Infection anatomical site

Culture is considered the most reliable means of diagnosing gonococcal infections. Anatomic sites to be cultured depend on the individual s sexual preferences and body areas exposed. In women, because the urethra and other sites are rarely the sole locus of infection, cervical cultures produce the highest yield and frequently are performed in conjunction with rectal cultures. Urethral cultures are recommended in women who have had hysterectomies and heterosexual men. In MSM, anorectal cultures generally produce the highest yields, and pharyngeal and urethral cultures are considered optional. ° " ... 

Many areas of the human body are colonized with bacteria— this is known as normal flora. Infections often arise from one s own normal flora (also called an endogenous infection). Endogenous infection may occur when there are alterations in the normal flora (e.g., recent antimicrobial use may allow for overgrowth of other normal flora) or disruption of host defenses (e.g., a break or entry in the skin). Knowing what organisms reside where can help to guide empirical antimicrobial therapy (Fig. 66-1). In addition, it is beneficial to know what anatomic sites are normally sterile. These include the cerebrospinal fluid, blood, and urine. 

Findings on physical examination, along with the clinical presentation, can help to provide the anatomic location of the infection. Once the anatomic site is identified, the most probable pathogens associated with disease can be determined based on likely endogenous or exogenous flora. 

An alternative classification, the Cierny-Mader staging system, is based on anatomic site and physiologic status of the patient.1 This classification scheme was developed for chronic osteomyelitis involving long bones and has limited application for small bones and digits. The detailed stratification has the greatest utility in clinical trials since it would permit comparison of treatment regimens in patients with diverse comorbidities and infection sites. 

SSIs are defined and reported according to Centers for Disease Control and Prevention (CDC) criteria.5 SSIs are classified as either incisional or organ/space. Incisional SSIs are further divided into superficial incisional SSI (skin or subcutaneous tissue) and deep incisional SSI (deeper soft tissues of the incision). Organ/space SSIs involve any anatomic site other than the incised areas. For example, a patient who develops meningitis after removal of a brain tumor could be classified as having an organ/space SSI. An infection is considered an SSI if any of the above criteria is met and the infection occurs within 30 days of the operation. If a prosthetic is implanted, the timeline extends out to 1 year. 

Infected individuals may be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomic sites. 

Urinary tract infections can be classified by anatomic site of involvement into lower and upper urinary tract infections. Lower UTls include cystitis, urethritis, prostatitis, and epididymitis, whereas upper urinary tract infections include pyelonephritis. UTls also may be further classified as complicated or uncomplicated. In females with a structurally normal urinary tract, both cystitis and pyelonephritis are considered uncomplicated UTls. UTls in men, elderly individuals, pregnant women, or patients with in-dwelling... 

Individuals infected with gonorrhea can be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomic sites. Interestingly, most of the symptomatic patients who are not treated become asymptomatic within 6 months, with only a few becoming asymptomatic carriers of the disease. " The most common clinical features of gonococcal infections are presented in Table 115-3. 

These agents must be delivered directly to the desired nerve bundle. The delivery is often a problem due to technical issues accessing these anatomical sites, particularly cervical, brachial plexus, lumbar plexus, sciatic, and popliteal blocks. This is commonly the reason for inadequate neural blockade. There maybe other issues precluding needle or catheter placement, such as patient cooperation, infection, or coagulation concerns. 

Monocytes A leukocyte that protects against blood-borne pathogens which rapidly moves to sites of infection in tissues. Monocytes consist of 3% to 8% of the leukocytes in the blood. In tissues, monocytes mature into different types of macrophages at different anatomic locations. Their main function is phagocytosis of foreign material, cellular debris, and pathogens that are not effectively controlled by neutrophils. 

Cellular reservoirs and anatomical sanctuary sites, such as the CNS, hamper HTV-l treatment and allow HTV-l to persist. To these ends, the SCID mouse model was modified to allow spread of HTV-1 infection betw een human MDM in mouse brain tissue behind an intact BBB. This model permitted comparative assessment of different anti-retroviral drugs by measurements of viral load and numbers of infected human macrophages (Limoges et al., 2000 Limoges et al., 2001). New drug delivery systems across the BBB and novel neuropro tec five therapeutics are under investigation (Persidsky et al., 2001 Dou et al., 2003 Dou et al., 2005). 

Many kinds of organic or functional defects can lead to postovulatory reductions in fertility. For instance, anatomical impediments to gamete transport can prevent fertilization. Poorly developed or insufficient endometria due to end organ insensitivity to steroids, insufficient steroid hormone production, or impediments to steroid action at the level of the endometrium will not adequately support the implantation site of an otherwise healthy embryo. Previous reproductive tract infections are responsible for the majority of these kinds of reproductive failures however, developmental defects and alterations in organ function caused by inappropriate stimulation or response also contribute. 

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