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Clin Med - ID > Bacterial > Flashcards

Bacterial Flashcards

1
Q

pertussis etiology

A
  • Bordatella pertussis
  • highly contagious infection
  • transmitted via resp droplets
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2
Q

Who is at risk from a pt with pertussis?

A
  • elderly

- pregnant

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3
Q

What is the clinical case definition of pertussis?

A
  • acute cough lasting at least 14d with one of paroxysmal cough, posttussive emesis, or inspiratory whoop
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4
Q

How is pertussis confirmed?

A
  • culture
  • PCR
  • leukocytosis with absolute/strikingly increased lymphocytosis
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5
Q

What is the pathogenesis of pertussis?

A
  • 2ndary bacterial infx

- primarily a toxin mediated dz

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6
Q

complications of pertussis in infants

A
  • hospitilazation
  • PNA
  • seizures
  • encephalopathy
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7
Q

What is the MC patient population for pertussis?

A
  • children
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8
Q

Define catarrhal phase

A
  • 1st stage of pertussis
  • URI sx x1w
    (congestion, rhinorrhea, sneezing, low-grade fever, tearing, coryza)
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9
Q

Define paroxysmal phase

A
  • 2nd stage of pertussis

- severe paroxysmal coughing fits (older infants/toddlers w/ or w/o cough; infants

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10
Q

Define convalescent phase

A
  • 3rd stage of pertussis

- chronic cough lasting weeks to months (resolving sx p ~1m of onset)

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11
Q

pertussis treatment

A
  • older than 1mo = macrolide abx (erythromycin, clarithromycin, aythromycin)
  • older than 2mo w/ macrolide allergy = bactrim (TMP-SMZ)
  • under 1 mo = azythromycin
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12
Q

Why are erythromycin and clarithromycin not recommended in infants?

A
  • increased risk for infantile hypertrophic pyloric stenosis (IHPS)
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13
Q

pertussis presentation

A
  • 3-12d incubation period
  • 3 stages
  • petechiae above nipple line
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14
Q

pt education about pertussis tx

A
  • tx generally ineffective @ changing clinical course but decreases contagiousness
  • abx given in paroxysmal stage doe not affect duration and severity
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15
Q

define acute rheumatic fever

A
  • systemic immune (autoimmune-like) process occurring 15-20d after group A streptococcal pharyngitis
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16
Q

acute rheumatic fever symptoms

A
  • Sydenham chorea
  • carditis
  • subQ nodules
  • erythema marginatum
  • migratory polyarthritis
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17
Q

acute rheumatic fever pathophysiology

A
  • migratory arthritis
  • Sydenham chorea (St. Vitus’ Dance)
  • carditis
  • genetics
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18
Q

When should you consider carditis in acute rheumatic fever?

A
  • new/changing valvula murmurs
  • cardiomegaly
  • CHF
  • pericarditits
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19
Q

What are the labs/EKG for acute rheumatic fever?

A
  • elevated ESR and CRP

- prolonged PR interval

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20
Q

How is acute rheumatic fever dx’d?

A
  • T. Ducket Jones criteria

- except chorea or possibly indolent carditis means you win the dx regardless of having the other sxs

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21
Q

What is the work-up for acute rheumatic fever?

A
  • throat culture
  • ASO
  • antistrep antibodies
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22
Q

images for acute rheumatic fever?

A
  • EKG
  • CXR
  • Echo
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23
Q

acute rheumatic fever treatment

A
  • PCN

- PCN allergy = oral cephalosporins

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24
Q

T/F: Abx will lessen the course/frequency/severity of cardiac dz from acute rheumatic fever.

A
  • false, no change
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25
Q

What is the treatment of severe carditis 2ndary to acute rheumatic fever?

A
  • corticosteroids
  • rest
  • digoxin
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26
Q

What is the tx for Sydenham chorea?

A
  • haloperidol

- antimicrobial prophylaxis

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27
Q

botulism etiology/epidemieology

A
  • Clostridium botulinum
  • gram (+), spore forming rod
  • neurotoxin inhibits ACh release @ neuromuscular jxn –> weakness, flaccid paralysis, respiratory arrest
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28
Q

When does the cure for botulism occur?

A
  • only after sprouting new n. terminals
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29
Q

types of botulism

A
  • infant (IB)
  • foodborne (FBB)
  • wound (WB)
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30
Q

infant botulism transmission

A
  • bee honey
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31
Q

foodborne botulism transmission

A
  • improper canning or home-prep of food
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32
Q

wound botulism transmission

A
  • s/p traumatic injury
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33
Q

botulism presentation

A
  • sudden onset 7 D’s leading to paralysis
  • GI sx (N/V)
  • CN palsies
  • ANS (opposite of SLUDGE)
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34
Q

What are the 7 D’s of botulism presentation?

A
  • diplopia
  • dry mouth
  • dysphagia
  • dysarthria
  • dysphonia
  • decreased muscle strength
  • dilated, fixed pupils
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35
Q

botulism workup

A
  • wound cultures
  • EMG
  • mouse neutralization bioassay
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36
Q

botulism tx

A
  • antitoxin
  • supportive care
  • PCN only for WB
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37
Q

What are the 3 species of chlamydia and the diseases that can result from each?

A
  • C. pneumoniae = PNA
  • C. psittaci = psittacosis or ornithosis
  • C. trachomatis = STDs and PNA
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38
Q

S and S of C. pneumoniae PNA

A
  • 3-4w incubation period
  • gradual, biphasic onset
  • follows URI
  • prolonged cough and malaise
  • hoarseness
  • H/A
  • pharyngeal erythema w/o exudate
  • TTP sinus
  • rhonchi and rales
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39
Q

S and S of C. psittaci PNA

A
  • incubation period of 5-14d +
  • sudden onset constitutional sx
  • nonproductive cough, initially absent
  • chest pain
  • high fever
  • pulse-temp dissociation
  • sleepy
  • splenomegaly
  • maculopapular rash
  • meningitis or encephalitis
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40
Q

S and S of C. trachomatis PNA

A
  • 2-3mo old
  • staccato cough
  • tachypnea
  • afebrile
  • scattered crackles w/o wheezing
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41
Q

Describe chlamydia

A
  • small
  • gram (-)
  • obligate intracellular
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42
Q

What do the 15 immunotypes of C. trachomatis cause?

A
  • A-C = chronic conjunctivitis
  • D-K = genital tract infx
  • L1-L3 = genital ulcer dz
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43
Q

What is the MC cause of STDs in US?

A
  • chlamydia
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44
Q

diagnostic tests for C. pneumoniae PNA

A
  • IgM titer
  • PCR
  • cell culture
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45
Q

diagnostic tests for C. psittaci PNA

A
  • paired acute/convalescent sera

- seriologic tests

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46
Q

diagnostic tests for C. trachomatis PNA

A
  • CBC = eosinohilia in kids

- screen parents

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47
Q

general chlamydia PNA tx

A
  • tetracyclines (bacteriostatic)

- macrolides (inhibit bacterial growth)

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48
Q

abx tx for all 3 types of chlamydia PNA

A
  • C. pneumoniae = doxycycline (except in kids)
  • C. psittaci = tetracycline/doxycyline
  • C. trachomatis = erythromycin
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49
Q

Who is most at risk for chlamydial GU infx?

A
  • adolescent female (squamocolumna jxn)
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50
Q

What are the S&S of chlamydial GU infx in females?

A
  • mucopurulent cervicitis
  • PID –>Fitz-Hugh-Curtis syndrome
  • dyspareunia
  • hx of sexual activity w/o condoms
  • most asymptomatic
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51
Q

What are the sx’s of chlamydial GU infx in males?

A
  • urethritis
  • epididymitits
  • hx or sexual activity w/o condom
  • fever
52
Q

What other infx are often associated with chlamydial GU infx?

A
  • gonorrhea
  • HIV
  • syphillis
53
Q

What is one of the leading causes of infertility in women?

A
  • C. trachoma
54
Q

C. trachomatis GU tx

A
  • 1st: azythromycin and doxycycline

- 2nd: erythromycin, PCN, and sulfisoxazole

55
Q

What are the complications of chlamydial GU infx?

A
  • HIV
  • reactive arthritis syndrome
  • miscarriage
  • preterm delivery
  • urethral scarring
56
Q

How do you work up chlamydial GU infx?

A
  • urine sample
  • CBC for eosinophilia
  • HIV
  • HCG
57
Q

presentation of C. trachomatis trachoma

A
  • chronic follicular or intese conjunctival inflam
  • tarsal conjunctiva scarring
  • entropion and trichiasis
  • corneal abrasions, scarring, opacifications leading to blindness
58
Q

Who else, besides the patient must be tested in chlamydial GU infx?

A
  • sexual partners
59
Q

What is a contraindication to using doxycycline or ofloxacin?

A
  • pregnancy
60
Q

Who should be regularly screened for C. trachoma?

A
  • all sexually active, nonpreg women 24y/o

- NO routine screenings women > 25 y/o

61
Q

What imaging can be done for C. trachoma?

A
  • US
  • CT
  • CXR
62
Q

Who should be admitted with C. trachomatis?

A
  • adolescents with PID
63
Q

What is the post therapy instructions?

A
  • no sex until all partners have been cured

- no sex for 1 week or until end of longer abx regimen

64
Q

Define C. trachomatis trachoma

A
  • chronic keratoconjunctivitis

- repeated reinfection

65
Q

What are the metabolic derangements of cholera?

A
  • hypoglycemia
  • acidosis
  • hyponatremia
  • hypokalemia
  • hypocalcemia (Chvostek, Trousseau signs)
66
Q

C. trachomatis trachoma tx

A
  • oral azythromycin + tetracycline eye ointment

- facial cleanliness

67
Q

types of C. trachomatis trachoma

A
  • follicular (TF)
  • inflam ( TI)
  • conjunctival scarring (TS)
  • trichiasis (TT)
68
Q

cholera etiology

A
  • Vibrio cholerae
69
Q

What is the hallmark sign of cholera?

A
  • profuse secretory diarrhea (rice water stool)
70
Q

What is the priority of cholera tx?

A
  • hydration with electolytes
71
Q

describe the diphtheria toxin

A
  • A and B fragments
72
Q

cholera pathophys

A
  • comma, shaped, gram (-) aerobic or facultative anaerobic bacillus
  • not acid- resistant (cant survive in the stomach ==> high infectious dose)
  • overwhelms large intestine with excessive fluid loss from small intestine
73
Q

cholera presentation

A
  • sudden onset
  • rice water stool
  • dehydration
74
Q

diphtheria presentation

A
  • 2-5d incubation period
  • non-specific, general URI sx
  • localized or coalescing pseudomembrane
  • cervical adenopathy = bull neck
  • fever and nasopharyngeal sx
  • cardiac and neuro toxicity
75
Q

cutaneous diphtheria presentation

A
  • indolent, non-healing ulcers covered with grey membrane

often co-infx w/ S. aureus and strep

76
Q

What is the work up for cholera?

A
  • stool culture
  • serologic testing
  • chem 7
77
Q

non pharm cholera tx

A
  • cholera cots (dont pee in the bucket or else ovehydration will kill pt)
78
Q

pharm cholera tx

A
  • doxy
  • TCN
  • TMP-SMZ (bactrim)
  • ciprofloxacin
79
Q

What does chlamydia PNA look like?

A
  • mycoplasma PNA
80
Q

What is the tx for chlamydia PNA?

A
  • macrolide
81
Q

What is the etiology of diphtheria?

A
  • Coynebacterium diphtheriae

- aerobic gram (+) rod

82
Q

How does diphtheria manifest?

A
  • URI

- cutaneous infx

83
Q

diphtheria pathophys

A
  • adheres to mucosal epithelial cells
  • endosomes release endotoxin causing localized inflam rxn
  • causes tissue destruction & necrosis
84
Q

describe the diphtheria toxin

A
  • A and B fragments
85
Q

How is the diphtheria toxin moved in the body?

A
  • lymph

- blood

86
Q

What is the MC cause of death of diphtheria?

A
  • airway obstruction/suffocation s/p psuedomembrane aspiration
87
Q

cutaneous diphtheria presentation

A
  • indolent, non-healing ulcers covered with grey membrane

often co-infx w/ S. aureus & strep

88
Q

diphtheria workup

A
  • culture
  • gram stain
  • toxigenicity (detection of toxin)
  • CBC
  • serum troponin
  • EKG
89
Q

diphtheria tx

A
  • erythromycin or PCN for 14d

- horse serum antitoxin

90
Q

Define gonorrhea

A
  • purulent infx of mucuous membrane caused by Neisseria gonorrhea
91
Q

Besides gonorrhea, what else does N. gonorrhea cause?

A
  • opthalmia neonatorum

- systemic neonatal infx

92
Q

What is the most common site of gonorrhea infx in women and what does it result in?

A
  • cervix

- endocervicitis & urethritis, complicated by PID

93
Q

What is the most common site of gonorrhea infx in men?

A
  • anterior urethritis
94
Q

What are gonococcal complications?

A
  • ectopic pregnancy
  • high risk for HIV
  • having gonorrhea is a risk factor for getting other STIs
  • conjunctivitis
95
Q

How is gonorrhea transmitted?

A
  • male to female
96
Q

gonorrhea S+S

A
  • anal, vaginal, penile, or pharyngeal d/c

- PID

97
Q

PID sx

A
  • lower abd pain
  • dysuria
  • cervical motion tenderness
  • adnexal tenderness
  • bleeding
  • perihepatitis
98
Q

Define disseminated gonococcal infx (DGI)

A
  • gonorrhea that has spread
99
Q

DGI S+S

A
  • arthritits/dermatitis syndrome (joint and tendon pain with rash) (Lover’s Heels)
  • 2nd stage = septic arthritis
100
Q

gonococcal work up

A
  • culture
  • seriologic tests
  • STD panel
  • NAAT, PCR, LCR
101
Q

gonorrhea tx

A 
- ceftriaxone IM
OR
- cefixime + azythromycin or doxy
(also tx for chlamydia)
- eval and tx sex partners
102
Q

What is not recommended in the tx of gonorrhea?

A
  • fluoroquinolones

- TCN

103
Q

PID tx

A
  • cefalosporins
104
Q

salmonella epidemiology

A
  • consumption of contaminated foods

- large inoculum unless in low acidic stomach (requires fewer) or postvaccine (requires more)

105
Q

salmonella pathophysiology

A
  • selectively attaches to specialized epithelial cells of the Peyer patches
106
Q

nontyphoidal enterocolitis presentation

A
  • loose, bloodless stools
  • smaller vol stool than cholera
  • resolves w/in 3-7d
107
Q

typhoid fever presentation

A
  • nonspecific features
  • 10-14d incubation period
  • H/A, malaise, myalgia, lethargy
  • dry cough
  • stepwise, low grade fever progression
  • bradycardia @ fever peak
  • rose spots
  • coated tongue
  • change in BM
108
Q

salmonella work up

A
  • blood cultures

- stool cultures

109
Q

T/F: Abx do not shorten salmonella duration of sx and may prolong duration of convalescent carriage.

A
  • true
110
Q

T/F: Abx are often used for uncomplicated nontyphoidal Salmonella gastroenteritis.

A
  • false
111
Q

What is the treatment for Salmonella bacteremia?

A
  • single bactericidal drug for 10-14d
112
Q

What are the surgical interventions for typhoid fever?

A
  • cholecystectomy
  • splenectomy
  • endarterectomy
113
Q

Shigella pathophys

A
  • fecal-oral route
  • ingestion of contaminated food or water
  • fomites
  • sexual contact
  • vectors (housefly)
  • low infectious dose
  • can withstand low pH
114
Q

Shigella symptoms

A
  • sudden onset severe abd cramping
  • high fever
  • emesis
  • anorexia
  • large vol. watery diarrhea
  • seizures
  • tenesmus
115
Q

Shigella signs

A
  • elevated T
  • tachycardia and tachypnea
  • dehydration
  • abd tenderness
  • CNS sx
  • anemia
  • renal failure
116
Q

Shigella work-up

A
  • CBC
  • blood culture
  • stool exam and culture
  • enzyme immunoassay for toxin
117
Q

Shigella tx

A
  • fluid + electrolytes
  • antipyretics
  • VIt A
  • Zn
  • beta lactams, quinolones, macrolides
118
Q

What do you not give for Shigella?

A
  • antidiarrheals
119
Q

tx of travelers diarrhea

A
  • doxy
120
Q

What are the types of tetanus?

A
  • neonatal
  • cephalic
  • local
  • generalized
121
Q

What causes tetanus?

A
  • Clostridium tetani
122
Q

What is formed by the C. tetani spores?

A
  • 2 toxins: tetanolysin & tetanospamin
123
Q

local tetanus presentation

A
  • muscle rigidity near site of injury
124
Q

general tetanus presentation (early)

A
  • local muscle spasms
  • neck/jaw stiffness
  • dysphagia
  • hyperirritability
125
Q

general tetanus presentation (late)

A
  • trismus
  • drooling
  • risus sardonicus
  • descending muscle rigidity
126
Q

tetanus tx

A
  • immunizations
  • ICU admit & supportive care
  • benzodiazepines
  • vecurnonium
  • magnesium sulfate
  • metronidazole NOT PCN

Clin Med - ID (6 decks)

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