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A brief, clear, thorough, and highly enjoyable updated approach to clinical microbiology, brimming with mnemonics, humor, summary charts and illustrations, from Ebola to AIDS to flesh-eating bacteria; to mad cow disease, hantavirus, anthrax, smallpox, botulism, Clostridium difficile diagnosis and treatment; treatment of gonorrhea in light of growing antimicrobial resistance; Tuberculosis diagnostics, drugs for treatment of latent TB infection and MDR TB; the latest antibiotics; pandemic flu, including H7N9; SARS-like coronavirus; the latest hepatitis C treatment options; the latest HIV diagnostics and approved HIV meds; Zika virus; Measles and a chapter on the latest emerging infectious diseases and drug resistant bacteria.
Critical Care and Hospitalist Medicine is a fundamental and thorough guide to the treatment of hospitalized patients in critical care situations. This concise critical care medicine book provides both introductory information as well as a complete base of knowledge that will be useful for anyone charged with caring for patients in the ICU, Emergency Department, and hospital. This book covers complicated subjects such as hemodynamic monitoring, airway management, mechanical ventilation, GI bleed, hematologic emergencies, neurologic emergencies, acid-base disorders, renal emergencies, and toxicology. Major updates to the book include a brand new chapter on the SARA-COV-2 Virus and COVID-19 disease. This chapter delves in the nature of the virus and clinical management of COVID-19 in the ICU. The MedMaster Medical Books series are not like any other medical textbooks. Our books are made to help healthcare students and professionals master medical knowledge in a simple, effective, and quick way. Our style makes it ridiculously simple to understand complex subjects and develop critical thinking skills. We believe medical information should be accessible, and we strive to package information in a way that is easy to digest and fun to learn. An ideal book for nurses, nurse practitioners, physician assistants, doctors, and other health care professionals.
The acronym "HACEK" is common in clinical microbiology, although its pronunciation may be somewhat controversial (hay-sek or hah-sek?). The acronym stands for Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella: all HACEK members are fastidious Gram-negative bacteria associated with infective endocarditis.
Most endocarditis is caused by Gram-positive bacteria (most commonly Staphylococcus or Streptococcus) with a minority caused by Gram-negatives or fungi. A recent multinational study attributed 1.4% of cases of endocarditis to HACEK organisms. Here, we will review the most common species isolated from the HACEK group.
Haemophilus parainfluenzae is one of the most common HACEK organisms associated with endocarditis. In contrast, H. influenzae, the otherwise best known and most commonly isolated member of the genus, is rarely associated with infective endocarditis.
H. parainfluenzae was originally described in 1922 by Thomas M. Rivers, who isolated it from influenza patients. He differentiated it from H. influenzae based on its requirement for NAD (V factor) but not hemin (X factor) in contrast to H. influenzae which requires both. Rivers initially hypothesized that it was a cause of influenza, although we now know that this disease is caused by the influenza virus.
His isolation of H. parainfluenzae from influenza patients was likely incidental as it is a commensal of the human oropharynx. It is not a cause of oral diseases such as dental caries or periodontitis and is preferentially isolated from dental plaque from healthy teeth. Outside the oral cavity, H. parainfluenzae is capable of causing a variety of infections such as otitis media, abscesses, and pneumonia, although it is an uncommon cause of these infections.
Aggregatibacter actinomycetemcomitans was originally isolated by R. Klinger in 1912 from an actinomycotic lesion and its species name means "occurring with actinomycetes". Its original genus name, "Actinobacillus", referred to the internal star shapes formed by colonies on solid media. In 2006, the genus was renamed Aggregatibacter, reflecting the propensity of organisms in this genus to grow as discrete clumps (aggregates) in broth culture.
Although best known for its role in infective endocarditis, A. actinomycetemcomitans is also an etiologic agent of periodontal disease. It is specifically associated with localized aggressive periodontitis (LAP), a form of periodontal disease that afflicts adolescents. This form of disease progresses from symptom onset to tooth loss in a matter of months as opposed to years as seen in adult periodontitis.
Colonization with virulent strains of A. actinomycetemcomitans is most common in individuals of African descent but relatively rare in most other ethnic groups. Among African-American adolescents, colonization rates can be up to 16.7% with a subset of carriers (up to 20%) progressing to LAP.
Cardiobacterium hominis was first described in 1962 and was isolated from patients with endocarditis. Like other HACEK organisms, C. hominis is found in the oropharynx but rarely the gastrointestinal tract. It is infrequently isolated from oropharyngeal specimens however, potentially due to overgrowth by other commensals. Unlike the other members of the HACEK group, C. hominis is very rarely implicated in diseases other than endocarditis.
Eikenella corrodens is named in honor of M. Eiken, the microbiologist who first discovered the organism. The species name indicates that it pits (or corrodes) into the surface of solid agar media. This pitting is associated with the presence of pilins, which may be important for adhesion to host tissue. It is a member of the Neisseriaceae family but cannot be recovered on selective media for Neisseria spp. such as Thayer-Martin agar.
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