MICROBIOLOGY Chapter 23 Microbial Diseases of the Cardiovascular

MICROBIOLOGY Chapter 23 Microbial Diseases of the Cardiovascular and Lymphatic Systems Dr. Abdelraouf A. Elmanama Ph. D Microbiology Medical Technology Department, Faculty of Science, Islamic University-Gaza 2008

The Cardiovascular System and Lymphatics System • Blood—Transports nutrients to and wastes from cells • WBCs—Defend against infection • Lymphatics—Transport interstitial fluid to blood • Lymph nodes—Contain fixed macrophages 2008

The Cardiovascular System 2008 Figure 23. 1

The Lymphatic System 2008 Figure 23. 2

Sepsis and Septic Shock • Sepsis • Bacteria growing in the blood • Severe sepsis • Decrease in blood pressure • Septic shock • Low blood pressure cannot be controlled 2008 Figure 23. 3

Sepsis • Gram-negative Sepsis • Endotoxins caused blood pressure decrease • Antibiotics can worsen condition by killing bacteria • Gram-Positive Sepsis • Nosocomial infections • Staphylococcus aureus • Streptococcus pyogenes • Group B streptococcus • Enterococcus faecium and E. faecalis 2008

Sepsis • Puerperal Sepsis (Childbirth fever) • Streptococcus pyogenes • Transmitted to mother during childbirth by attending physicians & midwives 2008

Bacterial Infections of the Heart • Endocarditis • Inflammation of the endocardium • Subacute bacterial endocarditis • Alpha-hemolytic streptococci from mouth • Acute bacterial endocarditis • Staphylococcus aureus from mouth • Pericarditis • Streptococci 2008

Bacterial Infections of the Heart 2008 Fgirue 23. 4

Rheumatic Fever • Inflammation of heart values • Autoimmune complication of Streptococcus pyogenes infections 2008 Figure 23. 5

Tularemia • Francisella tularensis, gram-negative rod • Transmitted from rabbits and deer by deer flies • Bacteria reproduce in phagocytes 2008

Tularemia 2008 Figure 23. 6

Brucellosis (Undulant Fever( • Brucella, gram-negative rods that grow in phagocytes • B. abortus (elk, bison, cows) • B. suis (swine) • B. melitensis (goats, sheep, camels) • Undulating fever that spikes to 40°C each evening • Transmitted via milk from infected animals or contact with infected animals 2008

Anthrax • Bacillus anthracis, gram-positive, endospore-forming aerobic rod • Found in soil • Cattle are routinely vaccinated • Treated with ciprofloxacin or doxycycline • Cutaneous anthrax • Endospores enter through minor cut • 20% mortality 2008

Anthrax • Gastrointestinal anthrax • Ingestion of undercooked food contaminated food • 50% mortality • Inhalational anthrax • Inhalation of endospores • 100% mortality 2008 Figure 23. 7

Biological Weapons • 1346 Plague-ridden bodies used by Tartar army against Kaffa • 1925 Plaque-carrying flea bombs used in the Sino-Japanese War • 1950 s U. S. Army spraying of S. marcescens to test weapons dispersal • 1972 International agreement to not possess biological weapons • 1979 B. anthracis weapons plant explosion in the Soviet Union • 1984 S. enterica used against the people of The Dalles • 2001 B. anthracis distributed in the U. S. 2008

Biological Weapons Bacteria Viruses Bacillus anthracis “Eradicated” polio and measles Brucella spp. Encephalitis viruses Chlamydia psittaci Hermorrhagic fever viruses Clostridium botulinum toxin Influenza A (1918 strain) Coxiella burnetti Monkeypox Francisella tularensis Nipah virus Rickettsia prowazekii Small pox Shigella spp. Yellow fever Vibrio cholerae Yersinia pestis 2008

Gangrene • Ischemia • Loss of blood supply to tissue • Necrosis • Death of tissue • Gangrene • Death of soft tissue • Gas gangrene • Clostridium perfringens, gram-positive, endosporeforming anaerobic rod, grows in necrotic tissue • Treatment includes surgical removal of necrotic tissue and/or hyperbaric chamber 2008

Animal bites and scratches • Pasteurella multocida • Clostridium • Bacteroides • Fusobacterium • Bartonella hensellae • Cat-scratch disease 2008

Plague • Yersinia pestis, gram-negative rod • Reservoir • Rats, ground squirrels, prairie dogs • Vector • Xenopsylla cheopsis • Bubonic plague • Bacterial growth in blood and lymph • Septicemia plague • Septic shock • Pneumonic plague • Bacteria in the lungs 2008

Plague 2008 Figure 23. 10, 11

Relapsing Fever • Borrelia spp. , spirochete • Reservoir • Rodents • Vector • Ticks • Successive relapses are less severe 2008

Lyme Disease • Borrelia burgdorferi • Reservoir • Deer • Vector • Ticks 2008

Lyme Disease 2008 Figure 23. 13 a

Lyme Disease 2008 Figure 23. 13 b, c

Lyme Disease • First symptom • bull's eye rash • Second phase • Irregular heartbeat, encephalitis • Third phase • Arthritis 2008 Figure 23. 14

Ehrlichiosis • Ehrlichia, gram-negative, obligately intracellular (in white blood cells) • Reservoir • Deer, rodents • Vector • Ticks 2008 Figure 23. 15

Typhus • Epidemic typhus • Rickettsia prowazekii • Reservoir • Rodents • Vector • Pediculus humanus corporis • Transmitted when louse feces rubbed into bite wound 2008

Typhus • Epidemic murine typhus • Rickettsia typhi • Reservoir • Rodents • Vector • Xenopsylla cheopsis 2008

Spotted Fevers (Rocky Mountain spotted fever( • Rickettsia rickettsii • Measles-like rash except that the rash appears on palms and soles too 2008 Figure 23. 18

Spotted Fevers (Rocky Mountain spotted fever( 2008 Figure 23. 16

Tick Life Cycle 2008 Figure 23. 17

Burkitt’s Lymphoma • Nasopharyngeal carcinoma • Epstein-Barr virus (Human herpesvirus 4) • Cancer in immunosuppressed individuals, and malaria and AIDS patients 2008

Infectious Mononucleosis • Epstein-Barr virus (Human herpesvirus 4) • Childhood infections are asymptomatic • Transmitted via saliva • Characterized by proliferation of monocytes 2008

Infectious Mononucleosis 2008 Figure 23. 20

Cytomegalic Inclusion Disease • Cytomegalovirus (Human herpesvirus 5) • Infected cells swell (cyto-, mega-) • Latent in white blood cells • May be asymptomatic or mild • Transmitted across the placenta, may cause mental retardation • Transmitted sexually, by blood, or by transplanted tissue 2008

Viral Hemorrhagic Fevers Classic Yellow fever Flavivirus Aedes aegypti Monkeys Dengue & DHF Flavivirus • A. aegypti • A. albopictus No known reservoir Emerging Marbug Filovirus • Monkeys (? ) Ebola Filovirus • Monkeys (? ) Lassa fever Arenavirus • Rodents Argentine hemorrhagic fever Arenavirus • Rodents Bolivian hemorrhagic fever Arenavirus • Rodents Hantavirus pulmonary syndrome Hantavirus • Rodents 2008

Ebola Virus 2008 Figure 23. 21

American Trypanosomiasis (Chagas’Disease( • Trypanosoma cruzi • Reservoir • Rodents, opossums, armadillos • Vector • Reduviid bug 2008 Figure 23. 22, 12. 33 d

Toxoplasmosis • Toxoplasma gondii 2008 Figure 23. 23

Malaria • Plasmodium vivax, P. ovale, P malariae, P. falciparum • Anopheles mosquito 2008 12. 31 b

Malaria 2008 Figure 23. 25

Malaria 2008 Figure 23. 24

Malaria 2008 Figure 12. 19

Leishmaniasis Disease Visceral leishmaniasis Cutaneous leishmaniasis Mucocutaneous leishmaniasis Babesiosis Fatal if untreated Papule that ulcerates and scars Disfiguring Replicates in RBCs Causative agent Leishmania donovani L. Tropica L. Braziliensis Babesia microti Vector Sandflies Ixodes ticks Reservoir Small mammals Rodents Treatment Amphotericin B or miltefosine Atovaquone + azithromycin Geographic distribution Asia, Africa, Southeast Asia, Africa, Mediterranean, Central America, South America Rain forests of Yucatan, South America U. S. 2008

Babesiosis 2008 Figure 12. 32

Schistosomiasis 2008 Figure 23. 28

Schistosomiasis • Tissue damage (granulomas) in response to eggs lodging in tissues • S. haemotobium • S. japonicum • S. mansoni • Swimmer’s itch 2008 Granulomas in urinary Africa, Middle East bladder wall Granulomas in intestinal wall East Asia Granulomas in intestinal wall African, Middle East, South American, Caribbean Cutaneous allergic reaction U. S. parasite of wildfowl to cercariae

Schitstosomasis (a) Male and female schitosomes. 2008 Figure 23. 27 a

Schitstosomasis 2008 Figure 23. 27 b