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Infections in Older Adults

Predisposition of Older Adults to Infection Risk factors for infection in older adults are numerous and often coexist in complex relationships. Seemingly similar patients by conventional criteria may have very different risk due to measures not often used in young adults. These include comorbid illness, polypharmacy, functional status (physical, cognitive, sensory), place of residence, and individual variations in physiologic changes that accompany age (e.g., declining glomerular…

Infections in Patients With Spinal Cord Injury

Spinal cord injury (SCI) is a devastating condition that is unique in terms of its multisystem impact and need for multidisciplinary management. Moreover, the prevalence and occurrence of SCI have continued to escalate over the years. In 2017, approximately 285,000 Americans experienced the consequences of SCI, and at least 17,500 new cases of SCI accrue each year in the United States. Although motor vehicle crash is…

Infections in Solid-Organ Transplant Recipients

Revised November 12, 2020 Advances in surgical techniques and immunosuppressive regimens have had a pivotal role in optimizing outcomes after transplantation. The introduction of cyclosporine in the 1980s and tacrolimus a decade later heralded the era of modern immunosuppression, and transplantation advanced from being a quasiexperimental procedure to an established and accepted modality of treatment for a wide range of end-organ diseases. Table 308.1 depicts the…

Infections in Recipients of Hematopoietic Stem Cell Transplants

Revised March 29, 2021 The clinical approach to infections in patients undergoing hematopoietic stem cell transplantation (HSCT) involves an understanding of basic transplantation techniques, clinical syndromes, host defense defects at different times after transplantation, the natural history of individual infections, and the mechanisms underlying reconstitution of the immune system after transplantation. In general the dominant elements of infectious risks for bacterial, viral, fungal, and parasitic infections…

Prophylaxis and Empirical Therapy of Infection in Cancer Patients

Revised November 29, 2020 Revised November 12, 2020 Cancer patients probably represent the best example of how both a disease and its treatment can impair the complex immunologic network aimed at maintaining the integrity of our body and defending it against infections from both the external and the internal environment. For decades we have known that a granulocyte count of less than 500 cells/mm 3 (and…

Infections in the Immunocompromised Host: General Principles

Components of Host Defense Appreciation of the predisposing risk factors is an essential but perplexing exercise because it suggests that each individual component plays an independent role. Certain organisms infect patients with specific defects, and these associations should be taken into account when selecting therapy. However, this is by no means always predictable. Theoretically, a specific deficiency increases the patient's susceptibility to the very pathogens that…

Transfusion- and Transplantation-Transmitted Infections

Revised June 25, 2020 Revised March 29, 2021 Transfusion-Associated Infections Beeson reported the first cases of transfusion-associated hepatitis in 1943, describing seven patients who developed illness 1 to 4 months after having received a red blood cell (RBC) or plasma transfusion. Later identified as transfusion-transmitted hepatitis B virus (HBV), the advent of the acquired immunodeficiency syndrome (AIDS) epidemic in the 1980s followed by recognition of transfusion…

Health Care–Acquired Hepatitis

Historical Background The potential for bloodborne transmission of hepatitis B first was noted in 1885, when Lurman described jaundice in factory workers who had received smallpox vaccine prepared from “human lymph.” More reports appeared in the subsequent decades as use of vaccines derived from human serum became more common. In addition, more frequent use of phlebotomy equipment, insulin therapy, and intramuscular injection of antibiotics all led…

Health Care–Associated Urinary Tract Infections

Definitions Health care–associated urinary tract infection (UTI) refers to UTI that is acquired while a patient is receiving medical treatment in a health care setting. The majority of health care–associated UTIs occur in patients whose urinary tracts are currently or were recently catheterized. All types of urinary catheters (indwelling, suprapubic, intermittent, and external or condom catheters) increase the risk of acquisition of bacteriuria and thus UTI.…

Nosocomial Pneumonia

Nosocomial pneumonia refers to pneumonia acquired while in a hospital. It is classically divided into hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) but has also been applied to the concept of health care–associated pneumonia (HCAP). The majority of studies on nosocomial pneumonias focus on VAP; hence, this chapter also focuses primarily on VAP, but the principles developed from VAP are thought to be generally applicable. Health…

Infections Caused by Percutaneous Intravascular Devices

The relentless progress of medical science and technology has been accompanied by the development of a host of new diagnostic and therapeutic medical devices, each of which is associated with its own complications. Included in the list of devices and the complications of their use to be discussed in this chapter are peripheral and central intravenous catheters, including nontunneled central catheters and tunneled catheters, peripherally inserted…

Disinfection, Sterilization, and Control of Hospital Waste

Each year in the United States there are approximately 53,000,000 outpatient surgical procedures and 46,000,000 inpatient surgical procedures. For example, there are at least 18 million gastrointestinal endoscopies per year. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membranes. A major risk of all such procedures is the introduction of infection. Failure to properly…

Infection Prevention and Control in the Health Care Setting

Hospital infection control traces its roots to the mid-19th century, when medical and scientific investigators noted the preventive benefits of hand hygiene, surgical antisepsis, and hospital hygiene. These measures remain at the core of infection prevention, with an expanding base of scientific research to guide their application in the setting of increasingly complex medical care and increasing antibiotic resistance. Infection-prevention programs are charged with a mission…

Kawasaki Disease

Revised November 8, 2020 Kawasaki disease (KD) is a self-limited vasculitis of infants and children that is now the most common cause of acquired heart disease in developed countries. Although the disease was first described by Tomisaku Kawasaki in Japan in 1967, the cause remains elusive decades later. The current paradigm is that an environmental agent triggers a severe immune response in genetically susceptible children. Historical…

Ticks, Including Tick Paralysis

Ticks are the most competent and versatile of all arthropod vectors of zoonotic infectious diseases for several reasons. First, ticks are not afflicted by most of the microorganisms that they may transmit or the paralytic salivary toxins that they may transfer during blood-feeding. Second, and unlike mosquitoes, ticks can transmit the broadest range of infectious microbes among all arthropods, including bacteria, viruses, and parasites. In addition,…

Mites, Including Chiggers

Mites, including chigger and scabies mites, are among the smallest arthropods, with most barely visible without magnification. Only about 20 species of the more than 3000 species of chigger, animal, plant, and scabies mites are of any medical importance, and most of these are simply biting nuisances and do not transmit infectious diseases. Mites are closely related to ticks but not as prodigious at blood-feeding. They…

Myiasis and Tungiasis

Flies and fleas are mostly bothersome biting nuisances of humans and animals that can also transmit infectious diseases and deeply invade living tissues, causing amputation, disfigurement, and, rarely, death. Flies can serve as mechanical vectors of shigellosis, and rat fleas can transmit bubonic plague and murine typhus. Flies may lay their eggs on human flesh, and their developing larvae, or maggots, can invade subcutaneous tissues and…

Scabies

Scabies, an infection by the itch or scabies mite, Sarcoptes scabiei var. hominis, remains a major public health problem throughout the developing world ( Fig. 293.1 ). Scabies in its most severe form, crusted or Norwegian scabies ( Fig. 293.2 ), has now become a significant reemerging ectoparasitosis in the developed world, especially among homeless people, institutionalized older adults, individuals with intellectual disability, and immunocompromised individuals.…

Lice (Pediculosis)

Pediculosis is a complex of three different human infestations with two species of blood-sucking lice of the insect order Phthiraptera, suborder Anoplura: Pediculus humanus and Phthirus pubis. Sometime after early humans began to wear clothes, P. humanus evolved into two clinically distinct ectoparasitic variants, P. humanus var. corporis, the body louse ( Fig. 292.1 ), and P. humanus var. capitis, the head louse ( Fig. 292.2…

Introduction to Ectoparasitic Diseases

Ectoparasites infest the skin and its appendages, such as the hair and sebaceous glands, and most external orifices, especially the ears, nares, and orbits. Like endoparasites, ectoparasites may be obligatory parasites, programmed to feed on human hosts to complete their life cycles, or facultative parasites, preferring to feed on nonhuman hosts, infesting humans only as accidental or dead-end hosts. Over the past 2 decades, there have…