SEMIOLOGY
OF
INFECTIOS
DISEASES
Prof. Dr. Yaşar Küçükardalı
Yeditepe University
Faculty of Medicine
Department of Internal Medicine

Semiology ; science of the findings and symtoms
of the deseases
Subjective and Objective information
subjective
objective
What the patient says
(chief complaint etc.)
Physician‘s physical
examination
Laboratory findings
Radiological findings
INFECTION

Infection: The invasion and multiplication of
microorganisms such as bacteria, viruses,fungus and
parasites that are not normally present within the body
and the reaction of host tissues to these organisms and the
toxins they produce .

An infection may cause no symptoms and be subclinical, or
it may cause symptoms and be clinically apparent.

An infection may remain localized, or it may spread
through the blood or lymphatic vessels to become systemic .



Microorganisms that live naturally in the body are not
considered infections. For example, bacteria that normally
live within the mouth and intestine are not infections.
transmissible diseases
communicable diseases
HOW BACTERIA AND VIRUSES ENTER THE
BODY
Pathogenic bacteria must gain access into the
body. The range of access routes for bacteria
includes:
 Cuts
 Contaminated food or water
 Close contact with an infected person
 Contact with the faeces of an infected person
 Breathing in the exhaled droplets when an
infected person coughs or sneezes
 Indirectly, by touching contaminated surfaces –
such as taps, toilet handles, toys and nappies.
VIRUSES ARE SPREAD FROM ONE PERSON TO
ANOTHER BY:
Coughs
 Sneezes
 Vomits
 Bites from infected animals or insects
 Transfusion of the contaminated blood products
 Exposure to infected bodily fluids through
activities such as sexual intercourse or sharing
hypodermic needles.
 Forgetting to wash your hands after handling
pets and animals is another way for germs to be
taken in by mouth.


Primary pathogens cause disease as a result of
their presence or activity within the normal,
healthy host, and their intrinsic virulence
Opportunistic pathogens can cause an infectious
disease in a host with depressed resistance.
 such as pathogenic bacteria or fungi in
the gastrointestinal or the upper respiratory
tract,
An opportunistic disease requires impairment of
host defenses, which may occur as a :
 result of genetic defects (such as Chronic
granulomatous disease),
 exposure to antimicrobial drugs
or immunosuppressive chemicals (as might occur
following poisoning or cancer chemotherapy),
 exposure to ionizing radiation,
FEVER





> 37.5 C oral, > 38.2
rectal
Endogen pirogens :
IL-1, TNF, INF
Eksogen pirogens:
Gr+, - , bacterial
endo or egzo toxins,
Daily physiologic
alteration may occur
1C
20-30 % elderly
patients may not
have fever during th
infection episode
HYPERPYREXIA
Hyperpyrexia is a fever with an extreme elevation of body
temperature greater than or equal to 41.5 °C (106.7 °F). Such a high
temperature is considered a medical emergency
 The most common cause is an
intracranial hemorrhage
sepsis,
Kawasaki syndrome,
neuroleptic malignant syndrome,
drug effects,
serotonin syndrome,
thyroid storm.
Heatstroke
malignant hyperthermia



Infections commonly associated with hyperpyrexia include: rubeola
and enteroviral infections
in hyperpyrexia the body's temperature regulation mechanism sets
the body temperature above the normal temperature, then generates
heat to achieve this temperature, while in hyperthermia the body
temperature rises above its set point due to an outside source.
CAUSES
OF
FEVER
İnfectious diseases
 Solid and hematologic malignancies
 Vasculitis and collageneous diseases
 Outoimmun
 Granulamatous
 Endocrin and metabolic
 Primary neurologic
 Other: FMF, allergic rx, alcoholic hepatitis,
hemolysis, histiositosis -X, drug fever, Kikuchi
diseases, pancreatitis, Sweet syndrome,
pulmonary emboli, hyperimmungloubulin D
syndrome

Continuous fever: Temperature does not fluctuate more than 1 °C in 24
hours, e.g. lobar pneumonia, urinary tract infection, brucellosis, or typhus.
Typhoid fever may show a specific fever pattern, with a slow stepwise
increase and a high plateau.
Remittent fever: Temperature remains above normal throughout the day
and fluctuates more than 1 °C in 24 hours, e.g., infective endocarditis.
Intermittent fever: The temperature elevation is present only for a certain
period, later cycling back to normal, e.g. malaria, kala-azar, pyaemia, or
septicemia
Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma,
being high for one week and low for the next week and so on
MOST COMMON SYMPTOMS RELATED TO SIDE
OF THE INFECTION
Systemic
Head and Neck
Pulmonary
Fever
Fatigue
Anorexia
Weakness
Extensive pain
Headache
Sore throat
Difficulty on swollow
Dyspnea
Coahing
Chest pain
Cardiovasculary
Hepatobiliary
Gastrointestinal
Palpitation
Chest pain
Dyspnea
Sencop
Cloudicatio intermit.
Right upper
guadrant pain ,
Right/left upper
quadrant dullness
Nausia
Vomiting
İcterus
Puriritis
Abdominal pain
Nausia
Vomiting
Diarea , mucoid, ..
Abdominal bloating
Perirectal puriritis
Pain during the
defecation
MOST COMMON SYMPTOMS RELATED TO SIDE
OF THE INFECTION
Urogenital
Musculosceletal
Burning during the
Muscle / joint pain
urination
Diminish ROM
Pollacuria
Flunk pain
Dificulty on urination
Referred pain
Ureteral discharge
Skin
Pururitis
Burning
Santral and
peripheric
nervous system
Loss of memory
Mental disorders
Nausia, vomiting
Parestesia
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
İnspection
Head and Neck
Discharge of ear,
Post nasal discharge
Hyperemic
conjonctiva
Icteric sclere
Hyperemic
apperence of
pharenx
Exuda on tonsil
Oscultation
Percussion
Palpation
Lymphadenomegaly
Tenderness of sinus
Neck stiffness
Tenderness of
thyroid
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
Chest
İnspection
Oscultation
Percussion
Palpation
Tacipnea
Bradipnea
Vesiculary
lesions
Rales
Roncus
Diminish
lung sound
Matite
Axillary
lymphadenomegaly
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
Cardiovasculary
İnspection
Oscultation
Percussion
Palpation
Slinter
hemoragia
Janeway lesion
Hyperemic
vasculary line
Altered
murmur
Diminished
heart sounds
Matite
Weak radial
pulse
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
İnspection
Hepatobiliary
İcterus
Abdominal
distansion
Vomiting
Dark urine
White stool
Oscultation
Percussion
Palpation
Hapatomegaly
Splenomegaly
Murphy sign
Rebound
Tenderness
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
Gastrointestinal
İnspection
Oscultation
Percussion
Palpation
Abd distantion
Cullen
Turner
Bloody stool
Hyperactive
bowel sounds
Silent abdomen
Sonorite
Tenderness
Rebound
Mc Burney
Matite
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
İnspection
Urogenital
system
Urethral
discharge
Glob vesicale
Genital herpetic
lesions
Piuria
Oscultation
Percussion
Palpation
Costa vertebral
angle tenderness
Suprapubic
dullness
Testiculary
tenderness
Inguinal LAM
Pelvic tenderness
Prostat
tenderness
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
İnspection
Muscle and
sceletal system
Milky synovial
fluid apperence
Brown urine
Foot ulcer
Chronic
discharge
Oscultation
Percussion
Palpation
Hot joint
Diminish ROM
Ballotman
Bone tenderness
Pain point of on
axial system
MOST PHYSICAL FINDINGS RELATED TO SIDE
OF THE INFECTION
İnspection
Central and
peripheral
nervous
system
Loss of memory
Neurologic
deficit
Vomiting
Dificulty on
swollow
Abnormal
talking
Oscultation
Percussion
Palpation
Neck stiffness
Loos of
sensation
Parestesia
Plegia
Abnormal
reflexes
CHARACTERISTICS OF VIRAL INFECTIONS




In general, viral infections are systemic.
This means they involve many different parts of
the body or more than one body system at the
same time; i.e. a runny nose, sinus congestion,
cough, body aches etc.
They can be local at times as in
viral conjunctivitis or "pink eye" and herpes.
Only a few viral infections are painful, like
herpes.
The pain of viral infections is often described as
itchy or burning.
Reye syndrome
Reye syndrome is sudden (acute) brain damage and liver function problems of unknown cause.
The syndrome has occurred in children who have been given aspirin when they have chicken pox or the flu. Reye syndrome has
become very uncommon since aspirin is no longer recommended for routine use in children.
DIAGNOSIS OF VIRAL DISEASES
Clinical presentation is used to detect viral disease by
looking for history of severe muscle and joint pains
before fever
also detect skin rash
lymph gland swelling

Laboratory investigations is not necessary to detect
viral infections, because no increase in the white
blood cells, the laboratory investigation is done to
find other bacterial infections, if it is suspected.
 Viruses commonly have self-limited life, so treatment
is usually reduce the symptoms only
and antipyretic and analgesicdrugs

CHARACTERISTICS
OF BACTERIAL INFECTION
The classic symptoms of a bacterial infection are:
localized redness,
heat,
swelling and pain.

One of the hallmarks of a bacterial infection is
local pain, that occurs at the site of the infection.
 Bacterial throat pain is often characterized by
more pain on one side of the throat.
 An ear infection is more likely to be diagnosed as
bacterial if the pain occurs in only one ear.
 Bacterial infections produces pus and milkycolored liquid

FEVER
WITHOUT LOCALISE
SYMPTOMS
Tuberculosis
 Endocarditis
 Micotic anevrisma
 Septic thrombophlebitis
 Spondilitis
 Osteomyelitis
 Pneumonia
 Intraabdominal abces
 Pyelonephritis
 Viral: CMV , mononucleosis, HIV, early
hepatitis

MAJOR SYMPTOMS MAY COEXIST WITH
FEVER

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











Eruption
Joint and bone pain
Lymphadenopathy
Face and neck swelling
Headache and neck stiffness
Neurological disturbances
Cold ang flu like symptoms
Coughing and chest pain
icterus
Splenomegali
Diarea
Abdominal pain
Disuria
Sepsis
Heart diseases
FEVER
AND PATECHIA
/ PURPURA
A petechia is a small (1 - 2 mm)
red or purple spot on the skin,
caused by a minor hemorrhage
(broken capillary blood vessels).
Bacteria, ricethsia, virus
 DİC
 Gram negative sepsis
 Endocarditis
 Meningococcemia
 Tiphus, Rocky Mountain Fever,
 Rubella, rubeola,
mononucleosis, hepatitis,
hemoragic fever

NON INFECTIOUS CAUSES OF PATECHIA /
PURPURA
Henoch schlein purpura
 SLE,
 ANCA
related vasculitis
PAN
Churg Strause
Wegener Granulomatosis

MACULOPAPULARY EXANTEM




Rubella, rubeola, coxacie, ecovirus,
mononucleosis, parvovirus
Streptococ,(erizipel,scarlet fever),
staphylococ, ( TSS) , sec. Siphylis
Drug rx, serum sickness, lupus,
Steven Johnson S, dermatomysotis,
Sweet Syndrome, Etiology ?
leucocytosis, skin lesions,
neutrophilic infiltration, myalgia,
headache, fever, (infection, malignity,
IBS vb )
An exanthem is a
widespread rash usually
occurring in children.
Exanthems can be caused
by toxins or drugs,
microorganisms, or can
result from autoimmune
disease.
VESICULARY AND PUSTULARY LESIONS
Varisella, zoster, herpes
symplex, coxachie A16, hand,
foot, mouth diseases,
 Spahpylococ sepsis
 Disseminated gonococ
infection ( distal)


Drug eruption, allergic
dermatitis, Sweet S, Steven
Johnson S,
Vesicles are small, fluidfilled sacs that can
appear on skin
NODULARY SKIN LESIONS


Treponema pallidum; Nocardia; and
atypical mycobacteria, particularly
Mycobacterium marinum and
Mycobacterium chelonae, as well as
Mycobacterium tuberculosis itself.
Fungal infections, including
blastomycosis, coccidioidomycosis,
sporotrichosis, and aspergillosis,
All these infectious disorders
are due to Staphylococcus
aureus or opportunistic bacteria
such as Nocardia, Legionella or
Aspergilli.
ULCERUOS SKIN LESIONS

Ulcerated skin lesions may result from
Staphylococcus infections

The necrotic ulcer of anthrax is often
surrounded by edema




Stomatitis is an inflammation inside the
mouth, such as a small sore or ulcer. Multiple
blisters in the mouth can be a sign of herpetic
stomatitis.
Rarely, a painless destructive ulcer with
undermining edges may result from
infection with Mycobacterium ulcerans
(Buruli ulcer).
cutaneous leishmaniasis. The lesion is a
chronic, usually painless ulcer,
skin dephteria,tularemi, ectima
gangrenosum ( pseudomonas aeroginosa) ,
ricetsia
Peripheral vasculary disease, Behçet
diseases, vasculitis, cholesterol
embolism, lymphoma, erithema
multiforme major,
FEVER








AND BONE/ JOINT PAIN
İnflammatory joint diseases together
with % 15-20 infectious pathogen
Bacterial artritis: gonococ / rubeola,
hepatitis, mumps, polyarticulary , others
monoarticulary
Cardinal findings of inflammation
No fever / mycobacterium, fungal
infection
Most common: Knee, hip, scholder,
elbow
Gram stain positive % 30-50 , staph,
Viral: rubeola, hepatitis B,
Reactive artritis: Chlamidia, Shigella,
Camphylobacter, Salmonella, Yersinia,
Gonococ
FEVER
AND DISSEMINETED
LAM
FEVER

AND
LOCALISED
LAM
Servical LAM: upper respiratory
tract infections Virus, Group A
streptococ, Ebstain Barr Virus,
Diphteria, Toxoplasmosis, tbc
lymphadenitis

Oxipital LAM: Rubella, rubeola,
non -spesific infections of scalp

Axillary, İnguinal LAM: Group
A streptococ

Inguinal LAM with pain:
herpes symplex,
lymphogranuloma venerum (
chlamidia) Soft chankır (
Haemophilus ducrei),
granuloma inguinale
FEVER


AND FACE
/ NECK
SWOLLEN
Mumps, pürülan parotitis
Parotis , salivary gland
lenfamatosis, Sjogren S,
Warthin TM
Neck: Lemierre S
 Actinomicosis:

Lemierre's syndrome (or Lemierre's disease, also known
as postanginal shock including sepsis and human necrobacillosis)
refers to thrombophlebitis of the internal jugular vein. It most often
develops as a complication of a bacterial sore throat infection in young,
otherwise healthy adults. The thrombophlebitis is a serious condition and
may lead to further systemic complications such as bacteremia or septic
emboli.
FEVER, HEADACHE AND NECK STIFNESS
İnfectious origine
 Drug Rx
 Allergic Rx,
 Leucemia
 SNS metastasis
 Subaracnoid hemoragia
 SVA ( emboli , trombosis)

MENINGITIS
Bacterial meningitis and viral encephalitis
are two life-threatening causes of infection
and inflammation within the central nervous
system (CNS).
 Evaluation in the acute care setting is focused
on identifying patients who require urgent
diagnostic testing and/or empiric treatment.
 Meningitis affects patients of all ages, but
those who are very young, elderly, or
immunosuppressed are at increased risk.

MENENGISM
Neck stiffness
 Headache
 Fever
 Nousia
 Vomiting
 Photophobia
 Diplopia
 Hyperestesia
 Generalise convulsion

MENENJITIS
LIKE
CONDITIONS
Purulan proceses near the meninx
Brain abceses, mastoiditis, otitis, osteomyelitis,
sinusitis, ………may caouse meningial irritation

INFLUENZA

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There are two main types of influenza
(flu) virus: Types A and B. The
influenza A and B viruses that
routinely spread in people (human
influenza viruses) are responsible for
seasonal flu epidemics each year.
Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (tiredness)
Some people may have vomiting and
diarrhea, though this is more common
in children than adults.
Acute respiratory diseases ( upper
end lower tract)
Sec bacterial infections may occur (
staph., pneumococ, H influenza)
FEVER AND FLU LIKE INFECTIONS
Bacterial tonsillitis and pharangitis
 Streptococal: odinophagia, LAM,
leucocytosis, scarlet; high fever with
fast klinical course skin lesions may
appear 2-5 day later
 Dihpteria
 Plaunt vincent angina
Non Bacterial pharangitis:
 Mycoplasma, Ebstain Bar virus,
adenovirus, coxachie virus, CMV,
herpes virus,
COLD: INFLUENZA LIKE INFECTIONS
Virus 90%, ( rhinovirus, coxachie virus,
Mycoplasma, Chlamidia
 Rhinitis, tosillopharengitis, larengotraceitis,
trakeobronchitis, bronchopneumonia

In the absence of outbreak, influenza may be
diffucult to differentiate from acut respiratory
illness caused by other viruses or mycoplasma
 Severe streptecocal pharangitis or early
bacterial pneumonia may mimic acute
influenza

SINUSITIS


Sinus infections are caused by
infections from a pathogenic
microorganism (virus,
bacterium, or fungus), which
grows within a sinus and
causes intermittent blockage of
the sinus ostium.
Sinus infection symptoms may
include sinus headache, facial
tenderness, pressure or pain in
the sinuses, fever, cloudy
discolored drainage, and feeling
of nasal stuffiness, sore throat,
and cough, and on rare
occasions, associated with facial
swelling.
OTITIS
Otitis is a general term for inflammation or
infection of the ear,
It is subdivided into the following:
 Otitis externa, or "swimmer's ear" involves the
outer ear and ear canal.
 Otitis media or middle ear infection involves
the middle ear. In otitis media, the ear is
infected or clogged with fluid behind the ear
drum, in the normally air-filled middle-ear
space.
 Otitis interna or labyrinthitis involves the
inner ear. The inner ear includes sensory
organs for balance and hearing. When the
inner ear is inflamed, vertigo is a common
symptom.



The eustachian tube is shorter in children
than adults which allows easy entry of
bacteria and viruses into the middle ear,
resulting in acute otitis media. Bacteria such
as Streptococcus pneumoniae (strep) and
Haemophilus influenzae (H. flu) account for
about 85% of cases of acute otitis media and
viruses the remaining 15%.
pus within the middle ear causes pain , there
is usually transient hearing loss during the
infection, Severe ear infections may cause the
eardrum to rupture. The pus then drains from
the middle ear into the ear canal.
BRONCITIS




Bronchitis is an inflammation
of the bronchial tubes,
People who have bronchitis
often cough up thickened
mucus, which can be discolored.
Often developing from a cold or
other respiratory infection,
acute bronchitis is very
common.
Acute bronchitis is usually
caused by viruses, typically the
same viruses that cause colds
and flu (influenza). The most
common cause of chronic
bronchitis is smoking
cigarettes. Air pollution and
dust or toxic gases in the
environment or workplace also
can contribute to the condition.
Viruses cause about 90% of
acute bronchitis cases,
whereas bacteria account for
about 10%
Mycoplasma pneumoniae,
Chlamydophila pneumoniae,
Bordetella pertussis,
Streptococcus pneumoniae,
Haemophilus influenzae
FEVER, COAHING, THORAX PAIN : PNEUMONIA

Pneumonia is a common lung infection caused by
bacteria, a virus or fungi
Pneumonia is due to infections caused primarily by
bacteria or viruses and less commonly by fungi and
parasites.
In bacterial pneumonia, your temperature may rise
as high as 38 degrees . This pneumonia causes
profuse sweating, and rapidly increased breathing
and pulse rate. Lips and nailbeds may have a bluish
color due to lack of oxygen in the blood. A patient's
mental state may be confused or delirious.
Bacteria are the most common cause of communityacquired pneumonia (CAP), with Streptococcus
pneumoniae isolated in nearly 50% of cases.
Haemophilus influenzae in 20%, Chlamydophila
pneumoniae in 13%, and Mycoplasma pneumoniae in
3% of cases;[20] Staphylococcus aureus; Moraxella
catarrhalis; Legionella pneumophila and Gramnegative bacilli
The initial symptoms of viral
pneumonia are the same as
influenza symptoms: fever, a
dry cough, headache, muscle
pain, and weakness. Within
12 to 36 hours, there is
increasing breathlessness;
the cough becomes worse and
produces a small amount of
mucus. There is a high fever
and there may be blueness of
the lips.
In adults, viruses account for
approximately a third[6] and
in children for about 15% of
pneumonia cases.[22]
Commonly implicated agents
include rhinoviruses,
coronaviruses, influenza
virus, respiratory syncytial
virus (RSV), adenovirus, and
parainfluenza.
BREATHING SOUNDS:
disease
chest
inspectio
n
palpation
(thoracic
vibration)
percussio
n
character of
breathing
sounds
patological
sounds
pneumonia
normal/
dyspnea
increased
normal/
matitiy
decreased/bronchi
olar/
bronchovesicular
inspiratory rales
atelectasis
depression
of one
hemithora
x
decreased
matity
decreased or
absent
inspiratory rales
pneumotho
rax
increase of
one
hemithora
x
decreased
hypersonor
ity
decreased or
absent
-
emphysem
a
increased
thoracic
index
normal/decreased
normal/hy
personor
decreased
-
COPD
normal/dy
spneic
normal
normal
normal/increased
wheezing/rhoncus
pulmonary
fibrosis
tachypnea
/dyspnea
normal
normal
normal
velcro rales
asthma
dyspnea
normal
normal
normal/decreased/
silent
wheezing/rhoncus
cardiac
failure
dyspnea
normal/increased
normal
normal
inspriatory
rales/rhoncus
pleural
effusion
increase of
one
hemithora
x
decreased
matitiy
decreased
-/Frotman
FEVER AND ICTERUS
Prehepatic
Clostridium perfiringens, M
pneumonia may cause
hemolysis ( low hgb,
reticulosis, high LDH)
Sicle cell anemia, G6PD
deficiency, PNH,
Hepatic
Acute viral hepatitis,
mononucleosis, CMV,
Sepsis: pneumococ,
klebsiella, Salmonella,
Bacterides fragilis E Coli,
Streptococ,
Milier tuberculosis
Intrahepatic abceses
Posthepatic
Chlangitis and
choledecolitiasis
FEVER AND SPLENOMEGALY
Lymphoproliferative disorders
 İnfections
 Hemolitic anemia

Non infectious
 Felty Syndrome
 Still Diseases
 Lupus Diseases
The causes of massive splenomegaly (spleen >1000 g)
are fewer, and include:
visceral leishmaniasis (kala-azar)
chronic myelogenous leukemia
myelofibrosis
malaria
primary lymphoma of spleen
FEVER AND DIAREA




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Diarrhea may be accompanied by fever
(temperature greater than 100.4ºF or 38ºC),
abdominal pain, or cramping
Viral diarrhea are typically associated
with mild-to-moderate symptoms with
frequent, watery bowel movements,
abdominal cramps, and a low-grade fever.
The following are the common causes of
diarrhea caused by viral infections:
rotavirus is a common cause of diarrhea in
infants;
norovirus (for example, Norwalk virus,
caliciviruses) is the most common cause of
epidemics of diarrhea among adults and
schoolage children (for example, cruise ship
infection, schools, nursing homes, day care
facilities, and restaurants); and adenovirus
infections are common in all age groups.






Bacterial infections cause the more serious
cases of diarrhea. Typically, infection with
bacteria occurs from contaminated food or
drinks (food poisoning). Bacterial infections also
cause severe symptoms, often with vomiting,
fever, and severe abdominal cramps
or abdominal pain. Bowel movements occur
frequently and may be watery.
The following are examples of diarrhea caused
by bacterial infections:
In more serious cases, the stool may contain
mucus, pus, or blood. Most of these infections
are associated with local outbreaks of disease.
Family members or others eating the same food
may have similar illnesses.
Campylobacter, salmonellae,
and shigella organisms are the most common
causes of bacterial diarrhea.
Less common causes are Escherichia
coli Yersinia, and listeria.
Use of antibiotics can lead to an overgrowth
of Clostridium difficile (C diff) bacteria in the
intestines.




Parasites cause infection of the digestive
system by the use of contaminated water.
Common parasitic causes of diarrhea
include Giardia lamblia, Entamoeba
histolytica, and Cryptosporidium.
Intestinal disorders or
diseases including inflammatory bowel
disease, irritable bowel syndrome
(IBS), diverticulitis, microscopic colitis,
and celiac disease can cause diarrhea.
Reaction to certain medications can
cause diarrhea. Common medications
include antibiotics, blood pressure
medications, cancer
drugs, gout medications,weight
loss drugs, and antacids (especially those
containing magnesium).
Intolerance to foods such as artificial
sweeteners and lactose (the sugar found
in milk) can cause diarrhea.
Definition
Location
Work-up
Acute pain
syndromes
Chronic pain
syndromes
ORGANIC VERSUS FUNCTIONAL PAIN
HISTORY
ORGANIC
FUNCTIONAL
Pain character
Acute, persistent pain
increasing in intensity
Less likely to change
Pain localization
Sharply localized
Various locations
Pain in relation to sleep
Awakens at night
No affect
Pain in relation to
umbilicus
Further away
At umbilicus
Associated symptoms
Fever, anorexia,
vomiting, wt loss,
anemia, elevated ESR
Headache, dizziness,
multiple system complaints
Psychological stress
None reported
Present
Definition
Location
Work-up
Acute pain
syndromes
Chronic pain
syndromes
FEVER AND ABDOMINAL PAIN
Intraabdominal infections
Time to antimicrobial therapy important
History and clinical findings are gold standart for
diagnosis
 Primary peritonitis: 1% ,chrosis with ascites,
nephrotic syndrome, monomicrobial, E.Coli,
pneumococ, group A streptococ,


Secondary peritonitis : necrotizing lesion of GI
tract, traumatic perforation, perforation during the
invasive procedure, aerobic ( E coli, enterobacter,
enterococus, streptococ, pseudomonas) and
anaerobic ( Bacteroides fragilis, Clostridium )
polymicrobial
INTRAABDOMINAL ABCESES
Progression of diffuse peritoitis
 Spontan and travmatik perforation of GI tract
 Leakega of surgical anastomos line

Tendency of intraabdominal abcesses
Crohn: intraperitoneal, retroperitoneal, bacterial
endocarditis
Gallbladder diseases: liver abcesses
Pancreatitis: pancreatic abcesses
Rigor:
UROGENİTAL İNFECTİONS
FEVER,
DISURIA AND POLLAKURIA
Üretritis: burning,discharge, leucocyturia,
gonococus, chlamidia, tricomonas, mycoplasma,
uroplasma , no fever,
 Uncomplicated urinary system infection in
womens: disuria, pollacuria, lower abdominal
pain E coli, Staph saprophiticus, short term
antibiotic


Asemptopmatic bacteriuria: pregnancy,
diabetes, transplantation, should be treated
Uncomplicated pyelonephritis: fever, chill,
lomber pain, costa vertebral tenderness
Blood and urine culture +, 100000 mo / ml E
Coli

Complicated pyelonephritis: plus, present
complicated urologic diseases
Malformation
Renal stone
Prostat hyperplasia
Desensus uteri
Diabetes

FEVER AND SEPSIS
Sepsis is a potentially life-threatening
complication of an infection.
 If sepsis progresses to septic shock, blood
pressure drops dramatically, which may lead to
death.

To be diagnosed with sepsis, you must exhibit at
least two of the following symptoms:
Body temperature above 101 F (38.3 C) or below
96.8 F (36 C)
Heart rate higher than 90 beats a minute
Respiratory rate higher than 20 breaths a minute
Leucocyt count >12000 or < 4000/ ul
Probable or confirmed infection

While any type of infection — bacterial, viral or
fungal — can lead to sepsis, the most likely
varieties include:
 Pneumonia
 Abdominal infection
 Kidney infection
 Bloodstream infection (bacteremia)
INFECTIVE ENDOCARDITIS
inflammatory process on-going inside endocardium
– due to infection after endothelium damage
– most often involving aortic and mitral valves
–
3-10/100 000/year
 Maximum at the age of 70-80
 More common in women
 Staphylococcus aureus is the most common
pathogen
 Streptococcal IE is still the most common
in developing countries




•
•
•
Fever – over 90% of patients
New intra-cardiac murmur - about 85% of patients
Roth spots, petechiae, glomerulonephritis – up to 30% of
patients
When we suspect?
Sepsis of unknown origin
Fever coexsisting with:
Intracardiac implantable material
IE history
Congenital heart disease or valve disease
IE risk factors
Congestive heart failure symptoms
New heart block
– Positive blood cultures
– Focal neurological signs without known aetiology
– Periferal abscesess (kidney, spleen, brain, vertebral column)
–
–
–
–
–
–
DUKE CRITERIA
Major criteria
1.
2.
Blood culture positive
for typical IE-causing
microorganism
Evidence of endocardial
involvement
Diagnosis
• 2 major criteria
• 1 major and 3 minor
• 5 minor criteria
Minor criteria
1.
2.
3.
4.
5.
Predisposition – heart
condition or i.v. drug
abuse
Fever – temp. >38 °C
Vascular phenomena –
arterial emboli etc.
Immunologic phenomena
– glomerulonephritis,
Osler’s nodes, Roth’s
spots
Microbiological evidence
– positive blood cultures
but do not meet major
criteria
PALPATION OF THE LIVER: