Transcript Diseases of Cardiovacular and Lymphatic Systems

Diseases of Cardiovacular and
Lymphatic Systems
Rheumatic Fever
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Caused by Streptcoccus pyogenes
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Generally starts out as sore throat caused by Strep. “bug”
Signs and symptoms:
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First expressed as a period of arthritis and fever
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Subcutaneous nodules at joints often accompany this stage
50% afffected, experience inflammation of heart probably due
to misdirected immune reaction against infection
Causes damage to heart valves
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Treatment
Treatment of rheumatic fever involves a dual approach —
antibiotics to rid your body of streptococcal infection and prevent
recurrences, and other medications to ease the symptoms of the
disease.
To eliminate any remaining strep bacteria once you have
rheumatic fever, your doctor may prescribe penicillin or another
antibiotic. Usually, you'll then need to be on some kind
suppressive schedule of antibiotics for several to many years to
prevent second attacks of rheumatic fever.
Tularemia
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Francisella tularensis, the organism that causes tularemia, is one
of the most infectious pathogenic bacteria known, requiring
inoculation or inhalation of as few as 10 organisms to cause
disease. It is considered to be a dangerous potential biological
weapon because of its extreme infectivity, ease of dissemination,
and substantial capacity to cause illness and death.
Francisella tularensis is a hardy non-spore forming organism that
is capable of surviving for weeks at low temperatures in water,
moist soil, hay, straw or decaying animal carcasses.
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Tularemia is a zoonosis. Natural reservoirs include small mammals such
as voles, mice, water rats, squirrels, rabbits and hares. Naturally acquired
human infection occurs through a variety of mechanisms such as: bites of
infected arthropods; handling infectious animal tissues or fluids; direct
contact or ingestion of contaminated water, food, or soil; and inhalation of
infective aerosols. F. tularensis is so infective that examining an open
culture plate can cause infection.
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Humans can contract tularemia in the following ways:
direct contact with an infected animal or carcass via broken skin
the bite of an infected flea or tick
ingesting infected meat (rare)
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Symptoms
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red spot on the skin, enlarging to an ulcer
enlarged lymph nodes of groin or armpits
headache
muscle pains
possible conjunctivitis
shortness of breath
fever
chills
sweating
weight loss
joint stiffness
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Treatment
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The goal of treatment is to eliminate the infection with antibiotic
therapy. Streptomycin and tetracycline are commonly used in
this infection.
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Tularemia is fatal in about 5% of untreated cases and in less
than 1% with treatment.
Complications
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meningitis
pneumonia
pericarditis
Anthrax
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Anthrax is an infectious disease caused by the spore-forming bacteria
called Bacillus anthracis.
Infection in humans most often involves the skin (cutaneous anthrax), the
gastrointestinal tract, or the lungs (inhalation anthrax).
Cutaneous anthrax is an infection of the skin with anthrax.
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The disease occurs after the bacteria contact skin cuts or abrasions.
Usually within two weeks, an itchy skin lesion develops (similar to an insect
bite).
This lesion may later blister and then break down, resulting in a black ulcer
which is frequently painless. The skin lesion is usually surrounded by
significant swelling.
Sometimes painful lymph nodes may develop. A scab is often formed which
then dries and falls off within two weeks.
In 20% of UN-treated individuals, the infection may spread through the
bloodstream and become fatal. However, in most individuals who receive
appropriate treatment, death from cutaneous anthrax is extremely rare.
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Inhalation anthrax develops when anthrax spores enter the lungs.
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A person may have spores in the nasal passages (which indicates
exposure), but that doesn't mean they will get the disease. In fact, antibiotic
therapy following known or suspected exposure can help prevent the
disease.
In order for a person to develop the actual disease, the spores must
germinate -- a process which may take several days, or even up to 60 days
to occur.
The spores move to the lymph nodes, and once they germinate, lead to the
release of several toxic substances (toxins).
This results in hemorrhage, swelling, and tissue death. The main form of
inhalation anthrax includes hemorrhagic infection of the lymph nodes in the
chest (hemorrhagic mediastinitis).
Up to half of affected individuals may also have a hemorrhagic meningitis.
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There are usually two stages of inhalation anthrax –
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the first stage can last from hours to a few days and is similar to a flulike illness with fever, headache, cough, shortness of breath, and
chest pain.
The second stage often develops suddenly and is notable for
shortness of breath, fever, and shock. This second stage is highly
fatal in up to 90% of individuals because of the build-up of toxins.
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Symptoms
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Cutaneous anthrax: papule, blister, ulcer with black
scar with extensive surrounding swelling
Inhalation anthrax: Initial stage -- fever, malaise,
headache, cough, shortness of breath, and chest
pain; Second stage -- fever, severe shortness of
breath, and shock
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Treatment
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The mainstay of treatment is early antibiotic therapy. Several
antibiotics are effective, including penicillin, doxycycline, and
ciprofloxacin (Cipro).
If an outbreak of anthrax is suspected, the antibiotic of choice is
ciprofloxacin, until it is known whether the anthrax strain is resistant
to any of the other usual antibiotics.
Because spores may take up to 60 days to germinate, the length of
treatment is usually 60 days.
For inhalation anthrax, people with known or suspected exposure
would be given oral antibiotics (pills).
If a person develops symptoms of the disease or has a positive test
for the disease itself (not just a test for "exposure"), antibiotics
would be given intravenously (IV) for 14 days, then orally for the
rest of the 60 days.
Cutaneous anthrax is treated with oral antibiotics (pills).
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The prognosis of cutaneous anthrax treated
with antibiotics is excellent. However, in the
absence of antibiotics, up to 20% of individuals
may die as anthrax may spread into the
bloodstream.
The prognosis of inhalation anthrax once it
reaches the second stage is poor, even with
antibiotic therapy. Up to 90% of cases in the
second stage are fatal.
Cat-scratch Disease
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Cat scratch disease is an infectious illness caused by the bacteria
Bartonella, believed to be transmitted by cat scratches, bites, or
exposure to cat saliva.
More than 40,000 cases occur annually in the US
Symptoms
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A history of contact with a cat
Common
Papule or pustule at site of injury (inoculation), usually the first sign
Swelling of the lymph nodes (adenopathy) occurs in the area near
where the skin was infected (bitten, scratched, etc.)
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Fever in approximately one third of patients
Fatigue
Malaise
Headache
Treatment
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Generally, cat scratch disease is not serious.
Treatment, other than reassurance, is not usually
recommended. However, in severe cases treatment
with antibiotics can be helpful.
Plague
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Plague is transmitted among rodents and to
humans by flea bite or ingestion of the feces of
fleas. It can also be transmitted human to
human when a plague victim develops
pneumonia and spreads infected droplets by
coughing. An epidemic may be started this
way.
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Symptoms
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Sudden onset of high fever
Chills
General discomfort, uneasiness, or ill feeling (malaise)
Muscular pains
Severe headache
Smooth, oval, reddened, painful swellings of swollen lymph
glands called buboes in the groin, armpits, neck, or
elsewhere in the body. Pain may occur in the area before the
swelling; the most common area is in the groin
Seizures
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Treatment
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Immediate treatment with antibiotics such as streptomycin,
chloramphenicol, or tetracycline is indicated.
Oxygen, intravenous fluids, and respiratory support are
additional treatments.
Patients with pneumonic plague are strictly isolated from
other patients.
People who have had contact with anyone infected by
pneumonic plague are observed closely and are given
antibiotics as a preventive measure.
Prognosis
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Half of bubonic plague victims die if not treated, and almost
all victims of pneumonic plague die if not treated. Treatment
reduces the death rate to 5%
Typhus
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Typhus is a rickettsial disease caused by one of two organisms,
Rickettsia prowazekii (epidemic typhus and Brill disease) and
Rickettsia typhi (murine or endemic typhus). Epidemic typhus and Brill
disease are uncommon in the United States.
Murine typhus occurs in the southeastern and southern states. There
are less than 100 cases per year. Murine typhus is a milder form and
is seldom fatal (less than 2%).
It is frequently seen in the summer and fall and typically lasts two to
three weeks. Risk factors for murine typhus include exposure to rat
fleas or rat feces, or exposure to other animals (such as cats,
opossums, raccoons, skunks, and rats).
Epidemic typhus occurs in poor hygienic conditions (which is why it is
sometimes called "jail fever"), usually when the temperature is cold. It
is spread by lice. Although very rare in the United States, it has
sometimes been spread by the lice and fleas of flying squirrels.
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SYMPTOMS OF MURINE TYPHUS:
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headache
backache
arthralgia
fever, extremely high (105 to 106 degrees Fahrenheit) and may last
up to two weeks
rash that begins on the trunk and spreads peripherally (The rash is
made up of dull red macules that may become slightly papular after
the initial appearance may last only a few hours.)
nausea and vomiting in most patients
hacking, dry cough
abdominal pain
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SYMPTOMS OF EPIDEMIC TYPHUS:
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severe headache
fever, high (104 degrees Fahrenheit)
cough in 70% of patients
arthralgia and myalgia, (muscle pain) severe
chills
falling blood pressure
stupor
delirium
rash that begins on chest and spreads to rest of trunk and
extremities, but not to palms and soles
early rash is faint and rose colored and fades with pressure (Later
the lesions become dull, red, and do not fade. People with severe
typhus may also develop petechiae.)
lights appear very bright, and exposure to light may hurt the eyes
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Treatment
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The goal of treatment is to eliminate the infection and to treat
the symptoms with antibiotics (such as tetracycline,
doxycycline, or chloramphenicol). For epidemic typhus,
intravenous fluids and oxygen may be necessary to help
stabilize the patient.
Prognosis
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Without treatment death may occur in 10 to 60% of patients
with epidemic typhus. Patients over the age of 60 have the
highest risk of death. With timely antibiotic therapy, the
affected person is expected to recover completely.
Less than 2% of untreated patients with murine typhus may
die, and appropriate antibiotic therapy will cure virtually all
patients.
Rocky Mountain Spotted Fever
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An infectious disease caused by Rickettsia rickettsii transmitted to
humans by the bite of ticks.
Symptoms
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fever
chills
incubation period of 2 to 14 days
severe headache
muscle pain
mental confusion
rash, first appearing on wrists and ankles, then spreading to most of
the body, usually starts a few days after fever starts; up to 20% of
people do not get a rash
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Treatment
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The objective of treatment is careful removal of the tick from
the skin and antibiotics to eliminate the infection.
Doxycycline or tetracycline are frequently used.
Chloramphenicol may be used in pregnant women.
Prognosis
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Treatment usually cures the infection. Complications are rare
but can include paralysis, hearing loss, and nerve damage.
The death rate is 5 to 7% and usually reflects a delay in
seeking treatment.
Gangrene
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A severe form of gangrene (tissue death) usually
caused by Clostridium perfringens (see also
necrotizing subcutaneous infection). It can also be from
Group A Streptococcus. Staphlococcus aureus and
Vibrio vulnificus can also cause similar infections.
Gas gangrene occurs as a result of infection by
Clostridium bacteria that, under anaerobic (low
oxygen) conditions, produce toxins that cause the
tissue death and associated symptoms.
Gas gangrene generally occurs at the site of trauma or a
recent surgical wound.
Symptoms
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moderate to severe pain around a skin injury
progressive swelling around a skin injury
moderate to high fever
skin color initially pale, later dusky progressing to dark red or purple
vesicle (blister) formation, coalescent (combine into large blisters)
blisters filled with brown-red fluid
drainage from the tissues, foul-smelling brown-red or bloody fluid
(serosanguineous discharge)
increased heart rate (tachycardia)
sweating
subcutaneous emphysema (air under the skin)
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Treatment
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Prompt surgical removal of dead, damaged, and infected
tissue (debridement) is necessary. Amputation of an arm or
leg may be indicated to control the spread of infection.
Antibiotics, preferably penicillin-type, should be given.
Initially, this is given intravenously (through a vein).
Analgesics may be required to control pain. Hyperbaric
oxygen has been tried with varying degrees of success.
Prognosis
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Gas gangrene is progressive and often lethal. Immediate
medical attention is required.
Lyme Disease
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Borrelia burgdorferi
Transmitted by bite of tick
One of the most common tickborne diseases in
the US
Field mice most important reservoir
Prevalent in atlantic ticks
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Symptoms:
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Bull's-eye rash at site of bite
Flulike symptoms appear on couple of weeks as
rash fades
During 2nd phase, irregular hearbeat
Neurological symp.
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Facial paralysis
Meningitis,
Encephalitis
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Early treatment with antibiotics seem to be effective
Lyme arthritis resolves in most patients within a few
weeks or months following antibiotic therapy, although
it can take years to disappear completely in some
people.
If the disease has persisted long enough, however, it
may irreversibly damage the structure of the joints.
Following treatment for Lyme disease, some people
still have muscle achiness, neurologic symptoms such
as problems with memory and concentration, and
persistent fatigue. NIH-sponsored researchers are
conducting studies to determine the cause of these
symptoms and how to best treat them.
Chagas’ Disease
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Chagas disease is caused by Trypanosoma
cruzi, a parasite related to the African
trypanosome that causes sleeping sickness. It
is spread by reduvid bugs and is one of the
major health problems in South America,
where 20 million people are infected. Due to
immigration, approximately 500,000 people in
the United States are believed to be infected.
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Chagas disease has two phases -- acute and chronic.
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The acute phase may have no symptoms or have very mild
symptoms.
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Symptoms of the acute phase include swelling and reddening at the
site of infection (where the blood-sucking insect caused the initial
infection).
This may be followed by swelling of one eye.
Lymph nodes that drain the area of the insect bite may become
swollen.
As the parasite spreads from the bite site, the patient develops
fever, malaise, and generalized swelling of the lymph nodes.
The liver and spleen may become enlarged.
The disease goes into remission after the acute phase and may
become chronic with no further symptoms for many years.
When symptoms finally develop, they appear as cardiac disease
(cardiomyopathy) and digestive abnormalities.
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Patients may develop congestive heart failure.
Swallowing difficulties may be the first symptom of
digestive disturbances and may lead to malnutrition.
Patients who have parasitic infection of the colon may
experience abdominal pain and constipation. Death is
usually caused by heart disease.
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Symptoms
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history of exposure in an area where Chagas disease is known
to occur
swollen red area at site of previous insect bite
enlarged lymph nodes
swelling of one eye
fever
irregular heartbeat (arrhythmia)
rapid heartbeat (tachycardia)
swallowing difficulties
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Treatment
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The acute phase should be treated. Benznidazole has been
shown to be effective. Experimental treatment may include
nifurtimox. Treating the chronic phase with antibiotics is not
helpful. Instead, the symptoms of heart and intestinal
disease should be treated.
Prognosis
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Approximately 30% of infected and untreated people will
develop chronic or symptomatic Chagas disease. It may take
more than twenty years from the time of the original infection
to develop heart or digestive problems.
Abnormal heart rhythms (arrythmias, ventricular tachycardia)
may cause sudden death. Once congestive heart failure
develops, death usually occurs within several years.
Leishmaniasis
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Leishmania are tiny protozoa. Their parasitic life cycle
includes the sandfly and an appropriate host. Humans
are one of those hosts. Leishmania infection can cause
skin disease (called cutaneous leishmaniasis). It can
affect the mucous membranes with a wide range of
appearance, most frequently ulcers. It may cause skin
lesions that resemble those of other diseases including
cutaneous tuberculosis, syphilis, leprosy, skin cancer
(basal cell carcinoma), and fungus infections.
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Leishmania can also cause systemic disease (visceral
leishmaniasis) with fatal complications.
When introduced into the body by the bite of a sandfly, the parasite
migrates to the bone marrow, spleen, and lymph nodes.
Systemic infection in children usually begins suddenly with
vomiting, diarrhea, fever, and cough.
In adults, fever for 2 weeks to 2 months is accompanied by
nonspecific symptoms such as fatigue, weakness, and loss of
appetite.
Weakness increases as the disease progresses. The skin may
become grayish, dark, dry and flaky.
The parasites damage the immune system by decreasing the
numbers of disease-fighting cells so death usually results from
complications such as other infections rather than from the disease
itself.
Death often occurs within 2 years.
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Symptoms
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history of exposure to the bite of sandflies
history in being in an area known for leishmaniasis
Systemic illness (visceral leishmaniasis)
fever, persistent, long duration (weeks), may cycle irregularly
night sweats
fatigue
weakness
appetite loss (anorexia)
weight loss
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abdominal discomfort, vague
vomiting (children)
diarrhea (children)
cough (children)
skin, scaly
skin, gray, dark, ashen
hair, thinning
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Skin disease (cutaneous leishmaniasis)
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Symptoms on the skin include:
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macule or papule, erythematous
skin ulcer, forms at site of original lesion
ulcer heals very slowly over a matter of months
smaller lesions may form around the ulcer (satellite lesions)
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Treatment
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Antimony-containing compounds are the principal
medications used to treat leishmaniasis. These
include:
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meglumine antimonate
sodium stibogluconate
Other drugs that may be used include:
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pentamidine
amphotericin B
Miltefosine
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Plastic surgery may be required to correct
disfigurement by destructive facial lesions
(mucocutaneous leishmaniasis). Removal of the
spleen (splenectomy) may be required in drugresistant cases (visceral leishmaniasis).
Schistosomiasis
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Causes and risks
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Schistosoma infections are contracted through contact with
contaminated water. The parasite in its infective stages is called a
cercaria. It swims freely in open bodies of water.
On contact with humans, the parasite burrows into the skin, matures
into another larval stage (schistosomula), then migrates to the lungs
and liver (where it matures into the adult form).
The adult worm then migrates to the anatomic area of its preference,
depending on which species is involved. Likely areas include the
bladder, rectum, intestines, liver, portal venous system, spleen, and
lungs.
Schistosomiasis is not usually found in the United States. However, it
is prevalent in many tropical or subtropical areas, and it is a common
illness thought to affect more than 200 million people.
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Symptoms
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Symptoms vary with the species of worm and the phase of
infection.
Initial invasion of the skin may cause itching and a rash
(swimmer's itch).
Heavy infestation may cause fever, chills, lymph node
enlargement, and liver and spleen enlargement.
Urinary symptoms may include frequency, painful urination
(dysuria), and blood in urine (hematuria).
Intestinal symptoms include abdominal pain and diarrhea
(which may be bloody).
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Treatment
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Praziquantel
With acute infection, corticosteroids may be given
Prognosis
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Treatment before significant damage or severe
complications usually produces good results.