CARDIOVASCULAR SYSTEM

Diseases caused by Bacteria

1. Septicemia
A general expression for microbial infection of the blood and blood vessels. In
previous generations, this condition was known as blood poisoning.
Subacute septicaemia: due to Streptococcus pyogenes is accompanied by fever,
weakness, and heart murmur.
The acute form is generally due to infection by Staphylococcus aureus and is
accompanied by rapid destruction of the heart valves.

Causative agents:

Gram-positive streptococcus named Streptococcus pyogenes.

Septicemia may also be caused by a number of Gramnegative rods that
release endotoxins.

Signs and symptoms:

Fever, malaise, and dropping blood pressure.

Transmission:

Diagnosis:

This is usually an immune system problem caused by antigen-antibody

reactions taking place at the heart valves. Heart valve replacement is sometimes required.

2. Rheumatic fever
Immune reaction taking place in the heart tissues
Streptococcus pyogene
Inflammation of the heart tissues is often accompanied by inflammation and arthritis
of the joints, a condition called rheumatoid arthritis. A streptococcal sore throat may
precede this condition.

3. Tularemia. Tularemia is due to a Gram-negative rod called Francisella tularensis.The

bacteria enter the body by contact, inhalation, ingestion of contaminated rabbit
meat, and the bite of ticks and other arthropods. Patients experience a blood
disorder accompanied by fever, malaise, and numerous nonspecific symptoms.
Antibiotics such as gentamicin are used in therapy.

4. Plague. Plague is caused by the Gram-negative rod Yersinia pestis. This organism is
similar to the agent of tularemia and is transmitted by its rodent reservoir, the rat
flea.The organism enters the lymphatic system and causes swelling of the lymph
nodes called buboes. This stage is called bubonic plague. When the bacteria enter the
blood, the condition is referred to as septicemic plague, and when the bacteria enter
the lungs, the disease is called pneumonic plague. Transmission by airborne droplets
is possible at this time. Aggressive antibiotic therapy is necessary to prevent death.
 The bacteria display a safety-pin appearance due to the accumulation of dye at the
poles of the cells. This characteristic is called bipolar staining.

5. Brucellosis. Brucellosis is also known as undulant fever because it is characterized by

alternating periods of high fever and relief. The bacterial agents belong to the
genusBrucella. They are small, Gramnegative rods and include B. abortus, B. suis, B.
melitensis , and B. canis. In animals, these bacteria cause abortion of the young
(contagious abortion) and sterility of the female. They are transmitted to humans by
unpasteurized milk and contaminated meat. On entering the bloodstream, the
bacteria cause fever, chills, and malaise. Prolonged treatment is required with
tetracycline, and vaccines are available for immunizing herds of animals.

6. Anthrax. Anthrax is due to the Gram-positive, aerobic, sporeforming rod Bacillus

anthracis. Spores from this organism are inhaled from the air, or they are acquired
during contact with contaminated soil or animals such as sheep and cattle. In the
bloodstream, B. anthracis causes severe hemorrhaging, and the spleen, kidneys, and
other bloodrich organs become engorged with blood. In the lungs, anthrax is
calledwoolsorter's disease and is accompanied by pneumonia. Aggressive antibiotic
therapy is necessary to prevent death.

7. Relapsing fever. Relapsing fever is so named because of the recurrent periods of fever.
The etiologic agent is Borrelia recurrentis , which is a spirochete. The organism is
transmitted by lice, which are natural parasites of humans. It may also be
transmitted among humans by ticks. Jaundice and rose-colored skin spots
accompany the infection, which may be treated by antibiotics.

8. Lyme disease. Lyme disease is caused by Borrelia burgdorferi. This organism is a

spirochete transmitted by ticks of the genus Ixodes. First observed in Lyme,
Connecticut, Lyme disease is now found throughout the United States.

9. Among the first symptoms of Lyme disease is a bull's-eye rash occurring on the skin.
The rash is called erythema chronicum migrans. It occurs at the site of the tick bite
and has a red center and expands over a period of several days. After the rash fades
and spirochetes enter the blood, fever and other symptoms appear. In addition, the
heart is affected and irregular heartbeat may be observed. On occasion, there is
paralysis of the face and meningitis. Some months later, patients display arthritis of
the large joints such as hips, ankles, elbows, and knees.

10. Lyme disease may be treated with a number of antibiotics, including penicillin and
tetracycline. A vaccine is currently available for dogs. Diagnosis of the disease
depends upon the observance of symptoms and awareness of exposure to ticks.
11. Rocky Mountain spotted fever. Rocky Mountain spotted fever is caused by the
rickettsia Rickettsia rickettsii. This submicroscopic bacterium is transmitted by ticksof
the genus Dermacentor. The disease is characterized by a maculopapular skin rash(a
spotted rash) occurring on the appendages and then spreading to the trunk. The
fever is very high, and headaches accompany the disease. Antibiotics such as
tetracycline are effective for therapy.

12. Epidemic typhus. Epidemic typhus is caused by Rickettsia prowazekii , a rickettsia

transmitted by the body louse of the genus Pediculus. The organism invades the
bloodstream and causes a maculopapular skin rash beginning on the body trunk and
spreading to the appendages. The fever is extremely high, and the death rate is
significant. Tetracycline antibiotics are effective for therapy, and elimination of lice is
essential to stem the spread of the epidemic.

13. Endemic typhus. Endemic typhus is also called murine typhus because it occurs in mice
and other rodents. It is transmitted by the rat flea and is caused by Rickettsia typhi , a
submicroscopic rickettsia. The symptoms are similar to those of epidemic typhus but
are much milder, and the mortality rate is much lower.

14. Other rickettsial diseases. Several other rickettsiae are known to cause diseases in
humans. One example is rickettsialpox, caused by Rickettsia akari. This organism is
transmitted by mites and causes a skin rash that resembles chickenpox. Another
disease is tsutsugamushi, also called scrub typhus. This disease is also transmitted
by mites. It occurs in Pacific regions and is characterized by a fever and skin rash.

15. Another rickettsial disease is trench fever, caused by Rochalimaea quintana. This
disease is transmitted by lice and was common during World War I, when it affected
soldiers in the trenches. Ehrlichiosis is a rickettsial disease due to Ehrlichia
canis.Patients suffer headache and fever, but there is no skin rash associated with
the disease. A similar disease is human granulocytic ehrlichiosis (HGE), which is also
caused by a species of Ehrlichia. Ehrlichia species are transmitted by ticks. The
diseases can be treated with tetracycline and other antibiotics.

16. Microbemia
Etiology
Gram-negative enteric bacilli, Staphylococcus aureus, and Streptococcus pneumoniae are
the most common pathogens in the United States. Of these, the most likely agent of a
given case of microbemia depends on host characteristics (age, granulocyte count,
associated conditions, prior antimicrobial therapy) and epidemiologic setting (community
vs. hospital-acquired, travel, animal exposure, etc.).
Pathogenesis
 Microbes generally enter the circulatory system via the lymphatics from areas of
localized infection or from diseased skin and mucous membranes colonized by members
of the normal bacterial flora.
Clinical Manifestations
Microbemias may be asymptomatic, symptomatic, transient, continuous, or intermittent.
Microbemias due to small numbers of relatively nonpathogenic microorganisms are
usually asymptomatic. Larger inocula or more pathogenic organisms may produce
systemic signs and symptoms: fever, chills, rigors, sweating, malaise, sleepiness, and
fatigue.
Microbiologic Diagnosis
Techniques used in diagnosis include cultures of localized sites of infection, multiple
blood cultures, and (rarely) blood serology.

Prevention and Treatment

Prevention in hospitals consists of hand-washing by personnel in contact with patients and
avoidance of unnecessary urinary and intravenous catheterization. After samples are taken for
culturing, treatment with intravenous broad-spectrum antimicrobial agents is usually begun,
based on an estimate of the most likely organisms and their usual antimicrobial susceptibility
patterns. This empirical therapy is modified if necessary when the pathogen and its
susceptibility pattern are identified.

17. Infective Endocarditis

Etiology

Staphylococcus aureus, viridans streptococci, and enterococci are the most common causes of
endocarditis.

Pathogenesis

Microbes that enter the blood lodge on heart valves. Previously damaged heart valves are more
susceptible. Bacterial colonies become covered with fibrin and platelets, which protect the
organisms from phagocytes and complement. Clots may dislodge as infected emboli.

Clinical Manifestations

Infective endocarditis may affect native or abnormal cardiac valves, prosthetic valves, and,
secondarily, other intravascular sites. Manifestations include fever, malaise, fatigue, weight loss,
skin petechiae, embolic infarction of vital organs, and valve dysfunction with congestive failure.
Metastatic infection in acute endocarditis is caused by virulent organisms.

Microbiologic Diagnosis
Infective endocarditis is diagnosed through blood cultures.

Prevention and Treatment

Antimicrobial prophylaxis is administered to patients with defective heart valves who are
undergoing dental and other procedures known to produce bacteremia. Therapy consists of
prolonged intravenous treatment with bactericidal antibiotics to eradicate bacteria within the
protective clot. Surgical replacement of infected valves may be required to cure prosthetic valve
infections.

18. Myocarditis