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Urinary Tract Infections

Abstract Urinary tract infection (UTI), an acute bacterial infection of the urinary bladder, kidney, or collecting system, is among the most commonly diagnosed infectious diseases. The spectrum of disease is broad, ranging from asymptomatic bacteriuria (ABU) and simple cystitis to septic shock. Highly active and bioavailable oral antimicrobials have made therapy for UTI convenient and inexpensive. However, widespread use (including overuse) of these drugs has promoted…

Osteomyelitis

Abstract The three distinct presentations of osteomyelitis are defined by the mechanism whereby infectious agents are introduced into bone: (1) hematogenous infection from bacteremia; (2) local spread from contiguous foci such as abscesses, insect bites, or infected exanthematous lesions; and (3) direct inoculation after trauma, invasive procedures, or surgery. There is no particular geographic distribution, and the incidence in the United States is 8 per 100,000…

Meningitis

Acknowledgment The author would like to acknowledge the first edition authors Thomas A. Kurrus † † Deceased. and Martin G. Tauber. Abstract Meningitis is a relatively rare inflammation of the membranes surrounding the brain and spinal cord. This inflammation results from locally produced cytokines (primarily interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]) and is most commonly caused by infectious agents such as viruses and bacteria…

Endocarditis

Abstract Infective endocarditis (IE) is a serious infection involving the interior of the heart, most commonly the heart valves. It is predominantly bacterial, most commonly caused by Staphylococcus aureus and streptococcal species. This chapter reviews the pathogenesis, clinical features, diagnosis, treatment, and prevention of this condition for both native and prosthetic valves. IE has always been a diagnosis that many physicians approach with anxiety and trepidation.…

Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract Exacerbations are episodes of increased respiratory and sometimes systemic symptoms in patients with underlying chronic obstructive pulmonary disease (COPD). They reflect increased airway inflammation usually induced by bacterial and/or viral tracheobronchial infection. These episodes are a major contributor to the morbidity and, in advanced disease, to the mortality associated with COPD. A careful clinical evaluation with selected application of diagnostic tests should be followed by…

Pharyngitis

Abstract “Sore throat” or pharyngitis is one of the most frequent complaints of patients in the acute care setting, accounting for nearly 7 million pediatric and 6 million adult visits each year. On the surface, pharyngitis would appear to pose few challenges to the clinician; the site of infection is both visible and accessible for inspection and culture, and most pharyngeal pathogens are self-limiting respiratory viruses.…

Acute Otitis Media

Abstract Acute otitis media (AOM) is the most common bacterial infection seen in pediatric patients, and treatment of AOM is the most common reason children receive antibiotics. Physician visits and antibiotic use for otitis media, however, have decreased in the last decade. AOM follows eustachian tube dysfunction, which is most often seen with a viral upper respiratory infection. Consequently, those organisms that are part of the…

Sinus Infections

Abstract Sinusitis is defined as an inflammation of the mucosal lining of the paranasal sinuses and can be caused by various factors including allergy, environmental irritants, and infection by viruses, bacteria, or fungi. It is also commonly referred to as rhinosinusitis because there is almost always coexisting inflammation in the nasal mucosa. Sinusitis can be classified as acute, subacute, and chronic. Acute sinusitis lasts up to…

Viral Respiratory Infections

Abstract Viruses are an important but underrecognized cause of pneumonias. The exact percentage of all pneumonias caused by viral infection is unknown, but viruses are probably responsible for at least 25% of cases. This figure will likely change as a result of utilization of molecular diagnostic panels. The most common respiratory viruses are influenza, rhinovirus, coronavirus, respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, and adenovirus.…

Aspiration Pneumonia

Abstract While microaspiration of oropharyngeal secretions is usually the cause of most cases of community- and hospital-acquired pneumonias, macroaspiration of oropharyngeal or upper gastrointestinal contents is the cause of aspiration pneumonia (AP). Chemical pneumonitis (CP) is triggered by aspiration of acidic gastric material. A variety of different microbial communities exist in the lung. It is postulated that a macroaspiration event may trigger an inflammatory response resulting…

Atypical Pneumonia

Abstract The term atypical pneumonia was first used more than 50 years ago to describe cases of pneumonia caused by an unknown agent(s) and that appeared clinically different from pneumococcal pneumonia. Although the original distinction between atypical and typical pneumonia arose from the perception that the clinical presentation of patients was different, recent studies have shown that there is excessive overlap with clinical manifestations from specific…

Hospital-Acquired Pneumonia

Abstract Hospital-acquired pneumonia (HAP) is a new infection of the lung parenchyma that develops more than 48 hours after hospital admission. Epidemiologic data suggest that HAP occurs in up to 1.6% of patients, prolongs hospital stay by 2 to 3 days, and represents the most common hospital-acquired infection leading to death in critically ill patients. The morbidity and mortality attributed to HAP are significantly increased if…

Community-Acquired Pneumonia, Bacterial

Abstract There have been several new developments concerning community-acquired pneumonia (CAP) since the prior version of Netter’s Infectious Diseases ; these include: advances in molecular diagnostic methods to identify the causative pathogen; increasing awareness of viral etiology; decreasing rate of Streptococcus pneumoniae (although still the most common bacterial cause); increase of macrolide-resistant S. pneumoniae ; awareness of the role of the lung microbiome; and elimination of…

Nontuberculous Mycobacterial Skin and Soft-Tissue Infections

Abstract Nontuberculous mycobacteria (NTM) are a group of acid-fast bacteria that are ubiquitous in the environment. They have been isolated from water and soil, and, when it is possible to identify the etiology, related infections are almost always associated with environmental sources. NTM skin and soft-tissue infections (SSTIs) have been reported with slowly growing NTM species (e.g., avium complex, kansasii, marinum, haemophilum), but rapidly growing NTM…

Herpes Simplex Virus Infection

Abstract Herpes simplex viruses (HSVs) are double-stranded deoxyribonucleic acid (DNA) viruses that cause lifelong infection and frequent reinfections or reactivations. There are two types of HSV: HSV-1, the cause of human cold sores, and HSV-2, the usual cause of genital herpes. Each virus type has different clinical manifestations, modes of transmission, and epidemiologies. The development of type-specific serologic assays has allowed for differentiation between the two…

Superficial Dermatophyte Infections of the Skin

Acknowledgments The authors wish to acknowledge the work of previous edition authors Gregory Raugi and Thao U. Nguyen. Abstract Fungal infections of the skin can be divided into superficial and deep infections. The vast majority are superficial and are caused by dermatophytes, which invade only fully keratinized tissues (stratum corneum, hair, and nails). They are classified into three genera: Epidermophyton, Microsporum, and Trichophyton . Less frequent…

Life-Threatening Skin and Soft-Tissue Infections

Abstract This chapter discusses those soft-tissue infections that are truly life threatening. As such, early clinical recognition is the most important aspect of their clinical management. Staphylococcal and streptococcal toxic shock syndromes (referred to here as StaphTSS and StrepTSS, respectively) have similar clinical features once established, yet their prognosis and management are quite different. Necrotizing soft-tissue infections occur in three distinct settings. The first, necrotizing fasciitis…

Folliculitis, Furuncles, and Carbuncles

Abstract Localized purulent infections of the skin are extremely common in all parts to the world, in all age groups, and in both sexes. Staphylococcus aureus is the single most common cause of these infections; most are minor, requiring only local treatment such as drainage, unless systemic effects are evident, in which case surgical incision and drainage as well as appropriate antibiotics are necessary. In the…