3. Management of Common Infections and PUO Flashcards
Does fever and elevated CRP does not always mean infection. What are some other differential diagnoses?
Are antibiotics or surgery better?
What two types of factors does the right dose of abx depend on?
Pancreatitis, drug fever, malignancy, blood in wrong place (thrombus/haemorrhage)
Surgery - abx have limited capacity to penetrate an abscess cavity. Altered biochemistry within an abscess can inhibit abx activity (pH/anaerbiasis).
1. Infection factors: organism, location, severity
2. Patient factors: age, pregnancy, renal/liver function, other meds and interactions
When can combination therapy be useful?
What is the difference between allergy and intolerence?
What medications are considered safe in penicillin allergic patients?
Empiric abx, synergy, prevent resistance e.g. TB, mixed infection. Not always useful e.g. antagonistic, compound toxicity
Allergy - involes immune reaction. Find out how severe e.g. type 1 immediate or type 4 delayed. E.g. IgE may be directed to the beta-lactam ring of penicillin.
Intolerence - adverse effect from a drug e.g. GI upset, headache, can try and manage SEs
Amikacin, azithromycin, ciproflaxacin, clarithromycin, doxycyclin, gentamicin, linezolid, rifampicin. trimethoprim, vancomycin and others…
What is antimicrobial stewardship?
Give examples of some organ-specific infections.
What is the typical cause of a UTI? How would you investigate?
Thoughtful use of abx - right abx, dose, route, duration. Use guidelines.
Urinary tract: UTI, PID. Skin and soft tissue: cellulitis. Resp: TB, COPD. CNS: meningitis, encephalitis. Abdo: hepatitis. Bone and joint: septic arthritis. CDV: endocardits.
Infection of urinary tract by organisms that normally reside in GI tract. Urinary WCC, culture. USS, flow. If asymptomatic but pregnant then treat. Beware S.aureus -> look for endocarditis
What could be some other causes of a hot, red leg apart from cellulitis?
What are some bacterial and viral pathogens causing respiratory tract infections?
What are typical and atypical agents that cause pneumonia?
DVT, contact dermatitis, gout, drug reaction, insect bite, lymphodema exacerbation
Bacterial: strep pneumoniae, legionella, mycoplasma. Viral: para(influenza), RSV, adeno, rhino
Typical: S. pneumoniae. H. influenzae. Atypical: legionella, mycoplasma, chlamydophila. Illness often milder
Distinguish between meningitis and encephalitis.
What could cause infective endocarditis?
What is PUO (pyrexia of unknown origin)?
Meningitis: inflammation of meninges, headache, stiff neck, photophobia. Viral meningitis does NOT need treatment
Encephalitis: inflammation of brain parenchyma, seizures, weakness, behaviour change, drop in GCS. UK encephalitis viral > bacterial.
Strep gallolyticus, staph aures, viridans strep
Temperature >38.3 degrees for >3 weeks with no obvious source despite investigations (history, exam, bloods, urine, CXR etc.)
What are the 3 main categories of causes of PUO?
How would you approach a case of PUO?
Infections (TB, endocarditis), malignancies (lymphoma, hepatocellular cancer), connective tissue diseases e.g. RA, rheumatological (giant cell arteritis, periodic fever syndromes), medication (abx, NSAIDs, recreational etc.)
History (travel, immunosuppression, contacts esp animal, drug history), bloods, RhF, ANA, dsDNA, serum and urine protein electrophoresis, serology (HIV, HBV etc.), imaging, biopsy. Prognosis: 70% diagnosed, rest get better with time.
