Color Atlas of Anatomy: A Photographic Study of the Human Body . surgeon and renowned medical The Netter Atlas of Human. Anatomy between human. Color Atlas and Text of Clinical Medicine 2nd Ed Forbes Jackson - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. PDF | Evidence shows that Ayurveda and biomedical systems of medicine This atlas is a guide for Integrative Medicine clinical methods to.
|Language:||English, Spanish, Hindi|
|Genre:||Fiction & Literature|
|ePub File Size:||22.50 MB|
|PDF File Size:||9.70 MB|
|Distribution:||Free* [*Regsitration Required]|
working pocket book for anyone in the field of anatomy and medicine. It is its il- lustrations which make it so useful and, indeed, unique; I know of no other similar . of Medical Gross Anatomy, University of Oklahoma, USA, Dept. of Cell Biology incorporated. The general structure and arrangement of the Atlas were main-. Atlas of medical parasitology (3rd edition). and impart a more practical orientation by including chapters on clinical syndromes, laboratory diagnostic.
There is usually a marked polymorph leucocytosis in peripheral blood. The single lesion resulted from infection with Mycobacterium marinum balnei , an organism that infects fish. Administration of oral broad-spectrum antibiotics eradicates the infection rapidly. Kennedy, J. Varicella pneumonia, which can be life-threatening, occurs mainly in adults who smoke and in the immunocompromised 1. The diagnosis is usually made on clinical grounds, but if necessary can be confirmed by viral isolation or by serology.
Understanding these lessons of the past, and their perceptual bases, may help influ- ence the form taken by future education-oriented visualiza- tions, and underscores the need for a more detailed reading of the visual culture of our medical past in order to understand the ever-changing present and future of both biomedicine and medical illustration. This research was sponsored by the Social Sciences and Rifkin, B. New York: Harry The authors gratefully acknowledge their contribution N.
We thank the other members of the Illustrating Robinson, C. Boileau Grant: Markham, Ontario: Incor- of the medical illustration community. Sobotta, J. Philadelphia, PA: This research on the incorporation of photography into Anatomy, Seventh Edition in English, trans.
Phila- regional anatomy is elaborated on in a forthcoming article. Lippincott Company. Ackerman, M. Ware, C. Perception for Rifkin and M. Ackerman eds Human Anatomy: From the Design, 2nd edn. San Francisco: Morgan Kaufmann. Renaissance to the Digital Age, pp. Harry Williams, D. Wilson-Pauwels, L. Evidence and Conditions for Three- Ontario Institute for Studies in Education.
A Basis of Visual Edu- Psychology: Human Perception and Performance 19 6: A Method Wishart, M. Department of Art as Medicine 2 Finnegan, S. Gilbert, S. Grant, J. Descriptive and Deductive. Baltimore, MD: Hochberg, J. Gombrich et al. Johns Hopkins University Press. Kemp, M. Bynum and R. Porter eds Medi- cine and the Five Senses, pp. Cambridge University Press.
Kennedy, J. Pictures to Touch. New Haven, CT: Yale University Press.
Marshall, J. McClellan, G. Newman, R. She is the principal investigator on Illustrating Medicine: Since , she has been the Editor of the Cana- dian Journal of Communication. Her research interests include the visual culture of science and medicine, feminist theories of the body, and aging in society. For more information on her research please visit: He conducts research in the development of digital media as instruments of biomedical research, teaching, and patient assistance.
Her research interests include information visualization and perception- based design theory, as well as the design and assessment of interactive learning environments. Her research examines the role of molecular visualization in fostering understanding of complex dynamic relationships in undergraduate science education. Related Papers. Dissecting Race: By Kate Cober. By Michael Sappol.
Evolution of neck vertebral shape and neck retraction at the transition to modern turtles: By Ingmar Werneburg. Comparison of performance parameters for conventional and localized surface plasmon resonance graphene biosensors. By Hamid Gholamhosseini. Download pdf. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link.
Need an account? Treatment is symptomatic in uncomplicated cases. Other encephalitis viruses may have similar consequences. They precede the main rash by several days. Pneumonia may be rapidly fatal in undernourished children with measles and in immunocompromised patients. Active immunization is available; combined with mumps and rubella vaccine MMR , it should be offered to all children aged between 1 and 2 years.
Passive immunization with normal human immunoglobulin can prevent the disease if given early in the incubation period, but immunity is short-lasting. Most patients with mumps present with swelling of the salivary glands 1. The virus may also attack the meninges or the brain, causing aseptic meningitis. Transient deafness can occur during the course of mumps, but permanent nerve deafness is a rare complication. Salivary gland swelling usually subsides within 2 weeks.
Breasts and ovaries are occasionally involved in females. The diagnosis can be confirmed if necessary by viral isolation and serology. This is important in patients who present without salivary gland involvement. No specific therapy is available. If there is salivary gland involvement, attention must be paid to oral hygiene and fluid intake. Diet should be bland. The pain and swelling of orchitis usually responds to a short course of steroid therapy. Antiemetics and intravenous fluids may be required for pancreatitis.
Mumps meningitis is a benign illness and needs only bed rest and symptomatic treatment. Active immunization is available alone or combined in MMR and it should be offered to children and adults without a history of the disease. The typical maculopapular, morbilliform rash starts on the neck and face and spreads to involve the trunk and the limbs. This infant also had typical catarrh and conjunctivitis. The rash is florid, and is likely to be associated with serious complications, including the development of overt kwashiorkor see p.
The corneal light reflex is distorted, and the preocular tear film is lacking. There is marked bilateral enlargement of the parotid glands, which are usually tender, associated with generalized facial oedema.
This girl was convalescent when photographed. It may be unilateral or bilateral and usually causes severe tenderness. Influenza is an acute viral infection which is spread by droplets from person to person. It is caused by three groups of related myxoviruses which produce fever, prostration, myalgia, headache and anorexia. The viruses undergo frequent antigenic changes, do not produce cross-immunity to each other and give rise to epidemics and pandemics.
Five pandemics have occurred in the twentieth century with massive mortality. For example, up to 20 million people died in , with millions more having continued morbidity from respiratory and neurological sequelae postencephalitic parkinsonism, see p. Acute infection may present with a spectrum of symptoms ranging from a very mild pyrexia which is rapidly self-limiting to an overwhelming infection with severe myalgia, headache, fever, sore throat, acute tracheitis and even pleurisy.
In addition, encephalitis, myositis and myocarditis may supervene, especially in the elderly. Secondary bacterial infection, often with Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumoniae, is a common complication in the debilitated elderly patient 1.
Treatment is usually symptomatic, but antiviral drugs such as amantadine may be of value in ameliorating symptoms more rapidly if given early in the course of the disease. Vaccination may give partial immunity, and should be offered to high-risk groups, such as the elderly, patients with. The influenza viruses A and B constantly alter their antigenic structure, especially the haemagglutinins and neuraminidases on the surface coat. To be effective in a current epidemic the vaccine must contain these antigens.
As the vaccine is prepared in chick embryos its use is contraindicated in patients hypersensitive to eggs. Its use is mainly for people at risk, including the elderly, especially in residential care, asthmatics and those with COPD, the immunocompromised, diabetes and patients with chronic renal disease. Rabies is caused by an RNA virus of the Rhabdoviridae family. Man is infected through bites from a rabid animal usually a dog 1. Rarely, the virus may gain entry through a cut, abrasion or area of eczema.
The incubation period may be as short as 2 weeks, but in some cases may be as long as 1 year. The virus, once in the body, spreads via peripheral nerves to the CNS causing encephalomyelitis which is almost uniformly fatal. The time from bite to first symptom ranges from about 35 days for bites on the face to 52 days for bites on the limbs.
Even in a country free from rabies such as the UK, the possibility of an illegally imported rabid animal should be considered. In this elderly patient, there is a left mid-zone cavitating pneumonia note the fluid level in the cavity and an accompanying left pleural effusion. The causative organism was Staphylococcus aureus.
Eventually flaccid paralysis develops 1. Some patients, especially those bitten by vampire bats, present initially with flaccid paralysis which often begins in the bitten limb, but which rapidly becomes generalized dumb rabies. Death results from respiratory paralysis. If possible, the diagnosis should be confirmed in the animal by histopathological examination of the brain. In humans the virus can be identified by immunofluorescence on skin or corneal impression smears or by brain biopsy.
Serological tests may also be diagnostic, but may be difficult to interpret if vaccination has been given since exposure to the virus. Management of bitten people includes thorough cleaning of the bite, passive immunization with human rabies immunoglobulin and an immediate course of human diploid cell rabies vaccine.
The outlook is poor if treatment is started after the onset of symptoms. Patients must be nursed in an intensive care unit. Heavy sedation and positive pressure ventilation are required. The disease is usually fatal but there have been several documented cases of recovery.
Prevention includes regular immunization of domestic animals in endemic areas and pre-exposure immunization of people at risk. Lassa fever is caused by infection with an arenavirus Lassa fever virus and is found predominantly in West Africa.
Infection with similar viruses causes Argentine and Bolivian haemorrhagic fevers in South America. The vector is the rodent, Mastomys natalensis. Onset of the clinical disease is gradual, with fever, headache and myalgia that particularly affects the legs. In addition there may be conjunctivitis, aphthous ulceration of the mouth, a fine generalized petechial rash and facial oedema 1.
As the platelet count falls, haemorrhage may occur from a variety of sites. A combination of viraemia and haemorrhage produces shock and this may be associated with evidence of viral myocarditis.
Encephalitis and permanent cranial nerve impairment may also occur. There is no specific treatment for the disease, but specific antiviral agents are promising. Symptomatic control of haemorrhage and shock are important. Prevention of spread of the disease depends on public health measures to control contact with rodents and with virus-laden rodent excreta. Hospital outbreaks involve careful handling of all blood and excreta of patients. Inspiratory spasms occur spontaneously or are induced by attempts to swallow.
This may lead to fear of water hydrophobia. It is caused by infection with either Marburg or Ebola viruses. Marburg disease was originally found in people in contact with green monkeys Cercopithecus aethiops which were obtained from Uganda.
Subsequently there was evidence of transmission by needles and directly from person to person. Both viruses cause acute disseminated intravascular coagulation DIC, see p. There is no specific treatment, but the patients require intensive circulatory support and control of the DIC with heparin; they may benefit from plasma containing virusspecific antibodies. Extensive precautions are needed to prevent the spread of infection.
Haemorrhagic fever occurs widely throughout the world. Other causes include dengue see p. All are potentially fatal conditions. It occurs in outbreaks, most often in spring and summer. Any age may be affected but it is most common in children, in whom the usual presentation is a mild febrile illness followed by marked erythema of the cheeks and the appearance of a pink maculopapular rash 1. The rash may become confluent and is most marked on the limbs; as it fades, it takes on a lacelike appearance.
The rash may come and go over about weeks. Adenopathy, arthralgia and arthritis are common especially in adults infected with the virus. Joints most involved are wrists and knees. The arthritis may, if prolonged, be mistaken for other forms of rheumatism. Transient marrow depression may occur during the course of the illness. In patients with congenital haemolytic anaemia, an aplastic crisis may be induced see p. The diagnosis can be confirmed by finding a specific IgM antibody in the serum.
As the disease is self-limiting, children require no therapy. Analgesics and anti-inflammatory drugs may be needed for relief of joint pain in adults. If there is an aplastic crisis, blood transfusion is indicated.
No vaccine is available for this disease. Type II is associated with sexually transmitted genital infection, whereas most other infections are caused by type I. Following the primary infection, the virus remains latent in the tissues and may re-emerge at a later stage to produce local lesions. Primary infection with type I virus usually occurs in childhood and takes the form of acute gingivostomatitis with multiple painful, shallow ulcers on the tongue, buccal mucosa and lips 1.
In genital herpes, ulcers are on the vulva, vagina, cervix or penis 1. In both instances, the primary lesions are self-limiting and clear in about 10 days. The local eruption may be accompanied by fever and malaise and, in the case of children, refusal to eat or drink. Other sites of primary infection are the fingers herpetic whitlow and the cornea dendritic ulcer, 1. Herpes simplex encephalitis is a rare but very serious presentation see p.
In the neonate, disseminated herpes simplex is a life-threatening illness. Patients with eczema may present with widespread lesions on the eczematous areas eczema herpeticum, 2. Reactivation of latent herpes simplex usually occurs in sites related to the primary infection 1.
In the immunocompromised patient, reactivation of virus may cause very severe local lesions 1. Genital herpes has reached epidemic proportions and differs from other sexually transmitted diseases because of the likelihood of spontaneous recurrence. It is extremely conta-. This boy's erythematous rash appeared 24 hours after the onset of a mild fever and sore throat. Note the 'slapped cheek' appearance of the face.
There is a causal relationship between genital herpes, cervical cell metaplasia and cervical carcinoma. Herpes simplex virus II is the most common infecting agent in young women. The primary lesions appear within a day or so of exposure and are. In women there is usually a vaginal discharge followed by tender lymphadenopathy with generalized fever.
In men the lesions are found on the glans, foreskin and penile shaft 1. In addition, lesions may be found in the perineum and perianal regions of homosexual men 1.
Recurrence of genital herpes is common and may be precipitated by local trauma, menstruation, pregnancy, stress, depression, intercurrent illness or immunosuppression.
The recurrence tends to be more localized and not as severe as the first attack. Patients often recognize the prodrome of recurrence with local itching and tingling.
The virus can be cultured from vesical fluid or from swabs from genital or mouth ulcers. Viral particles can also be identified under the electron microscope. Rising antibody titres may be found in primary herpes simplex. Most primary lesions are self-limiting and specific therapy is not usually required. If applied very early, acyclovir cream may abort the development of 'cold sores'. Acyclovir is the treatment of choice for primary genital herpes and for recurrence patients can start treatment at the first prodromal sign of recurrence.
Intravenous acyclovir should be used to treat herpes encephalitis and severe infections in the immunocompromised host and in the neonate.
An ophthalmological opinion should be sought when there is involvement of the eye. This young child was acutely ill with a high fever and had multiple vesicular lesions on the tongue, lips and buccal mucosa. In adult patients, a more common manifestation of herpetic stomatitis is the cold sore; this is usually a reactivation of latent infection.
Note the numerous lesions on the penis and the associated tissue reaction. Herpes simplex virus proliferates in the epithelial layer of the cornea. Urgent treatment with antiviral drops or ointment is indicated.
The ulcers have recurred in a common primary site for genital infection. Other common sites include the external genitalia and the lips. Varicella zoster causes two distinct diseases chickenpox varicella and shingles herpes zoster.
Chickenpox Chickenpox is a highly infectious disease caused by the Varicella zoster virus. It is usually mild in children but can be severe in adults and in immunocompromised patients. The incubation period is usually days. In adults especially, there may be a short prodromal illness with fever, malaise, headache and occasionally a transient erythematous rash.
The true rash is vesicular with a central distribution in the body 1. The spots are elliptical and come out in crops over a few days 1. Mucous membranes may also be affected 1. Scabs form rapidly and most have separated in days.
The most common complication, especially in children, is skin sepsis, usually due to superinfection with Staphylococcus aureus.
Varicella pneumonia, which can be life-threatening, occurs mainly in adults who smoke and in the immunocompromised 1. Other rare complications include encephalitis, cerebral ataxia and haemorrhagic chickenpox. The diagnosis is usually made on clinical grounds but electron microscopy, viral culture and serology may be required in difficult cases. No specific therapy is usually required. Children should be prevented, if possible, from scratching the spots. If the disease is severe, especially in the immunocompromised patient, the antiviral drug acyclovir may be used either parenterally or orally.
There is no active vaccine against Varicella zoster, though a live vaccine is in the late stages of development. Varicella zoster immune globulin may modify or prevent the disease if given within 1 week of contact.
Acyclovir may also be given prophylactically to immunocompromised patients who have been exposed to the disease. After several days, the rash is pleomorphic, as the lesions emerge in crops at irregular intervals.
The rash in this patient shows vesicles at different stages of development. The vesicles rupture and ulcerate, but heal without scarring. Chest X-ray shows widespread soft, nodular opacities throughout both lungs.
The complication varies in severity from mild to lifethreatening. Shingles is caused by reactivation of latent varicella virus in sensory root ganglia in patients previously infected with chickenpox. Reactivation is common in the elderly and in immunocompromised patients 1. The skin eruption, which is always unilateral, appears along the line of one or two dermatomes 1. The lesions are vesicular on an erythematous base. In ophthalmic herpes 1. Ophthalmic herpes zoster is a medical emergency: Dissemination of virus in the blood stream may result in the appearance of scattered chickenpox lesions elsewhere on the body.
Viraemia may be overwhelming in immunocompromised. Pain may precede the skin rash, and postherpetic neuralgia can be prolonged and severe, especially in the elderly. The most common complications are bacterial superinfection of the skin lesions and postherpetic neuralgia. Occasionally there may be motor nerve involvement, as in the Ramsay Hunt syndrome when seventh nerve paresis occurs 1.
Meningoencephalitis is a more serious but rarer complication. Acyclovir given orally within 72 hours, or in severe cases intravenously, along with local applications of acyclovir skin cream may hasten healing and reduce viral shedding, but there is little evidence that acyclovir prevents or reduces postherpetic neuralgia.
Analgesics are almost always required for pain control. If there is involvement of the eye, acyclovir should be given and an ophthalmological opinion should be sought. The rash shows the characteristic 'band' distribution, starting from the midline, where some vesicles can be seen. The vesicular skin eruptions are in the distribution of the ophthalmic division of the fifth cranial nerve.
Serious opthalmic complications are a real threat, especially when the tip of the nose is affected this indicates involvement of the nasociliary nerve, which also supplies the cornea.
The patient has a right seventh nerve paresis. In this patient a protective lateral tarsorrhaphy has been carried out. The virus may be transmitted by respiratory secretions, sexually, by blood transfusion or by organ transplantation. Maternal infection spreads transplacentally or perinatally to the fetus.
Most cytomegalovirus infections in the immunocompetent are subclinical, but there may be a glandular fever-like syndrome with fever, generalized lymphadenopathy, abnormal liver function tests and atypical mononuclear cells in the blood.
Primary infection or reactivation of latent infection in the immunocompromised patient may cause serious illness with pneumonia 1. Intrauterine infection may cause fetal death. Severe neonatal cytomegalovirus infection causes jaundice, hepatosplenomegaly 1.
The infected infant may, however, appear normal at birth, and develop symptoms later. The finding of specific IgM in serum is diagnostic of acute infection. Isolation of virus from urine or sputum may simply indicate prolonged excretion after past infection. Cytomegalovirus inclusion bodies in biopsy specimens from the lung or gastrointestinal tract are diagnostic, so biopsy provides definitive diagnosis in the immunocompromised patient.
Most acquired infections are self-limiting but severe disease, especially in the immunocompromised, should be treated with intravenous ganciclovir or phosphonoformate. Treatment may have to be prolonged; relapses are common unless maintenance therapy is continued on a long-term basis.
This infant has massive splenomegaly, hepatomegaly and a purpuric rash. A similar picture may be caused by a number of prenatal virus infections. CMV is second only to Pneumocystis as a cause of pulmonary disease in patients with HIV infection, and it is also seen in other immunocompromised patients, including those on anticancer therapy, systemic steroids, and drugs such as azathioprine and cyclophosphamide used to prevent organ transplant rejection.
CMV pneumonia cannot be diagnosed on clinical grounds or X-ray appearances alone. Numerous petechial haemorrhages are seen in the hard palate. In many patients there is also a tonsillitis, indistinguishable from that seen in acute streptococcal pharyngitis 1. Primary infection with EBV is often subclinical, especially in young children. Older children and young adults usually present with symptoms of glandular fever.
In the most common form of the disease, there is enlargement of glands both in the anterior and posterior triangles of the neck, and usually in the axillae and groins. The fauces and palate become inflamed and oedematous. There may be palatal haemorrhages and a whitish or yellow pseudomembrane appears on the tonsils 1. There is usually marked nasopharyngitis and often puffiness of the face. In the more generalized form of the disease, throat involvement is less marked.
Presenting features are fever, generalized adenitis, splenomegaly and occasionally jaundice. There may. A rash is more often seen in patients who have been given ampicillin or related drugs 1. Complications of infectious mononucleosis include myocarditis, autoimmune haemolytic anaemia, thrombocytopenia and meningo-encephalitis. Splenic rupture is a rare complication which is usually associated with trauma.
Postviral fatigue syndrome may follow EBV infection. The diagnosis is aided by the identification of atypical mononuclear cells in peripheral blood 1.
The PaulBunnell test for heterophil antibodies usually becomes positive in the second or third week of the illness. In children under about 7 years, the PaulBunnell test is rarely positive, and diagnosis should be confirmed by EBV serology.
Treatment is symptomatic. Antibiotics are not indicated and ampicillin and related drugs should not be prescribed because of the high incidence of allergic reactions. Steroid therapy may be indicated if there is respiratory obstruction or autoimmune manifestations. The maculopapular rash usually emerges during the second week of illness, and it is often indistinguishable from that of rubella 1.
Ampicillin rashes occur more commonly in patients with infectious mononucleosis than in other patients, so the appearance of this kind of rash in a patient with typical symptoms points strongly to the diagnosis of infectious mononucleosis.
There is a wide variation in cell size and shape and mitotic activity is greatly enhanced, but the cellular structure is not fundamentally deranged. Burkitt's lymphoma and nasopharyngeal carcinoma EBV has been implicated in the aetiology of Burkitt's lymphoma, a transmissible neoplastic tumour particularly involving the head and neck 1. The disease has a similar range of distribution to malaria, and it is thought that the virus may be transmitted via mosquitoes.
EBV has also been implicated in some nasopharyngeal carcinomas, and it may play a role in the genesis of hairy leucoplakia 1. After a rapid onset high fever, which lasts for a few days and then resolves, a generalized rubelliform rash appears 1. There may be cervical node enlargement and febrile convulsions may complicate the acute stage. The rash fades after hours, and the patient usually makes a complete and uncomplicated recovery. The disease is caused by herpes 6 virus and the disease is also known as sixth disease.
ORF Orf contagious pustular dermatitis is a paravaccinia virus infection of sheep and goats, which causes an eruption on the animals' lips. It is sometimes contracted by those who work with these animals, and in humans it usually causes a single papule on the skin of the hand, which develops from a flat vesicle to a haemorrhagic bulla. Occasionally, more than one papule may occur 1. The lesions are usually self-limiting, but may ulcerate and may act as a trigger for the onset of erythema multiforme see p.
Regional lymph node enlargement is common. Milker's nodules are similar lesions, caused by cowpox virus and seen in farm workers dealing with cattle. Other differential diagnoses include anthrax, vaccinial infection and infection with Erysipelothrix rhusiopathiae. An erythematous macular or rubelliform rash appears.
It is often particularly prominent on the buttocks and fades within 2 days. If the child has been treated with an antibiotic for the fever, the rash may be mistaken for drug sensitivity. These develop into pustules, but the condition is self-limiting, usually clearing within weeks. Skin infections, abscesses, toxic shock syndrome, food poisoning, toxic epidermal necrolysis, septicaemia, pneumonia, osteomyelitis and arthritis, meningitis, etc.
Skin infections, pharyngitis, pneumonia, otitis media, sinusitis, septicaemia, rheumatic fever, glomerulonephritis, meningitis, postpartum sepsis, necrotizing fasciitis, urinary tract infection, dental caries, etc. Meningitis, pneumonia, septicaemia, arthritis Urethritis, cervicitis, proctitis, urinary tract infection, septicaemia, arthritis, ophthalmitis, pelvic inflammatory disease Respiratory infection, conjunctivitis, otitis media. Anthrax Gastroenteritis, panophthalmitis Bacteraemia, gas gangrene, food poisoning, necrotic enteritis Tetanus Botulism Pseudomembranous colitis Myonecrosis, soft-tissue infection Diphtheria Acne Actinomycosis Nocardiasis, pneumonia Tuberculosis.
Corynebacterium diphtheriae Propionibacterium acnes Actinomyces israelii Nocardia Mycobacterium: A range of infections in immunocompromised patients Leprosy Neonatal disease, septic abortion, meningitis, septicaemia Erysipeloid, septicaemia. Page reference 49,, , , 49, , 50 , 50 , , , 77 51, Respiratory infection, meningitis Meningitis, urinary tract infection Chancroid Pontiac fever, legionnaires' disease Multiple organ infections.
Calymmatobacterium Treponema: T pallidum T pertenue T carateum B. Trachoma, conjunctivitis, blindness Non-specific urethritis non-gonococcal Pelvic inflammatory disease Reiter's syndrome Lymphogranuloma venereum Psittacosis Respiratory infection Pneumonia, pharyngitis Urinary and genital tract infection. Carriage rates are higher in hospital personnel. Organisms are transmitted by direct contact, by fomites and by aerosol sneezing. They survive for long periods on dry surfaces but are easily killed by disinfectants and antiseptic solutions.
In hospitals, patients with a higher risk of carriage include those taking steroids, those with diabetes mellitus, intravenous drug misusers and those on haemodialysis. The emergence of strains of the organism with multiple resistance to antibiotics is causing major problems of management and infection control. Certain areas of the body, especially the nasal mucosa and the skin of the axilla, groin and perineum, may become colonized by staphylococci; given favourable circumstances, the.
Tissue breakdown and abscess formation are characteristic of staphylococcal lesions 1. Staphylococci may also enter the blood with subsequent involvement of other organs such as bone p.
In addition to causing local sepsis, S. Epidermolytic exfoliative toxin is responsible for the syndrome of toxic epidermal necrolysis Lyell's disease, scalded skin syndrome. In this, there is sudden onset of fever and marked generalized erythema of the skin, followed by loss of large areas of the superficial layers of the epidermis, which produces an appearance resembling severe scalding. This condition occurs mainly in children 1. Ritter's disease is a neonatal form of the same condition. Staphylococcal toxic shock syndrome is a relatively rare condition about 40 cases in 58 million people in the UK per year.
It is due to the production of an exotoxin by S. The patients often become rapidly disorientated. There is a. Lesions of this kind are found most commonly in diabetic patients. The organisms were introduced by a contaminated intravenous injection, but a similar picture may occur in debilitated or immunocompromised patients secondary to staphylococcal skin infection. Note the presence of a large cavity septic infarct in the right upper zone. The possibility of right-sided endocarditis should always be considered when this picture is seen in an injecting drug misuser.
The condition occurs mainly in children, but a similar syndrome may occur at any age as a consequence of drug hypersensitivity 2. Many of the initial cases were in young women using superabsorbent tampons. This group now accounts for one-half of the cases; others include patients after surgery, and those with burns, boils and insect bites.
Men, women and children may be affected. The diagnosis may be confirmed by culture of swabs from the lesion or from a tampon. Patients usually have a high white cell count, lowered platelets from DIC , renal impairment and elevated creatine phosphokinase CPK from muscle injury. Most S.
In patients with an allergy to the penicillins, and especially if the organisms have multiple resistance to antibiotics, choice of appropriate antibiotic therapy must depend on sensitivity testing; therefore, close cooperation with microbiologists is essential. Methicillin-resistant S.
Epidemics of infections with MRSA have now occurred in many countries. These organisms, like other S. Admission of such a patient to a ward requires rigorous measures to control infection, which may involve closing wards or hospitals. Staphylococcal abscesses should be drained 1. They are the most common cause of hospital-acquired bacteraemia, and are increasingly penicillin resistant.
Specialist advice should be sought on treatment, which may need to be protracted. Infection can also occur on heart valves that have been damaged as a result of acute rheumatism or are congenitally abnormal p. The organisms are transmitted by direct contact, by droplets from the respiratory tract or indirectly through food, dust or fomites.
Late complications of S. Streptococcal tonsillitis is an acute illness with fever, marked general malaise and pain on swallowing. There is inflammation and oedema of the palate and fauces with spotty exudate on the tonsils 1.
The anterior cervical lymph nodes are. On the surface, this breast abscess did not appear large, but a large volume of pus was released when it was incised. After evacuation of the pus, the wound should be packed and left open. Local complications include otitis media, streptococcal rhinitis, sinusitis and peritonsillar abscess quinsy.
As with all streptococcal infections, late complications may appear about 10 days after the onset of the illness, especially in patients not treated with antibiotics. The diagnosis of streptococcal tonsillitis can be confirmed by culture of throat swabs.
There is usually a marked polymorph leucocytosis in peripheral blood. The diagnosis may be confirmed in retrospect, by the finding of a raised anti-streptolysin 0 titre ASOT. Scarlet fever is a streptococcal infection characterized by the appearance of an erythematous rash 1. The disease is seen mainly in children, who are susceptible to streptococcal erythrogenic toxin.
Scarlet fever is usually associated with streptococcal tonsillitis but it may also follow infection of wounds or burns streptococcal toxic shock syndrome.
The rash is a generalized punctate erythema which affects the trunk and limbs. As the rash fades, there may be desquamation of skin. Other characteristics of the disease are circumoral pallor 1. Complications of scarlet fever are similar to those of streptococcal tonsillitis. Streptococcal infections of skin and tissues Erysipelas and cellulitis are skin and tissue infections with S. Sites most often involved are the face 1. General symptoms include fever, malaise, rigors and sometimes delirium.
The local lesion consists of an area of spreading erythema with a well demarcated edge. Regional lymph nodes become tender and enlarged. There is a tendency for erysipelas to recur in a previously affected area. A similar clinicial picture, erysipeloid, may be produced by infection with Erysipelothrix rhusiopathiae 1. This is an occupationally acquired infection in farmers, meat and fish processors and veterinary surgeons. During the acute stage, the eyelids may become so swollen that they cannot be opened.
The entire face may become erythematous, and this appearance is accompanied by an unpleasant sensation of tightness and burning. The oedematous red papillae protrude through a thick, white, furry membrane. This appearance is typical of the first 2 days, but later the white fur peels off, to leave a deep red strawberry tongue.
Other common sites of entry for the bacteria are areas of infected eczema and fungal infections of the toe-web with fissuring. Necrotizing fasciitis is due to subcutaneous infection usually with beta-haemolytic streptococci but sometimes with S. Patients who have diabetes mellitus or are on steroids are more likely to be affected.
The organisms may be introduced by penetrating trauma or after surgery 1. The patients are usually febrile and shocked with local tenderness, occasionally with crepitus over the affected area and with a dusky redblue appearance of the skin.
Gas may be found on X-ray as in gas gangrene; 1. Treatment consists of urgent surgical intervention with debridement of the affected area. The organism may be identified by blood culture, culture of the affected tissue or Gram staining of the tissue Impetigo is most commonly seen in children and is a superficial infection of skin, usually caused by either Streptococcus pyogenes or Staphylococcus aureus.
It may occur de novo or as a secondary infection in areas of eczema or in pediculosis of the scalp. The lesions, which are often on the face, start as thinwalled vesicles that rupture and form yellowish crusts 1. Infection is often spread by scratching. Penicillin is the drug of choice for infections with S.
Antibiotic therapy should be continued for 10 days in order to lessen the risk of rheumatic fever. In cases of allergy to penicillin, erythromycin is the second choice drug. Impetigo usually responds to topical antibiotic therapy. Infection results from inhalation of droplets. No age is exempt from meningococcal disease but young children and young adults are most at risk, especially those in a closed environment such as a school or camp.
Transmission is by respiratory droplets. This picture shows extensive cellulitis and erysipelas, and the subcutaneous infection was extensive and accompanied by gas formation and crepitus. The patient died despite extensive surgical debridement and antimicrobial treatment.
The superficial nature of the infection and the characteristic honey-coloured serous crusting are typical. The incubation period is usually less than 1 week. Infection produces a wide spectrum of illness from fulminating septicaemia, which can kill in a few hours, to a subacute illness with intermittent fever and a 'flea-bite' type rash. The most common presentation is meningitis see p. Fulminating septicaemia WaterhouseFriderichsen syndrome is a devastating illness with extensive skin haemorrhage 1.
These patients usually do not live long enough to develop meningitis. Meningococci can be cultured from blood, pharynx, skin lesions and CSF. If examined, the CSF is found to be purulent 1. Lumbar puncture may, however, be hazardous because 'coning' of the brainstem may occur with disastrous consequences.
If the clinical diagnosis is not in doubt, therapy can be started without CSF examination. The clinical state and laboratory findings are a poor guide to prognosis, and meningococcal infection should always be treated urgently. Intravenous benzylpenicillin is still the drug of choice and should be given for days. Intensive care nursing with full supportive therapy is required, especially for fulminating septicaemic cases. Close contacts of the index case should receive prophylactic therapy usually with rifampicin or ciprofloxacin.
Vaccines may be used to contain epidemics. These produce immunity for years in patients over the age of 2 years, but do not alter the rate of nasal carriage. Vaccines are not yet available against group B the most common cause of meningococcaemia in the UK and some other countries.
The causal agent of anthrax is Bacillus anthracis, a spore-bearing organism. Most human infections result from contact with animals or animal products, such as hides, wool or bones, and therefore most cases occur in farmers, vets and abattoir workers.
Anthrax has an unfortunate potential for use in germ warfare, and anthrax spores may persist in an infected environment for many years. Cutaneous lesions are usually single and are most common on exposed sites, especially hands, arms, head or neck.
The classic anthrax lesion is the malignant pustule 1. This starts as a red papular lesion that vesiculates and becomes necrotic in the central area and finally dries up to form a thick, blackish scab which may take several weeks to separate. There is usually marked erythema and oedema of the surrounding tissues.
Fever, headache and malaise accompany most lesions. Anthrax septicaemia is much less frequent in humans than in animals. Pulmonary anthrax inhalation of spores and gastrointestinal anthrax ingestion of spores are rare forms of the disease and carry a high mortality.
Anthrax bacilli can be identified in stained smears from the lesion. Confirmation is by culture or animal inoculation. Benzylpenicillin is the treatment of choice. Erythromycin can be used if there is penicillin allergy. A killed vaccine is available for human use, but this is reserved for people in high-risk occupations. Other preventive measures include improvement of working practices, animal vaccination, proper disposal of animal carcases and sterilization of animal products such as bone meal.
A vaccine prepared from an alum precipitate of a B. A single malignant pustule in a typical position on the neck. The patient was a porter who carried animal hides over his shoulders. These organisms may produce two main syndromes: Clostridial cellulitis may be superficial and of relatively minor consequence, but it may lead to rapidly progressive tissue destruction. In anaerobic conditions, associated with large amounts of devitalized tissue, clostridia may produce extensive myonecrosis and release gas, which tracks along the tissue planes.
Gas gangrene has also been recorded at the site of intramuscular injections. The clinical features of myonecrosis occur within a few days of injury, especially in wounds with muscle damage, fractures, retained foreign bodies and impairment of the arterial supply.
Patients present with severe pain in the proximity of the wound, which rapidly becomes swollen with 'woody hard' oedema 1. A thin, watery, sweet-smelling discharge is often noted, and this becomes brown or frankly bloody later. Gas in the tissue planes may be apparent on X-ray before it can be felt 1. If a limb is involved, the part distal to the infection rapidly becomes cold, oedematous and pulseless before frank gangrene appears.
The patient remains conscious during this time and has few other features, the clinical state being dominated by great pain at the site.
There may be a slight fever. Progression of the condition leads to anorexia, profuse diarrhoea, circulatory collapse and renal and hepatic failure. There may be massive haemolysis. Treatment consists of extensive early surgical debridement of the affected part under penicillin cover.
The use of specific antitoxins and hyperbaric oxygen is controversial. Circulatory support is necessary to prevent renal failure. Death is inevitable if treatment is not available, and often occurs suddenly and unexpectedly during surgery. The necrosis of skin and muscle is clearly seen. All the key diagnostic features are seen. Tetanus has resulted from unclean handling of the umbilical cord; note the inflammation around the umbilicus.
The classic features of tetanus trismus, risus sardonicus and muscle spasms of the arms and legs are all present. The combination of myonecrosis and gas results in swelling and impaired distal circulation.
Clostridium tetani is a spore-bearing organism that produces a powerful exotoxin that acts on the CNS, preventing feedback inhibition of neural discharges. Spores are present in the soil, and humans may be infected by inoculation of spores, usually into a deep wound, but sometimes even through minor breaks in the skin.
Agricultural workers, athletes, road traffic accident casualties and the elderly with waning immunity are partic-. Contraction of all muscle groups leads to arching of the back and rigidity of the limbs.
The attacks are frightening for the patient and those caring for him, and patients remain fully conscious throughout. Neonates are also at risk 1.
After an incubation period ranging from a few days to about 3 weeks, muscle rigidity develops. This is often first noted as jaw stiffness trismus , but later becomes generalized, producing opisthotonos 1. Painful muscle spasms occur and these are often triggered by sensory stimuli such as loud noises 1.
There may also be involvement of the autonomic nervous system. The severity of the disease is inversely proportional to the length of the incubation period. The diagnosis is made on the history and clinical features of the disease. Patients with tetanus require intensive care nursing. Obvious wounds should be cleaned and debrided. Human tetanus immunoglobulin and penicillin should be administered as soon as possible. Moderate spasms can be controlled by diazepam, but severe tetanus may require full muscle relaxation and intermittent positive pressure ventilation.
Primary immunization should be achieved in early childhood with three doses of diphtheria, pertussis and tetanus DPT vaccine. Booster doses of tetanus toxoid are required every 10 years to maintain immunity, especially before pregnancy. After a penetrating injury an additional booster dose of toxoid should be given unless the previous booster dose was within 5 years. If the history of previous immunization is uncertain and if wounds are heavily contaminated, anti-tetanus human immunoglobulin should be given and a course of tetanus toxoid started.
Botulism results from ingestion of the endotoxin of Clostridium botulinum or, in some cases, from the release of endotoxin by surviving ingested organisms in the gut. This is usually caused by bacterial or spore contamination of improperly canned or preserved meat and meat products, which allows growth of the organism and toxin production.
Rarely, wounds may be infected with C. The toxin interferes with the release of acetylcholine at the neuromuscular junction and, as a result progressive descending muscle paralysis dominates the clinical picture with diplopia, laryngeal and pharyngeal palsy and generalized symmetrical paralysis of muscles, especially those of the cranial and respiratory systems.
Loss of the pupillary reflex is an early sign. The diagnosis is confirmed by finding toxin in the food, gastric contents or faeces. Airway support with assisted ventilation is the keystone of treatment. Antitoxin is of value and antibiotics may have a role if organisms survive in the gut. Public health measures are aimed at prevention during food preparation for preservation, especially when this is done at home.
A trivalent antitoxin is available for prophylaxis after exposure and also for those presenting with early symptoms. It neutralizes the toxins of C. Contraindications to its use are a history of hay fever, asthma or other allergy. Obstruction of the airway by a membrane is a life-. Diphtheria is now rare in the developed world, as a result of effective immunization campaigns, but is still relatively common in some countries, including Russia and other countries in the CIS.
It may be found in travellers returning from endemic areas. The causal agent is Corynebacterium diphtheriae. The most common type of diphtheria is faucialpharyngeal in which the local lesion takes the form of a greyish-white translucent membrane, which may start on the tonsils 1.
Other sites of the local lesion include the anterior nares, larynx and skin. The organisms multiplying in the local lesion produce a powerful exotoxin which especially affects the heart and the CNS.
Toxic complications include cardiogenic shock 1. Nervous system damage is due to demyelination of motor nerves. This may lead to paralysis of extraocular muscles, palate and pharynx and. The diagnosis is confirmed by culture of the organism from the local lesion. Diphtheria antitoxin should be given with penicillin or erythromycin, but antitoxin is prepared from horse serum and allergic reactions are common; it should only be given when the index of suspicion for diphtheria is high. Bed rest is important, especially in the presence of cardiac involvement.
Laryngeal obstruction may require intubation or tracheotomy. Infants should be immunized against the disease with combined diphtheria, pertussis and tetanus vaccine. The Schick test can determine immune status, but is now rarely used. Lowdose diphtheria vaccine should be given to adults whose immunity is uncertain if there is a chance of exposure e. The membrane is usually white or greyish-yellow in colour, and the child may have relatively few symptoms at this stage.
In this Sudanese child, it has led to a generalized flaccid paralysis. This child has a palatal palsy hence the nasogastric tube , and a 'bull neck' a characteristic appearance of cervical oedema.
Infection with Actinomyces israelii, an anaerobic filamentous bacterium, is uncommon in the West. The organism can be found as a commensal in the mouth and intestine, and it may invade any part of the body when immunity is suppressed. Three sites are commonly involved: In all these sites, the infection may ultimately discharge through the skin, forming sinuses 1.
Classically, these sinuses discharge typical sulphur granules 1. A prolonged course of high-dose penicillin is the treatment of choice. The organisms have a worldwide distribution and are soil saprophytes.
Most infections occur in people who have pre-existing immunosuppression resulting from cancer, cancer therapy, steroid therapy, alcoholism or HIV infection. Pulmonary nocardiasis appears similar to any other pneumonia, with fever, productive cough and progressive signs of lung consolidation. Despite antibiotics, the disease progresses to cavitation, and there may be direct spread to the pleural cavity with empyema formation. Bloodborne spread to the brain and other organs occurs.
Surgical drainage of the abscesses is required, along with prolonged antimicrobial therapy. Nocardiasis can be an acute, subacute or chronic infection by a family of Gram-positive filamentous 'higher' bacteria.
These are usually inhaled, but occasionally may enter via penetrating. After a period of decline lasting for most of the twentieth century, the incidence of tuberculosis TB is now increasing again in the UK, USA and much of the rest of the developed world. TB has always been endemic in poorer countries, and the incidence there is also on the increase.
The World Health Organization WHO estimates that one-third of the world's population is already infected with TB, and that a further million people worldwide will become infected over the next decade. The twentieth century reduction in the incidence of TB in the developed world was probably encouraged by improved social conditions, mass miniature radiography, good contact tracing, BCG Bacillus Calmette-Guerin vaccination of schoolchildren and the use of effective antituberculous therapy.
Cases continued to occur in the elderly, the debilitated, alcoholics, diabetics, immunocompromised patients and recent. The patient presented originally with an indurated subcutaneous mass in the anterior triangle of the neck.
The chronic nature of the condition is demonstrated by the signs of a previous sinus higher up in the neck, which has healed, and an actively discharging sinus below it.
The most potent risk factor for TB in the developed world seems to be socioeconomic deprivation. In the developing world, socioeconomic deprivation is of great importance, as is interaction with HIV infection, especially in sub-Saharan Africa. Mycobacterium tuberculosis is spread mainly by droplets, and relatively casual contact may be sufficient to ensure spread.
The organisms gain entry to the body by inhalation, ingestion or occasionally by inoculation through the skin.
Primary infection usually involves the lungs 1. The organisms provoke granuloma formation, often with caseation and cavitation. Occasionally, primary infection may lead directly to more widespread disease usually by haematogenous spread that may occur at any stage of the disease.
More commonly, the primary focus of infection in the lung heals, but the healed granuloma. If host resistance is lowered in later life, TB may be reactivated, spreading locally and, via the blood stream, throughout the body and producing many possible manifestations. Major complications include miliary TB diffuse haematogenous spread throughout the body, often visible as miliary mottling in the chest X-ray 1.