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Bloodlymphatic Disease
Bloodlymphatic Disease
Bloodlymphatic Disease
Figure 23.1
The Lymphatic System
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
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
Sepsis
Puerperal sepsis (childbirth fever)
Streptococcus pyogenes
Transmitted to mother during childbirth by attending
physicians and midwives.
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
Bacterial Infections of the
Heart
Figure 23.4
Rheumatic Fever
Inflammation of heart valves
Autoimmune complication of Streptococcus
pyogenes infections
Figure 23.5
RF
RF is characterized by a constellation of findings
major manifestations
valvular disease
cardiac murmurs, cardiac hypertrophy and dilation, and heart failure,
arrhythmias (particularly atrial fibrillation in the setting of mitral
stenosis), thromboembolic complications, and infective endocarditis.
Tularemia
Francisella tularensis,
gram-negative rod
Transmitted from
rabbits and deer by
deer flies.
Bacteria reproduce in
phagocytes.
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.
Anthrax
Bacillus anthracis, gram-positive, endospore-
forming aerobic rod
Is found in soil.
Cattle are routinely vaccinated.
Treated with ciprofloxacin or doxycycline.
Cutaneous anthrax
Endospores enter through minor cut
20% mortality
Anthrax
Gastrointestinal
anthrax
Ingestion of
undercooked food
contaminated food
50% mortality.
Inhalational anthrax
Inhalation of
endospores.
100% mortality.
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.
1950s: 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 United States
Biological Weapons
Bacteria Viruses
Bacillus anthracis “Eradicated” polio and measles
Brucella spp. Encephalitis viruses
Chlamydophila psittaci Hermorrhagic fever viruses
Clostridium botulinum toxin Influenza A (1918 strain)
Coxiella burnetti Monkeypox
Francisella tularensis Nipah virus
Rickettsia prowazekii Smallpox
Shigella spp. Yellow fever
Vibrio cholerae
Yersinia pestis
Gangrene
Ischemia: Loss of blood supply to tissue.
Necrosis: Death of tissue.
Gangrene : Death of soft tissue.
Gas gangrene
Clostridium perfringens, gram-positive, endospore-
forming anaerobic rod, grows in necrotic tissue
Treatment includes surgical removal of necrotic tissue
and/or hyperbaric chamber.
Animal Bites and Scratches
Pasteurella multocida
Clostridium
Bacteroides
Fusobacterium
Bartonella hensellae: Cat-scratch disease
Plague
Yersinia pestis, gram-negative rod
Reservoir: Rats, ground squirrels, and prairie dogs
Vector: Xenopsylla cheopsis
Bubonic plague: Bacterial growth in blood and
lymph
Septicemia plague: Septic shock
Pneumonic plague: Bacteria in the lungs
Plague
Figures 23.13b–c
Lyme Disease
Figure 23.13a
Lyme Disease
First symptom:
Bull's eye rash
Second phase:
Irregular heartbeat,
encephalitis
Third phase:
Arthritis
Figure 23.14
Figure 23.12
Ehrlichiosis
Figure 23.15
Typhus
Epidemic typhus
Rickettsia prowazekii
Reservoir: Rodents
Vector: Pediculus humanus corporis
Transmitted when louse feces rubbed into bite wound
Typhus
Epidemic murine typhus:
Rickettsia typhi
Reservoir: Rodents
Vector: Xenopsylla cheopsis
Spotted Fevers (Rocky Mountain
Spotted Fever)
Rickettsia rickettsii
Measles-like rash
except that the rash
appears on palms and
soles too.
Figure 23.18
Spotted Fevers (Rocky Mountain
Spotted Fever)
Figure 23.16
Tick Life Cycle
Figure 23.17
Human Herpes Virus 4 Infections
Infectious Mononucleosis
Childhood infections are asymptomatic.
Transmitted via saliva
Characterized by proliferation of monocytes
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Cancer in immunosuppressed individuals, and malaria
and AIDS patients
Infectious Mononucleosis
Figure 23.20
Cytomegalovirus Infections
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
Viral Hemorrhagic Fevers
Pathogen Portal of Reservoir Method of
entry transmission
Yellow fever Arbovirus Skin Monkeys Aedes
aegypti
Dengue Arbovirus Skin Humans Aedes
aegypti;
A. Albopictus
Marburg, Filovirus, Mucous Probably Contact with
Ebola, arenavirus membranes fruit bats; blood
Lassa other
mammals
Hantavirus Bunyavirus Respiratory Field mice Inhalation
pulmonary tract
syndrome
Ebola Virus
Figure 23.21
American Trypanosomiasis (Chagas’ Disease)
Trypanosoma cruzi
Reservoir: Rodents,
opossums, armadillos
Vector: Reduviid bug
Figure 23.23
Malaria
Plasmodium vivax, P. ovale, P. malariae, P. falciparum
Anopheles mosquito
Figure 12.31b
Malaria
Figure 23.25
Malaria
Figure 23.24
Malaria
Figure 12.19
OTHER PROTOZOA
BLOOD and TISSUE PROTOZOA
Plasmodium
Babesia
Trypanosoma brucei
Trypanosoma cruzi
Toxoplasma gondii
Leishmania
PROTOZOA FROM OTHER BODY SITES
Free-living Amebae
Naegleria
Acanthamoeba
Trichomonas vaginalis
PLASMODIUM
Disease: Malaria
P. vivax: Benign tertian malaria
P. malariae: Quartan malaria
P. falciparum: Malignant tertian malaria
P. ovale: Ovale tertian malaria
Lab Dx: Giemsa stained thick and thin
blood smears; IFA; PCR
Infected RBC:
P. vivax and P. ovale: reticulocytes
P. malariae: senescent erythrocytes
P. falciparum: erythrocytes of all ages
Cyclic paroxysm of fever:
P. vivax and P. ovale: every 48 hours
P. malariae: every 72 hours
P. falciparum: every 36-48 hours
P. falciparum: Blood
Stage Parasites
Thin Blood Smears
Figure 23.28
Schistosomiasis
Figure 23.27a
SCHISTOSOMA MANSONI
Disease: Schistosomiasis, intestinal
schistosomiasis, bilharziasis “snail fever”
Site in host: veins of LI
Portal of entry: skin
Definitive host: humans, baboons & rodents
Intermediate host: snail (Biomphalaria sp &
Tropicorbis sp)
Infective stage: cercariae
Lab Dx: eggs in stool; rectal or liver biopsy
Biomphalaria spp.
Schistosoma mansoni eggs: large (length 114 to 180 µm)
and have a characteristic shape, with a prominent lateral
spine near the posterior end. The anterior end is tapered
and slightly curved. When the eggs are excreted, they
contain a mature miracidium
Male and female schistosomes.
SCHISTOSOMA HAEMATOBIUM
Disease: Urinary schistosomiasis,
schistosomal hematuria, urinary bilharziasis
Site in host: veins of urinary bladder
Portal of entry: skin
Definitive host: humans, monkeys & baboons
Intermediate host: snail (Bulinus, Physopsis,
and Biomphalaria sp)
Infective stage: cercariae
Lab Dx: eggs in stool; cystoscopy
Bulinus spp.
S. haematobium eggs: large and have a prominent
terminal spine at the posterior end
S.haematobium: adult schistosomes live in pairs in the pelvic veins
(especially in the venous plexus surrounding the bladder); males are
10-15 mm in lenght by 0,8-1 mm in diameter, and have a ventral
infolding from the ventral sucker to the posterior end forming the
gynecophoric canal. Adult male with female in the copulatory groove.
SCHISTOSOMA JAPONICUM
Disease: Schistosomiasis, Katayama fever
Site in host: veins of SI
Portal of entry: skin
Definitive host: humans, dogs, cats,
horses, pigs, cattle, deer, caribou &
rodents
Intermediate host: snail (Oncomelania)
Infective stage: cercariae
Lab Dx: eggs in stool; liver biopsy
Onchomelania, hupensis spp.
S. japonicum egg: typically oval or subspherical, and
has a vestigial spine (smaller than those of the other
species)
Cercaria
Schistosomiasis
Figure 23.27b