bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency Infectious Diseases
Authors: Challener Douglas W. , Marcelin Jasmine R. , O’Horo John C.
Published: January 2022

Necrotizing fasciitis is an infection of the tissues between the skin and the muscular fascia. Patients may have a high fever, severe pain, tense edema, dark discoloration of the skin, and lethargy. The infection progresses very quickly, and rapid identification and treatment are essential for the best outcomes. Diagnosis is challenging because patients often have no cutaneous findings, especially in the early stage of disease. Imaging techniques such as computed tomography, magnetic resonance imaging, and ultrasonography may be useful adjuncts when establishing the diagnosis of necrotizing fasciitis. First-line treatment is surgical exploration and débridement.
Piggyback Ride Anyone?
Authors: Dioverti Prono Maria V. , Sohail M. Rizwan
Published: January 2022

Strongyloides stercoralis is an intestinal nematode that is endemic in tropical and subtropical areas (including the southeastern United States). It has a unique ability to fully replicate inside its host (autoinfection) and can cause overwhelming infections in immunocompromised patients. Chronic infection is typically asymptomatic or mildly symptomatic (diarrhea, constipation, and dermatologic manifestation) and may be associated with intermittent eosinophilia. The diagnosis of a Strongyloides infection classically is established by serial stool examinations. The recommended treatment for Strongyloides infection is ivermectin (200 mcg/kg daily, for 2 consecutive days), and repeat dosing can be considered 1 week after the initial treatment.
Dermatology Crisis
Authors: Khalil Sarwat , Abu Saleh Omar M.
Published: January 2022

Cutaneous reactions after antibiotic use most commonly present as exanthematous drug eruptions (80% of cases) or urticarial reactions (5%-10%). They can, however, manifest as severe cutaneous reactions (<1 per 1,000 new cases) that are associated with severe, diffuse mucocutaneous involvement and severe systemic symptoms. The 3 most important drug reactions to consider are drug rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome and toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. Diagnosis is confirmed histopathologically. Symptoms resolve rapidly within 1 to 2 weeks after discontinuation of the offending agent, and patients rarely require any treatment.
Flexor Tenosynovitis and Septic Arthritis After a Dog Bite
Authors: Riaz Talha , Abu Saleh Omar M.
Published: January 2022

Initial management of dog bites includes ascertaining the extent of injury, identifying devitalized tissues, and irrigating the wound. Microbiologic assessment, aerobic and anaerobic cultures, and radiographic imaging should be obtained. Vaccination needs against rabies and tetanus should be assessed. The bacteria that cause infection in bite wounds may originate from the dog’s mouth, the patient’s own skin, and the environment. First-line oral therapy is amoxicillin-clavulanate. Intravenous options include ampicillin-sulbactam, cefoxitin, ertapenem, or moxifloxacin. It’s important to determine deeper bone and joint damage from a dog bite because duration and choice of antibiotics differ for cellulitis versus tenosynovitis and septic arthritis.
Healthy Young Woman With Fever and Jaundice
Authors: Shweta FNU , Stone Eric C. , Virk Abinash
Published: January 2022

Yellow fever vaccine (YFV) can have rare but severe adverse events, including YFV-associated neurologic disease (YEL-AND), YFV-associated viscerotropic disease (YEL-AVD), and anaphylaxis. Risks of YEL-AND and YEL-AVD increase with age. YEL-AND is characterized by encephalitis, meningitis, Guillain-Barré syndrome, or acute disseminated encephalomyelitis within 28 days after vaccination. Meningoencephalitis is the most common manifestation. Diagnosis can be aided by polymerase chain reaction testing of cerebrospinal fluid for YF virus or for antibodies specific to the YF virus. Most patients with YEL-AND recover without residual deficits. Treatment should be chosen based on the presenting syndrome, and a neurologic consultation is warranted.
An Unusual Cause of Prosthetic Joint Infection
Authors: Oravec Caitlin P. , Osmon Douglas R.
Published: January 2022

It is important to obtain routine mycobacterial cultures in patients with a history of bacille Calmette-Guérin (BCG) treatment who present with culture-negative infection. BCG sepsis syndrome can develop a few days to months after instillations are completed. Presenting features include fever, weight loss, and dyspnea. Disseminated complications from BCG therapy usually are managed with 3 to 9 months of therapy: the first 2 to 3 months of treatment are with rifampin, isoniazid, and ethambutol, and then therapy is completed with rifampin and isoniazid. Glucocorticoids may also have a role in treatment.
A Travel Souvenir
Authors: Castillo Almeida Natalia E. , Kasten Mary J.
Published: January 2022

Infections of the urinary system may involve the lower urinary tract (confined to the bladder) or the upper urinary tract (pyelonephritis). The spectrum of urinary conditions ranges from asymptomatic bacteriuria, symptomatic urinary tract infection (UTI), and sepsis associated with UTI that requires hospital admission. The treatment of UTIs include antibiotics that can result in long-term alteration of the normal microbiota of the gastrointestinal tract and in the development of multidrug-resistant microorganisms. For this reason, a urine sample should be cultured to identify causative organisms and their antimicrobial susceptibilities.
Answers
Authors: Challener Douglas W. , Marcelin Jasmine R. , Cawcutt Kelly A.
Published: January 2022

This section consist of question and answers for the section
Interdisciplinary Pediatric Palliative Care
Authors: Wolfe Joanne , Hinds Pamela S. , Sourkes Barbara M.
Published: January 2022

Interdisciplinary Pediatric Palliative Care provides a uniquely integrated, comprehensive resource about palliative care for seriously ill children and their families. The field of palliative care is based on the fundamental principle that an interdisciplinary team is optimal in caring for patients and their families throughout the illness trajectory. The text integrates themes including goals of care, discipline-specific roles, cultural and spiritual considerations, evidence-based outcomes, and far more. It emphasizes the value of words and high-quality communication in palliative care. Importantly, content acknowledges challenging periods between team members and how those can ultimately benefit team, patient, and family care outcomes. Each chapter includes the perspective of the family of a seriously ill child in the form of a vignette to promote care team understanding of this crucial perspective. This second edition is founded on a wealth of evidence that reflects the innovations in pediatric palliative care science over the past 10 years, including initiatives in clinical care, research, and education. Interdisciplinary Pediatric Palliative Care is appropriate for all pediatric palliative clinicians, including physicians, nurses, psychosocial clinicians, chaplains, and many others. All subspecialists who deliver care to seriously ill children will find this book a must-have for their work.
Interdisciplinary Education and Training
Authors: Brock Katharine E. , Hwang Jennifer , Joselow Marsha , Lord Blyth , Duncan Janet , Lafond Deborah A.
Published: January 2022

This chapter delves into interdisciplinary education and training in pediatric palliative care, both its basis in the underlying principles of adult education, updates in interdisciplinary education, and its creative initiatives specific to the field. The chapter explores principles of adult education, principles of interdisciplinary education as a framework for pediatric palliative care, the unique pedagogy of pediatric palliative care, creative models of training, parents and families as teachers, and the benefits and challenges of interdisciplinary pediatric palliative education. In order to optimally tailor the teaching approach, the following factors must be considered: the background, perspective, and experience of the intended audience; the skills they bring; and the most likely and/or most significant gaps in their knowledge.
Neurological Symptoms
Authors: Liaw Shih-Ning , Freitas Jenna E. , Hauer Julie
Published: January 2022

Neurological symptoms are a common cause of discomfort and distress for children with neurological conditions. These symptoms are often challenging to evaluate and difficult to manage. In collaboration with other pediatric providers and subspecialties, pediatric palliative care offers a comprehensive, interdisciplinary approach to care that seeks to optimize the quality of life for these patients and provide psychosocial support for the families who care for them. This chapter describes the role that palliative care can serve in enhancing communication with families, supporting their goals of care, and managing complex neurological symptoms, including seizures, spasticity, dystonia, chorea, myoclonus, autonomic dysfunction, and central neuropathic pain.
Fatigue
Authors: Ullrich Christina , Jacobs Shana , Hinds Pamela S.
Published: January 2022

Fatigue in seriously ill children and adolescents can stem from a wide variety of diseases and other causes that directly and persistently adversely affect the moment-to-moment, day-to-day existence of these young patients. Fatigue across different ages in these ill children and adolescents is now defined and can be validly measured in non-burdensome ways. Because of these advances in science, the clinician’s focus can now be on mechanisms of action specific to the fatigue being experienced and, just as importantly, on the care interventions that match the causative factors. As troubling as fatigue can be for the seriously ill child and adolescent, at the very end of life it is helpful to frame fatigue as a natural process, possibly even a protective factor, and interventions to diminish the fatigue at that time are counter to best care practices.
Respiratory Symptoms
Authors: Sharpe Rose , Jordan Megan , Barfield Raymond , Gall Sarah , Bidegain Margarita , Lakis Kristen , Bartle Renee , Layok Emily
Published: January 2022

For many, breathing is a routine and almost unthought-of necessity. For others, breathing can be challenging or even impossible to do on one’s own. The primary job of the respiratory system is the intake of oxygen and the removal of carbon dioxide. This seemingly simple act requires healthy lungs, conducting airways, and an intact central nervous system to control the muscles of respirations, which form a semi-rigid bellow around the lungs and attach to the bones of the chest wall. For the respiratory system to function well, breathing must be organized, with each part of the system performing optimally. If any portion of the respiratory system has pathologies, breathing can become difficult, painful, and eventually cease to occur without assistance.
Solid Organ Transplant
Authors: Klouda Timothy , Boyer Debra , Helfand Lynne , McCown Michael , Purol Nicholas , Freiberger Dawn
Published: January 2022

While the frequency of solid organ transplantation has increased over the past 30 years, the care for recipients remains complex. Transplant medicine is focused on providing life-extending treatments for patients and families while recognizing their medical realities, symptom management challenges, and emotional needs. Patients and care givers experience a wide array of emotions during the transplant process due to the uncertain future ahead, preexisting morbidities, and caring for a new chronic condition. Palliative care has a vital role in all stages of transplantation to support and improve the quality of life for patients, families, and caregivers in these challenging situations.
Primary and Acquired Immune Deficiency Disorders
Authors: Koay Wei Li Adeline , Rakhmanina Natella , Wilkins Megan , Matthews Sarah , Doshi Ami
Published: January 2022

Children and adolescents living with primary or secondary immunodeficiencies often have an unpredictable prognosis and benefit from palliative care as a standard part of their regular care. This chapter illustrates the challenges faced by children and adolescents living with HIV, which have parallels to issues encountered by children with other immunodeficiencies. The nuances of palliative care management for children living with HIV are detailed according to various aspects of care: physical; structure and process of care of patients and families; psychological and psychiatric; social, cultural, spiritual, religious, and existential; ethical and legal, and care of the patient nearing the end of life.
Juvenile Sexual Offenders
Authors: Obara Simone A. , Saleh Fabian M.
Published: January 2022

In recent years, more attention is being paid to juvenile sex offenders despite lower rates of violent crime committed by juveniles (Puzzanchera, 2019). The media portrayal of the juvenile sex offender has included children, adolescents, girls, boys, healthy children, and children with physical and emotional disabilities. The public’s concern about juvenile sex offenders has waxed and waned in proportion to the number and heinousness of sex crimes reported during a given time period. Likewise, the public’s attitude toward the juvenile sex offender has vacillated between attempts to understand, treat, and rehabilitate the offender, and a wish to incarcerate and punish the youthful offender. In this chapter, we explore the phenomenon of the juvenile sex offender from three perspectives. We realize that this is a limited picture of a multidimensional phenomenon and that there are other areas worthy of an in-depth discussion. We have chosen to focus on the epidemiology of juvenile sex offenders, the recidivism potential of offenders, and the current available treatment models because these areas of interest seem to distinguish the juvenile offender from the adult. We leave the discussion of the developmental, biological, psychodynamic, and sociocultural factors that lead to juvenile sexual offending to others.
The Treatment of Sex Offenders
Authors: Giulini Paolo , Emiletti Laura , Garbarino Francesca , Scotti Andrea , Bradford John M. , Looman Jan , Saleh Fabian M. , Brodsky Daniel J.
Published: January 2022

This chapter reviews some treatment programs for sex offenders across the world. The treatment of sexual offenders is mainly within correctional facilities and aims to reduce sex offender recidivism. For a long while, vastly different standards of providing treatment for incarcerated sexual offenders existed around the world. In some locations, there was a very punitive attitude toward sexual offense. This provided the impetus for the establishment of the International Association for the Treatment of Sexual Offenders (IATSO). IATSO is an international nonprofit professional organization based in Vienna, Austria, which is committed to the promotion of research and the treatment for sexual offenders throughout the world. It was founded on March 24, 1998, in Caracas, Venezuela, during the 5th International Conference on the Treatment of Sexual Offenders. This organization also publishes a peer-reviewed journal titled, Sex Offender Treatment. The organization has board members and a scientific advisory committee.
Sepsis
Authors: Joseph Leeja , MacArthur Rodger D.
Published: January 2022

This chapter examines sepsis, which can be thought of as life-threatening organ dysfunction resulting from dysregulated host responses due to infection. Septic shock is a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase the rate of mortality. Diagnosis starts with a thorough history and physical examination. The history should focus on symptoms, recent surgery, underlying disease(s), recent antibiotic use, travel, and known risk factors such as the presence of indwelling catheters and other devices. Meanwhile, physical examination includes vital signs; recommended investigations include a CBC with differential, basic metabolic panel, hepatic function panel, coagulation studies, lactate level, and urinalysis. Early goal-directed therapy (EGDT) emphasizes a timely (within the first 3–6 hours of presentation) and coordinated approach to sepsis management, with a significant mortality benefit when efforts are made for early diagnosis, risk stratification, fluid resuscitation, early administration of antimicrobials, control of the source of infection, and hemodynamic optimization utilizing vasoactive drugs.
Infectious thyroiditis
Authors: Carey Jeanne , Baum Stephen G.
Published: January 2022

This chapter focuses on acute suppurative thyroiditis (AST), a rare but potentially life-threatening infection. AST is usually bacterial in etiology, although fungal, parasitic, and mycobacterial organisms have also been documented causes. The routes of infection are predominantly hematogenous or lymphatic; however, thyroid infections may also be the result of direct spread from an adjacent deep fascial space infection, an infected thyroglossal fistula, or anterior perforation of the esophagus. Thus, infectious thyroiditis may occur either as a local infection or as part of a disseminated systemic infection. Because prognosis depends on prompt diagnosis and treatment, it is important to differentiate AST from the noninfectious inflammatory conditions of the thyroid and other inflammations in the neck that it may closely resemble.
Otitis
Authors: Pelton Stephen I.
Published: January 2022

This chapter looks at otitis. The clinical burden from acute (AOM) and chronic suppurative otitis media (CSOM) and their associated morbidities is substantial, especially in children. In industrialized countries, AOM remains the most frequent reason for pediatric office visits and recurrent otitis media (ROM), or persistent middle ear fluid and associated hearing loss, reduces quality of life. In developing nations, infectious complications of AOM include suppurative intracranial infection and CSOM with severe hearing loss. The prescription of antimicrobials increases bacterial resistance, so the role of antimicrobials in AOM has been reevaluated, using an evidence-based approach. ROM and CSOM usually begin in the first year of life, due to Streptococcus pneumoniae, nontypeable Haemophilus influenzae (NTHi), or Moraxella catarrhalis.
Dental infections
Authors: Moskovitz Jessica , Hathaway Bridget , Grandis Jennifer Rubin , Johnson Jonas T.
Published: January 2022

This chapter addresses dental infections. Odontogenic infections and their complications may be encountered by any clinician who treats diseases of the mouth and throat. Understanding the anatomy and pathophysiology related to odontogenic infection provides the basis for knowledge of how a patient will present and how the patient needs to be treated. Although treatment of early dental infections can be less expensive and performed on an outpatient basis, delayed treatment is considerably more expensive due to the serious complications that can occur. Knowledge of signs and symptoms that indicate need for inpatient treatment of is therefore important for clinicians. Additionally, prompt diagnosis and treatment at early stages may reduce the healthcare burden related to odontogenic disease. Increasing access to regular preventative dental care may reduce the morbidity and cost associated with these infections.
Endophthalmitis
Authors: Brod Roy D. , Flynn Harry W. , Kaplan Lili G.
Published: January 2022

This chapter evaluates endophthalmitis, which is a vision-threatening inflammation of the inner eye fluids and tissues. Infectious endophthalmitis results from either exogenous or endogenous entry of microbes into the eye. In reported clinical series, exogenous endophthalmitis is much more common than endogenous (or metastatic) endophthalmitis. By far the most common cause of exogenous infection is intraocular procedures. Until recently, cataract surgery was the most frequently performed type of intraocular procedure, accounting for the greatest number of exogenous endophthalmitis cases. Intravitreal injection has now surpassed cataract surgery as the most frequently performed intraocular procedure and consequently is a significant contributor to the total number of exogenous endophthalmitis cases reported. Exogenous endophthalmitis can also occur after other types of intraocular surgery, including secondary lens implantation, glaucoma filtering surgery, vitrectomy surgery, and corneal transplantation. Organisms may also enter the eye during penetrating trauma, intraocular injection of medication, and from contiguous spread into the eye from an infected corneal ulcer. Gram-positive bacteria are the most common cause of exogenous endophthalmitis.
Fever and rash
Authors: Sensakovic John W. , Smith Leon G.
Published: January 2022

This chapter looks at fever and rash, one of the common symptom complexes presenting in medical practice. Because of the wide range of diseases that can present with this complex, the patient presenting with fever and rash is also one of the most challenging. Rapid recognition and therapeutic intervention are essential in certain diseases presenting with fever and rash to minimize as much as possible the associated morbidity and mortality. The major conditions involved include meningococcemia, Rocky Mountain spotted fever, staphylococcal toxic shock syndrome, streptococcal toxic shock-like syndrome, bacteremia or endocarditis with septic emboli, and rapidly spreading cellulitis. All these conditions can present with fever and rash in a fulminant, rapidly progressive form requiring expedient therapeutic intervention, often on an empiric basis before confirmation of the diagnosis if the associated mortality rates are to be minimized.
Deep soft-tissue infections
Authors: Ash Stephen , Kennedy Louis E.
Published: January 2022

This chapter studies deep soft-tissue infection. Necrotizing fasciitis (NF) and gas gangrene (GG) are serious infections of the deep soft tissue. They both carry a high morbidity and mortality. Thus, early diagnosis and treatment is important and is the key to improving outcome. Broadly speaking, NF is an infection primarily of the fascia and deep soft tissue of the skin, whereas GG is usually an infection of the skeletal muscle. Both GG and, particularly, NF are strongly associated with numerous underlying, premorbid risk factors, each of which requires medical management in order to improve the prognosis of an individual patient. Both conditions may be caused by one bacterial organism, or commonly, they may be polymicrobial and require treatment with broad-spectrum or multiple antibiotics.
Tungiasis and bed bugs
Authors: Cestari Tania F. , Pessato Simone
Published: January 2022

This chapter examines tungiasis and bed bugs. In recent years, increased ecotourism and international travel to tropical countries has produced a growing incidence of infestations formerly limited to certain regions. Tungiasis is a common ectoparasitic infestation that occurs mainly in the tropics, particularly where poverty and poor standards of basic hygiene exist. Despite recent progress in the treatment and prevention of tungiasis, diagnosis can present a challenge to those unfamiliar with the disorder, especially when happening in nonendemic countries. Standard therapy for tungiasis consists of surgical extraction of the embedded parasite under sterile conditions, followed by appropriate care of the resulting wound. Meanwhile, many physicians are unfamiliar with bedbugs and their bites. Awareness of the possibility of infestation is important to institute correct medication and parasite control measures.
Lymphadenopathy/Lymphadenitis
Authors: Friedland Gerald , Shenoi Sheela
Published: January 2022

This chapter focuses on lymphadenopathy/lymphadenitis. Fever and lymphadenopathy is a commonly encountered presentation in clinical practice. It is important to have a logical and systematic approach for the accurate diagnosis and treatment of patients with this syndrome. A thorough examination must include the location of lymphadenopathy, including an evaluation of all accessible lymph node-bearing areas, the size and consistency of palpated nodes, whether they are discrete or matted and whether tenderness is present and, if so, at what level of severity. Lymphadenopathy is considered localized if no more than two contiguous lymph node groups are involved. Meanwhile, generalized lymphadenopathy is present if nodes in two or more noncontiguous major lymph node-bearing areas are enlarged. Lymphadenopathy is a common and important finding in people with HIV infection. In most cases of infectious lymphadenopathy, clinical and laboratory findings short of biopsy often suggest the causative agent responsible for the enlarged nodes. The chapter then considers lymph node biopsy and fine-needle aspiration (FNA) biopsy.
Lung abscess
Authors: Patrawalla Amee , Dever Lisa L.
Published: January 2022

This chapter highlights lung abscess, which is a chronic or subacute lung infection initiated by the aspiration of contaminated oropharyngeal secretions. The result is an indolent, necrotizing infection in a segmental distribution, usually dependent, limited by the pleura. Lung abscess is almost always associated with anaerobic bacteria, although the majority of infections are polymicrobial with microaerophilic and aerobic bacteria present. In contrast, necrotizing pneumonia is an acute, often fulminant, infection characterized by irregular destruction of alveolar walls and therefore multiple cavities. This infection spreads rapidly through lung tissue, frequently crossing interlobar fissures, and is often associated with pleural effusion and empyema. The duration of illness before recognition is usually only a few days. The chapter then looks at the diagnosis and therapy of anaerobic lung abscess.
Endocarditis
Authors: Brusch John L.
Published: January 2022

This chapter examines endocarditis. The term “infective endocarditis” (IE) describes an infection of the endothelial surface of the heart, most commonly that of a valve. Cases may be categorized in several ways: as acute bacterial endocarditis (ABE) or subacute bacterial endocarditis (SBE) on the basis of the speed of their clinical progression; or by pathogenic organism (e.g., S. aureus) or by location (e.g., right or left-sided), or by the nature of the infected material, native tissue versus prosthetic or by the mechanism of acquisition such as intravenous drug abuse (IVDA). When approaching a case of possible IE, it is quite helpful to generate profile of disease process using these characteristics, especially when it comes to empirically choosing the initial antibiotic regimen. All varieties of IE share the same basic pathogenesis: a bloodstream infection (BSI) that delivers the organisms to the surface of the valve. Then, they must be able to firmly adhere.
Myocarditis
Authors: Blauwet Lori , Rosenbaum Andrew
Published: January 2022

This chapter evaluates myocarditis, which is a rare, potentially deadly, and often underdiagnosed cause of acute or chronic heart failure that primarily affects children and younger adults. Historically, the diagnosis of myocarditis was confirmed by histologic analysis of endomyocardial biopsy (EMB) specimens with findings of an inflammatory cellular infiltrate of the myocardium with or without myocyte necrosis and/or degeneration of adjacent myocytes. The type of inflammatory infiltrate, its distribution in cardiac tissue, and the degree of myocardial injury help construct the differential diagnosis. Clinically, myocarditis is defined by the time course and severity of illness. Acute myocarditis is the presence of an acute cardiomyopathy with myocardial inflammation. Meanwhile, chronic myocarditis is subdivided into two entities: chronic active myocarditis and chronic persistent myocarditis. The chapter also considers fulminant myocarditis, cardiac sarcoidosis, and idiopathic giant cell myocarditis (GCM).
Vascular infection
Authors: Beekmann Susan E. , Henderson David K.
Published: January 2022

This chapter looks at vascular infection. Diagnosis and treatment of vascular infections is complex and depends on a variety of factors, including the location of the infected tissue, the microbiology of the infection, and patient-specific factors such as anatomy and immune status. Purulent or suppurative thrombophlebitis is inflammation of a peripheral or central venous wall because of the presence of microorganisms. Meanwhile, endarteritis (or infective arteritis) and mycotic aneurysms are infections of the arterial walls. The term “mycotic aneurysm” is a misnomer that refers to any arterial aneurysm of infectious cause, fungal or bacterial, and may also include secondary infections of preexisting aneurysms or pseudoaneurysms. Vascular graft infections present an even wider spectrum of disease that depends on the type and location of the graft. Management of infections located on vascular prostheses is further complicated by the fact that prosthesis excision can jeopardize a patient's life and organ function, and alternative grafting techniques, including ex situ bypass, autologous reconstruction, and a variety of other graft materials, must be considered. Finally, endovascular repair of aneurysms has resulted in a variety of infectious complications of endovascular stents, stent-grafts, and other intra-arterial devices.
Acute viral hepatitis
Authors: Bhamidimarri Kalyan Ram , Martin Paul
Published: January 2022

This chapter addresses acute viral hepatitis, which is a systemic infection with predominant hepatic involvement. It remains a significant cause of morbidity and mortality in the United States despite the availability of effective vaccines against two major infections (hepatitis A and B) that cause acute viral hepatitis. There are five major hepatotropic viruses (A, B, C, D, and E) and several non-hepatotropic viruses that cause acute hepatitis characterized by acute hepatic inflammation and necrosis. Acute viral hepatitis typically runs its course in 6 months or less, in contrast to chronic hepatitis, which persists for longer. However, with modern serologic, molecular diagnostic testing and efficacious therapeutic options, the time course is less important in distinguishing acute from chronic viral hepatitis. The clinical illness produced by these viruses can range from asymptomatic or clinically inapparent to a fulminant and fatal acute infection.
Infectious complications in acute pancreatitis
Authors: Barkin Jodie A. , Barkin Jamie S.
Published: January 2022

This chapter highlights infectious complications in acute pancreatitis (AP). Patients with AP have two types of diseases. Type 1 is edematous or mild, non-necrotic pancreatitis, which is usually not associated with persistent or multiorgan system failure (MOSF) that lasts more than 48 hours. Type 2 is necrotizing pancreatitis, which is often associated with persistent organ system failure (more than 48 hours) and is prone to development of pancreatic infection. Infected pancreatic necrosis in AP patients was found to occur by routine use of CT-guided fine needle aspiration (FNA) within 14 days of hospital admission. Recognition of infection in patients with necrotizing pancreatitis is based primarily on clinical suspicion and imaging. The chapter then considers the role of enteral nutrition to prevent infection.
Esophageal infections
Authors: Wong Uni , Raufman Jean-Pierre
Published: January 2022

This chapter discusses esophageal infections, which are commonly encountered in clinical practice and contribute significant morbidity, particularly in those with pathologic or iatrogenic impaired cellular immunity. Patients with AIDS encompass a large proportion of those with infectious esophagitis. However, with the increased use of highly active antiretroviral therapy (HAART) to treat HIV/AIDS, the risk of opportunistic esophageal infections has decreased in this patient population. Others who are particularly susceptible to opportunistic esophageal infections include those receiving chemotherapy, radiation, or immunotherapy for cancer, and those receiving immunosuppressants following solid organ or bone marrow transplantation. Regardless of the causative organism, infection results in mucosal inflammation with hallmark symptom of odynophagia (painful swallowing). Prompt recognition with identification of the pathogen and initiation of therapy is of paramount importance because esophageal infections generally respond quickly to appropriate therapy.
Gastroenteritis
Authors: Morgan Douglas R. , Chidi Vivian , Owen Robert L.
Published: January 2022

This chapter examines gastroenteritis, which, broadly defined, refers to any inflammatory process of the stomach or intestinal mucosal surface. However, the term usually refers to acute infectious diarrhea, a diarrheal syndrome of less than 2 weeks' duration, which may be accompanied by fever, nausea, vomiting, abdominal pain, dehydration, and weight loss. The acute infectious diarrheas can be divided into noninflammatory, inflammatory, and invasive. Most cases of acute gastroenteritis are self-limited and do not require medical attention. Physician consultation generally is advised for patients with a fever, dysentery (bloody stools), significant abdominal pain, dehydration, and risk factors for disease requiring intervention. Initial evaluation consists of the history, physical examination, and screening stool examination. Laboratory testing and antimicrobial therapy are recommended in a limited subset of patients based on this initial evaluation.
Sexually transmitted enteric infections
Authors: Quinn Thomas C.
Published: January 2022

This chapter focuses on sexually transmitted enteric infections, which may involve multiple sites of the gastrointestinal tract and result in proctitis, proctocolitis, and enteritis. These infections occur primarily in men who have sex with men (MSM) and heterosexual women who engage in anal–rectal intercourse or in sexual practices that allow for fecal–oral transmission. Anorectal infections with syphilis, gonorrhea, condyloma acuminata (human papillomavirus, HPV), lymphogranuloma venereum (LGV), and granuloma inguinale (donovanosis) have been recognized for many years. Depending on the pathogen and the location of the infection, symptoms and clinical manifestations vary widely. Symptoms include constipation, tenesmus, rectal discomfort or pain, hematochezia, and a mucopurulent rectal discharge. The large number of infectious agents that cause enteric and anorectal infections necessitate a systematic approach to the management of these conditions.
Pelvic inflammatory disease
Authors: Ledger William J.
Published: January 2022

This chapter focuses on pelvic inflammatory disease (PID), which is a classification that attempts to encompass too wide a range of clinical syndromes. It includes seriously ill women with a tubo-ovarian abscess, who require hospitalization, intravenous antibiotics, and sometimes operative intervention for a cure. In contrast, most women with PID either are asymptomatic or have such mild symptoms that they do not seek medical care. To address these concerns, the International Infectious Disease Society for Obstetrics-Gynecology (I-IDSOG-USA) suggested the term “upper genital tract disease” (UGTI) be used with the designation of the etiologic agent. In addition, the UGTI can be placed in stages, depending upon the clinical severity of the infection. However, there are no prospective studies available with the statistical power to dictate absolute criteria to determine hospital admission or the best choice of antibiotics to prevent long-term morbidity.
Urinary tract infection
Authors: Liu Peter , Hamilton Keith W. , O’Donnell Judith A.
Published: January 2022

This chapter looks at urinary tract infections (UTIs), which account for a significant burden of morbidity, cost, and healthcare resource utilization in both the inpatient and outpatient setting. UTIs occur in patients of all ages with a predilection for females throughout life and males at each end of the age spectrum. The term “urinary tract infection” encompasses a group of conditions that includes cystitis, pyelonephritis, and asymptomatic bacteriuria. Appropriate management of a patient with a UTI requires consideration of multiple factors, including age, sex, underlying comorbidities, pregnancy, history of prior UTIs, site of infection, anatomic aberrations, and the pathogen involved. Determination of the location of the infection as upper versus lower tract is essential to selection of optimal therapy. Lower urinary tract infection is infection involving the bladder, or cystitis, and is characterized by dysuria, pyuria, urinary frequency, or urinary urgency. Upper urinary tract infection, or pyelonephritis, is infection involving the bladder and kidney that classically presents with fever and flank pain, with or without the symptoms of lower tract infection.
Candiduria
Authors: Sobel Jack D.
Published: January 2022

This chapter assesses candiduria, which is rare in the absence of predisposing factors. Most infections are associated with use of Foley catheters, internal stents, percutaneous nephrostomy tubes, and age extremes of life. Diabetic patients, especially when their diabetes is poorly controlled, are particularly at risk primarily because of increased instrumentation, urinary stasis, and obstruction secondary to autonomic neuropathy. Most adult patients with candiduria are asymptomatic, especially those with indwelling bladder catheters. More important than the knowledge of antifungal agents for treating candiduria is understanding the indications and rational basis for initiating treatment. Regrettably, despite the availability of a variety of potent antifungal agents, data from controlled studies are scant.
Bursitis
Authors: Parker Richard H.
Published: January 2022

This chapter explores bursitis, or inflammation of bursal sacs, which is a common condition. Most cases of bursitis involve either the olecranon or the prepatellar bursa, and the majority are related to trauma. Septic and nonseptic bursitis of superficial bursae such as at the olecranon and prepatellar sites may present as both red and tender areas. Clinical features, including fever or infection at another site, may help differentiate infected from noninfected. Bursitis of deeper bursae, such as trochanteric bursitis, is usually not infectious but tuberculous bursitis of the greater trochanter and other deeper sites has occurred. Microorganisms from the skin cause most infectious bursitis. Diagnosis of septic bursitis requires aspiration of fluid for microscopy, culture, cell counts, and glucose. Therapy is started following a decision as to whether the inflammation is infectious or noninfectious.
Infectious polymyositis
Authors: Kappagoda Shanthi , Singh Upinder
Published: January 2022

This chapter discusses infectious polymyositis, which is a rare entity in which there is generalized muscle damage (rhabdomyolysis) caused by an infectious agent. The syndrome of rhabdomyolysis results from muscle necrosis and is characterized by muscle pain, elevated serum creatinine phosphokinase (CPK) concentrations, and myoglobinuria which may lead to renal dysfunction. A variety of factors can lead to rhabdomyolysis. These include crush and compression injuries, drug and alcohol ingestion, metabolic and electrolyte disturbances, hypothermia and hyperthermia, envenomation, and a variety of infections. It is important to distinguish rhabdomyolysis caused by a pathogen from that caused by sepsis, hypotension, or electrolyte imbalances that accompany a severe systemic infection.
Iliopsoas abscess
Authors: Erb Larson , Lipsett Pamela A.
Published: January 2022

This chapter examines iliopsoas abscess (IPA), which is a rare condition defined by a collection of purulence in the iliopsoas muscle compartment. IPA is classified in two distinct varieties based upon the etiology of the disease. IPA can be either primary wherein the infection spreads via a hematogenous or lymphatic route, or secondary when it is a contiguous extension of another infection—most often musculoskeletal, intraabdominal, or genitourinary. Symptoms can consist of a classic triad of back/flank pain, fever, and a limp on ambulation (flexion deformity), however all three are rarely present and more generalized symptoms of malaise and weight loss may be present. The common presentation with more vague and general symptoms often leads to a delay in diagnosis and treatment that significantly worsens associated morbidity and mortality. Early and effective management is key to a successful recovery.
Bacterial meningitis
Authors: Johnson Jennie E. , Tunkel Allan R.
Published: January 2022

This chapter investigates bacterial meningitis. Meningitis is the inflammation of the meninges, mainly the inner meninges comprised of the arachnoid and pia mater, which surround the brain and spinal cord and through which cerebrospinal fluid (CSF) flows. Meningitis can be caused by viral, bacterial, fungal, or parasitic infections or by noninfectious etiologies such as medications, inflammatory diseases, and malignancies, as well as autoimmune disorders. Bacterial meningitis occurs most commonly by hematogenous spread but can also occur by direct invasion from the sinuses, ear, or post-operatively. Rates of bacterial meningitis in the Unites States have declined significantly in the past decades. This trend is largely due to availability of effective vaccines against the most common pathogens and education of high-risk populations. Despite this decline, the case fatality rate of bacterial meningitis in the US has remained fairly stable but varies depending on pathogen and host factors.
Intracranial suppuration
Authors: Wispelwey Brian , Arnold Christopher J.
Published: January 2022

This chapter looks at intracranial suppuration or brain abscess. A brain abscess begins as a localized area of cerebritis that develops into a collection of pus surrounded by a well-vascularized capsule. Brain abscesses most commonly result from contiguous septic foci, but hematogenous spread from a distant source and neurosurgical procedures or trauma represent other risk factors. The age distribution of patients with brain abscess varies with its cause. A brain abscess from an otogenic focus typically occurs in patients younger than 30 and shows a male predominance. Brain abscess secondary to sinusitis typically occurs in men in their second to third decade of life. Most patients with bacterial brain abscess require surgical management. The two available procedures are aspiration and excision.
Spinal epidural abscess
Authors: DiNubile Mark J.
Published: January 2022

This chapter assesses spinal epidural abscess. Epidural abscess of the spine represents a potentially crippling but treatable cause of back pain. Although relatively infrequent, the incidence appears to be increasing. Early diagnosis and aggressive therapy are essential for optimizing outcomes. Even with an indolent presentation, patients can still suffer seemingly unprovoked catastrophic neurologic deterioration related to delays in recognition and appropriate intervention. Every patient who complains of new or progressive back pain, fever, and local spine tenderness must be quickly assessed for the possibility of spinal epidural abscess. Traditional management of spinal epidural abscess involves immediate surgical drainage and prolonged antibiotic therapy. Operative evacuation of the abscess allows for decompression as well as procurement of pus and tissue samples for microbiologic processing.
Cerebrospinal fluid shunt infections
Authors: Adderson Elisabeth E. , Flynn Patricia M.
Published: January 2022

This chapter explores cerebrospinal fluid (CSF) shunt infections. CSF shunts are critical for many patients surviving congenital central nervous system (CNS) anomalies, infection, or intracranial hemorrhage. Infection is a common complication of these devices and a leading cause of morbidity and hospitalization. Clinical studies performed over the past half-decade have more clearly defined the optimal means to prevent and treat these infections. In patients with suspected CSF shunt infections, initial management includes obtaining CSF from the shunt reservoir or ventricle for diagnostic studies. Patients with presentations suggestive of ventriculitis or meningitis should begin antimicrobial therapy while awaiting these results. Management that includes complete removal of the infected shunt, placement of an extraventricular drain (EVD) if required, intravenous antimicrobials, and shunt replacement once the CSF is sterile, has a success rate of more than 85% and is recommended for most patients with infected CSF shunts.
Evaluation of suspected immunodeficiency
Authors: Fleisher Thomas A. , Rosenzweig Sergio D.
Published: January 2022

This chapter highlights the evaluation of suspected immunodeficiency. The need to evaluate immunologic function has become a part of the standard practice of clinical medicine, resulting at least in part from the secondary immunodeficiency produced by HIV infection. Clinical suspicion of a defect in immune function is primarily generated by the medical history, and any patient with a history of increased susceptibility to infection should be evaluated for secondary forms of immunodeficiency due to other comorbidities or HIV infection. The family history has also proved important with the increasing number of immune deficiencies that have been characterized at the molecular level, each one with its particular inheritance pattern. The physical examination can provide clues in the case of specific primary immunodeficiencies. This may also provide clues to the evaluation of secondary immune disorders.
Infection in the neutropenic patient
Authors: Holaday Eric , Mishkin Aaron , Samuel Rafik
Published: January 2022

This chapter discusses infection in the neutropenic patient. Patients receiving chemotherapy are at high risk for developing neutropenia and severe infections when their neutrophil count is depressed. Given the lack of inflammatory cells associated with neutropenia, signs of infection may be subtle. Some patients may not mount a fever at all, and the presence of hypotension, tachycardia, or delirium may be the only presenting features of infection. By its very nature, neutropenic fever occurs in those who are immunologically vulnerable and often carry significant infectious comorbidities, such as central venous access, breakdown of the body's physical barriers to infection, and nutritional deficiencies. Therefore, it is not surprising that febrile neutropenia carries significant morbidity and mortality. Researchers have been investigating modalities to help prevent febrile neutropenia, such as the use of colony-stimulating factors, dietary changes, and infection control measures. The chapter focuses on the main causes of infections in febrile neutropenia and selection of antimicrobial therapies.
Biologics
Authors: Ward Rebecca A. , Sen Pritha , Vyas Jatin M.
Published: January 2022

This chapter evaluates biologic therapies, which have revolutionized nearly every discipline of medicine. As the understanding of the relevant immunologic pathways of cancer, rheumatologic disease, and hematopoietic and solid organ transplantation has evolved, so has the discovery of new monoclonal antibodies for targeted therapy. Currently, more than 100 monoclonal antibodies have been approved for clinical use. The chapter highlights two major categories of commonly used monoclonal antibodies and their associated infectious complications. It outlines the immunologic mechanism of action and indications of use of these important biologic therapies. The chapter also examines the commonly reported infectious complications and summarizes the role for pre-implementation diagnostics, post-implementation surveillance, and antimicrobial prophylaxis.