Universitat Internacional de Catalunya
Infectious Diseases
Teaching staff
Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:
RESPONSIBLE
Dra. Esther Calbo Sebastian: ecalbo@csc.uic.es
OTHERS
Dra. Carmen Muñoz: cmunoza@uic.es
Dra. Anna San Gil: asangil@uic.es
Dr. Josep Maria Guardiola: jmguardiola@uic.es
Dra. Lucía Boix: lboixp@uic.es
Dra. Analía Elguezabal: aelguezabal@uic.es
Dr. Josep Maria Badia: jmbadia@uic.es
Dra. Paloma Puyalto: ppuyalto@uic.es
Introduction
Infectious diseases are still nowadays a relevant cause of disease and death despite the advances achieved by medicine. The presentation form and the therapeutic approach of infectious diseases are submitted to multiple changes: the increased population with immune deficiencies, the development of resistance mechanisms by frequent microorganisms that disable antimicrobials, globalization or the increasing outpatient management of sanitary assistance that forces to settle the bases of a deep knowledge of these diseases pathogenesis.
The pandemic caused by SARS-Cov-2 has been a great example of the challenge of diagnosing, treating and preventing an infectious disease.
This subject aims to provide the student the conceptual framework necessary for recognizing the infectious origin of a disease, identifying especially vulnerable hosts and establishing preventive strategies at individual and community level.
The purpose of this course is for the student to acquire the necessary theoretical knowledge, abilities and attitudes so that, added to the ones acquired previously in Microbiology, will be able to face clinical situations (general infectious syndromes) and establish a diagnostic orientation.
Pre-course requirements
The student must have basic knowledge in structure and function of the human body as well as in clinical Microbiology.
Objectives
The general aim of the course is to recognize the presentation form of infectious diseases as well as to develop the ability of rationalizing the use of diagnostic and therapeutic methods.
Specific objectives:
- Recognize the infectious origin of a disease through a medical record and an oriented physical examination.
- Know the main infectious agents, its epidemiology and principal biological features of clinical interest.
- Direct the diagnostic process of the main infectious syndromes according to its location, to the host and to the pathogen requesting the appropriate microbiological tests for each type of infection.
- Know the medical and surgical treatment of some of the main infectious diseases.
- Know the sensitivity of microorganisms to the different antimicrobials as well as the innate and acquired resistance mechanisms.
- Know the main antimicrobial groups and the main therapeutic outline used in community. Acquire a compromise in the rational use of antimicrobials.
- Know the main nosocomial infections and its surveillance and control (hand hygiene and isolations).
- Direct prevention of infections associated to travels and identify the imported infectious pathology.
Competences/Learning outcomes of the degree programme
- 07 - Understand and recognise normal structure and function of the human body at the molecular, cellular, tissue, and organ and systemetic levels, at different stages of life and in both sexes.
- 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
- 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
- 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
- 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
- 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
- 19 - Propose preventive measures appropriate to each clinical situation.
- 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
- 26 - Assume role in the prevention and protection from diseases, injuries or accidents and maintenance and promotion of health, both individual and at the community level.
- 27 - Recognize role in multidisciplinary teams, assuming leadership when appropriate, for the delivery of health care, such as interventions for health promotion.
- 28 - Obtaining and using epidemiological data and assess trends and risks in health related decision-making.
- CB-1 - To have acquired advanced knowledge and demonstrated, within the context of highly specialised scientific and technological research, detailed comprehension based on theoretical and practical aspects and a working methodology from one or more fields of study.
- CB-2 - To know how to apply and incorporate knowledge, an understanding of it and its scientific basis and the ability to solve problems in new and loosely defined environments, including multidisciplinary contexts that include both researchers and highly specialised professionals.
Learning outcomes of the subject
- Do a syndromes’ diagnostic approach to a patient with an infectious disease.
- Argue the justification of additional diagnostic tests and stratify its interest and indication. Make a reasoned use of diagnostic methods.
- Establish adequate medical and surgical treatments.
- Identify preventive strategies at an individual and population level.
Syllabus
MASTERCLASSES
1. Introduction:
A. Introduction to infectious diseases
-Pathogenic and clinical manifestations of infectious diseases.
-Host’s defense mechanisms.
-Epidemiology of infectious diseases.
B. Pathogen microorganisms for the human being
- Structure and classification of the bacteria of clinical interest. Structure, composition and replication of virus.
-Sampling and transport.
-Direct diagnostic methods: microscopic exam, culture, antigen detection and amplification method. Indirect techniques: serologies.
2. Infections by Gram positive:
-Staphylococcal infections:
a. S aureus:
-Microbiological main features. Epidemiology.
-Clinical manifestations: skin and soft tissue infections, localized infections with cutaneous rash (SSSS), sepsis and endocarditis, pleuropulmonary infections, osteoarticular infections, pericarditis, meningitis.
-Diagnosis and treatment.
b. S epidermidis and other negative plasma coagulase staphylococci:
-infections associated to foreign bodies. Nosocomial bacteremia.
-Diagnosis and treatment.
-Streptococcal infections.
-Classification. Principal microbiological features.
-Epidemiology, pathogeny and clinic of the infections by S pyognes, S agalacataiae and streptococci of viridans group.
- Infections by Gram positive:
-Infections by cyanobacteria, Rhodococcus, Bacillus, Erysipelothrix.
3. Infections by Gram negative. Sepsis and septic shock:
-Definition of sepsis. Definition of bacteremia. Systemic inflammatory response, sepsis. Physiopathogeny of septic shock. Clinical manifestations and complications.
-General epidemiology of Gram negative bacteremia. Most important origin focus. Etiology of Gram negative bacillary sepsis of community and nosocomial.
-Infections by enterobacteria.
-Infections by Pseudomonas.
4. Soft tissue infections
- Cellulitis.
- Gaseous gangrene.
5. Endocarditis and vascular infections
-on native valve
-on prosthetic valve
- users of parental transmission’s infections
-infections associated to endovascular catheters use
6. Infectious diarrhea
-Infections by Salmonella no typhi, Shigella and Campylobacter.
-Taxonomy. Epidemiology. Source of infection, transmission mechanisms, incidence. Laboratory diagnosis. Treatment.
-Diarrhea by Clostridium difficile.
-Enteropathogen viruses: rotavirus, adenovirus, calicivirus.
-Protozoans: Giardia lamblia, Entamoeba hystolitica.
-Diarrhea and AIDS
-Chronic diarrhea
7. Miscellany:
-Sporulated anaerobes. Classification. Tetanus and botulism.
-Actinomycosis and nocardiosis.
-Leptospirosis.
-Brucella. Pasterurella. Yersinia.
8.A. Infections by acquired immune deficiency syndrome and AIDS.
-Epidemiology and natural history of infection by VIH.
-Opportunistic infections. Associated neoplasia.
-Diagnosis and treatment. Primary and secondary prophylaxis. Prevention of infection by HIV.
8.B Infections in no AIDS immunosuppressed
-Opportunists in patients with immunosuppression by neutropenia, splenectomy, complement alterations, dysgammaglobulinaemia, and organ transplanted patient.
9A. Infections by typical and atypical mycobacteria.
-Pulmonary and extrapulmonary tuberculosis.
9.B Infections by fungi
-Classification and microbiological features of the main fungi causers of opportunistic infections.
-Candidiasis. Cryptococcosis. Aspergillosis. Mucormycosis. Infrequent systemic mycosis.
-Global view of antifungal therapy.
10.A. Infections by protozoon
-Classification of the main infections caused by protozoon.
-Leishmaniasis. Etiology. Biological cycle.Treatment and prophylaxis. Leishmania and AIDS. Toxoplasmosis. Giardiasis Amebiasis.
10.B. Infections by cestodes, trematodes and nematodes:
-Cestodes: taeniasis, cystercercosis, hydatodisis.
-Trematodes: schistosomiasis.
-Intestinal and tissue nematodes: Fascioliasis. Echinococcosis. Filariasis. Onchocercosis. Toxocariasis. Anisakiasis. Strongyloidiasis. Ascaridiasis.
CASE METHODS
1. Acute and chronic fever of unknown origin.
- fever and exanthema
-fever and splenomegaly and lymphadenopathy. Nodosum erythema.
-mononucleosis syndrome. Infections by herpes group: herpes simplex virus I, II, CMV and Epstein Barr.
-Borreliosis. Epidemiology. Laboratory diagnosis. Lyme disease.
-Rickettsiosis. Boutonneuse fever. Epidemic exanthematous typhus. Brill’s disease. Endemic typhus. Q fever.
2. Meningo encephalitis
-Pyogenic meningitis. Infections caused by Neisseria meningitides. Serogroups. Epidemiology. Carrier state. Pathogenesis and clinical manifestations. Treatment and prevention.
-lymphocytic meningitis. Infections by Enterovirus. Classification.
-infectious encephalitis, myelitis and neuritis. Cerebral abscess, epidural abscesses.
3. Respiratory infection of high respiratory tract.
-sinusitis, otitis, tonsillitis, pharyngitis.
-common cold. Respiratory virus. Flu.
-acute and chronic bronchitis.
4. Respiratory infection of low respiratory tract.
-Nosocomial and community-acquired pneumonia (pneumococcus, Clampydophila spp, Mycoplasma and Legionella).
- SARS-Cov-2 infection.
- Pulmonary abscess. Anaerobes in the respiratory tract. Pleural empyema.
5. Fever in travelers.
-paludism. Microbiological features, epidemiology and biological cycle of Plasmodium spp.
-chikungunya. Typhoid fever. Dengue.
-viral hemorrhagic fevers: yellow fever, Dengue, Lassa fever, Ebola hemorrhagic fever. Hantavirus. Rabies.
PROBLEM-BASED LEARNING
1.Urinary infections
-asymptomatic bacteriuria, cystitis, pyelonephritis.
-epididymitis, orchitis, prostatitis.
2. Sexual transmission diseases
-urethritis, vulvovaginitis, cervicitis.
-infections caused by Neisseria gonorrhoeae. Epidemiology. Transmission mechanisms. Clinical manifestations of disseminated disease. Laboratory diagnosis and treatment.
-Infections caused by Treponema: syphilis and trepanomatosis non sexually transmited (Piam, Bejel)
-genital ulcers.
-pelvic inflammatory disease.
3. Peritonitis and other intraabdominal infections.
-Description of non-sporulated anaerobes. Concept. Classification and distribution. Main infections caused by anaerobic microorganisms.
- Liver, splenic, perinephric and retroperitoneal abscess.
-Primary, secondary and tertiary peritonitis.
4. Septic arthritis and osteomyelitis
- community infections
-infections related to osteosynthesis and prosthetic material.
LABORATORY SKILLS
1.Nosocomial infections. Surveillance and control of nosocomial infections.
-Main nosocomial infections.
-Isolations.
-Hand hygiene
-Postexposure and surgical prophylaxis
-Surveillance systems
- Compulsory to state diseases. Epidemiological surveys.
2. Interpretation of antibiogram and of microbiological diagnostic methods.
- resistance in Gram-positive
- resistance in Gram-negative
- programs for a rational use of antimicrobials
-analysis of rapid diagnostic methods
3. Radiology of infections
-anatomy of main infections
-interventional radiology
- role of scintigraphy in the diagnosis process
4. Pathological anatomy of infections
Teaching and learning activities
In person
The masterclass is the scene in which a lecturer transmits knowledge in a classroom to the whole group of students. The format, however, allows the introduction of small group activities inside the classroom and the deployment of strategies that promote the active participation of students.
The method case is the solution process of clinical cases. They are group activities that are solved with the active participation of the professor after the deliberation of students.
Problem- based learning is similar to the method case but makes students responsible to find a solution to the problem. The professor acts as a tutor that facilitates the learning process from their metacognitive abilities. It can also be done in groups.
The skills laboratory is in an area in which the student can develop basic communication and physical examination abilities with mannequins, robots and also simulated patients and real sick ones. They are done in small groups.
Evaluation systems and criteria
In person
1. Participation in the skills lab (SL) (10%): Contents practical skills taught in laboratories. The student must demonstrate the skills acquired in the laboratory of clinical simulation. It is essential to attend the lab to be tested. The practical contents constitute 15% of the final grade.
2. Tests (70%):
a.Partial exam: multiple-choice test. Errors discount 1/3 of the question value (MIR-like). 15% of the total course mark.
b.Final: Multiple-choice test. Errors discount 1/3 of the question value (MIR-like).60% of the total course mark.
3. Continuous assessment (5%):
- Participation in class and exams test volunteers 5% of the final grade.
4. Problem based learning (10%)
FINAL QUALIFICATION:
- Weighted sum of the continuous assessment (5%), partial (15%), Final Test (60%), PBÑ (10%) and evaluation of SL (10%)
- Students must pass the final Test and SL evaluations separately with a note = or> 5 to pass the course. % Do not apply if you do not exceed the end.
Bibliography and resources
- Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, and Loscalzo, Eds. HARRISON PRINCIPIOS DE MEDICINA INTERNA.17a edición. McGraw Hill, 2009. ISBN: 9789701067888
- Rozman y Cardellach F. Farreras: MEDICINA INTERNA 16º edición. Hacourt Brace de España, SA. 2008
- Mandell, Bennett, Dolin. Enfermedades infecciosas. Principios y Práctica. Editorial Médica Panamericana.
- V. Ausina Ruiz, S. Moreno Guillen.Tratado SEIMC de Enfermedades Infecciosas y Microbiología Clínica. Editorial Médica Panamericana