MOST OF PEOPLE FAIL TO ACHIEVE THEIR GOALS, NOT BECAUSE THEY DO NOT HAVE ABILITY, BUT THEIR LACK

OF COMMITMENT. (Zig Ziglar, motivator)

NICK VUJICIC

HEE AH LEE

HIROTADA OTOTAKE

The Imaging on Infectious Disease & Tropical Medicine

Andi Darwis Junus Baan
Dept of Radiology Wahidin Sudirohusodo Hospital/ Faculty of Medicine Hasanuddin University Makassar, INDONESIA

GROUPS OF ORGANISM

TARGET ORGANS/SYTEMS

1. 2. 3.

Bacterial Granulomatous Viral

Most common:
Central nervous system

(CNS)
Respiratory systems

4.

Parasitic :
protozoal & metazoal

5.

HIV/AIDS

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CNS INFECTION
- Life-threatening disease

- Routes:
1. Hematogenous dissemination 2. Direct extension

- Infectious agent are considered pathologic when a normal individual is infected by an adequate

inoculums and opportunistic if the host is

compromised
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CNS INFECTION
Including :
-

Meningitis
Cerebritis & Brain Abscess

Encephalitis

Meningitis is the most common CNS infection

Imaging recommendation: CT & MRI

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MENINGITIS
May be normal early

Subarachnoid space,

pia enhance
Basal cisterns effaced Complications:
Hydrocephalus

Ventriculitis
Infarction
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ENCEPHALITIS
Diffuse, nonfocal

brain inflammation
Most (but not all) caused by virus Herpes Can be acute or

chronic

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PULMONARY INFECTION
Access the respiratory system and

cause infection by route:

Inoculation via the tracheobronchial tree

by inhalation droplets
Aspiration of oropharyngeal secretions Direct extension

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PULMONARY INFECTION Pattern

Pathologically:
Central airways [tracheobronchitis] Small airways [bronchiolitis] parenchyma

Pneumonia:
Lobar pneumonia Bronchopneumonia Interstitial pneumonia
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PULMONARY INFECTION
Lobar pneumonia involve the entire lobe of

the lung w/o bronchial involvement.

Bronchopneumonia first involve the bronchus

and then spreads to the alveoli.

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PULMONARY INFECTION
Imaging studies:
Chest X-Ray [CXR] usually sufficient for

clinical practice
CT more sensitive, will detect infection

an average 5 days before CXR abnormal

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PULMONARY INFECTION
Imaging findings
Consolidation: Bacterial, fungal, mycobacterial
Nodule: Fungal, mycobacterial, nocardia Linear or interstitial: PCP, viral Associated features Pleural effusion: Bacterial Cavitation: Bacterial Lymphadenopathy: Bacterial
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Avian Influenza
Viral pneumonia nonspecific Usually involves small airways
Bronchial wall thickening Air trapping, or

Subsegmental atelectasis

Variable radiographic pattern

Diffuse interstitial thickening or

patchy consolidation Focal air-space opacities uncommon

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Avian Influenza

Radiographs from Patient 1 (A), Patient 2 (B), and Patient 3 (C) show widespread consolidation, collapse, and interstitial shadowing. In Panels D, E, and F, three chest radiographs show the progression in Patient 4 on days 5, 7, and 10 of illness, respectively.
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Viral pneumonia

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HIV/AIDS
30% of ptx w/ AIDS have neurologic Cx
Clinical findings should guide imaging stx

[NOT REVERSE]
Most common imaging findings:

white matter disease + atrophy

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HIV/AIDS
HIV encephalopathy
Multifocal nonenhancing WM hyperintensities Diffuse cerebral & cerebellar atrophy

Opportunistic infection
Toxoplasmosis: ring-enhancing mass[es] basal ganglia
Cryptococcosis: meningoencephalitis CMV: encephalitis, ventriculitis

Lymphoma: solitary or multifocal lesions; solid or ringenhancing at deep [basal ganglia, periventricular]

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Normal Brain

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HIV/AIDS

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HIV/AIDS

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HIV positive in a 23 yo woman with fever & head-ache

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CT scan 5 months after therapy of toxoplasmosis

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HIV/AIDS
Manifestation in other organ/system include:
Respiratory tract

GI tract
Bone

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HIV/AIDS
Manifestation in respiratory tract Pneumocystic carinii pneumonia (PCP) Associated w AIDS or immunocompromised host CXR :

Perihilar ground-glass opacity

Air-space consolidation may be seen Pneumatoceles may develop

CT is highly sensitive
Ground-glass opacity visible in all ptx
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HIV/AIDS

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HIV/AIDS

PCP
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HIV/AIDS

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Malaria
Imaging studies:
Respiratory symptoms CXR

Splenomegaly US
CNS symptoms CT or MR

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Dengue Hemorrhagic Fever

Imaging study: Chest X-ray CXR-RLD pleural effusion is typical. Bilateral pleural effusions are common

in patients with DSS

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Pleural effusion

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Varicella
May cause pneumonia & central nervous system deficits.

Imaging studies: Chest X-ray.

MRI may be useful if suspicion of

myelitis or encephalitis exists

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Varicella

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Mumps
Imaging may be needed for

complicated cases involving

certain organ systems.
Parotitis
Orchitis

Meningoencephalitis
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Cytomegalovirus
CMV pneumonia can be suggested by

chest radiograph findings

CT scan is more sensitive for the

identification of infiltrate
CMV may cause aseptic meningitis,

encephalitis can be detected by CT and or MRI

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CMV Ventriculitis with periventricular enhancement (Owls eyes)

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Acute CMV Pneumonia

TETANUS
Imaging studies of the head and spine

reveal no abnormalities.
Severe tetanus with opisthotonos,

results in over flexion of the spine which can produce a multi-segment of anterior wedging compression fracture of the spine.
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Ascariasis
CXR may show fleeting opacities during

pulmonary migration
Plain abdomen may show
A whirlpool pattern of intraluminal worms.

Narrow-based air fluid levels without distended

loops of bowel on upright plain films suggest partial obstruction.

Wide-based air fluid levels with distended loops

suggest complete obstruction.

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Small bowel obstruction caused by ascariasis.

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Eosinophilic Loeffler infiltrate

Tuberculosis
CXR may show normal findings Lung TB divided into
Primary TB : consolidation, patchy,

lymphadenopathy, & pleural effusion

Reactivation TB : cavitation in upper lobe Minimal/no response to therapy considered AIDS or drug resistant

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Tuberculosis
CNS involvement need CT and or MRI Two different but related processes:
Meningitis TB basilar meningitis Tuberculoma: Solitary or multiple

Solid or rim-enhancement

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Primary complex

Cavitating apical tuberculosis

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Cavitating tuberculosis

Miliary tuberculosis

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Brain TB

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Brain TB

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Spondylitis TB

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Spondylitis TB

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Spondylitis TB

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Leprosy
Characterized by localized skin lesion Nerve involvement leads to skin anesthesia,

muscle atrophy and autoamputation of digits

Musculoskeletal abnormalities plain film :
- Osseous changes usually confined to face & feet - Distal and proximal phalangeal resorption

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Anthrax
Most common in agricultural country

Contact w/ tissues animals

Three form
Cutaneous Gastrointestinal Inhalational

Inhalational anthrax occurs when

spore-containing dust is inhaled

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Anthrax
CXR
widening of the mediastinum
progressively pleural effusions lung opacity is usually minimal

CT scan for early detection of

enlargement of lymph nodes peribronchial thickening edema, or pleural effusions.
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Severe acute respiratory syndrome (SARS)

SARS is a serious, potentially life-threatening

viral infection
Caused by a previously unrecognized virus

from the Coronaviridae family

Serial CXR can be used to monitor and

evaluate patient progress

The role of HRCT is still controversial.

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SARS - CXR
Initial CXR abnormal in approx. 60% of ptx.

Abnormalities observed in in nearly all ptx by

10-14 days after symptom onset

Early stage a peripheral, pleural-based opacity

(ground-glass opacification to frank consolidation) or interstitial infiltrates

Calcification, cavitation, pleural effusion, or

lymphadenopathy is NOT OBSERVED in SARS

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SARS - CT
Ptx w/ strong clinical possibility SARS,

if CXR finding is normal consider CT

Findings ground-glass opacification, w/ or

w/out thickening of the intralobular interstitium

or interlobular interstitium, frank consolidation

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Toxocariasis
In a patient with pulmonary involvement,

chest radiograph may show multiple nodules

with surrounding ground-glass opacities, or possibly pleural effusion.
Ultrasonography reveals multiple hypoechoic

areas in the liver.

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Toxocariasis
CT scan
Hepatic lesions are of low density.
Pulmonary involvement manifests with multiple

nodules and surrounding ground-glass opacities,

or rarely, pleural effusion.

In the CNS, granulomas appear cortically or

subcortically, showing a hyperintense appearance on proton density and T2-weighted images.

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If we are soft to ourselves today, the world will be harder to us in the future. But, if we are hard to ourselves today, the world will be softer to us in the future.

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Daftar Pustaka
1. David Sutton & Jeremy W.R.Young. A Concise Textbook of Clinical Imaging, 2nd ed. Mosby, 1995. Grainger & Allison. Diagnostic Radiology, 4th ed. Churchill-Livingstone, 2002. Wilfred Peh. The Asian-Oceanic Textbook of Radiology, 2003.

2. 3.

4.

W. Richard Webb & Charles B. Higgins. Thoracic Imaging. Lippincott William & Wilkin, 2005

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