Infectious Diseases Lecture 12 of the Course “Medical English” for Sophomore Medical Students of Taipei Medical University

School of Medicine Taipei Medical University

Winston W. Shen, M.D.

Professor and ChairmanDepartment of Psychiatry

Taipei Medical University College of Medicine and

Chief, Department of Psychiatry TMU-Wan Fang Medical Center

Taipei, TAIWAN

E-mail address: Shenwinw@gmail.com

The Schedule for the Course “Medical English” (Version of 3/29/07) Week 1 (March 1) The Digestive System

Week 2 (March 8) The Respiratory System Week 3 (March 15) The Cardiovascular System Week 4 (March 22) The Musculoskeletal System (Turning in a 400-word essay on “My Visit to the Clinic (Hospital)” (in double-line space hard copy)

Week 5 (March 29) The Central Nervous System Week 6 (April 5) No class (Spring break) Week 7 (April 12) Urinary and Reproductive Systems Week 8 (April 19) The First Examination Week 9 (April 26) Medical Records (Turning in a 400-word essay on “My Favorite Book” (in double-line space hard copy)

Week 10 (May 3) Scientific Papers Week 11 (May 10) Hematology Week 12 (May 17) Infectious Diseases Week 13 (May 24) The Second Examination Week 14 (May 31) Endocrinology (Turning in a 400-word essay on “How to Be a Good Physician” (in double line space hard copy)

Week 15 (June 7) Immunology Week 16 (June 14) Oncology Week 17 (June 21) No Class Week 18 (June 28) Final (The Third) Examination

Bacteria Fungi Protozoa Multicellular parasites

Prions

The Pathogens of Infectious Diseases

Rank Cause of death Deaths 2002 % of all Death Deaths 1993 1993 Rank

N/A All infect. diseases 14.7 million 25.9% 16.4 million 32.2% 1. Lower resp. infections 3.9 million 6.9% 4.1 million 1 2. HIV/AIDS 2.8 million 4.9% 0.7 million 7 3. Diarrheal diseases 1.8 million 3.2% 3.0 million 2 4. Tuberculosis (TB) 1.6 million 2.7% 2.7 million 3 5. Malaria 1.3 million 2.2% 2.0 million 4 6. Measles 0.6 million 1.1% 1.1 million 5 7. Pertussis 0.29 million 0.5% 0.36 million 7 8. Tetanus 0.21 million 0.4% 0.15 million 12 9. Meningitis 0.17 million 0.3% 0.25 million 81 10. Syphilis 0.16 million 0.3% 0.19 million 1111. Hepatitis B 0.10 million 0.2% 0.93 million 6, 12-1712. Tropical diseases 0.13 million 0.2% 0.53 million 9, 10, 16-18

Other causes of death include maternal and perinatal conditions (5.2%),

nutritional deficiencies (0.9%)noncommunicable conditions (58.8%), and injuries (9.1%).12. Note:

Worldwide Mortality Due to Infectious Diseases

Bacillus Coccus Spirillum

www.faculty.southwest.tn.edu/

Pl. -ci )  Any of various bacteria having a round or ovoid form such as streptococcus or staphylococcus, usually grouped in chains

(NL < Gk bakt rion, dim. Of baktéría staff; akin to báktron stick, L baculum, Bacillum)

pl. -cil·li  

(Any rod-shaped or cylindrical bacterium of the genus Bacillus)

pl. -ril·la  

NL, equiv. to L spīr(a) (see spire2) + -illum dim. suffix ]

Both Gram-positive and Gram-negative bacteria may have a membrane called an S-layer. In Gram- negative bacteria, the S-layer is directly attached to the outer membrane. In Gram-positive bacteria, the S-layer is attached to the peptidoglycan layer. Unique to Gram-positive bacteria is the presence of teichoic acids in the cell wall. Some particular teichoic acids, lipoteichoic acids, have a lipid component and can assist in anchoring peptidoglycan, as the lipid component is embedded in the membrane.

Gram-positive bacteria are those that retain a crystal violet dye during the Gram stain process. Gram-positive bacteria appear blue or violet under a microscope, while Gram-negative bacteria appear red or pink. The Gram classification system is empirical, and largely based on differences in cell wall structure.

Bacillus, Listeria, Staphylococcus Streptococcus Enterococcus Clostridium

Mycoplasma The Deinococcus- Thermus bacteria

˙Gram Positive Cocci

▪ Streptococcus (e.g. Streptococcus Pneumoniae) ▪ Staphylococcus (e.g. Staphylococcus aureus) ▪ Enterococcus (Previously Group D Streptococcus)

˙ Gram Positive Rods

▪ Corynebacteria: Corynebacterium diphtheriae ▪ Listeria monocytogenes ▪ Bacillus anthracis (Anthrax) ▪ Erysipelothrix rhusiopathiae

˙ Gram Positive Branching Organisms

▪ Actinomycetes

Gram-Positive Bacteria

Family Practice Notebook, LLC, 2007

Both Gram-positive and Gram-negative bacteria may have a membrane called an S-layer. In Gram-negative bacteria, the S-layer is directly attached to the outer membrane. In Gram-positive bacteria, the S-layer is attached to the peptidoglycan layer. Unique to Gram-positive bacteria is the presence of teichoic acids in the cell wall. Some particular teichoic acids, lipoteichoic acids, have a lipid component and can assist in anchoring peptidoglycan, as the lipid component is embedded in the membrane.

Gram-positive bacteria are those that retain a crystal violet Dye during the Gram stain process. Gram-positive bacteria Appear blue or violet under a microscope, while Gram-negative bacteria appear red or pink. The Gram classification system is empirical, and largely based on differences in cell wall structure.

Acetobacteriaceae Alcaligenaceae Bacteroidaceae Chromatiaceae Enterobacteriaceae Legionellaceae

Neisseriaceae Nitrobacteriaceae Pseudomonadaceae Rhizobiaceae Rickettsiaceae Spirochaetaceae Vibrionaceae

˙Gram-Negative Rods ▪ Anaerobes ٠ Bacteroidaceae (e.g. Bacteroides fragilis)

▪ Facultative Anaerobes ٠ Enterobacteriaceae (e.g. Escherichia coli) ٠ Vibrionaceae (e.g. Vibrio Cholerae) ٠ Pasteurellae (e.g. Haemophilus Influenzae)

▪ Aerobes ٠ Pseudomonadaceae (e.g. Pseudomonas aeruginosa)

˙Gram-Negative Cocci ▪ Aerobes

٠ Neisseriaceae (e.g. Neisseria Meningitidis)

˙Gram Negative Obligate Intracellular Parasites ٠ Rickettsiae (e.g. Rickettsia)

Gram-Negative Bacteria

Family Practice Notebook, LLC, 2007 .

Furuncle: Boil, infected hair follicle. Carbuncle: Boil resulting from cluster of

furuncles. Bacteremia: Targets kidneys, lungs, hearts, bone. Possible coagulopathy. Endocarditis can result. Osteomyelitis can also result.

Toxic Shock Syndrome: Result of TSS-Toxin. Food Poisoning: Staph Aureus causes food poisoning

Enterotoxins A-EMethicillin-Resistant Staph Aureus (MRSA): Must be treated with Vancomycin. Coagulase-Negative Staph (CNS): Less v

Staphylococcus Aureus Suppurative::

Pharyngitis: 5-15 yrs old. Scarlet Fever: Desquamation of outer skin layer on trunk. Caused by the virulence factor, Erythrogenic Toxin.

Toxic-Shock Like Syndrome: Similar to Staph, Pyoderma:

IMPETIGO: Cutaneous lesions in kids ERYSIPELAS: Cutaneous lesions in adults. Pneumonia: Bacteremia: Can lead to arthritis, osteomyelitis, endocarditis, meningitis.

Non-suppurative Sequele Rheumatic Fever: 2-3 weeks after soar throat, low-grade fever & polyarthritis. Heart Murmur

Streptococci

Nosocomial infections are those which are a result of treatment in a hospital or hospital-like setting, but secondary to the patient's original condition. Infections are considered nosocomial if they first appear 48 hours or moreafter hospital admission or in 30 days after discharge.

Nosocomial Infection

Reasons for Causing Nosocomial Infections: ˙Patients have weakened state of immune systems. ˙Inpatients are sicker in the hospital. ˙Medical staff who move from patient to patient can spread pathogens. ˙Many medical procedures bypass the body's natural protective barriers. ˙Routine use of anti-microbial agents in hospitals creates selection pressure for the emergence of resistant strains.

(From Late Latin nosocomi (um), hospital (ultimately from Greek nosos, disease + komein, to take care of) + -al.]

Adapted from: Wikipedia, 2007

Carbuncle (KAR-bung-kul) is an abscess larger than a boil, usually with one or more openings draining pus onto the skin. It is usually caused by bacterial infection. It is treated by drainage of the carbuncle, once it begins to "point" (begin to open to the surface), along with giving antibiotics to stop suppuration spread deep to subcutaneous fascia.

The Infection of the Skin

www.humanillnesses.com/

Abscesses (AB-seh-sez) are localized or walled off accumulations of pus* caused by infection that can occur anywhere within the body.

Furuncle (FYOOR-ung-kul)(L fūrunculus petty thief, boil, equiv. to fūr thief (cf. furtive) + -unculus dim. suffix extracted from derivs. of n-stems)

is also known as boil, is a type of abscesses of hair follicles

www.brooksidepress.org/.../Furuncle1500.jpg

Cellulitis Erysipela

www.globalrph.com/antibiotic/cellulitis.jpg

(L. erysipelas < Gk, equiv. to erysi- [prob. akin to erythrós red] + -pelas prob. skin [akin to pélma sole of the foot; cf. L pellis skin) ]

(Fr. charboucle, from L. carbunculus "red gem,“ also "red, inflamed spot," lit. "a little coal," from carbo (gen. carbonis) "coal" (see carbon). Originally

www.signalhillschool.org/.../ringworm.jpg

www.nepalinternationalclinic.com

Vaginal yeast infections are caused by a fungi called Candida albicans and Trichomonas vaginalis.Yeasts are tiny organisms that normally live in small numbers on the skin and inside the vagina.The acidic environment of the vagina helps keep yeast from growing. If the vagina becomes less acidic, too many yeast can grow and cause a vaginal infection.

www.moondragon.org www.brooksidepress.org

Tinea corporis is that the fungus involves the glabrous (relatively hairless) skin. The infection is limited to the stratum corneum of the epidermis.

Tinea pedis, Tinea manuum, and Tinea cruris refer to Tinea corporis that is limited to the foot, hand, and groin, respectively.

History lesson: The term tinea has an interesting origin.A worm of a moth would sometimes grow on a woolen blanket. The resulting round holes were similar to the rounded lesions seen on the skin of patients. The genus name for the moth was Tinea, and thus this name was used as part of the Latin binomials naming these infections.

(L: larva of a moth or beetle that devours books, clothes.)

Fungus Infestation (Ringworm and Vaginal Infections)

richomonas vaginalis.Yeasts

www.med.yale.edu/.../graphics/rad1.gif

Pulmonary Tuberculosis

Hilar adenopathy

Lobar infiltrate Right middle lobe fissure

hi·lar ('hI-lar)adj. of, relating to, affecting, or located near a hilum (hilar lymph nodes of the lung). ad·e·nop·a·thy aden-'äp-&-thi, "ade-'näp-noun, pl. -thiesany disease or enlargement involving glandular tissue; especially : one involving lymph nodes <cervical adenopathy>

(1758, of fluids, from in- "in“ + filtrate (see filter (n.). Infiltration in fig. sense of “a passing into” (anything immaterial) is from 1840; Military sense of “stealthypenetration of enemy lines” Dates from 1930.)

˙ A sexually transmitted disease (STD)

˙ Being caused by Treponema pallidum.

˙ Being called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

Syphilis

Because of the outbreak in the French army, it was first called morbus gallicus, or the French disease. In that time the Italians also called it the "Spanish disease", the French called it the la maladie anglaise ("the English disease") and "Italian disease" or "Neapolitan disease", the Russians called it the "Polish disease", and the Arabs called it the"Disease of the Christians.

Primary Stage

www.uimc.discoveryhospital.com/shared/enc/

Secondary Stage

www.md.ucl.ac.be/.../humains/Syphilis72.jpeg

Late Stage

(New L. Treponēma, genus name : Gk. trepein, “to turn”; see trep- in Indo-European roots + Greek nēma, “thread”)

http://upload.wikimedia.org/ wikipedia/en

Word History: In 1530 Girolamo Fracastoro, a physician, astronomer, and poet of Verona, published a poem entitled "Syphilis, sive Morbus Gallicus,“ translated as "Syphilis, or the French Disease." In Fracastoro's poem the name of this dreaded venereal disease is an altered form of the name of the hero Syphilus, a shepherd who is supposed to have been the first victim of the disease. Where the name Syphilus itself came from is not known for certain, but it has been suggested that Fracastoro borrowed it from Ovid's Metamorphoses.

American Heritage Dictionary -

Where the name Syphilus itself has been suggested that Fracastor borrowed it from Ovid's Metamorphoses. In Ovid's work Sipylus (spelled Siphylus in some manuscripts) is the oldest son of Niobe, who lived not far from Mount Sipylon in Asia Minor. Fracastoro's poem about Syphilus was modeled on the story of Niobe. Fracastoro went on to use the term syphilis Where the name Syphilus.

Severely Acute Respiratory Syndrome (SARS)

www.droid.cuhk.edu.hk/.../ www.vschool.scu.edu.tw/.../news/ima/source/sars2

Lobar infiltratesRespiratory distress developed in 88.7% patients, with the most severe day happened on the 10th hospitalized day (10±2.7 days).

Diarrhea exacerbated in 41.9% patients after admission, with the most severe day on the 9th hospitalized day (9.7±4.7days).

www.math.tu-berlin.de/aktMath/site/pics/SARS-Virus.jpg

A respiratory disease of unknown etiology that apparently originated in China in 2003; characterizedby fever and coughing or difficulty breathing or hypoxia; can be fatal.

Coronavirus= SARS virus Avian influena A(a rapidly mutating virus)

www.rkm.com.au

Protozoa (in Greek proto = first, and zoa = animals) are single-celled eukaryotes (organisms whose cells have nuclei) that commonly show characteristics usually associated with animals, most notably mobilityand heterotrophy.

Protozoa (1/3)

Consumers of bacteria (prokaryotes)

Parasites and symbionts of metazoa

Animal Kingdoms

Eukaryote (NL Eukaryota, earlier Eucaryotes (1925) “those having a true nucleus,” equiv. to eu- eu- + Gk káry (on) nut, kernel (see karyo-) + NL -ota, -otes; see –ote)

Protozoa

MetazoaA subdivision of the animal kingdom that includes all multicellular animal organisms having cells that are differentiated and form tissues and organs.

Two major functions of protozoa

(Sing. Protozoon)

(Trichomoniasis vaginitis) (Trich) (Candida albicans)

Protozoa (2/3)

(Samples of Diseases)

˙Intestinal nematode infections ▪ Roundworm infection (Ascaris lumbricoides)

www.museudavida.fiocruz.br/publique/media/ovo ▪ Hookworm infection (Ancylostoma duodenale, Necator americanus)

www.egov.oregon.gov/DHS/ph/phl/

www.stanford.edu/.../Images/Tapeworm

▪Tapeworm infection(Taenia saginata)

www.stanford.edu/.../Tvag_trophs_ii_sm.jpg

˙Vaginal yeast infections

The Plasmodium genus of protozoal parasites (mainly P. falciparum, P.vivax, P. ovale, and P. malariae) have a life cycle which is split between a vertebrate host and an insect vector.

The Plasmodium species, with the exception of P.malariae (which may affect the higher primates) are exclusively parasites of man.

The mosquito is always the vector, and is always an Anopheline mosquito, although, out of the 380 species of Anopheline mosquito, only 60 can transmit malaria. Only female mosquitos are involved as the males do not feed on blood.

Protozoa (3/3)Malaria

WWW. outreach.eos.nasa.gov/.../malaria_world_2000.gif

Transmissible Spongiform Encephalopathy (TSE)

Creutzfeldt-Jacob Disease (Mad CowDisease)

Variant Creutzfeldt-Jacob Disease

Kuru

Gerstmann-Sträussler-Scheinker syndrome (GSS)

Fatal familial insomnia (FFI) (very rare autosomal dominant ihherited disease)

www.library.thinkquest.org/05aug/00112/mad_cow_page.htm

Ten Commandments to Write Better English 1. Thou shalt use correct grammar (1/2)

Original versions The dentist felt strange that I cannot help but laughing, but only I know the story.

Since the story’s happening situation was at the National Central Library of Paris, I hope someday I could have the chance to visit this place.

I stand for a whole afternoon just for reading the book until I finished the last page. The hospital is the place where a person gets birth and death ..

Ten Commandments to Write Better English 1. Thou shalt use correct grammar (2/2)

Original versions

If I can fly, I can travel to any place of the world. I want lying on clouds and relaxing all afternoon. This book brings me so much joy and wisdom, I would always cherish those lessons Morrie taught me. It hurt Hassen greatly not only on physical but also on psychical on the process. Through the entire process, all sorts of noises kept me imaging what the doctor was doing to my knee.

Ten Commandments to Write Better English 2. Thou shalt use simpler sentences. (1/2)

Original versions The second son Ivan was a fanatic idealist. He hated his father and finally went insane because he felt responsible for his father’s death. He told me that when he was on his way to school, he fell into a hole and at that time he was riding a motorcycle. The patients get sick not only in physical but also in mental condition. It is quite meaningful for us who will be the doctors in a few years.

Ten Commandments to Write Better English 2. Thou shalt use simpler sentences. (2/2)

Original versions Although his clinic was closed, he still opened the door to have full check on me. The clinic could be seen lots of people waiting for the number to get in. I was not like other children who went out playing weekends, I had to go to the hospital see Mom. Mitch Albom is the author of the book, “The Five People You Meet in Heaven,” as well as other books. He told many stories which were much more incredible.

Ten Commandments to Write Better English 3. Thou shalt vary your writing (1/2)

Original version

Don’t take little things around us for granted and I thought that everyone would find that life was good. My bad pulling out memory was seven years ago when my wisdom tooth was making real trouble Not like common people, he embraced aging. Aging is not just equal to decay, and it also means growth

Ten Commandments to Write Better English 3. Thou shalt vary your writing (2/2)

Original version

A meaningful life lies in experiencing life fully. Reading is not only a pleasure for me, but also a necessity. Abruptly, a group of pirates came and want to eat and drink something. That is the beginning of the story, the beginning of the adventure of the sad man.

Ten Commandments to Write Better English 5. Thou shalt avoid redundancies

Original versions People miss their way because of academic background,

social status, marriage, money . . . etc. They talked about anything and everything. I learned some ceremonies about the religion organization, “The Priory of Sion.” The Priory of Sion was an organization, was founded in 1099.

Ten Commandments to Write Better English 6. Thou shalt avoid using Latinate words

Original version

In Amir’s childhood, he possessed his father attention and respect through the kite fight contests.

Ten Commandments to Write Better English 7. Thou shalt use strong verbs

Original version

Some parts really moved me and gave me lots of inspiration.

Ten Commandments to Write Better English 8. Thou shalt use the parallel construction. (1/2)

Original versions Laziness, procrastination, cowardice, and incompetence are characteristics of a real loser. In a nutschell, this book, For One More Day, is a wonderful book worth spending your time to read, to think, to indulge in. My favorite book let me know that I should be more open minded, search for new ideas, and never afraid of trying new things.

Ten Commandments to Write Better English 8. Thou shalt use the parallel construction. (2/2)

Original versions The hospital is the place where a person gets birth and death.

What the patients need are not only treat the body, but also to be relieved in mind. The government officials need to consider to treat the patients not only near the clinic but also the patients who are far away from the clinic. Darcy and Elizabeth represented pride and prejudice individually.

Ten Commandments to Write Better English 9. Thou shalt avoid using empty phrases

Original versions

Last but not the least, a man is not valued by whether he is number one or not. Talking about my favorite book, it has to be “Big Fish,” which was written by American writer, Daniel Wallace. Everyday there were a lot of medicines that I should take.

Ten Commandments to Write Better English 10. Thou shalt be specific in using words. (1/2)

Original versions He wanted to use the remnant time to research for “death.” The wound which was stitched together did not have any problem . It is so grateful that they got together to face the incoming death, no matter Mitch or Morrie. One day when I woke up, I felt sick and unwilling to go to school.

Ten Commandments to Write Better English 10. Thou shalt be specific in using words. (2/2)

Original versions

A doctor should think in a patient’ rather in his own way.

We decides to get the patient’s background first by studying his/her notes. When I arrived, we did not have to wait like normal patients. The doctor said that I should get a stitch up my wound.

Exercises VI

25. Which of the following countries has been recently established diplomatic relationship with Taiwan: (A) Saint Lucia, (B) Yeman, (C) Malaysia, or (D) Botswana.

26. Which of the following bacteria is Gram-negative: (A) Streptococcus (e.g. Streptococcus Pneumoniae) (B) Staphylococcus (e.g. Staphylococcus aureus) (C) Bacillus anthracis (Anthrax)

(D) Enterobacteriaceae (e.g. Escherichia coli)

27. Which is of following is NOT caused by a fungus: (A) Tinea corporis, (B) Tinea mannum, (C) Trichomoniasis vaginalis, or (D) Carbuncle.

Choosing the Most Appropriate Answers