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Senior - ID 2 > 11 - Staphylococcal/streptococcal > Flashcards

11 - Staphylococcal/streptococcal Flashcards

1
Q

Flesh eating bacteria may be?

A

Monomicrobial or polymicrobial

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2
Q

Many people who are affected by flesh eating bacteria also have?

A

Co-morbidities

  • DM,
  • immunocompromised
  • obesity
  • PVD
  • Advanced age
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3
Q

The infection is often ___ but it doesnt have to be

A

Synergestic infection of 2 organisms

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4
Q

Common organisms for necrotizing fasciitis?

A 
Group A hemolytic strep
Staph 
Vibro
Aeromonas 
Bacteroides
Clostridium 
Peptostreptoccus
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5
Q

Necrotizing fasciitis can look like superficial cellulits but

A

They often are much deeper infections

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6
Q

Pathognomonic for necrotizing fasciitis?

A

Pain out of proportion

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7
Q

Common features of necrotizing fasciitis?

A 
Pain out of proportion
Failure to respond to abx
Woody feel
Systemic toxicity
TTP beyond erythema
Crepitus 
Bullous lesions
Skin necrosis
Ecchymosis
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8
Q

Good meds to start pending lab results?

A

Pen G and Clindamycin
Doripenem
Vancomycin

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9
Q

What is a key to reduced mortality?

A

Early and extensive debridement reduces mortality

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10
Q

What newish treatments is really good for necrotizing fasciitis as an adjunct?

A

HBO - hyperbaric oxygenation

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11
Q

X rays may show?

A

Gas bubbles (60%) - not required for diagnosis

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12
Q

Preferred radiology?

A

MRI - soft tissues and edema

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13
Q

What causes strep throat?

A

Streptococcus pyogenes

- group A Beta-hemolytic streptococcus

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14
Q

MC age group for strep?

A

5-12 yrs old

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15
Q

Peak season for strep throat?

A

Late fall - early spring

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16
Q

Strep is not commonly seen?

A

In kids under 3

Adults (not so much in practice though)

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17
Q

S/S strep throat?

A 
Sore throat
Tonsils - red + enlarged
Exudate
Dysphagia
Odynophagia
Constitutional symptoms
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18
Q

Classic strep presentation?

A

Hurts to swallow

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19
Q

Tx for strep?

A

Benzathine Penicillin
- IM
Or
Pen V x 10 days

Alt
Clindamycin

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20
Q

Complications of unresolved strep?

A 
Rheumatic fever
Glomerulonephritis
Periotonsillar abscess
Otitis media
Acute sinusitis
Mastoiditis
Meningitis
Pneumonia
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21
Q

Differential for strep?

A

Other streptococcus

Neisseria gonorrhoea

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22
Q

Scarlet fever is?

A

Group A beta-hemolytic strep infection

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23
Q

Group a beta hemolytic is a ___ toxin?

A

Erythrogenic toxin

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24
Q

S/s of scarlet fever?

A 
Fever
Chills
HA
Vomiting
Pharyngitis
Tongue dorsum - white exudate
Projecting edematous papillae
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25
Q

Scarlet fever also has?

A

Rash

  • fine papular or punctate lesion
  • begins on axillae, groin and neck
  • forehead and cheeks appear flushed
  • circumoral pallor
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26
Q

The scarlet fever rash feels?

A

Like coarse sandpaper

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27
Q

Tx for scarlet fever?

A

Pen V

Erythromycin

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28
Q

What is scalded skin syndrome?

A

Similar to scarlet fever

Endotoxin mediated response

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29
Q

Scalded skin syndrome is aka?

A

Ritter disease

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30
Q

Scalded skin rash?

A

Acute exfoliation
Sandpaper like
Bullae
Nikolskys sign

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31
Q

MC sites for ritter syndrome?

A

Oral or nasal cavities
Throat
Umbilicus

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32
Q

S/s of scalded skin syndrome?

A 
Fever
TTP
Warmth to palpation 
Diffuse erythematous rash
Nikolsky’s sign 
Dehydration
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33
Q

What is nikolskys sign?

A

Gentle stroking of the skin
Separate at the epidermis

Basically you rub the skin gently with your finger and it peels off

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34
Q

Tx for scalded skin syndrome?

A

Supportive care - dehydration
Eradication of organism
IV nafcillin pending C and S results

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35
Q

Differential for scalded skin syndrome?

A

R/O toxic epidermal necrosis

36
Q

What is toxic shock syndrome?

A

Toxin mediated multisystem disease

Secondary to trivial staphylococcal infection

37
Q

Common bug for toxic shock syndrome?

A

Staphyloccus aureus

  • rarely Group A Strep
38
Q

TSS is seen with?

A

Tampon use

But can be any staphylococcal infection

39
Q

S/s of TSS?

A 
Influenza like syndrome
Fever (>102)
Confusion
Tissue infection
N/V
Diarrhea
Chills 
Myalgia
40
Q

Presenting complaints for TSS?

A 
Pain 
Vomiting
Nausea
Diarrhea
Influenza like symptoms
HA
Dypsnea
41
Q

Physical for TSS?

A 
Bullae
Scarlet fever - like rash
Petechiae or maculopapular rash
Desamanation 
HOTN
Orthostatic syncope
42
Q

Presentation of desquamation with TSS?

A

1-2 weeks after onset of illness

Involves palms and soles

43
Q

Consider TSS with?

A

Sudden onset of fever
Rash
HOTN
Systemic evidence of toxicity

44
Q

Diagnostic criteria for multi-system involvement with TSS?

A

3 + of

  • GI
  • muscular (CK >2x normal)
  • mucous membrane
  • renal (bun 2x normal)
  • hepatic (bili 2x normal)
  • hematological (platelets <100k)
  • CNS - disorientation

With no other obvious cause

45
Q

Tx for TSS?

A

Aggressive supportive therapy

Nafcillin (pending labs)

Pen G + clinda for strep

D/C tampon use

46
Q

Sequela of TSS?

A 
Prolonged/refractory Hypovolemic shock
ARDS
Bacteremia
Acute renal fx
Electrolyte and acid-base imbalance
Cardiac dysrhythmia
DIC  w thrombocytopenia
Mortality (3%)
47
Q

GBS aka

A

Streptococcus agalactia

48
Q

GBS is a major cause of?

A

Major cause of sepsis/meningitis in neonates

Peripartum fever in women

49
Q

Types of neonatal presentation (GBS)

A

Early onset
- 1st week (median - 20hrs)

Late onset
- 1 week - 3 months

50
Q

Where do neonates get GBS from when its early onset?

A

From a colonized maternal tract

51
Q

Risk factors for GBS?

A

Fever and prolonged labor

Prematurity

52
Q

S/s of early onset GBS>?

A 
Respiratory distress
Lethargy
Hypotension 
Pneumona
RDS
Fever
Lethargy
Irritability
Poor feeding
Seizures
53
Q

Where do neonates get late onset GBS from?

A

At birth
Later from mom
Nursery personnel

54
Q

Presentation for GBS?

A

Bacteremia w ukn source
Osteomyelitis
Facial cellulitis
Septic arthritis

55
Q

Labs for GBS?

A 
Cultures and susceptibilities
CBC
UA
CSF 
Chemistries
56
Q

Tx for GBS?

A

Pen G

57
Q

Complications for GBS?

A

Moratlity 10-40%
50% if they have meningitis

Longterm neruo
Seizures
Profound MR
Mild language delay
Hearing loss
Blindness
58
Q

Who gets adult GBS?

A 
Pregnancy
Elderly
Sickly
- DM
- malignancy
- immunocompromised
59
Q

Fatality rate for adult GBS?

A

40%

60
Q

MC manifestation of adult GBS?

A

Peripartum fever

61
Q

Considerations for adult GBS?

A 
Peripartum fever
Urinary tract infections
Pneumonia
Endocarditis
Septic arthritis 
Cellulitis and soft tissue infections
62
Q

Less common GBS presentation?

A

Meningitis
Osteomyelitis
Intra-abdominal/pelvic abscess

63
Q

Tx for GBS?

A

Pen G

64
Q

Common presentation of MRSA?

A

Skin - cellulitis, abscess
Joint - septic arthritis, bursitis
Pneumonia

65
Q

Where does MRSA commonly come from?

A 
Institutions
Hospitals
Prisons
Sports
Military
66
Q

MRSA accounts for?

A

60% of staff infections in

  • alaska
  • california
  • georgia
  • texas
67
Q

Outpatient vs inpatient MRSA tx?

A

<5cm - outpatient

- multiple or >5cm

68
Q

Drugs for <5cm MRSA?

A

Trimethoprim sulfamethoxazole
Doxycycline
Clinda

69
Q

Meds for MRSA >5cm or multiple?

A

Vancomycin

70
Q

Physicians and MRSA?

A

Docs are commonly colonized with MRSA and can spread that shit

71
Q

Tx for MRSA carriers?

A

Bactroban - nares and wounds
Chlorhexidine (hibiclins) baths

X 5 day course

72
Q

What causes tetanus?

A

Clostridium tetani

73
Q

Forms of clostridium tetani?

A

Spore (dormant)
- soil, dust, poo

Vegetative cell (active)

74
Q

Active tetanus cell in the wound release 3 toxins which one matters?

A

Tetanospasmin is responsible for the disease

75
Q

4 types (presentations) of tetanus S/S?

A

Generalized
Local tetanus
Cephalic tetanus
Neonatal tetanus

76
Q

MC/most sever tetanus?

A

Generalized tetanus

Can affect all skeletal muscles

77
Q

Cephalic tetanus affects?

A

Facial muscles

78
Q

Neonatal tetans?

A

Basically generalized but in neontates

79
Q

S/s of tetanus?

A 
Trismus/lock jaw
Irritability 
Muscle cramps
Dysphagia
Associated fx and dislocations
Respiratory (severe)
Seizures
Opisthotonos
Flexion and abductins of arms
Clenching of fists (on thorax)
Extension of lower extremities
80
Q

Death is likely if (tetanus)

A

Respiratory muscles are involved

81
Q

MC s/s of tetanus?

A

Trismus or lock jaw

82
Q

Whats different about tetanus seizures?

A

The dont loose consciousness

They are painful

83
Q

Labs and diagnostics for tetanus?

A

No good ones, its clinical

84
Q

Tx for tetanus?

A

Seizures - diazepam

Disease

  • tetanus immune globulins
  • metronidazole
85
Q

A bacteria walks into a bar. The bar tender says “we dont serve your kind here”

A

The bacteria says “but I work here, I’m staph”

Senior - ID 2 (6 decks)

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