Bacterial superinfection

Influenza is an acute viral disease caused by Influenza A (sporadic, epidemic, and pandemic) or B (sporadic outbreaks) virus. Symptoms typically occur suddenly and include high fever, chills, headache, muscle aches, sore throat, and malaise. Serious complications can be caused by bacterial superinfection of the respiratory tract. 

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

Topical antivirals are not used to treat adenovirus conjunctivitis. Topical antibiotics are often prescribed for viral conjunctivitis, ostensibly to prevent bacterial superinfection. In reality, this is a case of the patient insisting on a medication to speed healing.11 Avoid the use of antibiotics for a viral infection.12 Eliminating superfluous antibiotic use also helps prevent the development of antibiotic resistance. 

Alvisi et al. [21] open label adults acute diarrhea or bacterial superinfection of intestinal inflammatory diseases 1 Yersinia 2 patients with no pathogen various nonclassic enteric flora1 20 800 mg (5-10 days) NA NA NA... 

Suspected aspiration with infection Influenza with bacterial superinfection Inpatient... 

Bacterial superinfection Staphylococcus aureus, gram-negative bacteria) rarely demands antibiotic treatment scarring may be prevented by prednisone 1 mg/kg daily for 1-2 weeks in severe cases. 

In resistant cases of seborrheic blepharitis, bacterial superinfection must be considered and an antibiotic ointment may be added to the regimen if indicated. 

Steroids are specifically contraindicated in the treatment of HSV conjunctivitis, because they can increase virus replication and interfere with the host immune response to the infection. Topical antibiotics are also of limited value in treating HSV. The risk of bacterial superinfection is low, and the potential toxic and hypersensitivity reactions associated with topical antibiotic use may obscure the clinical course of the underlying viral infection. 

Topical antibiotics are often used in the treatment of dermatitis with bacterial superinfection. However, in Germany sensitization to the aminoglycoside antibiotic neomycin was less frequent in patients with anogenital dermatitis (15) compared with the UK, where 15 of 79 patients with positive patch tests and anogenital complaints were positive to neomycin (17). Framycetin contact sensitivity was frequent in the UK, partly through cross-reactivity with neomycin (16). 

Chickenpox is caused by varicella-zoster virus. Every year, about 3.5 million people in the United Slates, mostly children. contract chickenpox. The incidence peaks between 3 and 9 years of age. Chickenpox causes a generalized rash, with 300 to 500 blister-like lesions occurring on the scalp, face, and trunk. Symptoms include loss of appetite, malaise, and headache. The disease is usually benign but can lead lo bacterial superinfection, pneumonia, encephalitis, and Reye s syndrome. About 5(1 to 100 previously healthy children die of the diseu.se. About 2% of all cases occur in adults, w ho have more serious symptoms than children have. 

The initial bronchitis is nonbacterial. White blood cell elevation, fever, pulmonary infiltrates seen on radiograph, and colored secretions may all be present to mimic the changes of a bacterial process. This process is sterile during the first 3 days bacterial superinfection occurs in about 4—6... 

In the absence of a complicating bacterial superinfection, acute bronchitis is almost always self-limiting. The goals of therapy, therefore, are to provide comfort to the patient and, in the unusually severe case, to treat associated dehydration and respiratory compromise. 

Secretions are typically copious but generally thin mucolytics are not required. Careful attention to the appearance of secretions will assist in the early identification of bacterial superinfection, which may be associated with secretions that are other than clear or white. 

Bacterial superinfection is commonly noted 3 to 5 days postexposure. Early, aggressive antibiotic therapy should be directed as specifically as possible against identified organisms. Careful, frequent Gram s stains and cultures of sputum are used to identify a predominant organism. Persistent fever, infiltrates, or elevated white blood cell count in the presence of thickened, colored secretions should prompt the institution of a broad-spectrum antibiotic (such as ampicillin or a cephalosporin). The choice of antibiotic should be based on local experience with either community-acquired or nosocomial organisms. Antibiotics are not used prophy-lactically in this setting such therapy would only serve to select a resistant bacterial population in the injured individual. 

Oxygen supplementation is provided for evident hypoxia or cyanosis. Expeditious fluid replacement is mandatory when hypotension is present. Combined systemic hypotension and hypoxia may damage other organ systems. Bacterial superinfection is sufficiently common to warrant careful surveillance cultures. There is no literature support, however, for use of routine prophylactic antibiotics. 

Bacterial superinfection of pox lesions was relatively uncommon except in the absence of proper hygiene and medical care. Arthritis and osteomyelitis developed late in the course of disease in about 1% to 2% of patients, more frequently occurred in children, and was often manifested as bilateral joint involvement, particularly of the elbows.70 Viral inclusion bodies could be demonstrated in the joint effusion and bone marrow of the involved extremity. This complication reflected infection and inflammation of a joint followed by spread to contiguous bone metaphyses, and sometimes resulted in permanent joint deformity.71 Cough and bronchitis were occasionally reported as prominent manifestations of smallpox, with attendant implications for spread of contagion however, pneumonia was unusual.72 Pulmonary edema occurred frequently in hemorrhagic- and flat-type smallpox. Orchitis was noted in approximately 0.1% of patients. Encepha-... 

Side effects arising from vaccination are relatively uncommon but nevertheless finite. Low-grade fever and axillary lymphadenopathy may coincide with the culmination of the cutaneous pox lesion. The attendant erythema and induration of the vaccination vesicle is frequently misdiagnosed as bacterial superinfection. Formation of a scar on healing of the vesicle occurs routinely, and constitutes a permanent record of a take, or a successful primary vaccination. 

Includes patients with lesions that had bacterial superinfection, or that made the patient uncomfortable enough to consult a physician. Unusual complications included were a patient with fetal vaccinia, a patient with a melanoma developing in the vaccine scar, and a patient with monoarticular arthritis following vaccination. 

The use of topical corticosteroids, used in the successful treatment of ACD, has been questioned as a treatment for irritant dermatitis (van der Valk and Maibach 1989). They may be effective in chronic, hyperkeratotic irritant dermatitis, but their prolonged use may lead to epidermal atrophy and, consequently, increased irritant sensitivity. Other therapeutic options in irritant dermatitis include topical tars and phototherapy (ultraviolet B or psoralen plus ultraviolet A). In difficult cases of chronic, irritant hand dermatitis, radiation may be indicated (Goldschmidt and Pan-izzon 1991). Bacterial superinfection may be a complication of contact dermatitis it is treated with topical or systemic antibiotics. Potential irritants, such as irritant cleansing products, must be identified and (whenever possible) eliminated, not only in the workplace but in the home (Frosch 1989). 

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