SEMIOLOGY OF INFECTIOS DISEASES Prof Dr Yaar Kkardal

SEMIOLOGY OF INFECTIOS DISEASES Prof. Dr. Yaşar Küçükardalı Yeditepe University Faculty of Medicine Department of Internal Medicine

Semiology ; science of the findings and symtoms of the deseases

Subjective and Objective information subjective objective What the patient says (chief Physician‘s physical complaint etc. ) examination Laboratory findings Radiological findings

INFECTION Infection: The invasion and multiplication of microorganisms such as bacteria, viruses, fungus and parasites that are not normally present within the body and the reaction of host tissues to these organisms and the toxins they produce. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent. An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic. Microorganisms that live naturally in the body are not considered infections. For example, bacteria that normally live within the mouth and intestine are not infections. transmissible diseases communicable diseases

HOW BACTERIA AND VIRUSES ENTER THE BODY Pathogenic bacteria must gain access into the body. The range of access routes for bacteria includes: Cuts Contaminated food or water Close contact with an infected person Contact with the faeces of an infected person Breathing in the exhaled droplets when an infected person coughs or sneezes Indirectly, by touching contaminated surfaces – such as taps, toilet handles, toys and nappies.

VIRUSES ARE SPREAD FROM ONE PERSON TO ANOTHER BY: Coughs Sneezes Vomits Bites from infected animals or insects Transfusion of the contaminated blood products Exposure to infected bodily fluids through activities such as sexual intercourse or sharing hypodermic needles. Forgetting to wash your hands after handling pets and animals is another way for germs to be taken in by mouth.

Primary pathogens cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic virulence

Opportunistic pathogens can cause an infectious disease in a host with depressed resistance. such as pathogenic bacteria or fungi in the gastrointestinal or the upper respiratory tract, An opportunistic disease requires impairment of host defenses, which may occur as a : result of genetic defects (such as Chronic granulomatous disease), exposure to antimicrobial drugs or immunosuppressive chemicals (as might occur following poisoning or cancer chemotherapy), exposure to ionizing radiation,

FEVER > 37. 5 C oral, > 38. 2 rectal Endogen pirogens : IL -1, TNF, INF Eksogen pirogens: Gr+, - , bacterial endo or egzo toxins, Daily physiologic alteration may occur 1 C 20 -30 % elderly patients may not have fever during th infection episode

HYPERPYREXIA Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41. 5 °C (106. 7 °F). Such a high temperature is considered a medical emergency The most common cause is an intracranial hemorrhage sepsis, Kawasaki syndrome, neuroleptic malignant syndrome, drug effects, serotonin syndrome, thyroid storm. Heatstroke malignant hyperthermia Infections commonly associated with hyperpyrexia include: rubeola and enteroviral infections in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point due to an outside source.

CAUSES OF FEVER İnfectious diseases Solid and hematologic malignancies Vasculitis and collageneous diseases Outoimmun Granulamatous Endocrin and metabolic Primary neurologic Other: FMF, allergic rx, alcoholic hepatitis, hemolysis, histiositosis -X, drug fever, Kikuchi diseases, pancreatitis, Sweet syndrome, pulmonary emboli, hyperimmungloubulin D syndrome

Continuous fever: Temperature does not fluctuate more than 1 °C in 24 hours, e. g. lobar pneumonia, urinary tract infection, brucellosis, or typhus. Typhoid fever may show a specific fever pattern, with a slow stepwise increase and a high plateau. Remittent fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours, e. g. , infective endocarditis. Intermittent fever: The temperature elevation is present only for a certain period, later cycling back to normal, e. g. malaria, kala-azar, pyaemia, or septicemia Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high for one week and low for the next week and so on

MOST COMMON SYMPTOMS RELATED TO SIDE OF THE INFECTION Systemic Head and Neck Pulmonary Fever Fatigue Anorexia Weakness Extensive pain Headache Sore throat Difficulty on swollow Dyspnea Coahing Chest pain Cardiovasculary Hepatobiliary Gastrointestinal Palpitation Chest pain Dyspnea Sencop Cloudicatio intermit. Right upper guadrant pain , Right/left upper quadrant dullness Nausia Vomiting İcterus Puriritis Abdominal pain Nausia Vomiting Diarea , mucoid, . . Abdominal bloating Perirectal puriritis Pain during the defecation

MOST COMMON SYMPTOMS RELATED TO SIDE OF THE INFECTION Urogenital Musculosceletal Santral and peripheric nervous system Burning during the urination Pollacuria Flunk pain Dificulty on urination Referred pain Ureteral discharge Muscle / joint pain Diminish ROM Loss of memory Mental disorders Nausia, vomiting Parestesia Skin Pururitis Burning

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION İnspection Head and Neck Discharge of ear, Post nasal discharge Hyperemic conjonctiva Icteric sclere Hyperemic apperence of pharenx Exuda on tonsil Oscultation Percussion Palpation Lymphadenomegaly Tenderness of sinus Neck stiffness Tenderness of thyroid

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION Chest İnspection Oscultation Percussion Palpation Tacipnea Bradipnea Vesiculary lesions Rales Roncus Diminish lung sound Matite Axillary lymphadenomegaly

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION Cardiovasculary İnspection Oscultation Percussion Palpation Slinter hemoragia Janeway lesion Hyperemic vasculary line Altered murmur Diminished heart sounds Matite Weak radial pulse

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION İnspection Hepatobiliary İcterus Abdominal distansion Vomiting Dark urine White stool Oscultation Percussion Palpation Hapatomegaly Splenomegaly Murphy sign Rebound Tenderness

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION Gastrointestinal İnspection Oscultation Percussion Palpation Abd distantion Cullen Turner Bloody stool Hyperactive bowel sounds Silent abdomen Sonorite Tenderness Rebound Mc Burney Matite

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION İnspection Urogenital system Urethral discharge Glob vesicale Genital herpetic lesions Piuria Oscultation Percussion Palpation Costa vertebral angle tenderness Suprapubic dullness Testiculary tenderness Inguinal LAM Pelvic tenderness Prostat tenderness

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION İnspection Muscle and sceletal system Milky synovial fluid apperence Brown urine Foot ulcer Chronic discharge Oscultation Percussion Palpation Hot joint Diminish ROM Ballotman Bone tenderness Pain point of on axial system

MOST PHYSICAL FINDINGS RELATED TO SIDE OF THE INFECTION İnspection Central and peripheral nervous system Loss of memory Neurologic deficit Vomiting Dificulty on swollow Abnormal talking Oscultation Percussion Palpation Neck stiffness Loos of sensation Parestesia Plegia Abnormal reflexes

CHARACTERISTICS OF VIRAL INFECTIONS In general, viral infections are systemic. This means they involve many different parts of the body or more than one body system at the same time; i. e. a runny nose, sinus congestion, cough, body aches etc. They can be local at times as in viral conjunctivitis or "pink eye" and herpes. Only a few viral infections are painful, like herpes. The pain of viral infections is often described as itchy or burning.

Reye syndrome is sudden (acute) brain damage and liver function problems of unknown cause. The syndrome has occurred in children who have been given aspirin when they have chicken pox or the flu. Reye syndrome has become very uncommon since aspirin is no longer recommended for routine use in children.

DIAGNOSIS OF VIRAL DISEASES Clinical presentation is used to detect viral disease by looking for history of severe muscle and joint pains before fever also detect skin rash lymph gland swelling Laboratory investigations is not necessary to detect viral infections, because no increase in the white blood cells, the laboratory investigation is done to find other bacterial infections, if it is suspected. Viruses commonly have self-limited life, so treatment is usually reduce the symptoms only and antipyretic and analgesicdrugs

CHARACTERISTICS OF BACTERIAL INFECTION The classic symptoms of a bacterial infection are: localized redness, heat, swelling and pain. One of the hallmarks of a bacterial infection is local pain, that occurs at the site of the infection. Bacterial throat pain is often characterized by more pain on one side of the throat. An ear infection is more likely to be diagnosed as bacterial if the pain occurs in only one ear. Bacterial infections produces pus and milky-colored liquid

FEVER WITHOUT LOCALISE SYMPTOMS Tuberculosis Endocarditis Micotic anevrisma Septic thrombophlebitis Spondilitis Osteomyelitis Pneumonia Intraabdominal abces Pyelonephritis Viral: CMV , mononucleosis, HIV, early hepatitis

MAJOR SYMPTOMS MAY COEXIST WITH FEVER Eruption Joint and bone pain Lymphadenopathy Face and neck swelling Headache and neck stiffness Neurological disturbances Cold ang flu like symptoms Coughing and chest pain icterus Splenomegali Diarea Abdominal pain Disuria Sepsis Heart diseases

FEVER AND PATECHIA / PURPURA A petechia is a small (1 - 2 mm) red or purple spot on the skin, caused by a minor hemorrhage (broken capillary blood vessels). Bacteria, ricethsia, virus DİC Gram negative sepsis Endocarditis Meningococcemia Tiphus, Rocky Mountain Fever, Rubella, rubeola, mononucleosis, hepatitis, hemoragic fever

NON INFECTIOUS CAUSES OF PATECHIA / PURPURA Henoch schlein purpura SLE, ANCA related vasculitis PAN Churg Strause Wegener Granulomatosis

MACULOPAPULARY EXANTEM Rubella, rubeola, coxacie, ecovirus, mononucleosis, parvovirus Streptococ, (erizipel, scarlet fever), staphylococ, ( TSS) , sec. Siphylis Drug rx, serum sickness, lupus, Steven Johnson S, dermatomysotis, Sweet Syndrome, Etiology ? leucocytosis, skin lesions, neutrophilic infiltration, myalgia, headache, fever, (infection, malignity, IBS vb ) An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.

VESICULARY AND PUSTULARY LESIONS Varisella, zoster, herpes symplex, coxachie A 16, hand, foot, mouth diseases, Spahpylococ sepsis Disseminated gonococ infection ( distal) Drug eruption, allergic dermatitis, Sweet S, Steven Johnson S, Vesicles are small, fluidfilled sacs that can appear on skin

NODULARY SKIN LESIONS Treponema pallidum; Nocardia; and atypical mycobacteria, particularly Mycobacterium marinum and Mycobacterium chelonae, as well as Mycobacterium tuberculosis itself. Fungal infections, including blastomycosis, coccidioidomycosis, sporotrichosis, and aspergillosis, All these infectious disorders are due to Staphylococcus aureus or opportunistic bacteria such as Nocardia, Legionella or Aspergilli.

ULCERUOS SKIN LESIONS Stomatitis is an inflammation inside the mouth, such as a small sore or ulcer. Multiple blisters in the mouth can be a sign of herpetic stomatitis. Ulcerated skin lesions may result from Staphylococcus infections The necrotic ulcer of anthrax is often surrounded by edema Rarely, a painless destructive ulcer with undermining edges may result from infection with Mycobacterium ulcerans (Buruli ulcer). cutaneous leishmaniasis. The lesion is a chronic, usually painless ulcer, skin dephteria, tularemi, ectima gangrenosum ( pseudomonas aeroginosa) , ricetsia Peripheral vasculary disease, Behçet diseases, vasculitis, cholesterol embolism, lymphoma, erithema multiforme major,

FEVER AND BONE/ JOINT PAIN İnflammatory joint diseases together with % 15 -20 infectious pathogen Bacterial artritis: gonococ / rubeola, hepatitis, mumps, polyarticulary , others monoarticulary Cardinal findings of inflammation No fever / mycobacterium, fungal infection Most common: Knee, hip, scholder, elbow Gram stain positive % 30 -50 , staph, Viral: rubeola, hepatitis B, Reactive artritis: Chlamidia, Shigella, Camphylobacter, Salmonella, Yersinia, Gonococ

FEVER AND DISSEMINETED LAM

FEVER AND LOCALISED LAM Servical LAM: upper respiratory tract infections Virus, Group A streptococ, Ebstain Barr Virus, Diphteria, Toxoplasmosis, tbc lymphadenitis Oxipital LAM: Rubella, rubeola, non -spesific infections of scalp Axillary, İnguinal LAM: Group A streptococ Inguinal LAM with pain: herpes symplex, lymphogranuloma venerum ( chlamidia) Soft chankır ( Haemophilus ducrei), granuloma inguinale

FEVER AND FACE / NECK SWOLLEN Mumps, pürülan parotitis Parotis , salivary gland lenfamatosis, Sjogren S, Warthin TM Neck: Lemierre S Actinomicosis: Lemierre's syndrome (or Lemierre's disease, also known as postanginal shock including sepsis and human necrobacillosis) refers to thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteremia or septic emboli.

FEVER, HEADACHE AND NECK STIFNESS İnfectious origine Drug Rx Allergic Rx, Leucemia SNS metastasis Subaracnoid hemoragia SVA ( emboli , trombosis)

MENINGITIS Bacterial meningitis and viral encephalitis are two life-threatening causes of infection and inflammation within the central nervous system (CNS). Evaluation in the acute care setting is focused on identifying patients who require urgent diagnostic testing and/or empiric treatment. Meningitis affects patients of all ages, but those who are very young, elderly, or immunosuppressed are at increased risk.

MENENGISM Neck stiffness Headache Fever Nousia Vomiting Photophobia Diplopia Hyperestesia Generalise convulsion

MENENJITIS LIKE CONDITIONS Purulan proceses near the meninx Brain abceses, mastoiditis, otitis, osteomyelitis, sinusitis, ………may caouse meningial irritation

INFLUENZA There are two main types of influenza (flu) virus: Types A and B. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year. Fever* or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (tiredness) Some people may have vomiting and diarrhea, though this is more common in children than adults. Acute respiratory diseases ( upper end lower tract) Sec bacterial infections may occur ( staph. , pneumococ, H influenza)

FEVER AND FLU LIKE INFECTIONS Bacterial tonsillitis and pharangitis Streptococal: odinophagia, LAM, leucocytosis, scarlet; high fever with fast klinical course skin lesions may appear 2 -5 day later Dihpteria Plaunt vincent angina Non Bacterial pharangitis: Mycoplasma, Ebstain Bar virus, adenovirus, coxachie virus, CMV, herpes virus,

COLD: INFLUENZA LIKE INFECTIONS Virus 90%, ( rhinovirus, coxachie virus, Mycoplasma, Chlamidia Rhinitis, tosillopharengitis, larengotraceitis, trakeobronchitis, bronchopneumonia In the absence of outbreak, influenza may be diffucult to differentiate from acut respiratory illness caused by other viruses or mycoplasma Severe streptecocal pharangitis or early bacterial pneumonia may mimic acute influenza

SINUSITIS Sinus infections are caused by infections from a pathogenic microorganism (virus, bacterium, or fungus), which grows within a sinus and causes intermittent blockage of the sinus ostium. Sinus infection symptoms may include sinus headache, facial tenderness, pressure or pain in the sinuses, fever, cloudy discolored drainage, and feeling of nasal stuffiness, sore throat, and cough, and on rare occasions, associated with facial swelling.

OTITIS Otitis is a general term for inflammation or infection of the ear, It is subdivided into the following: Otitis externa, or "swimmer's ear" involves the outer ear and ear canal. Otitis media or middle ear infection involves the middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space. Otitis interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, vertigo is a common symptom. The eustachian tube is shorter in children than adults which allows easy entry of bacteria and viruses into the middle ear, resulting in acute otitis media. Bacteria such as Streptococcus pneumoniae (strep) and Haemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media and viruses the remaining 15%. pus within the middle ear causes pain , there is usually transient hearing loss during the infection, Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal.

BRONCITIS Bronchitis is an inflammation of the bronchial tubes, People who have bronchitis often cough up thickened mucus, which can be discolored. Often developing from a cold or other respiratory infection, acute bronchitis is very common. Acute bronchitis is usually caused Viruses cause about 90% of by viruses, typically the same acute bronchitis cases, viruses that cause colds and flu whereas bacteria account for (influenza). The most common about 10% cause of chronic bronchitis is smoking cigarettes. Air pollution Mycoplasma pneumoniae, and dust or toxic gases in the Chlamydophila pneumoniae, environment or workplace also Bordetella pertussis, can contribute to the condition. Streptococcus pneumoniae, Haemophilus influenzae

FEVER, COAHING, THORAX PAIN : PNEUMONIA Pneumonia is a common lung infection caused by bacteria, a virus or fungi Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. In bacterial pneumonia, your temperature may rise as high as 38 degrees. This pneumonia causes profuse sweating, and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious. Bacteria are the most common cause of communityacquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases. Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases; [20] Staphylococcus aureus; Moraxella catarrhalis; Legionella pneumophila and Gram-negative bacilli

The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips. In adults, viruses account for approximately a third[6] and in children for about 15% of pneumonia cases. [22] Commonly implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and parainfluenza.

BREATHING SOUNDS: disease chest inspection palpation (thoracic vibration) percussio n character of breathing sounds patological sounds pneumonia normal/ dyspnea increased normal/ matitiy decreased/bronchi olar/ bronchovesicular inspiratory rales atelectasis depression of one hemithorax decreased matity decreased or absent inspiratory rales pneumothor ax increase of one hemithorax decreased hypersonori ty decreased or absent - emphysem a increased thoracic index normal/decreased normal/hyp ersonor decreased - COPD normal/dys pneic normal/increased wheezing/rhoncus pulmonary fibrosis tachypnea/ dyspnea normal velcro rales asthma dyspnea normal/decreased/ silent wheezing/rhoncus cardiac failure dyspnea normal/increased normal inspriatory rales/rhoncus pleural effusion increase of one hemithorax decreased matitiy decreased -/Frotman

FEVER AND ICTERUS Prehepatic Clostridium perfiringens, M pneumonia may cause hemolysis ( low hgb, reticulosis, high LDH) Sicle cell anemia, G 6 PD deficiency, PNH, Hepatic Acute viral hepatitis, mononucleosis, CMV, Sepsis: pneumococ, klebsiella, Salmonella, Bacterides fragilis E Coli, Streptococ, Milier tuberculosis Intrahepatic abceses Posthepatic Chlangitis and choledecolitiasis

FEVER AND SPLENOMEGALY Lymphoproliferative disorders İnfections Hemolitic anemia Non infectious Felty Syndrome Still Diseases Lupus Diseases

The causes of massive splenomegaly (spleen >1000 g) are fewer, and include: visceral leishmaniasis (kala-azar) chronic myelogenous leukemia myelofibrosis malaria primary lymphoma of spleen

FEVER AND DIAREA Diarrhea may be accompanied by fever (temperature greater than 100. 4ºF or 38ºC), abdominal pain, or cramping Viral diarrhea are typically associated with mild-to-moderate symptoms with frequent, watery bowel movements, abdominal cramps, and a low-grade fever. The following are the common causes of diarrhea caused by viral infections: rotavirus is a common cause of diarrhea in infants; norovirus (for example, Norwalk virus, caliciviruses) is the most common cause of epidemics of diarrhea among adults and schoolage children (for example, cruise ship infection, schools, nursing homes, day care facilities, and restaurants); and adenovirus infections are common in all age groups.

Bacterial infections cause the more serious cases of diarrhea. Typically, infection with bacteria occurs from contaminated food or drinks (food poisoning). Bacterial infections also cause severe symptoms, often with vomiting, fever, and severe abdominal cramps or abdominal pain. Bowel movements occur frequently and may be watery. The following are examples of diarrhea caused by bacterial infections: In more serious cases, the stool may contain mucus, pus, or blood. Most of these infections are associated with local outbreaks of disease. Family members or others eating the same food may have similar illnesses. Campylobacter, salmonellae, and shigella organisms are the most common causes of bacterial diarrhea. Less common causes are Escherichia coli Yersinia, and listeria. Use of antibiotics can lead to an overgrowth of Clostridium difficile (C diff) bacteria in the intestines.

Parasites cause infection of the digestive system by the use of contaminated water. Common parasitic causes of diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium. Intestinal disorders or diseases including inflammatory bowel disease, irritable bowel syndrome (IBS), diverticulitis, microscopic colitis, and celiac disease can cause diarrhea. Reaction to certain medications can cause diarrhea. Common medications include antibiotics, blood pressure medications, cancer drugs, gout medications, weight loss drugs, and antacids (especially those containing magnesium). Intolerance to foods such as artificial sweeteners and lactose (the sugar found in milk) can cause diarrhea.

Definition Location Work-up Acute pain syndromes Chronic pain syndromes ORGANIC VERSUS FUNCTIONAL PAIN HISTORY ORGANIC FUNCTIONAL Pain character Acute, persistent pain increasing in intensity Less likely to change Pain localization Sharply localized Various locations Pain in relation to sleep Awakens at night No affect Pain in relation to umbilicus Further away At umbilicus Associated symptoms Fever, anorexia, vomiting, wt loss, anemia, elevated ESR Headache, dizziness, multiple system complaints Psychological stress None reported Present

Definition Location Work-up Acute pain syndromes Chronic pain syndromes

FEVER AND ABDOMINAL PAIN Intraabdominal infections Time to antimicrobial therapy important History and clinical findings are gold standart for diagnosis Primary peritonitis: 1% , chrosis with ascites, nephrotic syndrome, monomicrobial, E. Coli, pneumococ, group A streptococ, Secondary peritonitis : necrotizing lesion of GI tract, traumatic perforation, perforation during the invasive procedure, aerobic ( E coli, enterobacter, enterococus, streptococ, pseudomonas) and anaerobic ( Bacteroides fragilis, Clostridium ) polymicrobial

INTRAABDOMINAL ABCESES Progression of diffuse peritoitis Spontan and travmatik perforation of GI tract Leakega of surgical anastomos line Tendency of intraabdominal abcesses Crohn: intraperitoneal, retroperitoneal, bacterial endocarditis Gallbladder diseases: liver abcesses Pancreatitis: pancreatic abcesses Rigor:

UROGENİTAL İNFECTİONS

FEVER, DISURIA AND POLLAKURIA Üretritis: burning, discharge, leucocyturia, gonococus, chlamidia, tricomonas, mycoplasma, uroplasma , no fever, Uncomplicated urinary system infection in womens: disuria, pollacuria, lower abdominal pain E coli, Staph saprophiticus, short term antibiotic Asemptopmatic bacteriuria: pregnancy, diabetes, transplantation, should be treated

Uncomplicated pyelonephritis: fever, chill, lomber pain, costa vertebral tenderness Blood and urine culture +, 100000 mo / ml E Coli Complicated pyelonephritis: plus, present complicated urologic diseases Malformation Renal stone Prostat hyperplasia Desensus uteri Diabetes

FEVER AND SEPSIS Sepsis is a potentially life-threatening complication of an infection. If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death. To be diagnosed with sepsis, you must exhibit at least two of the following symptoms: Body temperature above 101 F (38. 3 C) or below 96. 8 F (36 C) Heart rate higher than 90 beats a minute Respiratory rate higher than 20 breaths a minute Leucocyt count >12000 or < 4000/ ul Probable or confirmed infection

While any type of infection — bacterial, viral or fungal — can lead to sepsis, the most likely varieties include: Pneumonia Abdominal infection Kidney infection Bloodstream infection (bacteremia)

INFECTIVE ENDOCARDITIS inflammatory process on-going inside endocardium – due to infection after endothelium damage – most often involving aortic and mitral valves – 3 -10/100 000/year Maximum at the age of 70 -80 More common in women Staphylococcus aureus is the most common pathogen Streptococcal IE is still the most common in developing countries

• • • Fever – over 90% of patients New intra-cardiac murmur - about 85% of patients Roth spots, petechiae, glomerulonephritis – up to 30% of patients When we suspect? Sepsis of unknown origin Fever coexsisting with: – – – – – Intracardiac implantable material IE history Congenital heart disease or valve disease IE risk factors Congestive heart failure symptoms New heart block Positive blood cultures Focal neurological signs without known aetiology Periferal abscesess (kidney, spleen, brain, vertebral column)

DUKE CRITERIA Major criteria 1. 2. Minor criteria Blood culture positive for 1. typical IE-causing microorganism 2. Evidence of endocardial 3. involvement 4. Diagnosis • 2 major criteria • 1 major and 3 minor • 5 minor criteria 5. Predisposition – heart condition or i. v. drug abuse Fever – temp. >38 °C Vascular phenomena – arterial emboli etc. Immunologic phenomena – glomerulonephritis, Osler’s nodes, Roth’s spots Microbiological evidence – positive blood cultures but do not meet major criteria

PALPATION OF THE LIVER: