Bacterial Infections Flashcards
1
Q
What is a potential complication of Group A Strep pharyngitis?
A
Scarlet Fever
2
Q
Describe the rash of scarlet fever.
A
Resembles a Sunburn
Sandpaper Consistency
Most intense in groin and axillary
Enlarged Red Papillae (Strawberry Tongue)
3
Q
What is a complication of scarlet fever?
A
Rheumatic Fever
4
Q
What must be met for a Positive JONES Criteria?
A
Two Major Criteria
OR
One Major + Two Minor Criteria
5
Q
What are the Major Criteria of JONES?
A
Joint - Polyarthritis
Oh My Heart - Carditis
Nodules - Subcutaneous Nodules
Erythema Marginatum
Sydenham’s Chorea
6
Q
What are the Minor Criteria of JONES?
A
Fever
Arthralgia
Inflammatory Markers
ProlongedPR interval
7
Q
What drugs do you use to treat Rheumatic Fever?
A
Penicillin G
Aspirin
NSAIDs
8
Q
Patients who have had rheumatic fever should be treated with a continuous course of antimicrobial prophylaxis for how long?
A
5 years
9
Q
What are the drugs of choice for rheumatic fever prophylaxis?
A
Penicillin V (oral)
Erythromycin (oral)
Pencilling G (IM)
10
Q
What percentage of people are asymptomatic carriers of Staphylococcus aureus?
A
25%
11
Q
A purulent skin and soft tissue infection with possibly an abscess would lead to a high suspicion of what pathogen? Typically causes abscess, furuncle, carbuncles, and cellulitis with purulence.
A
Staphylococcus Aureus
12
Q
What is the treatment for an SSTI caused by Staph. Aureus?
A
Incision and Drainage (PRIMARY)
Antibiotics
13
Q
What antibiotics should be used when treating S. aureus orally?
A
Dicloxacillin or Clindamycin
MRSA - Clindamycin, Bactrim, or Doxycycline
14
Q
What antibiotics should be used when treating S. aureus via IV medications?
A
Nafcillin or Cefazolin
MRSA - Vancomycin or Daptomycin
15
Q
A non purulent skin and soft tissue infection that commonly causes cellulitis and erysipelas would lead to a high suspicion of what pathogen?
A
Beta-hemolytic streptococci (Group A Strep.)
16
Q
What antibiotics should be used when treating Beta-hemolytic streptococci orally?
A
Amoxicillin
Cephalexin or Clindamycin
17
Q
What antibiotics should be used when treating Beta-hemolytic streptococci via IV medications?
A
Nafcillin or Cefazolin
Vancomycin or Daptomycin
18
Q
What pathogen causes approximately 60% of all cases of osteomyelitis?
A
Staph. aureus
19
Q
What are the most common sites of osteomyelitis?
A
Long bones
Vertebrae
20
Q
What is a common complication to be mindful of with vertebral osteomyelitis?
A
Epidural Abscess
21
Q
What are the common signs of epidural abscess?
A
Fever
Severe Back Pain
Neck Pain
Radicular Pain (pinched nerve in a dermatome)
Spinal Cord Compression
22
Q
What are the three causes of osteomyelitis?
A
Hematogenous Spread (through the blood)
Contiguous Focus of Infection (Open Fracture & Surgery)
Vascular Insufficiency
23
Q
What is Hematogenous Osteomyelitis commonly associated with?
A
Sickle Cell Disease
IV Drug Use
Diabetes
Old Age
24
Q
How do patients with hematogenous osteomyelitis present?
A
Sudden High Fever
Chills
Pain and Tenderness
25
What is Contiguous Focus of Infection Osteomyelitis usually caused by?
Prosthetic Joint Replacement or Orthopedic Surgery
Neurosurgery
Trauma
26
What pathogens most commonly cause Contiguous Focus of Infection Osteomyelitis?
Staph. aureus
Staph. epidermis
27
What are the signs of Contiguous Focus of Infection Osteomyelitis?
Localized Inflammation
- High fever and other toxic signs are absent
28
What is the most common site of osteomyelitis due to vascular insufficiency?
Foot
Ankle
29
What are the best bedside clues to the presence of osteomyelitis due to vascular insufficiency?
easy advancement of probe to bone through skin ulcer
Ulcer Area greater than 2cm x 2cm
30
How is the diagnosis of osteomyelitis made?
Isolation of Organism from:
- blood
- bone
- contiguous focus
31
What is usually elevated and can be useful to follow the course of during the treatment of osteomyelitis?
ESR and CRP (Inflammatory Markers)
32
List the steps of imaging used to detect and diagnose bone infections.
1. X-Ray
2. CT Scan
3. Bone Scan or Gallium Scan
4. Bone Biopsy (diagnostic)
33
What suspicion would prompt you to order an MRI when assessing for osteomyelitis?
Epidural Abscess
34
How long do you need to treat osteomyelitis for?
4 - 6 weeks (possibly longer)
35
What antibiotics do you use to treat osteomyelitis?
Cefazolin (IV)
Nafcillin or Oxacillin (IV)
36
What antibiotics do you use to treat osteomyelitis caused by MRSA?
Vancomycin (IV)
Daptomycin (IV)
37
When Staphylococcus aureus enters the blood (staph. bacteremia) what three things should you consider?
Endocarditis
Osteomyelitis
Deep Infections
38
How do you rule out infective endocarditis?
Trans-esophogeal Echocardiogram
39
How do you treat staphylococcal bacteremia?
Vancomycin or Daptomycin (IV)
(4 - 6 weeks)
40
Characterized by an abrupt onset of high fever, vomiting, and watery diarrhea due to the toxins of staphylococcus aureus.
Toxic Shock Syndrome
41
What are two common signs of toxic shock syndrome?
Macular Erythematous Rash
Non-purulent Conjunctivitis
42
Why are blood cultures negative when looking for evidence of a pathogen with Toxic Shock Syndrome?
Symptoms are from the TOXIN
(not systemic infection)
43
How do you treat toxic shock syndrome?
REMOVE SOURCE OF TOXIN
Clindamycin (IV)
44
Common causes of infections by coagulase-negative staphylococci
Intravascular Devices
Prosthetic Devices
Wound Infection following Cardiothoracic Surgery
45
What are the signs and symptoms of a coagulase-negative staphylococci infection?
Purulent or Serosanguineous Drainage
Erythema
Pain or Tenderness
- at site of foreign body or device
Joint Instability and Pain of Prosthetic Joint
46
How do you treat infections caused by coagulase-negative staphylococci?
Remove Device or Foreign Body (if possible)
Vancomycin (IV)
- if normal kidney function
47
What causes Tetanus?
neurotoxin tetanospasmin
(clostridium tetani)
48
What are the risk factors for tetanus?
Unvaccinated
Older Adults
Migrant Workers
Newborns
IV Drug Users
49
What are the early signs of tetanus?
Jaw and Neck Stiffness
Dysphagia
Irritability
50
What are the late signs of tetanus?
Spasms of the Jaw muscles (Trismus)
Painful tonic convulsions from minor stimuli
Spasms of the glottis and respiratory muscles
- causes asphyxia and apnea
51
What is the most common cause of death as a result of tetanus?
Respiratory failure
52
What is the immunization schedule of Tetanus, Diphtheria, and Pertusis for children and what vaccine would they be receiving?
DTaP
2 months
4 months
6 months
15-18 months
4 - 6 years
53
When should women receive their Tdap vaccine while pregnant?
27-36 weeks
54
How do you treat someone with symptoms of Tetanus?
Tetanus Immune Globulin (500 units IM)
Debride Wound
Metronidazole (IV or PO)
Bed Rest and Limit Stimuli
55
A paralytic disease caused by a toxin that has been classified by the CDC asa high-priority agent due to potential concern for bioterrorism
Botulism
(clostridium botulinum)
56
What are the three forms of naturally occurring botulism?
Food-borne: canned, smoked, or vacuum packed
Infant: Honey
Wound: IV Drug Use
57
How long after ingestion of the botulism toxin do signs and symptoms appear?
12 - 36 hours
58
Symmetric descending flaccid paralysis progressing to respiratory failure and death may occur unless mechanical assistance is provided. What is the disease?
Botulism
59
How do you treat botulism?
Equine Serum Heptavalent Botulism Antitoxin
- given within 24 hours of symptom onset
Intubation and Mechanical Ventilation
Parenteral fluids
Contact the CDC
60
Disease that causes tenacious gray membrane that covers that tonsils and pharynx and may lead to upper airway and bronchial obstruction.
Diphtheria
(corynebacterium diphtheria)
61
Why should a presumptive diagnosis of diphtheria should be made on clinical grounds without waiting for laboratory verification?
Emergency treatment is needed.
62
Susceptible people exposed to diphtheria (not with an active case) should receive what treatments?
Diphtheria Toxoid Booster
- complete series if unimmunized
Penicillin G or Erythromycin x7 days
63
What is the treatment for people with active diphtheria?
Removal of membrane
Antitoxin (from horse serum)
PCN G or Erythromycin x14 days.
64
This disease may be sporadic or come from outbreaks and is associated with eating contaminated foods such as: unpasteurized dairy, hot dogs, deli meats, cantaloupe, and soft cheeses.
Listeriosis
(listeria monocytogenes)
65
Infection of listeriosis usually occurs in the last trimester of pregnancy and may result in what?
Spontaneous Abortion or Stillbirth
(surviving infants at risk for neonatal listeriosis)
66
A neonatal infection acquired in utero that results from listeriosis and has a high mortality rate
Granulomatous infantisepticum
67
Listeriosis in the blood that occurs in neonates or immunocompromised adults and is considered a febrile illness without a recognized source.
Bacteriemia (listeriosis)
68
Listeriosis that affects infants less than two months old as well as older adults.
Meningitis (listeriosis)
69
In a patient with meningitis caused by listeriosis, what would you find in the cerebrospinal fluid?
Lymphocytic Pleocytosis
- with variable protein and glucose
70
How do you diagnose listeriosis?
Lumbar Puncture
- neutrophil elevation and increased protein
Culture from Biological Sample
- stool
- blood
- cerebrospinal fluid
- amniocentesis
71
What is the treatment of choice for listeriosis?
Ampicillin (IV)
72
Acute infection of the respiratory tract where adults are often the reservoir of the disease.
Pertussis (Whooping Cough)
(Bordetella pertussis)
73
Bursts of rapid, consecutive coughs followed by deep, high pitched inspiration (whoop).
Paroxysmal Stage
74
How do you diagnose pertussis?
Isolating organism from nasopharyngeal culture
- require special agar
75
How can you prevent pertussis?
Vaccination (DtaP)
Erythromycin (prophylaxis)
76
What is the treatment for pertussis?
Azithromycin
Clarithromycin
Bactrim
76
Infection that may cause sinusitis, otitis, and epiglottitis?
Haemophilus Infuenzae Type B
77
What are the treatment options for Haemophilus?
Augmentin
78
How do you treat more seriously ill patients with haemophilus that have toxic clinical features with multi-lobe pneumonia?
Ceftriaxone (IV)
Fluoroquinalone (IV)
79
Abrupt onset of high fever, drooling, and inability to handle secretions. Severe sore throat despite unimpressive exemption of the pharynx. Stridor and respiratory distress from obstruction.
Epiglottitis
80
How do you diagnose epiglottitis?
Direct visualization
- performed in ICU with intubation ready
81
What is the drug of choice for epiglottitis?
Ceftriaxone (IV)
PCN Allergy: Fluoroquinalone (IV)
82
Infection that is transmitted by the ingestion of the organism, usually from tainted food or drink (CHICKEN)
Salmonellosis
(salmonella enterica)
83
Clinical syndrome characterized by GI symptoms as well as constitutional symptoms such as fever, malaise, headache, cough, and sore throat. Progressive infection evolves with delirium.
Typhoid Fever
84
How long is it until Typhoid Fever reaches a plateau and the patient is much more ill?
7-10 days
85
What type of diarrhea is seen with Typhoid Fever?
Pea Soup diarrhea
86
Physical examination findings of someone with Typhoid fever.
Hepatosplenomegaly
Bradycardia (Relative)
Meningismus
Rose Spots (faint pink or salmon colored)
87
How do you treat Typhoid Fever?
Azithromycin
Ceftriaxone
88
How do you treat chronic carriers of Typhoid fever?
Cholecystectomy
89
What is the most common form of salmonellosis?
Salmonella Gastroenteritis
90
What are the signs and symptoms of Salmonella Gastroenteritis?
Fever
Nausea and Vomiting
Cramping Abdominal Pain
Diarrhea
- bloody
- 4 to 7 days
91
How do you diagnose Salmonella Gastroenteritis?
Stool Culture
92
How do you treat Salmonella Gastroenteritis in patients who are severely ill, have sickle cell disease, or are immunocompromised?
Ciprofloxacin
Levofloxacin
(3-14 days)
93
Prolonged or recurrent fears accompanied by bacteremia and local infection. May result in mycotic aortic aneurysm.
Salmonella Bacteremia
94
Usually abrupt onset of bloody diarrhea, lower abdominal cramps, and tenesmus (cramping rectal pain).
Shigellosis
95
What are the laboratory findings in a patient with Shigella?
Stool shows many leukocytes and red cells.
96
How do you treat uncomplicated Shigellosis?
Treat dehydration and hypotension
97
What antibiotics should be used for severe cases of shigellosis and immunocompromised patients?
Fluroquinalones
Ceftriaxone
98
Acute diarrheal illness that is toxin mediated. Causes hyper secretion of water and chloride ions and massive diarrhea (up to 1L per hour). Death results from profound hypovolemia.
Cholera
(vibrio cholera)
99
How does the stool of cholera appear?
Gray and turbid
No odor
No blood or pus
100
How do you treat Cholera?
Lactated Ringers (IV)
101
Outbreaks of this have been associated with the consumption of raw milk. Dairy cattle and poultry an important reservoir.
Campylobacter jejuni
102
C. jejuni toxins cause inflammation which causes what?
Toxic Megacolon
103
How do you treat uncomplicated Campylobacter jejuni?
Hydration and Electrolyte Balancing
104
How do you treat severe campylobacter jejuni?
Azithromycin
105
Zoonotic infection carried by wild rodents that then transmit fleas that bite humans and spread the disease. Extremely virulent.
Plague
(Yersinia pestis)
106
A sign of the plague that develops when the organisms spread through the lymphatics to the lymph node.
Buboes
107
What are the signs and symptoms of the Plague?
Sudden onset of high fever
Purpuric spots (black plague)
108
How do you treat the Plague?
Fluroquinalones
Amino-glycosides
Doxycycline
109
How do you diagnose urethritis and cervicitis? (Gonorrhea)
Nucleic Acid Amplification Test (mucosal sites)
First Catch in the Morning (Men)
110
What is the treatment for Gonorrhea?
Ceftriaxone (IM)
111
What is treatment for Chlamydia?
Doxycycline (non-pregnant)
Azithromycin 1g (pregnant)
112
Vesicopustule that breaks down to form a painful, soft ulcer with a necrotic base, surrounding erythema, and undermined edges.
Chancroid
(Haemophilus ducreyi)
113
What is the treatment for Chancroids?
Azithromycin 1g (oral)
Ceftriaxone 250mg (IM)
114
Acute infection of children and young adults that is transmitted from cats to humans as the result of a scratch or bite. Most commonly presents as regional lymphadenitis.
Cat Scratch Disease
(Bartonella henselae)
115
How do you diagnose Cat Scratch Disease
Clinical Diagnosis
116
What is the treatment for Cat Scratch Disease?
Self Limited
Azithromycin 500mg x1 w/ 250mg x4 days (Z-Pak)
- lymphadenitis
117
Acute and chronic STI caused by Chlamydia trachomatis serotypes L1-L3. Initial papular or ulcerative lesion (usually on external genitalia) is evanescent and often goes unnoticed.
Lymphogranuloma Venereum
118
What is the most common presentation of lymphogranuloma venereum?
Proctocolitis
119
What appears 1-4 weeks after exposure to lymphagranuloma venereum?
Inguinal or Femoral Buboes
120
What is the preferred diagnosis of lymphogranuloma venereum?
Nucleic amplification test for chlaymida trachomatis
121
Who should be actively screened for Chlamydia?
Sexually active women 25 or younger
Women 26+ with risk factors for STI
Pregnant Women
HIV Patients
Men with risk factors for STIs
