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URIUpper respiratory infection, see there.
infection(in-fek'shon) [L. infectio, discoloration, dye]
The most common pathogenic organisms are bacteria (including mycobacteria, mycoplasmas, spirochetes, chlamydiae, and rickettsiae), viruses, fungi, protozoa, and helminths. Life-threatening infectious disease usually occurs when immunity is weak or suppressed (such as during the first few months of life, in older or malnourished persons, in trauma or burn victims, in leukopenic patients, and in those with chronic illnesses such as diabetes mellitus, renal failure, cancer, asplenia, alcoholism, or heart, lung, or liver disease). Many disease-causing agents, however, may afflict vigorous persons, whether they are young or old, fit or weak. Some examples include sexually transmitted illnesses (such as herpes simplex or chlamydiosis), respiratory illnesses (influenza or varicella), and food or waterborne pathogens (cholera, schistosomiasis).
Systemic infections cause fevers, chills, sweats, malaise, and occasionally, headache, muscle and joint pains, or changes in mental status. Localized infections produce tissue redness, swelling, tenderness, heat, and loss of function.
Pathogens can be transmitted to their hosts by many mechanisms, namely, inhalation, ingestion, injection or the bite of a vector, direct (skin-to-skin) contact, contact with blood or body fluids, fetomaternal contact, contact with contaminated articles (fomites), or self-inoculation.
In health care settings, infections are often transmitted to patients by the hands of professional staff or other employees. Hand hygiene before and after patient contact prevents many of these infections.
The body's defenses against infection begin with mechanisms that block entry of the organism into the skin or the respiratory, gastrointestinal, or genitourinary tract. These defenses include chemicals, e.g., lysozymes in tears, fatty acids in skin, gastric acid, and pancreatic enzymes in the bowel; mucus that traps the organism; clusters of antibody-producing B lymphocytes, e.g., tonsils, Peyer's patches; and bacteria and fungi (normal flora) on the skin and mucosal surfaces that destroy more dangerous organisms. In patients receiving immunosuppressive drug therapy, the normal flora can become the source of opportunistic infections. Also, one organism can impair external defenses and permit another to enter; e.g., viruses can enhance bacterial invasion by damaging respiratory tract mucosa.
The body's second line of defense is the nonspecific immune response, inflammation. The third major defensive system, the specific immune response, depends on lymphocyte activation, during which B and T cells recognize specific antigenic markers on the organism. B cells produce immunoglobulins (antibodies), and T cells orchestrate a multifaceted attack by cytotoxic cells. See: B cell; T cell; inflammation for table
Once pathogens have crossed cutaneous or mucosal barriers and gained entry into internal tissues, they may spread quickly along membranes such as the meninges, pleura, or peritoneum. Some pathogens produce enzymes that damage cell membranes, enabling them to move rapidly from cell to cell. Others enter the lymphatic channels; if they can overcome white blood cell defenses in the lymph nodes, they move into the bloodstream to multiply at other sites. This is frequently seen with pyogenic organisms, which create abscesses far from the initial entry site. Viruses or rickettsiae, which reproduce only inside cells, travel in the blood to cause systemic infections; viruses that damage a fetus during pregnancy (such as rubella and cytomegalovirus) travel via the blood.
Although many infections (such as those that cause characteristic rashes) are diagnosed clinically, definitive identification of infection usually occurs in the laboratory. Carefully collected and cultured specimens of blood, urine, stool, sputum, or other body fluids are used to identify pathogens and their susceptibilities to treatment.
Many infections, like the common cold, are self-limited and require no specific treatment. Understanding this concept is crucial because the misuse of antibiotics does not help the affected patient and may damage society by fostering antimicrobial resistance, e.g., in microorganisms such as methicillin-resistant Staphylococcus aureus. Many common infections, such as urinary tract infections or impetigo, respond well to antimicrobial drugs. Others, like abscesses, may require incision and drainage.
bladder infectionSee: urinary tract infection
cytomegalovirus infectionAbbreviation: CMV infection
During pregnancy, the woman can transmit the virus transplacentally to the fetus with devastating results. Approx. 10% of infected infants develop CMV inclusion disease, marked by anemia, thrombocytopenia, purpura, hepatosplenomegaly, microcephaly, and abnormal mental or motor development; more than 50% of these infants die. Most fetal infections occur when the mother is infected with CMV for the first time during this pregnancy, but they may also occur following reinfection or reactivation of the virus. Patients with AIDS or organ transplants may develop disseminated infection that causes retinitis, esophagitis, colitis, meningoencephalitis, pneumonitis, and inflammation of the renal tubules.
CMV is transmitted from person to person by sexual activity, during pregnancy or delivery, during organ transplantation, or by contaminated secretions; rarely, (5%) blood transfusions contain latent CMV. Health care workers caring for infected newborns or immunosuppressed patients are at no greater risk for acquiring CMV infection than are those who care for other groups of patients (approx. 3%). Pregnant women and all health care workers should strictly adhere to standard infection control precautions.
Primary infection in the healthy is usually asymptomatic, but some people develop mononucleosis-type symptoms (fever, sore throat, swollen glands). Symptoms in immunosuppressed patients are related to the organ system infected by CMV and include blurred vision progressing to blindness; severe diarrhea; and cough, dyspnea, and hypoxemia. Antibodies seen in the blood identify infection but do not protect against reactivation of the virus.
Antiviral agents such as ganciclovir and foscarnet are used to treat retinitis, colitis, and pneumonitis in immunosuppressed patients; chronic antiviral therapy has been used to suppress CMV, but this protocol has not been effective in preventing recurrence of CMV or development of meningoencephalitis. Ganciclovir has limited effect in congenital CMV. No vaccine is available.
Health care providers can help prevent CMV infections by advising pregnant women and the immunocompromised to avoid exposure to contact with people who have confirmed and or suspected cases of CMV. The virus spreads from one person to another as a result of exposure to blood (as in transfusions) and other body fluids including feces, urine, and saliva. Contact with the diapers or drool of an infected child may result in infection of a person who has previously been unexposed to the infection. CMV is the most common congenital infection, affecting about 35,000 newborns each year. CMV infection that is newly acquired during the first trimester of pregnancy can be esp. hazardous to the developing fetus. As a result, young women who have no antibodies to CMV should avoid providing child care to infected youngsters. In the U.S., nurses who have failed to advise infected patients of the risk that CMV may pose to others have been judged to be negligent by the courts. Parents of children with severe congenital CMV require support and counseling. Although CMV infection in most nonpregnant adults is not harmful, it can cause serious illnesses or death in people with HIV/AIDS, organ transplants, and those who take immunosuppressive or cancer chemotherapeutic drugs. Infected immunosuppressed patients with CMV should be advised about the uses of prescribed drug therapies, the importance of completing the full course of therapy, and adverse effects to report for help in managing them. Family caregivers for infected people should be taught to observe standard precautions when handling body secretions. Since asymptomatic people may have and secrete the virus, standard precautions should be maintained by health care professionals at all times when such secretions are present or being handled.
deep neck infection
diabetic foot infection
fungal infection of nail
health-care associated infectionAbbreviation: HAI
hospital-acquired infectionNosocomial infection.
Hospital-acquired infections result from the exposure of debilitated patients to the drug-altered environment of the hospital, where indwelling urinary catheters, intravenous lines, and endotracheal tubes enter normally sterile body sites and allow microbes to penetrate and multiply. Over 2 million nosocomial infections occur in the U.S. annually. Antibiotic-resistant organisms such as Enterobacter spp., Pseudomonas spp., staphylococci, enterococci, Clostridium difficile, and fungi often are responsible for the infectious outbreaks that result. Standard precautions and infection control procedures limit the incidence of nosocomial infections.
opportunistic infectionAbbreviation: OI
reproductive tract infectionAbbreviation: RTI
risk for infection
slow virus infection
surgical site infection
surgical wound infectionSurgical site infection.
transfusion-associated bacterial infectionTransfusion-transmitted bacterial infection.
transfusion-transmitted bacterial infectionAbbreviation: TTBI.
Viruses may also be transmitted from blood donors to transfusion recipients. They may include cytomegalovirus, encephalitis viruses, and, rarely, hepatitis viruses or human immunodeficiency virus.
upper respiratory infectionAbbreviation: URI
urinary tract infectionAbbreviation: UTI
Escherichia coli causes about 80% of all UTIs. In young women, Staphylococcus saprophyticus is also common. In men with prostate disease, enterococci are often responsible. The small remaining percentage of infections may be caused by Klebsiella species, Proteus mirabilis, Staphylococcus aureus, Pseudomonas aeruginosa, or other virulent organisms.
The presenting symptoms of UTI vary enormously. Young patients with bladder infections may have pain with urination; urinary frequency or urgency, or both; pelvic or suprapubic discomfort; low-grade fevers; or a change in the appearance or odor of their urine (cloudy, malodorous, or rarely bloody). Older patients may present with fever, lethargy, confusion, delirium, or coma caused by urosepsis. Patients with pyelonephritis often complain of flank pain, prostration, nausea, vomiting, diarrhea, and high fevers with shaking chills. UTI may also be asymptomatic, esp. during pregnancy. Asymptomatic UTI during pregnancy is a contributing factor to maternal pyelonephritis, or fetal prematurity and stillbirth.
Urinalysis (obtained either as a clean catch or catheterized specimen) and subsequent urinary culture are used to determine the presence of UTI, the suspect microorganism, and the optimal antibiotic therapy. A dipstick test may identify leukocyte esterase and nitrite in a urinary specimen, strongly suggesting a UTI. The presence of more than 8 to 10 white blood cells per high-power field of spun urine also strongly suggests UTI, as does the presence of bacteria in an uncentrifuged urinary specimen.
Sulfa drugs, nitrofurantoin, cephalosporins, or quinolones may be used for the outpatient treatment of UTIs while the results of cultures are pending. Patients sick enough to be hospitalized may also be treated with intravenous aminoglycosides, medicine to treat nausea and vomiting, and hydration. The duration of therapy and the precise antibiotics used depend on the responsible organism and the underlying condition of the patient. Patients with anatomical abnormalities of the urinary tract, e.g., children with ureteropelvic obstruction or older men with bladder outlet obstruction, may sometimes require urological surgery.
The following conditions predispose sexually active women to development of UTI: the use of a contraceptive diaphragm, the method of sexual intercourse, (greatly prolonged or cunnilingus), and failure to void immediately following intercourse.
Prevention of UTI in Young Women
Fluid intake should be increased to and maintained at to six to eight glasses daily. Although cranberry and other fruit juices are often recommended for patients with UTI, there is little objective evidence to show they have an impact. The urinary tract anesthetic phenazopyridine and sitz baths may provide relief from perineal discomfort. The anal area should be wiped from front to back or wipe the front first to prevent carrying bacteria to the urethral area; the bladder should be emptied shortly before and after intercourse; the genital area should be washed before intercourse; if vaginal dryness is a problem, water-soluble vaginal lubricants should be used before intercourse; a contraceptive diaphragm, cap, shield, or sponge should not remain in the vagina longer than necessary. An alternative method of contraception should be considered.
Instructing the patient should emphasize self-care and prevention of recurrences. The antibiotic regimen should be explained, and the patient should be aware of signs and symptoms and, when they occur, should report them promptly to the primary caregiver.
|Superficial Fungal Infections|
|Disease||Causative Organisms||Structures Infected||Microscopic Appearance|
|Epidermophytosis (e.g., dhobie itch)||Epidermophyton, (e.g., floccosum)||Inguinal, axillary, and interdigital folds; hairs not affected||Long, wavy, branched, and segmented hyphae and spindle-shaped cells in stratum corneum|
|Favus (tinea favosa)||Trichophyton schoenleinii||Epidermis around a hair; all parts of body; nails||Vertical hyphae and spores in epidermis; sinuous branching mycelium and chains in hairs|
|Ringworm (tinea, otomycosis)||Microsporum (e.g., audouinii)||Horny layer of epidermis and hairs, chiefly of scalp||Fine septate mycelium inside hairs and scales; spores in rows and mosaic plaques on hair surface|
|Trichophyton (e.g., tonsurans)||Hairs of scalp, beard, and other parts; nails||Mycelium of chained cubical elements and threads in and on hairs; often pigmented|
|Thrush and other forms of candidiasis||Candida albicans||Tongue, mouth, throat, vagina, and skin||Yeastlike budding cells and oval thick-walled bodies in lesion|
|Systemic Fungal Infections|
|Aspergillosis||Aspergillus fumigatus||Lungs||Y-shaped branching of septate hyphae|
|Blastomycosis||Blastomyces brasiliensis, B. dermatitidis||Skin and lungs||Yeastlike cells demonstrated in lesion|
|Candidiasis||Candida albicans||Esophagus, lungs, peritoneum, mucous membranes||Small, thin-walled, ovoid cells|
|Coccidioidomycosis||Coccidioides immitis||Respiratory tract||Nonbudding spores containing many endospores, in sputum|
|Cryptococcosis||Cryptococcus neoformans||Meninges, lungs, bone, skin||Yeastlike fungus having gelatinous capsule; demonstrated in spinal fluid|
|Histoplasmosis||Histoplasma capsulatum||Lungs||Oval, budding, uninucleated cells|