Diseases of Cardiovacular and Lymphatic Systems

1
Diseases of Cardiovacular and Lymphatic Systems
2
Rheumatic Fever

• Caused by Streptcoccus pyogenes
• Generally starts out as sore throat caused by
  Strep. bug
• Signs and symptoms
• First expressed as a period of arthritis and
  fever
• 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

3
(No Transcript)
4

• 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.

5
Tularemia

• 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.

6

• 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.
• 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)

7
(No Transcript)
8

• Symptoms   
• 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

9

• Treatment   
• The goal of treatment is to eliminate the
  infection with antibiotic therapy. Streptomycin
  and tetracycline are commonly used in this
  infection.
• Tularemia is fatal in about 5 of untreated cases
  and in less than 1 with treatment.
• Complications   
• meningitis
• pneumonia
• pericarditis

10
Anthrax

• 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.
• 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.

11

• Inhalation anthrax develops when anthrax spores
  enter the lungs.
• 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.

12

• There are usually two stages of inhalation
  anthrax
• the first stage can last from hours to a few days
  and is similar to a flu-like 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.

13

• Symptoms   
• 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

14
(No Transcript)
15

• Treatment   
• 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).

16

• 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.

17
Cat-scratch Disease

• 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   
• 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.)

18

• Fever in approximately one third of patients
• Fatigue
• Malaise
• Headache
• Treatment   
• 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.

19
Plague

• 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.

20
(No Transcript)
21

• Symptoms  
• 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

22

• Treatment   
• 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   
• 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

23
Typhus

• 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.

24

• SYMPTOMS OF MURINE TYPHUS
• 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

25

• SYMPTOMS OF EPIDEMIC TYPHUS
• 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

26

• Treatment   
• 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   
• 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.

27
Rocky Mountain Spotted Fever

• An infectious disease caused by Rickettsia
  rickettsii transmitted to humans by the bite of
  ticks.
• Symptoms   
• 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

28
(No Transcript)
29

• Treatment   
• 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   
• 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.

30
Gangrene

• 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.

31
(No Transcript)
32

• Gas gangrene generally occurs at the site of
  trauma or a recent surgical wound.
• Symptoms   
• 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)

33

• Treatment   
• 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   
• Gas gangrene is progressive and often lethal.
  Immediate medical attention is required.

34
Lyme Disease

• 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

35

• Symptoms
• 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.
• Facial paralysis
• Meningitis,
• Encephalitis

36

• 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.

37
Chagas Disease

• 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.

38
(No Transcript)
39

• Chagas disease has two phases -- acute and
  chronic.
• The acute phase may have no symptoms or have very
  mild symptoms.
• 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.

40

• 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.

41

• Symptoms   
• 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

42

• Treatment   
• 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   
• 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.

43
Leishmaniasis

• 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.

44

• 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.

45

• Symptoms   
• 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

46

• abdominal discomfort, vague
• vomiting (children)
• diarrhea (children)
• cough (children)
• skin, scaly
• skin, gray, dark, ashen
• hair, thinning

47
(No Transcript)
48

• Skin disease (cutaneous leishmaniasis)
• Symptoms on the skin include
• 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)

49

• Treatment   
• Antimony-containing compounds are the principal
  medications used to treat leishmaniasis. These
  include
• meglumine antimonate
• sodium stibogluconate
• Other drugs that may be used include
• pentamidine
• amphotericin B
• Miltefosine

50

• Plastic surgery may be required to correct
  disfigurement by destructive facial lesions
  (mucocutaneous leishmaniasis). Removal of the
  spleen (splenectomy) may be required in
  drug-resistant cases (visceral leishmaniasis).

51
Schistosomiasis

• Causes and risks   
• 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.

52

• Symptoms   
• 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).

53

• Treatment   
• Praziquantel
• With acute infection, corticosteroids may be
  given
• Prognosis   
• Treatment before significant damage or severe
  complications usually produces good results.