General - Questions and Answers

The questions and answers in this chapter are available to subscribers as part of the Oxford eLearning platform. To access the questions, follow the link below, or go to http://oxford-elearning.oup.com/books http://oxford-elearning.oup.com/books/test/24/10.1093/med/9780199827626.003.0104

Etiologic Agents - Questions and Answers

The questions and answers in this chapter are available to subscribers as part of the Oxford eLearning platform. To access the questions, follow the link below, or go to http://oxford-elearning.oup.com/books http://oxford-elearning.oup.com/books/test/24/10.1093/med/9780199827626.003.0100

Travel Medicine

Travel between developing countries and developed countries is increasing every year. Approximately 880 million passengers arrived at international airports in 2009. The increase in travel to Africa has outpaced the increase for all other regions by almost twice, with the rate of growth reaching 8.1% in 2006. Asian and Pacific Rim countries continue to hold substantial travel interest. Travel to the Middle East has kept pace with travel growth despite the political instability there. More people are traveling to destinations that present higher risks of infectious diseases. Knowledge of prevention measures for preventable diseases becomes increasingly important. Management of posttravel illness becomes increasingly important. Subjects covered include preparation for travel, deep vein thrombosis prevention, motion sickness, jet lag, altitude sickness, vaccination and immunization, and traveler's diarrhea.

Obstetric and Gynecologic Issues Related to Infectious Diseases

Infection is the most common complication during pregnancy and the postpartum period. Choices are limited for antibiotic therapy are limited. One must take into account the effect of pregnancy on serum levels, distribution of antibiotics, placental transfer, the fetus, the newborn, excretion in milk, the breast-feeding infant. Antimicrobial therapy is selected on the basis of experience and guidelines. Diagnosis and treatment of urinary tract infections, bacterial vaginosis, preterm labor, preterm rupture of membranes, intra-amniotic infection, and major perinatal and puerperal infections are reviewed.

Health Care–Associated Infections

Health care–associated infection (HAI) is an infection that occurs in hospitals, nursing homes, clinics, or home health care programs. Infection control departments have been constituted to prevent and control infectious complications in health care settings. Prevention and control require combinations of education and training, procedures and policies, surveillance and reporting, and interventions that include isolation and teamwork. Common HAIs (nosocomial infections) include urinary tract infections, surgical site infections, bloodstream infections, and ventilator-associated pneumonia. Diagnosis and treatment of each type of infection are reviewed.

Infections in Patients With Hematologic Malignancies

The clinical approach to patients with hematologic malignancies and infection requires definition of several patient factors (immunologic competence [or defect], residential environment, and the syndrome), infection factors (its type, location, progress, and pathogen), and treatment factors (medical or surgical or both). Management of patients with hematologic malignancies and infection requires knowledge of general infectious diseases and factors pertaining to the hematologic malignancy, pathophysiology of the hematologic malignancy, types of antineoplastic chemotherapy used in treatment, and immunologic effects of both the malignancy and the associated chemotherapy, and complications and toxicities of both the malignancy and the associated chemotherapy. Diagnosis and treatment of specific infections are reviewed.

Sepsis Syndrome

Systemic inflammatory response syndrome (SIRS) is the specific host systemic response that may be elicited by various stimuli, including infection, burns, pancreatitis, ischemia, trauma, hemorrhage, immune-mediated tissue injury, and exogenous stimuli. 2. Sepsis is SIRS resulting from infection. Sepsis syndrome is sepsis with altered tissue perfusion of vital organs (resulting in oliguria, hypoxemia, elevated levels of lactate, or altered mentation or any combination of these conditions) When a patient has SIRS, the objective is to define its cause. If SIRS is caused by infection, appropriate antibiotics must be administered and supportive care guided by the patient's history and physical examination.

Pneumonia

There are 2 basic types of pneumonia: community-acquired pneumonia and nosocomial pneumonia. Community-acquired pneumonia is an acute infection of the pulmonary parenchyma acquired while the patient was in the community rather than in a hospital. Older or immunosuppressed patients with CAP may present with nonrespiratory symptoms: confusion, failure to thrive, worsening of an underlying chronic illness, or falls. Nosocomial pneumonia: pneumonia that develops more than 48 hours after admission to a health care facility and which was not incubating at the time of admission. Prevention, diagnosis, and treatment are also reviewed.

Parasitic Infections

This chapter covers protozoa, helminths, and arthropods. 1. Protozoa are single-celled, microscopic eukaryotic organisms like amebae and Giardia. Helminths are parasitic worms including nematodes (roundworms), cestodes (tapeworms), and trematodes (flukes). Arthropods, like ticks and mites, are generally considered parasites. Specific organisms reviewed include Giardia lamblia, Cyclospora cayetanensis, Blastocystis hominis, Entamoeba histolytica, Plasmodium falciparum, Babesia microti, and Toxoplasma gondii. Diagnosis and treatment of different types of infection are also reviewed.

Paracoccidioides brasiliensis

Paracoccidioides brasiliensis is found only in Latin America. It is endemic in Mexico, Central America, and South America. Most cases (80%) have been reported from Brazil, followed by Venezuela, Colombia, Ecuador, and Argentina. Most cases occur in tropical and subtropical forests, where temperatures are mild and humidity is high throughout the year. Infection can be asymptomatic or can cause mucosal lesions involving the mouth, lips, tongue or nose. It can also cause lymphadenopathy, dyspnea, cough, and skin lesions. Diagnosis and treatment are also reviewed.