Micro 3054 Lecture 22 Intro PartIV; Chapter22 p.519-548 Human microbial diseases

Diagnosis, prognosis, treatment. Lewis Thomas: 1930s very few medical emergencies.

Modern times: TREAT! Broad-spectrum antibios.:"refuge for diagnostically destitute"

J.G. Strep. Pneumoniae (90% of pneumonias; varied capsules). Cephalosporin by I.V. If antibiotic resistant, J.G. = dead! Switch to Pen. next day. (Major goal: Get microbiology out of the incubator!)

Upper respiratory structures coated with mucus. Coevol.: Host makes IgA; pathogen IgA protease; host: protease inhibitor; pathogen resists inhibitor, etc. Epiglottis swelling emergency. (blocked air passage=irreversible death. Vaccinate now) (meningitis New England J. of Med.: IVantibio. within 45 min.)Alpha-, beta-, gamma hemolysis. Beta: read newspaper thru. Pyogenic vs. pyrogenic

Real scientific test: Soft lens evaluation. Is chocolate agar as good as blood agar? 500 plates of each streaked. No growth on any plate. Therefore, both equivalent. (Scientific method?).

Virulence: degree of pathogenicity. Jim Henson's death. Why strain so virulent? "Flesh-eating bacteria" periodic foray. Why? http://www.nnff.org/ Nat. Necrotizing Fasciitis Found. Am Heart Association: Strep throat = shot of pen. Rheumatic fever pt.; monthly shot benzathine penicillin.

Corynebacterium diphtheriae no problem. If beta particle lysogenizes, still no problem. Induced (iron starvation, U.V., chemicals) toxin blocks mammalian prot. synthesis. Lysogenic conversion +others.

Toxoid: Nontoxigenic, immunogenic inactivated toxin (formaldehyde, mild heating) Rhinovirus: "Why don't you virologists do something about the common cold?" SSRNA in many varieties. No invariant structures for vaccine. Picornaviruses.1/2-1/4 of colds = rhinovirus.

Mycoplasmas (no cell wall) Walking pneumoniae "rarely fatal", unless you happen to drop dead from it…Mycoplasmas difficult to grow, squeeze through sterile filters.

Chlamydia are energy parasites. Chlamydia psittaci rare, but up to 20% can die. Bird rookeries.

Q fever: Coxiella burnetii, a rickettsia. Tick bites, aerosols from animal tissues (packinghouses)

Legionellosis: 1976 American Legion convention in Philadelphia. Several came down with "untreatable" disease (later: tetracycline effective; maintain long course. Cause: energy crisis.)

Bordetella pertussis controversial part of DPT vaccine, yet acellular has solved problem. Tuberculosis still major killer outside U.S. Significant in AIDS rich areas, but on decline in central U.S.BCG is widely used in Europe (so, their skin tests are positive).

Influenza: A Victoria H2N2 is an example. 1918 pandemic probably antigenic shift from avian viruses recombined in pigs.Swine flu Guillain-Barre syndrome linkage. Croup: Bark-like hoarseness, especially at night. Steamy bathroom air to treat.

RSV (respiratory syncitial virus) Large, multinucleate cells form. Very transmissible, low % die. No vaccine Hantavirus: typical emerging disease. High mortality. Avoid mouse urine!

Histoplasmosis, coccidioidomycosis, blastomycosis. Hope resistant. Amphotericin B bad stuff! Pneumocystis carinii problem for AIDS, a great, poorly-understood opportunist.

The following are from the site- http://www.nidcd.nih.gov/health/hearing/otitismedia.asp#can

(National Institute on Deafness and other Communication Disorders)

Are there different types of otitis media? Yes. The first type is called acute otitis media (AOM). This means that parts of the ear are infected and swollen. It also means that fluid and mucus are trapped inside the ear. AOM can be painful. The second type is called otitis media with effusion (fluid), or OME. This means fluid and mucus stay trapped in the ear after the infection is over. OME makes it harder for the ear to fight new infections. This fluid can also affect your child's hearing.

Can otitis media affect my child's hearing? Yes. An ear infection can cause temporary hearing problems. Temporary speech and language problems can happen, too. If left untreated, these problems can become more serious.An ear infection affects important parts in the ear that help us hear. Sounds around us are collected by the outer ear. Then sound travels to the middle ear, which has three tiny bones and is filled with air. After that, sound moves on to the inner ear. The inner ear is where sounds are turned into electrical signals and sent to the brain. An ear infection affects the whole ear, but especially the middle and inner ear. Hearing is affected because sound cannot get through an ear that is filled with fluid.

1. Read. Make sure the pharmacy has given you printed information about the medicine and clear instructions about how to give it to your child. Read the information that comes with the medicine.

2. Plan. Sometimes it is hard to remember when you have given your child a dose of medicine. Before you give the first dose, make a written plan or chart to cover all of the days of the medication. Some children may require 10 to 14 days of treatment.Your chart might look like this:

3. Follow Through. Be sure to give all of the medicine to your child.

Will my child need surgery?Some children with otitis media need surgery. The most common surgical treatment involves having small tubes placed inside the ear. This surgery is called a myringotomy. It is recommended when fluids from an ear infection stay in the ear for several months. At that stage, fluid may cause hearing loss and speech problems. A doctor called an otolaryngologist (ear, nose, and throat surgeon) will help you through this process if your child needs an operation. The operation will require anesthesia.

In a myringotomy, a surgeon makes a small opening in the ear drum. Then a tube is placed in the opening. The tube works to relieve pressure in the clogged ear so that the child can hear again. Fluid cannot build up in the ear if the tube is venting it with fresh air. After a few months, the tubes will fall out on their own. In rare cases, a child may need to have a myringotomy more than once.

From- http://www.aafp.org/afp/20030315/tips/22.html (Am. Academy of Family Physicians)

Otitis media, the most common reason for prescribing antibiotics in children, figures prominently in the problem of antibiotic resistance. The usefulness of antibiotics in the treatment of ear infections has been widely investigated. A meta-analysis found that antibiotics improved resolution of otitis media at one week post-treatment by 13 percent (94 percent resolution for treatment versus 81 percent for placebo). Most analyses also have shown modest reductions in clinical symptoms after the first three to five days of antibiotic use compared with placebo. Recurrent acute otitis media: Delayed antibiotic-prescribing strategy Immunization with influenza vaccine