7) Infectious Disease (Part 1) Flashcards
Bacterial meningitis diagnosis
- Lumbar Puncture
- Head CT first if evidence of increase intracranial pressure
Bacterial meningitis first-line antibiotic choice
- IV Ceftriaxone or Cefotaxamine + Vancomycin
- Add Ampicillin (if over 50 years old to cover for Listeria)
- Plus dexamethasone (to prevent deafness)
Encephalitis diagnosis
- Head CT
- PCR of CSF for HSV
Encephalitis first-line antibiotic choice
- IV acyclovir (foscarnet if acyclovir resistant herpes)
Otitis externa diagnosis
- Clinical
- External canal erythema/inflammation
- Tragal or auricle tenderness with palpation
Otitis externa first-line antibiotic choice
- Drops ofloxacin or ciprofloxacin
Otitis media diagnosis
- Clinical
- Bulging &/or reduced mobility of the tympanic membrane
Otitis media first-line antibiotic choice
- Anoxicillin-clavulanate or amoxicillin
Acute bacterial sinusitis diagnosis
- Clinical (no improvement in 7 days)
Acute bacterial sinusitis firs-line antibiotic choice
- PO Amoxicillin or amoxicillin-clavulanate
Streptococcal pharyngitis diagnosis
- Positive rapid strep
- Culture (gram + cocci in pairs)
Streptococcal pharyngitis first-line antibiotic choice
- PO Penicillin V or Amoxicillin
Types of UTIs
- Uncomplicated cystitis
- Pyelonephritis
- Acute prostatitis
- Acute epididymitis
Uncomplicated cystitis diagnosis
- UA, Urine culture
- Voiding symptoms, but usually afebrile
Uncomplicated cystitis first-line antibiotic choice
- PO Nitrofurantoin (macrocrystals)
- Trimethoprim-sulfamethoxazole
- fosfomycin (Monurol)
Pyelonephritis diagnosis
- UA, Urine culture
- Voiding symptoms, febrile, flank pain and tenderness
Pyelonephritis first-line antibiotic choice
- IV Ampicillin + gentamicin
- PO Ciprofloxacin
- PO Levofloxacin
- PO Trimethoprim-sulfamethoxazole
Acute prostatitis diagnosis
- UA, Urine culture
- Perineal or suprapubic pain; exquisite tenderness on rectal exam
Acute prostatitis first-line antibiotic choice
- IV Ampicillin + gentamicin
- PO Ciprofloxacin
- PO Levofloxacin
- PO Trimethoprim-sulfamethoxazole
Acute epididymitis diagnosis
- Fever, voiding symptoms
- Painful enlargement of epididymis
- Scrotal ultrasound
Acute epididymitis first-line antibiotic choice
- Sexually transmitted: IM Ceftriaxone + PO Doxycyclin
- Non-Sexually transmitted: PO Ciprofloxacin, Levofloxacin, or Trimethoprim-sulfamethoxazole
Sexually transmitted infections
- Trichomonas vaginalis
- Gonorrhea
- Chlamydia
- Syphilis
- Herpes simplex virus
- Lymphogranuloma venereum
Trichomonas vaginalis diagnosis
- Wet mount with motile trichomonads; pH >4.5
- Affirm VP III DNA probe test
Trichomonas vaginalis first-line antibiotic choice
- PO Metronidazole or Tinidazole
Gonorrhea diagnosis
- NAAT for Neisseria gonorrhoeae (gram – diplococci)
Gonorrhea first-line antibiotic choice
- IM ceftriaxone
Chlamydia diagnosis
- Nucleic acid amplification test (NAAT) for Chlamydia trachomatis (gram – coccoid or rod shape)
Chlamydia first-line antibiotic choice
- PO Azithromycin or Doxycycline
Syphilis diagnosis
- Rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) + confirmatory test such as fluorescent treponemal antibody absorption (FTA-ABS)
Syphilis first-line antibiotic choice
- IM benzathine penicillin G
Herpes simplex virus diagnosis
- Viral culture
- PCR for HSV
Herpes simplex virus first-line antibiotic choice
- PO Acyclovir, valacyclovir, or famciclovir
Lymphogranuloma venereum diagnosis
- Inguinal lyphademopathy, “groove sign”
Lymphogranuloma venereum first-choice antibiotics
- PO doxycycline
Relevant pathogens in the oral flora of the animal
- Pasteurella spp
- Capnocytophaga spp
- Bartonella henselae
- Anaerobes
Preemptive early antimicrobial therapy for 3–5 days is recommended for patients with animal bites who are
- Immunocompromised
- Asplenic
- Advanced liver disease
- Preexisting or resultant edema of the affected area
- Moderate to severe injuries (especially to the hand or face)
- Injuries that may have penetrated the periosteum or joint capsule
First-line prophylactic antibiotic dose for animal bites
- Amoxicillin/clavulanate (Augmentin), 875/125 mg every 12 hours x 3-7 days
Second line antibiotic doses for animal bites
- Clindamycin, 300 mg 3 times per dayplusciprofloxacin (Cipro), 500 mg twice per day
- Doxycycline, 100 mg twice per day
- Penicillin VK, 500 mg 4 times per dayplusdicloxacillin, 500 mg 4 times per day
- A fluoroquinolone; trimethoprim/sulfamethoxazole, 160/800 mg twice per day; or cefuroxime axetil (Ceftin), 500 mg twice per dayplusmetronidazole (Flagyl), 250 to 500 mg 4 times per day, or clindamycin, 300 mg 3 times per day
Prophylaxis for puncture wound through intact shoe
- Cover s. aureus and P. aeruginosa
Prophylaxis for puncture wound that wasn’t through shoe
- Cover gram-positive bacteria
Clostridium tetani prevention in young children (DTaP)
- 2, 4, and 6 months
- 15 through 18 months
- 4 through 6 years
Clostridium tetani prevention in preteens (Tdap)
- 11 through 12 years
Clostridium tetani prevention in adults (Td or Tdap)
- Every 10 years
Infection versus bacteremia
- Infection = invasion of normally sterile tissue by organisms resulting in infectious pathology
- Bacteremia = presence of viable bacteria in the blood
qSOFA (Sepsis related organ failure assessment)
- Altered mental status (Glasgow Coma Score <15)
- Respiratory rate ≥22
- Systolic BP ≤100
Sepsis
- Life threatening organ dysfunction caused by a dysregulated host response to infection
- Infection + Organ dysfunction
(2 or more points in the SOFA score)
Septic shock (all 3)
- Clinical criteria for sepsis
- Requires vasopressors to maintain a mean arterial pressure >65mm Hg
- Lactate level >18mg/dL
Multiple organ dysfunction syndrome
- Severe end of the severity illness spectrum in sepsis
Evaluating multiple organ dysfunction syndrome
- Respiratory – PaO2/FiO2 ratio
- Hematology – platelet count
- Liver – serum bilirubin
- Renal – Serum creatinine (or urine output)
- Brain – Glasgow coma score
- Cardiovascular – Hypotension and vasopressor requirement
Management principles in sepsis and septic shock (within 45 minutes)
- Airway, correct hypoxemia, IV access, broad spectrum antibiotics (after cultures)
- Basic Labs including: lactate, ABG, Cultures (blood, sputum, urine, stool, wound, etc)
Management principles in sepsis and septic shock (within the first hour)
- IV crystalloid fluids (normal saline or Ringer’s lactate)
- If hypotensive despite fluids: norepinephrine
Fever of unknown origin
- Fever higher than 38.3C (100.9F) on several occasions
- Duration of fever for at least 3 weeks
- Uncertain diagnosis after 1 week of study in the hospital
Fever of unknown origin etiologies
- Infections (eg, abscess, osteomyelitis, endocarditis, syphilis, tuberculosis, rheumatic fever)
- Malignancy (eg, hepatocellular carcinoma, leukemia, renal cell carcinoma, lymphoma)
- Systemic rheumatic diseases (eg, Giant cell arteritis, polyarteritis nodosa, rheumatoid arthritis, lupus)
- Others (eg, drug fever, thyroiditis)
