Bacterial Infections of Wounds
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Transcript Bacterial Infections of Wounds
Review from last lecture
Skin Infections:
Contrasting Staph aureus with Strep pyogenes
Folliculitis, boils and carbuncles
Rocky mountain spotted fever (R. rickettsii)
Lyme disease (B. burgdorferi)
Anthrax (Bacillus anthracis)
Bacterial infections of Wounds:
Tetanus (C. tetani)
Gangrene (C. perfringens)
Burn infections (P. auerginosa)
Actinomycosis (A. israelii)
Sexually-transmitted Diseases
Denise Kirschner,PhD
Dept of Micro/Immuno
MICRO 532 Nov 29, 2001
Outline
Epidemiological principles of STDs
UTI/Bladder infections
Infections of mucosal surfaces
Neisseria gonorrhea and Chlamydia trachomatis
Ulcerative Infections
Syphilis (T. pallidium) and Chancroid (H. ducreyi)
General uro-genital tract information
More female infections that males
Urine is sterile
Above bladder entrance-sterile, below lots of
IM: Lactobacillus, Staphylococcus, Cornybacterium,
Haemophilus, Streptococcus, Bacteriodes
Urinary tract infections (UTI):
More than 100,000 bacteria/ml indicated
Bladder infection
Catherization is the major cause of infection (usually IM)
Intercourse (for women)
Sexually-transmitted Diseases
Mucosal infections
• gonorrhea
• chlamydia
Ulcerative infections
• herpes simplex
• syphilis
• chancroid
• LGV
Proliferative infections
• papillomavirus
Systemic infections
• HIV
• hepatitis B
Epidemiologic Principles of STDs
Occurrence of STDs in the U.S.
Disease
Incidence Prevalence
-Chlamydia
4,000,000
-Gonorrhea
1,400,000
Papillomavirus
800,000 45,000,000
Herpes simplex
300,000 30,000,000
Syphilis (primary) 50,000
(all stages) 100,000
100,000
HIV
70,000
1,500,000
Chancroid
~4,000
?
Trends in common STDs
500
400
chlamydia
gonorrhea
syphilis
chancroid
300
200
60
40
100
20
0
1950
1960
1970
1980
Year
1990 1995
1980
1990 1995
Note: 60% of all N. gonorrhea infection are ages 15-24
Determinants of STD Morbidity
Rate of transmission
Sexual behavior (rate of
new partner acquisition)
Duration of infectivity
Factors That Affect the Transmission of STDs:
• Age
• Gender
• Genetic susceptibility
• Sexual practices
• Contraceptive and
"hygienic" practices
• Circumcision
Determinants of the
Duration of Infectivity in STDs
Etiologic agent
tendency to asymptomatic
carriage
antimicrobial resistance
Access and utilization of the
health care system
Compliance with therapy
Contact tracing
Theoretical Structure of an STD Core Group
PPNG in Colorado Springs,
Dec. 1989 - Dec. 1991
- not gang-related
- gang-related
C
A
S
E
S
D J F M A M J J A S O N D J F M A M J J A S O N D
PPNG Outbreak,
Colorado Spgs., 1989-91
56 cases in a 2-year period
Traced to a network of 578 persons
• 410 (218 males and 192 females) were affiliated with a
street gang that moved to the area in May 1988.
Mean age: females (19.7 yrs); males (21.5 yrs)
Prominent behaviors among females: multiple
partners, heavy crack use, drugs for sex
CO-INFECTIONS
Relevance of STD Co-infections
May identify a core group member
STDs increase transmission of HIV
ulcerative and mucosal infections only
Effect of HIV on expression of STDs
i.e., a "sentinel event"
accelerates HPV-associated tumors
facilitates spread of gonococcus
alters the natural course of syphilis
Presumptive therapy
80-90% of college men with 1 STD have
others (50% with Chlamydia)
Infections of mucosal
surfaces
Infections caused by
gonococci and chlamydiae
urethritis
cervicitis
epididymitis
proctitis
pharyngitis
eye infection
+
+
>
+
>>
Epidemiologic characteristics of
chlamydial and gonococcal infections
GONOCOCCUS
PATIENT AGE
teenagers > young adults
CHLAMYDIA
teenagers > young adults
SEXUAL HISTORY usually acquired from a
recent contact
may have been acquired
in the remote past
ASX INFECTION
(male)
~ 50% of infected sexual
partners
~ 5% of infected males
( higher in some areas)
ASX INFECTION
(female)
ASX=asymptomatic
50 - 80% of
infected females
~ 50% of infected sexual
partners
Microbiology of gonorrhea
Strict human pathogen
Gram-negative diplococcus
Adherent- pilus (antigenic variation)
IgA protease (cleaves IgA)
Oxidase-positive
Fastidious growth
Modified Thayer-Martin media (VCN)
Virulence determinants of
Neisseria gonorrhoeae
pilus colonization factor--> antigenic variation
opa proteins-------------------> phase variation
lipooligosaccharide--------->antigenic variation
IgA1 protease
transferrin/lactoferrin binding proteins
intracellular environment?
Treatment of gonococcal
infections
PPNG
Tetracycline resistance
Quinolone resistance
Single-dose treatment options for
uncomplicated disease:
1944 10^5 units of penicillin
1970 10^7 units
Resistance (R plasmids)
PPNG strain
Microbiology of
Chlamydia trachomatis
Obligate intracellular bacteria
Not G+/G- (lacks part of LPS)
Complex, 2-stage life cycle
Elementary body (spore like)
Reticulated body (vegetative like)
Treatment: antibiotics:
tetracyclines (not penicillin-why?)
Chlamydial infections
urethritis (NGU)
epididymitis
proctitis
mucopurulent cervicitis
pelvic inflammatory disease
trachoma (serotypes A-C)
LGV (L1, L2, L3)
50-60% of women with
infertility have serologic
evidence of chlamydia or
gonococcus, but no history of
symptoms!
Ulcerative infections
Frequency of genital ulcer
infections
HSV>>syphilis>>chancroid
Distinguishing features of
genital ulcers
anatomical location
multiplicity
pain
induration
Microbiology of syphilis
Treponema pallidum
spirochete -- labile spiral
bacterium with axial filaments
man is the only recognized
host
non-cultivable
Gram-negative like
T. pallidum darkfield examination
% reactive cases
iary
ge
Manifestations of 1° Syphilis
Chancre (may be unnoticed)
painless, but tender
indurated
highly contagious
rapid dissemination
motility of the organism?
Congenital
MANIFESTATIONS OF SECONDARY SYPHILIS
Rash
Lesions
mucous patches
Fever
Natural history of secondary
syphilis
1/3
Secondary
infection
1/3
1/3
spontaneous
resolution
infected without
clinical disease
tertiary syphilis:
Neurosyphilis
DTH
Organisms rare
Syphilis- principles of
treatment
T. pallidum is exquisitely sensitive to
penicillin
Dosing and penicillin formulation
used depends on the stage of the
disease
Microbiology of chancroid
Haemophilus ducreyi
Gram-negative coccobacilli
fastidious and labile
Diagnosis is usually clinical, by
exclusion of other agents of
genital ulcers
Epidemiology and treatment of
chancroid
CDC reported a 10-fold increase in
incidence from 1978 - 1987
10% of patients are co-infected with
either HSV or T. pallidum
Males >> females
Occurs in sustained, urban outbreaks
Associated with female commercial sex
workers and “sex-for-drugs” trade
TREATMENT: sensitive to ceftriaxone or
azithromycin in single dose