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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…

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…