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Infections With Neisseria gonorrhoeae

Abstract Diagnosis of infection with Neisseria gonorrhoeae (NG), commonly known as gonorrhea, is important because the sequelae of untreated gonorrhea can include pelvic inflammatory disease (PID), perihepatitis, ectopic pregnancy, infertility, and chronic pelvic pain in women and epididymitis or infertility in men. Infection with gonorrhea also increases risk of both acquiring and transmitting human immunodeficiency virus (HIV). Gonorrhea is the second most common notifiable condition in…

Infections Caused by Chlamydia trachomatis , Including Lymphogranuloma Venereum

Abstract Chlamydia trachomatis is an obligate intracellular bacterium that infects mucosal surfaces of humans, including oropharyngeal, anogenital, and conjunctival surfaces. C. trachomatis can be classified through molecular typing into strains causing ocular infections (trachoma), nonulcerative oropharyngeal and/or anogenital infections (chlamydia), and a distinct ulcerative syndrome called lymphogranuloma venereum (LGV). C. trachomatis infections are highly prevalent worldwide, especially in adolescents and young adults, and can cause substantial…

Human Papillomavirus

Abstract Genital human papillomavirus (HPV) infection is estimated to be the most common sexually transmitted infection (STI) in the United States and worldwide. Oncogenic, or “high-risk” HPV types, such as HPV types 16 and 18, can cause cervical and other anogenital precancers, anogenital cancers, and oropharyngeal cancers. Other HPV types, such as HPV types 6 and 11, can cause anogenital warts as well as recurrent respiratory…

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

Abstract Human immunodeficiency virus (HIV) is a sexually transmitted infection that causes progressive immune dysfunction, putting affected individuals at risk for opportunistic infections and certain cancers. It was first recognized in the early 1980s, when men who had sex with men (MSM) in several cities in the United States presented with an unusual fungal pneumonia caused by Pneumocystis carinii (now called Pneumocystis jiroveci ) and others…

Herpes Simplex Virus Genital Infection

Abstract Genital herpes is a globally endemic sexually transmitted infection (STI) and the most common cause of genital ulcer disease. Classically, genital herpes manifests as a cluster of painful vesicular or ulcerative mucocutaneous lesions; however, such presentations account for a minority of cases, as the clinical manifestations vary widely. Genital herpes is caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2), two closely…

Trichomonas vaginalis

Abstract Trichomonas vaginalis is estimated to be the most common treatable sexually transmitted infection (STI) worldwide. It is an important contributor to perinatal morbidity, cervical cancer, poor sperm quality, and HIV acquisition and transmission. Less is known about the importance of asymptomatic infection. T. vaginalis shares many of the same risk factors as other STIs but tends to be more prevalent among older women. Risk factors…

Surgical Site Infections

Abstract Surgical site infections (SSIs), previously known as wound infections , remain one of the most common adverse events that occur with hospitalized surgical patients or after outpatient surgical procedures, despite many advances in preventive techniques. A 2015 report from the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC) documents SSI as accounting for 16% of all healthcare-associated infections (HAIs)…

Pyomyositis (Pyomyositis Tropicans)

Acknowledgments The authors would like to acknowledge Dr. Joseph F. Woodward for his contribution to this chapter in the previous edition. Abstract Pyomyositis, a disease historically seen in tropical climates, is characterized by primary abscess formation in the skeletal musculature. It is increasing in incidence in temperate climates, especially in immunocompromised hosts. In all cases, Staphylococcus aureus is the most commonly implicated organism. Clinical presentation is…

Peritonitis

Acknowledgments The authors would like to acknowledge Dr. Christopher M. Watson for his work on the previous edition chapter. Abstract The peritoneum is the thin lining separating the intra-abdominal and extra-abdominal spaces. Inflammation of this lining is termed peritonitis . This inflammation alone is nonspecific and can be caused by many different etiologies. Peritonitis can be subdivided into three main categories: primary, secondary, and tertiary. Primary…

Anorectal Abscess and Fistula in Ano

Abstract Anal abscess and fistula in ano are not uncommon and have a high recurrence rate. Both are easy to identify on clinical examination. Identification of the internal opening or discerning the pathway of a fistula may be challenging and may require radiologic imaging. In most cases, surgical drainage of the abscess or fistula infection is the primary treatment. Some fistulas will require staged treatment to…

Necrotizing Soft-Tissue Infections

Abstract Necrotizing soft-tissue infections (NSTIs) are highly fatal infections that share features, including the presence of necrotic tissue and the need for surgical debridement (among other therapies). NSTIs are under the category of complicated skin and soft-tissue infections (SSTIs). The nomenclature of these infections has typically been complicated and confusing because different terms are used to describe specific types of NSTI based on location, causative organisms,…

Liver Abscess: Pyogenic and Amebic Hepatic Abscess

Abstract Liver abscess is comprised of two main types: pyogenic and amebic. The most common type is pyogenic, which usually results from biliary and intra-abdominal infections. On the other hand, amebic liver abscess occurs far less frequently and is a complication of Entamoeba histolytica infection. Both abscess types present in a similar manner, often manifesting vague and nonspecific symptoms, necessitating a high index of suspicion for…

Intraabdominal Abscess

Acknowledgments The authors would like to acknowledge Dr. Christopher M. Watson for his work on the previous edition chapter. Abstract Intraabdominal abscesses (IAAs) can serve as significant causes of morbidity if not promptly diagnosed and treated. IAAs occur when a previously sterile site, such as a solid intraabdominal organ or the peritoneal fluid, becomes inoculated via natural or iatrogenic means and the infection is walled off…

Hydatid Cyst Disease (Echinococcosis)

Acknowledgments The authors would like to acknowledge Dr. Austin L. Spitzer for his contribution to this chapter in the previous edition. Abstract Hydatid cyst disease or echinococcosis is a parasitic infection caused by the Echinococcus tapeworm larvae. Of the seven recognized species, Echinococcus granulosus and Echinococcus multilocularis , which cause cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively, pose clinically significant and potentially lethal public health…

Acute Diverticulitis

Abstract Diverticulitis of the colon is an extremely common disease, accounting for close to 30,000 annual hospital admissions in the United States. Asymptomatic diverticulosis is widely pervasive among older individuals of Westernized countries; however, the rate of progression to acute diverticulitis is likely less than 10%. Although the precise pathogenesis of progression from diverticulosis to diverticulitis is not clear, herniation of bowel mucosa through the colon…

Acute Ascending Cholangitis and Suppurative Toxic Cholangitis

Abstract Acute ascending cholangitis is a biliary tract infection resulting from bile duct obstruction. It carries potential for significant morbidity and mortality and requires prompt diagnosis and treatment. Clinical presentation can range from a mild, self-limited course to a serious, life-threatening condition requiring emergent intervention. Patients typically have some combination of fever, jaundice, and abdominal pain. A methodical patient history and imaging workup can usually elucidate…

Acute Appendicitis

Abstract Acute appendicitis is the most common surgical emergency and appendectomy is the most common emergency operation, with more than 250,000 procedures reported annually in the United States. Acute appendicitis results from appendiceal endoluminal obstruction, typically caused by a fecalith. Although no specific risk factors have been identified, appendicitis is slightly more common in males, the young, and the elderly, with more advanced disease on presentation…

Systemic Fungal Infections

Abstract The endemic mycoses are geographically restricted pathogens that exist as molds in specific environmental niches, where humans encounter them. In the United States, the major endemic mycoses are histoplasmosis, blastomycosis, and coccidioidomycosis. The extent of disease manifested by a given patient depends on both the size of the inoculum of the organism and the ability of the host to mount an effective immune response. The…