S enteritidis causes what disease armadillos do

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10.1016 / B978-3-437-58122-9.00001-7


Elsevier GmbH

Fig 1.1


Pseudomembranous necrotizing colitis (pseudomembranous colitis) caused by Clostridium difficile during antibiotic therapy

Fig 1.2


The β-hemolysis (complete hemolysis) of obligately pathogenic A-streptococci can be demonstrated by culturing on blood-containing culture media.

Fig 1.3


Angina tonsillaris (lacunaris)

Fig 1.4


Fig 1.5




Fig 1.7


Hand, foot and mouth disease. a Blisters on the hands. b Blisters on the feet. c Enanthem with aphthae in the throat.



Confluent, small-spotted scarlet fever rash



The scarlet fever rash spares the area around the mouth (perioral pallor).



Deep red strawberry or raspberry tongue in scarlet fever

Fig. 1.11


Coarse lamellar flaking on the palms of the hands after having experienced scarlet fever

Fig. 1.12


Gonococcal urethritis with purulent fluorine

Fig. 1.13


Extragenital manifestations of gonorrhea

Fig. 1.14


Oligoarthritis associated with a gonococcal infection



Gonococcal rash

Fig. 1.16


Gonoblennorrhea (purulent conjunctivitis) in the newborn

Fig. 1.17


Waterhouse-Friderichsen Syndrome. Severe necrotizing skin lesions in meningococcal sepsis, meningococcal sepsis, Waterhouse-Friderichsen syndrome, Waterhouse-Friderichsen syndrome, meningococcal sepsis.



Fig. 1.19




Fever course in typhoid or paratyphoid fever





a Typhoid roseoles. b Maculopapular rash in typhoid.

Fig. 1.23


Erythema nodosum after Yersinia enterocolitis



Routes of transmission of Yersinia pestis



Different causes of enteritis



Helicobacter pylori in the gastric mucosa





Fig. 1.29


Individual mycobacteria in the sputum



Mycobacterium tuberculosis infection. Absorption into the lungs via droplet infection, equilibrium formation or primary tuberculosis; Transition to latency with persistent mycobacteria in a productive granuloma; exogenous reinfection or endogenous reactivation via weakening of the cellular immune response: active (post-primary) tuberculosis; Transmission of infection through coughed up mycobacteria.



Schematic representation of the course of primary tuberculosis



Miliary tuberculosis of the lungs



Tuberculoma with Langhans giant cells and numerous epithelial cells. Lymphocytic infiltrates can be found in the edge area.





Development of tubercular meningitis



Positive intracutaneous test for the detection of tuberculosis


[L157 / M451]

Diagnosis and therapy of tuberculosis. INH = isoniazid, RMP = rifampicin, PZA = pyrazinamide.



a Tuberculoid Leprosy Tuberculoid Leprosy. b Lepromatous leprosy.



Ulcus durum (hard chancre) in syphilis


[a: R132; b, c: E664]



Hair loss in syphilis ("like moth-eaten")



Condylomata lata in syphilis



Condylomata acuminata due to human papillomavirus (HPV)





Saber scabbard tibia in Lues connata



Hutchinson teeth Hutchinson teeth ("as wide as long") in Lues connata





Way of transmission of Lyme disease



Erythema chronicum migrans after a tick bite



Stage II symptoms of Lyme disease



Lymphadenosis cutis benigna in Lyme disease



Lyme arthritis in the left knee joint



Routes of transmission of relapsing fever



Fever course in relapsing fever



Two-phase fever with assignment of the affected organs in Weil's disease



Chlamydia life cycleChlamydia life cycle. EB = elementary body, RB = initial body (reticulate body).



Chlamydia trachomatis serotypes


[G157; E570]

Chlamydia trachomatis and blindness. a Outline of the pathogenesis. b Scarring of the cornea causes a long-lasting trachoma grain to form in the eye.



The most common form of neonatal conjunctivitis is chlamydial infection, chlamydial neonatal conjunctivitis, neonatal conjunctivitis, chlamydia.

Fig. 1.60


Inflammatory thickened inguinal lymph nodes in lymphogranuloma venereum

Fig. 1.61


Ornithosis (interstitial pneumonia)



Pathogenesis of Rickettsial Infections



Petechial bleeding in typhus



Blackish necrotic ulcer in skin anthrax



Conjunctival bleeding in pertussis





Legionella in a lung biopsy



Routes of transmission of brucellosis

Fig. 1.69


Wound dressing for infection with Pseudomonas aeruginosa with the typical blue-green pus





Ulcus molle with multiple ulcers

Importance of Bacterial Infections for Exam and Practice

Bacterial speciesParticularly relevant to the examRelevant to the examPractically relevant
Staphylococci (Section 1.1)Abscesses, mixed infections, MRSAFood poisoningColitis
Streptococci (Section 1.2)
  • pneumonia

  • Scarlet fever

  • Erysipelas

  • Impetigo contagiosa

  • meningitis

  • Tonsillar angina

  • Phlegmon

Enterococci (Section 1.3)
  • Urinary tract infection

  • Endocarditis

  • Lobar pneumonia

Neisseries (Section 1.4)
  • gonorrhea

  • Meningitis, sepsis

Corynebacteria (Section 1.5)diphtheriaErythrasma
Enterobacteria (Section 1.6)
  • EHEC

  • HUS

  • Salmonella enteritis

Typhus abdominalis
  • Yersinia enterocolitis

  • pest

  • Dysentery

Vibrionen (chapter 1.7)cholera
Campylobacter (Section 1.8)Enterocolitis
Helicobacter (Section 1.8)
  • gastritis

  • Gastric ulcer

Clostridia (Section 1.9)
  • Gas fire

  • pseudomembranous colitis (Section 1.1.2)

Mycobacteria (Section 1.10)tuberculosisleprosy
Spirochetes (Chapter 1.11)
  • Lyme disease

  • syphilis

  • Relapsing fever

  • Leptospirosis

Chlamydia (Chapter 1.12)urogenital infections (including adnexitis)
  • Ornithosis

  • Conjunctivitis

  • Trachoma

  • Lymphogranuloma venereum

  • atypical (interstitial) pneumonia

Rickettsia (Chapter 1.13)
Bacilli (Chapter 1.14)anthrax
Bordetellen (Chapter 1.15)whooping cough
Legionella (Section 1.16)Legionnaires' diseasePontiac fever
Brucellen (Chapter 1.17)
  • Bang disease

  • Malta fever

Listeria (Chapter 1.18)Listeriosis
Francisellen (Chapter 1.19)Tularemia
Pseudomonads (Section 1.20)nosocomial infectionssnot
Haemophilus (Chapter 1.21)EpiglottitismeningitisUlcer molle

Bacterial infections

  • 1.1

    Staphylococci 2

    • 1.1.1

      Diseases 2

    • 1.1.2

      Differential Diagnosis 4

    • 1.1.3

      Notification requirement 5

    • 1.1.4

      Multi-resistant germs 5

  • 1.2

    Streptococcus 8

    • 1.2.1

      Non-A streptococcal disease 9

    • 1.2.2

      Streptococcal A disease 10

  • 1.3

    Enterococci 15

  • 1.4


    • 1.4.1

      Gonorrhea 16

    • 1.4.2

      Meningitis 18

  • 1.5

    Corynebacteria 20

  • 1.6

    Enterobacteria 22

    • 1.6.1

      Physiological enterobacteria 22

    • 1.6.2

      Obligatory pathogenic coliform bacteria22

    • 1.6.3


    • 1.6.4


    • 1.6.5


  • 1.7


  • 1.8

    Campylobacter and Helicobacter34

    • 1.8.1

      Campylobacter jejuni and Campylobacter coli34

    • 1.8.2

      Helicobacter pylori35

  • 1.9

    Clostridia 36

    • 1.9.1

      Gas fire37

    • 1.9.2

      Tetanus 38

    • 1.9.3

      Botulism 40

  • 1.10

    Mycobacteria 42

    • 1.10.1

      Tuberculosis 42

    • 1.10.2


  • 1.11


    • 1.11.1

      Syphilis (Lues) 52

    • 1.11.2

      Lues connata56

    • 1.11.3

      Lyme Disease56

    • 1.11.4

      Relapsing Fever 61

    • 1.11.5

      Leptospirosis 63

  • 1.12


    • 1.12.1

      Diseases caused by Chlamydia trachomatis65

    • 1.12.2

      Diseases caused by Chlamydia pneumoniae68

    • 1.12.3

      Chlamydia psittaci diseases: ornithosis69

  • 1.13

    Rickettsia 70

    • 1.13.1

      Q fever 70

    • 1.13.2

      Typhus 71

  • 1.14


  • 1.15


  • 1.16

    Legionella 76

    • 1.16.1

      Legionnaires' Disease77

    • 1.16.2

      Pontiac Fever 78

  • 1.17


    • 1.17.1

      Bang's disease and Malta fever (Mediterranean fever) 79

  • 1.18


  • 1.19


  • 1.20


    • 1.20.1

      Infections caused by Pseudomonas aeruginosa82

    • 1.20.2


  • 1.21

    Haemophilus Bacteria 83

    • 1.21.1

      Haemophilus influenzae84

    • 1.21.2

      Ulcer molle85

In 2001, several laws were passed through the Disease Law Reform ActRenewed Disease Law Replaced. The essential one, especially for doctors and alternative practitioners article 1 this law bears the name Infection Protection Act (IfSG). In the meantime, several smaller additions have been made, in 2013 even several with significant effects.

The IfSG (Chapter 5) not only lists in detail the various reporting obligations, but also the persons and institutions affected by them, but also deals with prevention (vaccinations) and the fight against communicable diseases and (as is generally the case) with criminal offenses - and regulations on fines. It is still the case that a good knowledge of the various laws, especially the IfSG, is essential with regard to the alternative practitioner examination.

With regard to the reporting requirements for infectious diseases, it is important to note that "Reporting obligation according to § 6" means that the disease in question is already with Suspicion, also at illness and death of the patient is to be reported to the health department, and that this obligation is also unrestricted for the Naturopath applies. Against means "Reporting obligation according to § 7"that the disease only occurs when proof of the pathogen or its antibodies and at death of the patient is to be reported. In these cases, however, the obligation to notify does not apply to the doctor or alternative practitioner, but to the Laboratory doctor or Pathologistwho has provided evidence. Section 7 is only relevant for the alternative practitioner insofar as the diseases listed therein are to be considered relevant to the examination in principle and at the same time under the Treatment ban fall.

With regard to the Infectious disease therapy one can formulate in a general way that almost every illness can be treated by the naturopath that Not after the Sections 6 and 7 must be reported is the not mentioned in § 34 will and that eventually not one of the sexually transmitted diseases belongs. This is formulated in § 24. In addition, the alternative practitioner is restricted to a lesser extent by other laws, e.g. with regard to oral infections affecting the oral cavity or infections in the puerperium.

The one specified for the individual diseases Contagion indexInfectious diseases contagion index contagion index, infectious diseases indicates the likelihood of pathogen transmission through contact with an infected person. 1.0 stands for a transmission probability of 100%; with a contagion index of 0.25, infection occurs only in every 4th contact. In contrast, denotes the Manifestation indexInfectious diseases manifestation index Manifestation index, infectious diseases the relative proportion of those who, in the context of an infection, then actually became visible (apparent) visible (apparent) get sick. If these values ​​are not specified in the following, they are not known or cannot be precisely defined.

Diseases caused by fungi, worms and parasites are discussed (apart from malaria) in the subject of microbiology.

In Table 1.1, bacterial infections, infectious diseases, and bacterial bacterial infectious diseases are classified according to their relevance to exams and practice.



Staphylococci The only representative pathogenic for humans, at the same time also a germ of eminent importance in everyday medical practice, is Staphylococcus aureusStaphylococcus aureus(S. aureus). Because of its insensitivity to drought and the resulting widespread distribution in the ground and dust, it was formerly known as the so-called. Dry and air germ designated. S. aureus can withstand temperatures up to 60 ° C and even the hydrochloric acid of the stomach. Also in Animal kingdom the germ is widespread, so that you can directly or indirectly (food, excretions) infect the animal can, but the infected human the most important source of infection represent.

The infection mostly occurs healthy germ carriers by Droplet or smear infection (e.g. towels): At least every 4th adult harbors the germ in the nasopharynx - with a focus on the Vestibulum nasi.

It should also be mentioned as a representative of physiological flora the epidermis, Staphylococcus epidermidisStaphylococcus epidermidis. The germs are in the microscope from the pathogenic staphylococci indistinguishable.



The diseases caused by this germ are by far predominant invasive growth, but sometimes also staphylococci toxins to its toxins staphylococciToxins traced back. Among other things, the following clinical pictures of S. aureus caused:
  • Abscess, Boils and Carbuncles (Dermatology)

  • Impetigo contagiosa (specialist in dermatology)

  • Puerperal mastitis (specialist gynecology)

  • Osteomyelitis (musculoskeletal system)

  • Sinusitis and otitis media (breathing compartment)

  • Endocarditis (cardiovascular system)

  • Pneumonia, meningitis or encephalitis especially in infants

  • Lyell syndrome or SSSS (staphylococcal scalded skin ssyndrome of scalded skin) syndrome of scalded skin Infants by Staphylococcus aureusToxins (Department of Dermatology) Lyell's Syndrome SSSS s. Staphylococcal scalded skin syndromestaphylococcal scalded skin syndrome (SSSS)

In general, S. aureus can be too purulent infections at every organ of the body. These suppurations are characterized by the fact that they are usually circumscribed stay and under Meltdown of the respective tissue Abscesses to lead. Conversely, it can be deduced from this that the Abscesses a patient's abscesses, staphylococcal staphylococcal abscesses on the skin or internal organs (liver, kidney, lungs, brain, etc.) mostly by staphylococci caused - partly as a mixed infection with other bacteria. In addition, the germ is also particularly common on one sepsisStaphylococci involved (⅓ of all cases) .Staphylococcal sepsis

In addition to its environmental resistance and ubiquitous distribution, a further problem with S. aureus is that even extensive, difficult-to-progress infections no immunity leave. As a result, relapses are virtually unlimited.

In the hospital, Staphylococcus aureus is one of the most common causes that are difficult to control nosocomial infections. This is especially true for the MRSAMethicillin Resistant Staphylococcus aureus (MRSA) (M.ethicillinresistent S.taphylococcus aureus), MRSA (methicillin-resistant Staphylococcus aureus) which are only sensitive to a few (reserve) antibiotics such as vancomycin. For a number of years, however, strains have been spreading that cannot even be controlled with antibiotics by reserve antibiotics. The problem has grown so far over the years that in 2009 a Reporting obligation according to § 7 IfSG for MRSA (Not for the usual S. aureus!) Was introduced, provided the germ was in blood or Liquor is proven. This is one of the few, rather half-hearted measures that are attempted to curb the increasing spread of resistant germs, especially in hospitals.

Essentially, the hygiene problem is widely discussed in German clinics, medical committees and the Federal Ministry of Health, but nothing decisive has happened so far. The result of many years of extensive discussions could perhaps be summarized as follows: “The mountain gave birth and gave birth to a mouse.” In any case, compared to what has been advanced and achieved in neighboring countries, what is happening in Germany can only be seen as embarrassing describe. This is detailed below.

The others are essential with regard to the examination and everyday medical practice Properties of MRSA bacteria. Basically, they are related to
  • your resistance across from Disinfectants or

  • caused by them Clinical pictures

cannot be distinguished from common S. aureus.
Your percentage frequency is indeed
  • in Clinics and other facilities such as retirement homes relative high, but they are also in the usual population represented to a certain (small) proportion.

  • Even in Animal kingdom they can be found, which is not surprising in view of the antibiotic treatments (see below).

It should be noted that in the majority of MRSA infections it is still possible to find antibiotics to which the bacteria respond. absolute Resistances across from allClasses of antibiotics used in clinics are currently still rare Exceptions.
Food poisoning
Around ⅓ of all Staphylococcus aureus strainsStaphylococcus aureusFood poisoningFood poisoningStaphylococcus aureus form in food (milk and dairy products, meat, salads, fruit, seafood) during their reproduction EnterotoxinsEnterotoxins Staphylococcus aureus. The naming of these exotoxinsExotoxinsStaphylococcus aureusStaphylococcus aureusEntero- / Exotoxins (subject microbiology) is based on their effect on the (Thin) intestine (= Enteron). The Toxins (not the bacteria themselves!), although they consist of protein, are caused by the usual preparation and heating of the infected food not reliably destroyedbecause they can even withstand 100 ° C for a short time. If such foods are eaten, the enterotoxins are absorbed into the intestinal wall and run within 2-6 hours to Nausea with vomiting, Vomiting, staphylococcal enteritisstomach pain and diarrhea, usually without a fever. The extremely short "incubation time" is an important indicator of intoxication, because it takes significantly longer for the germs contained in food to multiply sufficiently and to cause the first symptoms of food poisoning.

Staphylococci are next to enteritis salmonella most common causes triggered by bacterial toxins Food poisoning. It should be noted that staphylococci, in particular, are basically foodIntoxications and Not around Infections acts, which is why e.g. Antibiotics useless are.

Inflammation of the small and / or large intestine caused by Staphylococcus aureusStaphylococcus aureusEnterocolitisEnterocolitisStaphylococcus aureus occurs especially when the intestinal flora penetrates Broad spectrum antibiotics has been massively damaged, so that the staphylococci find space to multiply themselves. Most of the time, the staphylococci were already present to a small extent as part of the intestinal flora in these cases. The condition is not all that common and is easy to treat. The focus is on diarrhea Staphylococcus aureusloose stools, usually without any further symptoms.


Differential diagnosis

Antibiotic-associated colitis due to Clostridium difficile
More dangerous and meanwhile also clearly more often than the staph colitis is the pseudomembranous necrotizing colitispseudomembranous necrotizing colitis(Colitis pseudomembranacea)Pseudomembranous colitis necrotizing colitis pseudomembranacea is caused by the bacterium in the intestines of some healthy people Clostridium difficileClostridium difficile, antibiotic-associated colitis, pseudomembranous colitisas part of a Antibiotic therapy developAntibiotic-associated colitis, Clostridium difficile, antibiotic-associated colitis, Clostridium difficilecan. At up In 10% of the population, the bacteria or their spores can be detected in small quantities as part of the colon flora - especially in people who have recently or recently been in inpatient treatment. The infection so occurs particularly frequently nosocomial, which points to the inadequate hospital hygiene in Germany.
Following the infection, the germ only becomes pathogenic when the physiological flora has been decimated by long-term use of potent antibiotics to such an extent that the clostridia can use the space that has become free for their own reproduction. They then produce different ones Toxinswhich can lead to irreversible damage to the colon mucosa. This is reminiscent of the situation that one Infants with their still incompletely built intestinal flora no honey because it could contain spores of Clostridium botulinum (Section 1.9.3).
The Clostridium difficile toxinsToxinsClostridium difficileClostridium difficileToxins cause in mild cases loose stools, in severe cases too Colon necrosis, resulting Ulcers as well as flat necrotic Deposits (pseudo-membranes)Pseudomembranes: Clostridium difficile, therefore in addition to strong ones Water losses also bloody diarrhea (Fig. 1.1). In some of the cases it happens Intestinal perforations or to one toxic megacolon. The accompanying too Small intestine-Infections in general are mostly present nausea is at pure colon involvement rather Rare. In this case, this also applies to the Absence fever because the clostridia are non-invasive and the toxins do not stimulate the immune system sufficiently. Only the one following the megacolon or perforation Peritonitis generated high fever.
The disease must immediately receive medical treatment (including one of the few reserve antibiotics such as vancomycin or metronidazole), usually in the clinic. However, pseudomembranous colitis occurs particularly frequently in the clinic under the broad-spectrum antibiotic therapies that are customary there.
This form of colitis is now considered to be most common nosocomialNosocomial diarrheaDiarrheaDiarrhoeosocomial and Clostridium difficile together with MRSA as most significant nosocomial problem germ. The cause is not only the widespread poor hygiene, but also the special one resistance the Spurs of clostridia, which among other things 110 ° C, the hydrochloric acid of the stomach as well all disinfectants survive unscathed.

Caregivers who care for patients who have been found or suspected of having clostridia should therefore keep their hands up in connection to the obligatory disinfection also to wash thoroughly because Spurs only mechanically can be removed from the skin.

According to well-founded estimates by the Braunschweig University Hospital, around 100,000 infections occur in Germany every year. Reports were made in the year 2016 but only those good 2,300 serious infections. This affected almost exclusively old people over 70 years of age. The Lethality was about 50 %. Above all, the large number of severe, immediately life-threatening infections indicates the increasing ineffectiveness of previous reserve antibiotics such as Vancomycin, so that in many cases of infection by Clostridium difficile (and other multi-resistant bacteria, see below) no curative therapy is available. Of course, the pharmaceutical industry has long been researching new classes of antibiotics, but because of the comparatively low profit margin at great expense, not with the same emphasis as is common with modern immunomodulators and antibodies. In addition, one can confidently assume that new antibiotics, like all previous ones, will lose their effectiveness again because the rethinking started in theory has not yet reached those practicing.
One is interesting or associated with little anticipation for the patient Therapy methodthat one as Stool transplantFecal transplantation (or fecal therapy) is called fecal therapy and is now in clinical trials good effectiveness both in acute cases and in prophylaxis in patients suffering from relapses of this clostridial colitis. Here, stool from a healthy donor, after enrichment with physiological saline solution and coarse filtering, is brought either retrograde into the large intestine or anterograde via a nasogastric tube into the patient's small intestine. The transmission is preferably preceded by colon cleansing and therapy with vancomycin for several days.
One could of course consider whether one could not achieve similarly good results by building up a more physiological intestinal flora using Mutaflor, among other things®, Nystatin, lactulose, lactic acid bacteria and possibly enterococcal preparations, but this could only be found out through appropriate studies. In times when the presence of Candida albicans in the stool is considered physiological, such a therapy would possibly be preferred to the stool of a "healthy donor" anyway.
The Pseudomembranous colitis is notifiable to Section 7 IfSG.

There are several reasons why under a Antibiotic therapy also beyond staphylococci and clostridia Diarrhea Diarrhea after antibiotic therapy:

  • For one, some have antibiotics own effects on the intestinal wall. For example, erythromycin stimulates the motilin receptors; Amoxicillin also speeds up intestinal transit, while neomycin even causes inflammation.

  • On the other hand, the Displacement of physiological bacteria to an overgrowth with pathogenic germs (so-called. Dysbiosis), Dysbiosis, after antibiotic therapy, enteritis, after antibiotic therapy, not just directly to one Enteritis but also inadequate the usual metabolism of fiber, so that a osmotic diarrhea arises. The dysbiosis of the intestine can usually be treated without problems. Diarrhea osmotic (digestive system).


Reporting requirement

Staphylococci are fundamental not notifiable and fall with it too Not under that Treatment ban. However, according to § 6 IfSG, infectious diseases or diseases of the gastrointestinal tract caused by food intoxication must be reported under certain conditions. This would e.g. for the pseudomembranous colitis apply even if they had not already been included in § 7 IfSG in the meantime. Basically, a reporting obligation always results in a Treatment ban for the naturopath.
The for MRSA-Bacteria MRSA (methicillin-resistant Staphylococcus aureus) reporting obligation Reporting obligation MRSA bacteria (just for proof blood or Liquor!) existing Reporting obligation according to § 7 IfSG could theoretically affect all staphylococcal diseases within the meaning of § 24 IfSG, because these germs are also found on an outpatient basis to a very small extent. By looking at the infections caused by the aspect Not common staph infections distinguish, the naturopath would then be subject to a treatment ban. On the other hand, the mandatory reporting for MRSA introduced a few years ago clearly relates to the nosocomial area. Therefore, the staphylococci of a festering wound or paronychia do not constitute a treatment prohibition.


Multi-resistant germs

In the 1990s, in the multi-resistance western germs, multi-resistant multi-resistant germs countries, there was initially little attention given to multi-resistance of human pathogenic bacteria to a large number of common and previously effective antibiotics Staphylococcus aureus concerned. The term was coined (see above) as a name for these staphylococci M.ethicillinresistent S.taphylococcus aureus (MRSA), Methicillin-Resistant Staphylococcus aureus (MRSA) MRSA (Methicillin-Resistant Staphylococcus aureus) because the antibiotic MethicillinMethicillins were representatives of the penicillins with a particularly broad spectrum of activity. The name has survived to this day, although methicillin has long since stopped being used in human medicine in favor of newer developments. Methicillin thus only symbolizes the entire group of broadly effective penicillins together with the closely related cephalosporins.