Pneumococcal Vaccine

The overall annual incidence of pneumococcal bacteremia is 50-80 cases per 100,000 in persons 65 yr of age and older approximately 85 of these cases are associated with pneumonia. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia in older patients is 30-40 nearly 50 of these deaths could potentially be prevented by the use of pneumococcal vaccine (23). Moreover, the continued emergence of drug-resistant Streptococcus...

References

E., Proctor, R. A. et al. (1997) Decreased susceptibility to antibiotic killing of a stable small colony variant of Staphylococcus aureus in fluid phase and on fibronectin-coated surfaces. J. Antimicrob. Chemother. 39(5), 603-608. 2. Gardner, P., Leipzig, T. J., and Sadigh, M. (1988) Infections of mechanical cerebrospinal fluid shunts. Curr. Clin. Top. Infect. Dis. 9,185-214. 3. Gardner, P., Leipzig, T., and Phillips, P. (1985) Infections of central nervous system...

Diagnostic Tests

There are several office assessments of nutritional status that have been validated in elderly adults and thoroughly reviewed elsewhere (20). That extensive reference includes nomograms, chart forms, drug nutrient interaction checklists, and nutrition-screening protocols ranging from simple waiting room questionnaires to detailed an-thropometric measures and laboratory assessments. One helpful screen is to assess weight and height and calculate body mass index (BMI weight in kg (height in...

Conclusion

The diabetic patient has a distinct predisposition to many infection processes because of a combination of several factors (1) the presence of a disordered metabolic state, (2) impairment of various facets of the immune function, (3) the presence of neuropathy, and (4) the presence of vascular compromise. With aging, the predilection, severity, and mortality related to infections are greater thus, the elderly diabetic is at special jeopardy for infections. The clinician needs to maintain acute...

Herpes Virus Infections 51 Varicella Zoster

Varicella-zoster virus (VZV) is a DNA virus and a member of the herpes virus family. It causes two distinct clinical syndromes primary disseminated infection, which is manifested as chickenpox, and reactivation of latent virus in the dorsal root ganglia, leading to herpes zoster or shingles. Herpes zoster is a painful, vesicular exanthem which erupts in one to two dermatomes after a prodrome of days to weeks and may take up to a month to heal (86). Most patients report a deep aching or burning...

With Continuous Ambulatory Peritoneal Dialysis

Clinical Relevance and Microbiology The rate of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD) is decreasing, down from 2.8 to 0.8 episodes per year (4). S. aureus and coagulase-negative staphylococci account for 50-80 of CAPD peritonitis cases. Streptococci cause approx 10 , of these infections and Gram-negative bacilli are isolated in another 20 of cases. Infections with mycobacteria and fungi are rare but cause serious complications. Sources of peritonitis...

Epidemiology And Clinical Relevance

Elderly Veterans Assistance

Malnutrition is rare in developed countries, but in the United States and other Western cultures the elderly represent a population at special risk (see Table 1) (4,5). Nutrient intake is often reduced in older adults by comorbidities such as dental disorders, stroke, dementia, or cancer. Furthermore, elderly adults often live alone, rarely prepare food for themselves, may substitute cheaper foods in place of more expensive but more nutritious foods, or live in nursing homes or are homebound...

Respiratory Viruses 11 Influenza

Of the viral infections that cause disease in older adults, influenza is recognized as one of the greatest causes of morbidity and mortality. Pneumonia and influenza together comprise the fifth leading causes of death in persons aged 65 yr and older. Influenza viruses are enveloped ribonucleic acid RNA viruses that are classified as A, B, or C, based on stable internal proteins 1 . The virus contains two major surface proteins, hemagglutinin H and neuraminidase N , which can undergo minor...

Influenza Vaccines

Although persons gt 65 yr old comprise approximately 13 of the United States population and have low rates of infection with influenza virus 10 of total influenza infections , they account for nearly 50 of the hospitalizations 20,000 to gt 300,000 per epidemic and 90 of the deaths 20,000 to gt 40,000 per epidemic attributed to influenza. The highest estimated rates are among persons gt 65 yr old and persons of any age with underlying cardiovascular disease in combination with either diabetes...

Clinical Relevance

Diabetes mellitus affects at least 6 of the U.S. population, and at least another 6 of diabetics may be undiagnosed 1 . However, in persons 65 yr and older, 11 have diabetes with probably another 8 being undiagnosed. Of all diabetics in the U.S., 43 are 65 yr and older. The vast majority of these individuals 90-95 belong to the type II category and the rest belong to type I. Diabetic complications are more common the longer the duration of the disease has been present. A significant percentage...

Introduction

Pneumonia Elderly Patients

Serious fungal infections can be separated into the opportunistic mycoses, including candidiasis, cryptococcosis, aspergillosis, and mucormycosis zygomycosis , and the endemic mycoses, comprised of histoplasmosis, blastomycosis, and coccidioidomycosis. The fungal infections represented in these broad groups differ with respect to the characteristics of the organisms causing infection, their epidemiology, the clinical manifestations, the approach to diagnosis, and the principles guiding therapy....

Viral Hepatitis 21 Hepatitis A

Hepatitis A HAV is an RNA virus in the picornavirus family see Table 2 . The virus is easily transmitted by the fecal-oral route. In countries where the virus is endemic and sanitation is poor, most people become infected in early childhood when the disease is mild and life-long immunity results 59 . Recently, a shift in the prevalence of cases from childhood to adulthood has occurred, presumably due to improved living conditions. In the United States and other industrialized nations, the...

Bronchitis

Several advances have occurred in our knowledge of the natural history and management of bronchitis. The first step has been a classification of patients with chronic bronchitis into four groups see Table 1 1 . Chronic bronchitis is a syndrome defined by cough and production of sputum on most days for at least 3 months a year for 2 consecutive years 2 . It is often complicated by airway obstruction leading to the commonly used term chronic obstructive pulmonary disease COPD . Acute bronchitis...

Resistance In Grampositive Bacteria

2.1. fi-Lactam-Resistant Staphylococci Penicillin resistance in staphylococci dates back to the 1950s 24 . Hence, it is now rare to find staphylococci susceptible to penicillin. Despite its prevalence, the ubiquitous nature of penicillin resistance in staphylococci should not be accepted with complacency. The staphylococcal penicillinase PC1 is an inducible -lactamase exo-enzyme. Four variants A-D exist. The staphylococcal penicillinase genes are carried on plasmids and transposons and can be...

Treatment And Prevention

The CDC in conjunction with the American Thoracic Society in 1994 modified its TB treatment recommendations because of the rise of MDR-TB cases see Table 1 30 . However, the CDC also recommends that if the frequency of isoniazid resistance is 4 or less in a given community or if the population in question has a low risk for drug resistance, the empiric four-drug regimen is not necessary. Although there has been much concern over the emergence of drug-resistant isolates of Mtb and the complex...

Erysipelascellulitis

Erysipelas and cellulitis are acute spreading infections of the skin, usually involving large confluent areas and accompanied by systemic toxicity. Erysipelas is a superficial skin infection involving the cutaneous lymphatic vessels, caused most commonly by group A streptococci and occasionally by group C or G streptococci. Erysipelas most often involves the face, has a characteristic, well-demarcated appearance with raised margins, and is accompanied by systemic symptoms of fever and chills....

Necrotizing Skin And Softtissue Infections

Necrotizing soft-tissue infections are a group of severe, rapidly progressing, often life-threatening infections characterized by extensive tissue damage, sometimes with gas production and frequently progressing to gangrene 12 see Table 3 . Most of these Clostridial myonecrosis Non-clostridial crepitant cellulitis Peptostreptococci, Bacteroides spp., Enterobacteriaceae Local trauma, surgery Diabetes mellitus Group A streptococci, Mixed Enterobacteriaceae and anaerobes Minor trauma, abdominal...

Clinical Manifestations 21 Orofacial Infections

The oral cavity of older adults, especially immunocompromised persons, are susceptible to a variety of bacterial, fungal, and viral infections. The lesions are often of protracted duration, and may not be associated with a clinically significant inflammatory reaction. Palpation and percussion of the oral structures are critical as tenderness may be the only abnormal finding. 2.1.1. Vesiculobullous Gingivostomatitis and Aphthous Ulcers Vesiculobullous lesions of the oral mucosa and perioral...

Cholecystitis

Epidemiology and Clinical Relevance The most common cause for surgical intraabdominal infections in the elderly is acute cholecystitis, and the number of cholecystectomies in the elderly is increasing 6 . The incidence of this disease is higher in the female. However, the female-to-male ratio lowers from 3 1 in younger adults to 1.5 1 in patients older than 50. Cholelithiasis accounts for 95 of acute cholecystitis, with the other 5 termed acalculous cholecystitis. The incidence of...

Eyelid Infections

Bacterial Conjunctivitis Lashes Mattered

Epidemiology and Clinical Relevance Inflammatory disorders of the eyelid constitute a major class of external eye infections affecting the elderly. The eyelid, particularly the lid margin, is a common site of ocular adnexal infection in the elderly. Staphylococcal blepharitis is by far the most common lid infection encountered. As with other forms of blepharitis, staphylococcal blepharitis is a chronic condition that has periodic exacerbations, which often leads the patient to seek medical...

Otitis Externa

Epidemiology and Clinical Relevance Otitis externa, an inflammatory condition involving the superficial layer of the external auditory canal, may be acute or chronic. Acute otitis externa in the elderly is generally a benign disorder, which may be localized or generalized. Chronic otitis externa is caused by the irritation due to the drainage from the middle ear in patients with chronic suppurative otitis media. An uncommon form of external otitis called malignant otitis externa is an...

Bowel Obstruction In The Elderly

Causes of bowel obstruction usually specific to the elderly include sigmoid volvulus, Ogilvie's Syndrome, colon carcinoma, and gallstone ileus. These conditions in the elderly patient can lead to gangrene with resulting perforation. Sigmoid volvulus is 20 times more likely in the patient age 60 yr and greater 19 . This age association may be due to acquired redundancy of the sigmoid colon. High-residue diets are believed to be the causative factor in developing a redundant sigmoid 20 . Other...

Orbital Infections

Epidemiology and Clinical Relevance Preseptal cellulitis represents a superficial cellulitis of the eyelid skin and subcutaneous tissue. This infection can arise from one of three sources paranasal sinus infections, direct extension from a localized infection of the eyelid or adjacent tissues i.e., acute dacryocystitis or hordeola , and periorbital trauma i.e., infected cuts or abrasions to the periorbital facial area . This infectious process is confined to the lid because the orbital...

Sinusitis

Scan Sinus Abnormality

Epidemiology and Clinical Relevance It is estimated that sinusitis affects 16 of the United States population annually, leading to approx 16 million office visits and a yearly expenditure of approx 2 billion dollars on its medical therapy 29 . Sinusitis, an infection of one or more of the paranasal sinuses, usually begins as a complication of viral upper respiratory tract infection in the elderly population. Obstruction of sinus drainage and retention of secretions are the fundamental...

Corneal Infections

Herpes Zoster Corneal Involvement

Epidemiology and Clinical Relevance Infectious keratitis constitutes a sight-threatening ocular emergency and requires prompt recognition and immediate referral to an ophthalmologist. Bacterial keratitis results from a breakdown in the corneal epithelial barrier and subsequent bacterial invasion of the corneal stroma. Bacterial invasion and white cell infiltration of the cornea leads to tissue destruction and may even lead to perforation if therapy is not instituted in a timely manner....

Vaginitis

Vaginal complaints are a common reason for women of all ages to visit their physician, with an estimated 3.2 million initial visits to physicians offices for this population in 1997 8 . Decreased estrogen production in the postmenopausal woman causes a number of changes in the vagina, which can lead to a variety of symptoms 21 . The amount of glycogen in the epithelial cells diminishes, leading to a reduction in the lactobacilli population that help to protect the vagina from other bacteria by...

Endemic Mycoses

Coccidioides Mycosis

Epidemiology and Clinical Relevance As the population of the United States ages, and as older adults remain in better health for a longer period of time, they travel more extensively and indulge in a variety of different outdoor avocations that are associated with increased risk of infection from endemic mycoses 19 . Endemic mycoses are found in soil or vegetation each has its own ecological niche from which it is aerosolized and subsequently inhaled see Table 2 . Older persons may become...

Herpes Simplex Virus Type Ii Hsv2

Genital herpes simplex virus HSV infection is not a reportable disease but is considered to be extremely common in the U.S. with approximately 45 million adults approx 22 of the population aged 15-74 yr estimated to be infected in 1990, based on the serologic results of a random sampling of civilian adults examined as part of the National Health and Nutrition Examination Survey NHANES III 12 . This represents a 32 increase compared to 1978, when the seroprevalence of HSV-2 was 16 among the...

Sepsis

Bacterial Uti Pathophysiology

Bender 1. EPIDEMIOLOGY AND CLINICAL RELEVANCE 1.1. Definitions Sepsis is the clinical syndrome denoting systemic inflammatory response to an infection. There is some confusion over the use of the terms bacteremia and septicemia. Most studies in the United States used the term bacteremia to denote a positive blood culture with evidence of infection. Septicemia was used to denote a state of microbial invasion from a portal of entry into the bloodstream that...

Primary Pyodermas

Superficial skin infections, also called primary pyodermas, are the most common skin infections occurring in all age groups. These include impetigo, folliculitis, furuncles, carbuncles, and paronychia. Most of these infections are caused by group A streptococci or by Staphylococcus aureus. Pseudomonas aeruginosa is a cause of hot tub folliculitis, an infection associated with recreational use of contaminated whirlpools and hot tubs resulting in a self-limited pruritic papular eruption in a...

Chlamydia

Chlamydia infection was the most common reportable communicable disease in the U.S. in 1998, with almost 540,000 cases reported 16 . Chlamydia trachomatis is an infection predominantly of adolescents, with the highest rate of infection being in the 15-19 and 20-24 yr age groups. The prevalence of infection drops off greatly after age 35, with adults over age 55 accounting for less than 1 of the nationwide cases. The number of Chlamydia infections nationwide is increasing, possibly due to...

Syphilis

Nationwide statistics for syphilis are most important for early syphilis primary and secondary because these represent the recently acquired incident cases, and the cases that are most infectious. Primary and secondary syphilis are relatively uncommon in older adults, with only 4 of the cases in the U.S. occurring in persons aged 55 yr and older during 1997 8 . Nationwide efforts for syphilis elimination have led to dramatic declines in syphilis rates in all age groups, but between 1996 and...

Clinical Features of Infections

Infections in the elderly often present in an atypical, nonclassical fashion. Furthermore, the differential diagnosis of infectious diseases in the elderly differs from the young because it is dependent on both the clinical setting and the patient's underlying functional status. For example, free living, independent, healthy elderly are prone to respiratory infections, such as bacterial pneumonia, genitourinary infections and intraabdominal infections including cholecystitis, diverticulitis,...

Epidemiology of Aging and Infectious Diseases

INFECTIOUS DISEASES AND HISTORY OF MANKIND Throughout recorded history, mankind has always faced the scourges of infectious diseases. Infections were the major causes of mortality prior to the modern era of antimicrobial chemotherapy, and even today, infectious diseases worldwide account for over one-third of the deaths. Until the mid-20th century, such diseases as typhus, plague, typhoid fever, cholera, diphtheria, smallpox, and tuberculosis caused major outbreaks of illnesses and accounted...