triggers fever, vasodilation, inflammation, shock, and disseminated intravascular coagulation (blood clots within blood vessels)
Almost every Gram-negative bacterium that can breach the skin or mucous membranes, grow at 37C, and evade the immune system can cause disease and death in humans
Pseudomonas?
STAPHYLOCOCCUS AUREUS
Produces Coagulase which clots plasma Coagulase: thrombin like activity
Staphylococcus epidermidis: = Coagulase negative AUREUS: They show reduced or no growth on media. Certain drugs (SXT, barbiturates) induce their growth
Cystitis is a bacterial infection of the bladder or lower urinary tract. = Cystitis - acute bacterial
Plates that show no growth at 24 hours should always be incubated another day and read again.
Normal values depend on the test being performed. Normal results are reported as "no growth" and indicate an absence of infection.
Proteus
The finding of nitrite positivity by dipstick testing is an indirect method of detecting bacteriuria. Apos- itive test is specific, but a negative test may be a false-negative for several reasons. If urine has been in the bladder a short time, there may have been insufficient time for reduction of nitrate to nitrite by the bacterias reductase enzymes
Between 2-5% of women's visits to primary care doctors are for UTI symptoms. In some cases, hemorrhagic cystitis is a side effect of radiation therapy
Cystitis is defined as inflammation of the urinary bladder.
Cystitis (UTI, Bladder Infection) Cystitis is an inflammation of the bladder due to infection with a microorganism (such as a bacteria or virus). Cystitis is second only to respiratory infections in frequency.
Urinary Tract (Kidney and Bladder) Infections
IATROGENIC CYSTITIS: Induced by radiation or chemotherapy. Also known as hemorrhagic cystitis.
Aneurysms in adults are more common in women and the risk increases with age. Acquired aneurysms are often due to trauma, infections or iatrogenic in nature. The risk for multiple aneurysms is higher in women.
An irregular heart beat (atrial fibrillation) can give rise to tiny blood clots, which can lodge in the brain and cause strokes
Diagnose-Me: Condition: Endocarditis
The hallmark of the staphylococcal infection is the abscess, which consists of a fibrin wall surrounded by inflamed tissues enclosing a central core of pus containing organisms and leukocytes. From this focus of infection, the organisms can be disseminated hematogenously even from the smallest abscess. The ability to elaborate proteolytic enzymes facilitates the process. This can result in pneumonia, bone and joint infection, and infection of the heart valves. In the immunocompromised host, such as the neutropenic cancer patient with a central venous line, serious complications or fatal sepsis can occur in 20-30% of cases following catheter-related S aureus bacteremia.
coagulase-negative staphylococci will generally be considered to represent contamination - The microorganisms are the same uropathogens as found in UTIs
The Coroner, Dr. McLellan said there was "no encephalopathy". He lied. The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness. Other neurological symptoms may include myoclonus (involuntary twitching of a muscle or group of muscles), nystagmus (rapid, involuntary eye movement), tremor, muscle atrophy and mild diffuse weakness, dementia, seizures, and loss of ability to swallow or speak.
Encephalopathy with staphylococcal endocarditis: multiple neuropathological findings.
Complications of TSS include acute renal failure, adult respiratory distress syndrome, disseminated intravascular coagulation, electrolyte disturbances, cardiomyopathy, and encephalopathy. Toxic encephalopathy probably related to cerebral edema.
Iatrogenic Endocarditis related to intravenous drug - S aureus is the most common (<50% of cases) etiologic organism. Other causative organisms include streptococci, fungi, and gram-negative rods (eg, pseudomonads, Serratia species).
COMPARE: subacute bacterial endocarditis with multiple brain abscesses If bacterial endocarditis is not adequately treated, it can be fatal. This is dependent on the infecting organism. Even when treated, further damage to a heart valve may result in heart failure. In addition, blood clots can form and travel throughout the bloodstream to the brain or lungs. Arteries may become blocked if accumulations of bacteria and blood clots on the valves (called vegetations) break loose (becoming emboli), travel through the bloodstream to other parts of the body, and lodge in an artery, blocking it. Blockage of an artery to the brain can cause a stroke, and blockage of an artery to the heart can cause a heart attack. Emboli can also cause an infection in the area in which they lodge. Collections of pus (abscesses) may develop at the base of infected heart valves or wherever infected emboli settle. Heart valves may become perforated and may start to leak (causing regurgitation) significantly within a few days. Some people go into shock, and their kidneys and other organs stop functioning (a condition called septic shock).
Infections in arteries can weaken artery walls, causing them to bulge or rupture. A rupture can be fatal, particularly if it occurs in the brain or near the heart. Symptoms of acute and subacute bacterial endocarditis may include chills, joint pain, paleness (pallor). Other symptoms can also include blood in the urine (hematuria). When the number of is large enough, endocarditis can develop, even in people who have normal heart valves.
Submit a case in point where an ovarian cyst which suppurated into an abdominal abscess due to Staph. aureus; the Staph. aureus could have resulted in a bacteraemia with metastatic spread to the heart causing mitral valve endo-carditis, which in turn was complicated by metastatic spread of Staph. aureus to the brain resulting in brain abscesses.
Single or multiple abscesses within the brain, usually occurring secondary to a focus of infection outside the central nervous system. May mimic brain tumor but evolves more rapidly (days to a few weeks). It starts as a cerebritis, becomes necrotic, and subsequently becomes encapsulated: Afebrile or low-grade fever; Bacteremia from lung abscess, pneumonia, etc: Most common infective organisms - streptococci, staphylococci, enteric gram-negative bacilli and anaerobes (usually same as source of infection), Nocardia
Although bacteremia due to gram-negative bacilli is unlikely to cause endocarditis unless a prosthetic valve is present, it may nevertheless cause life-threatening sepsis. Further, the rate of bacteremia following urinary tract procedures is high in the presence of urinary tract infection (UTI).
Compare: Suddenly Weak and Dizzy with the deceased's ECG. View eMedicine ECG Cases and arranged by diagnosis.
The Cardiologist and the Internet
Vascular Protection Presentation
EKG (ECG) Tracings for Education and Reference
NO GROWTH, presentation taken from BRAIN ABSCESSES
Urinalysis cannot
substitute for urine culture to document the presence of UTI
Urine hCG tests may give a false negative result in very dilute urine.
streptococcal urinary tract infection
gives a false negative nitrite result.
Ascending infection in UTI can occur, leading to pyelonephritis, renal failure and sepsis.
TEN: Surviving patients completely heal in 3 to 4 weeks, but up to 50% will have residual, potentially disabling ocular lesions. - Accumulated clinical evidence points to drugs as the most important, if not the only, cause of toxic epidermal necrolysis. The eyes may become very painful, swell, and become so filled with pus that they seal shut.
Ocular Gyric Crisis: eyes roll back, jaw drops, tongue falls back
Oculogyric crisis - spasm of extra-ocular muscles, forcing the eyes into upward or lateral gaze. Oculogyric crisis Eyeball(s) become fixed in one position for minutes to hours. Extrapyramidal Symptoms
Stevens-Johnson syndrome is an extreme allergic reaction, usually to a drug, but also to certain bacterial and viral infections.
Pseudomonas infections of the eye cause ulcers that may spread to cover the entire eye, pain, reduced vision, swelling of the eyelids, and pus accumulation within the eye.
Behcets disease
Meningoencephalitis Information
In February 2000, Health Canada organized a National Steering Committee to develop a coordinated approach to respond to West Nile virus.
An Unusual Bacterium Causing a Brain Abscess
Major bacteria that cause meningitis are streptococcus, Haemophilus influenzae, staphylococcus and meningococcus.
West Nile virus
Role For Staph's Toxic Shock Toxin
Invasive Gastroenteritis SAME SYMPTOMS
The activation of T cells, mediated by the T-cell receptor (TCR), activates a battery of specific membrane-associated, cytosolic and nuclear proteins.
T cell activation and immune responses.
Hypotension: systolic blood pressure < 90 mm Hg (adults) or < 5th percentile for age (children under 16 years of age), or orthostatic hypotension, dizziness or syncope
Soft tissue infections with toxin-producing bacteria can lead to toxic shock syndrome.
The hallmark of the staphylococcal infection is the abscess, which consists of a fibrin wall surrounded by inflamed tissues enclosing a central core of pus containing organisms and leukocytes.
in patients who have congenital or acquired cellular immune deficiencies, fatal disseminated infection or B-cell lymphomas can occur.
P aeruginosa - Number 3-ranked isolate in hospital-acquired UTIs - Second most frequent cause of brain abscess and meningitis in patients with cancer
Second most frequent cause of brain abscess and meningitis in patients with cancer
Failure to determine early empiric antibiotic coverage for possible pseudomonal infections
The location of the reaction within the skin will determine characteristics of dermatologic manifestations
Clinical manifestations of TSS range from a mild, trivial disease, often misdiagnosed as a viral syndrome, to a rapidly progressive, potentially fatal, multisystem illness. Criteria for the diagnosis of TSS are defined in the case definition. (See Table 10.) In this regard, the typical patient with TSS will present with erythroderma, fever, hypotension, and other evidence of organ involvement. A prodrome of fever, chills, arthralgias, myalgias, nausea, vomiting, and diarrhea may precede the more dramatic manifestations of the syndrome by 2-4 days. The majority of patients are hospitalized after 1-2 days of active illness. In addition to the characteristics listed in the case definition, TSS also is identified by its sudden onset and rapid progression to multisystem dysfunction
Immunologic and Toxin-Mediated Syndromes
The Sepsis Syndrome: Differential Diagnosis of the Flu-Like Illness
The most important distinction among staphylococci is whether or notthey produce the enzyme coagulase. S. aureus is the most common pathogen among the catalase positive gram positive cocci and is differentiated from other staphylococci by the coagulase test. Here the bacterial cells have been suspended in a drop of rabbit plasma. Coagulase bound to the cell wallacts on fibrinogen and causes the clumping of the bacteria. Coagulaseis an important virulence factor of S. aureus.
Staphylococci cause abscesses, boils, and other infections of the skin, such as impetigo. They can also produce infection in any organ of the body (e.g., staphylococcal pneumonia of the lungs).
Metastatic abscesses may occur almost anywhere and, when extensive, produce symptoms and signs characteristic of infection in the affected organ. Multiple abscess formation is especially common with staphylococcal bacteremia. Between 25 and 40% of patients with persistent bacteremia develop hemodynamic instability and therefore represent cases of septic shock.
One hypotheses is that the patient may have had an ovarian cyst which suppurated into an abdominal abscess due to Staph. aureus; the Staph. aureus may have resulted in a bacteraemia with metastatic spread to the heart causing mitral valve endo-carditis, which in turn was complicated by metastatic spread of Staph. aureus to the brain resulting in brain abscesses.
Electrolyte abnormalities are the hallmark of chronic renal failure. ...
Relationship between hypertension and renal function
Dehydration in older patients may cause renal failure.
Patients with prerenal azotemia present with severe dehydration =
Diabetes Insipidus
leads to excretion of large volumes of dilute urine
Patients excrete dilute urine until they are hypovolemic, then AVP is released, resulting in hypernatremia with concentrated urine.
(From Wikipedia, the free Encyclopedia)
Diabetes insipidus (DI), actually water diabetes, is a disease characterized by excretion of large amounts of dilute urine, which disrupts the body's water regulation.
This fluid "overload" can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain.
The term Diabetes Insipidus refers to an abnormal state of water diuresis (as opposedto an abnormal state of osmotic diuresis, as in diabetes mellitus); DI is characterized by alarge volume of dilute urine (hypotonic polyuria) associated with increased fluid intake(polydipsia). It is now known that there are four types of DI: (1) neurogenic (or central)DI, where the water diuresis results from a deficiency of the antidiuretic hormone (ADH),often referred to as AVP (arginine vasopressin); (2) nephrogenic DI, where the waterdiuresis results from an inability of the kidneys to respond to ADH; (3) primary polydipsicDI (or primary polydipsia) in which the water diuresis is due to suppression of ADH byexcessive fluid intake [the high intake can result from abnormal thirst (dipsogenic DI), frompsychological or emotional disturbances (psychogenic DI) or from fashionablebutscientifically unprovenbeliefs in the benefits of a high fluid intake (iatrogenic DI)]; (4)gestagenic DI, which occurs only during pregnancy and is due to destruction of vasopressin by the placenta.
One Caveat: common manifestations of hypernatremia are non-specific, and include muscular twitching, hyperreflexia, spasticity, and seizures.
Diabetes insipidus: Excessive output of very dilute urine can result in large free water losses and severe hypernatremic dehydration.
While the abscess cavity may be significant, the associated edema pattern is often a greater factor in producing midline and transtentorial shifts.
Limitations of Techniques: Plain radiographs of the paranasal sinuses can only suggest a possible etiology for cerebral abscess. Early findings of CT examinations are not specific for cerebral abscess. The edema pattern and moderate mass effect cannot be differentiated from tumor or stroke in some patients. MRI findings in patients with cerebritis may resemble findings in stroke, while findings in the infarcts that result from vasculitis and cerebritis may resemble those of embolic strokes. Nuclear medicine single photon emission computed tomographic (SPECT) findings are not specific for brain abscess unless a white cell tag is used.
Failure to administer double-coverage antibiotics for potentially life-threatening pseudomonal infections
Failure to monitor adverse effects of treatment
