Bacterial Infections I Flashcards
1
Q
What are the gram + cocci
A
2
Q
S. aureus
S. epidermidis
S. saprophyticus
S. lugdunensis
A
What are the 4 kinds of Staphylococcus?
3
Q
Which staph is the most pathogenic?
A
S. aureus
4
Q
Which staph is the most common on skin?
A
S. epidermidis
5
Q
Which staph is responsible for hospital acquired infections?
A
S. epidermidis
6
Q
Which staph is responsible for urinary tract infections?
A
S. saprophyticus
7
Q
Which staph is commonly found in foreign body and prosthetic device infections?
A
S. lugdunensis
8
Q
Which staph is coagulase positive? How does it work?
A
S. aureus
Produces enzyme = ability to clot blood
9
Q
Which staph species are coagulase negative?
A
S. epidermidis, S. saprophyticus, S. lugdunensis
10
Q
How is staph usually transmitted?
A
through direct tissue invasion
11
Q
What are some additional common forms of staph?
A
Skin and soft tissue infections
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis
12
Q
What does severe local infection sometimes lead to ?
A
bacteremia
13
Q
**Staph exotoxin production is associated with what 3 syndromes?
A
Staphylococcal food poisoning
Toxic Shock Syndrome
Scalded Skin Syndrome
14
Q
Staph skin infections usually present with ???? Which 2 are most common?
A
pustules, crusting, cellulitis, furuncles (boils), folliculitis, and abscesses, erythema and purulent drainage
15
Q
Staph skin infection with an abscess, what do you do?
A
drain the abscess
culture the material
if systemic signs of infection -> blood cultures
empiric abx (alter treatment after culture results)
16
Q
Staph skin infection with low risk of MRSA, what abx do you give?
A
cephalexin (Keflex)
dicloxacillin
17
Q
Outpatient staph skin infection with high risk of MRSA, what abx do you give?
A
clindamycin - TID
doxycycline / minocycline
sulfamethoxazole/trimethoprim (Bactrim)- BID
18
Q
Inpatient staph skin infection, what abx do you give?
A
vancomycin - 1st line
clindamycin
cefazolin (Ancef)
nafcillin / oxacillin
linezolid (Zyvox)
*also available oral but very costly!!
19
Q
60% of all osteomyelitis cases caused by _____
40% is caused by _____
A
S. aureus
Strep
20
Q
What kind of infection results from extension of deep soft tissue infection or direct inoculation (open fracture or wound)?
A
Staphylococcal Osteomyelitis
21
Q
What is the treatment for Staphylococcal Osteomyelitis?
A
-confirm with x-ray, CT or bone scan (bone scan is the most sensitive)
-culture
-broad spectrum empiric coverage - IV preferred
(No real first line - vancomycin + 3rd or 4th gen cephalosporin (ex. ceftriaxone)
-Adjust abx pending culture and sensitivity
22
Q
Staphylococcal Osteomyelitis that comes back as MSSA, what is the treatment?
A
nafcillin IV / oxacillin / cefazolin
23
Q
Staphylococcal Osteomyelitis that comes back as MRSA, what is the treatment?
A
vancomycin IV
24
Q
____ caused by focal concentration of toxin producing S. aureus. Name some common ways to contract it.
A
toxic shock syndrome
Vagina - tampon use
Nasopharynx - packing
Direct inoculation through wound or abscess
25
Sudden onset high fever, hypotension, myalgia, N/V, watery diarrhea
Diffuse erythematous rash, particularly on palms and soles, that desquamates
Can cause hepatic damage, thrombocytopenia, and confusion
May progress with renal impairment, syncope, and shock
What is the clinical presentation of Toxic shock sydrome?
26
What do you need to monitor on a patient with TSS?
hepatic and renal function
27
What is the abx treatment for TSS?
vancomycin plus clindamycin plus 1 of the following: pip/taz or cefepime (Maxipime) or carbapenem (imipenem or meropenem)
28
Scalded skin syndrome is most common in ____ and _____. Why?
infants and young children.
Transmitted via birth canal or
Hands of adult carriers
29
What is scalded skin syndrome due to ?
S. aureus toxins
30
Widespread bullae with sloughing
Epidermis peels easily
Fever, malaise
Can lead to sepsis & electrolyte abnormalities
What are the s/s of scalded skin syndrome?
31
What is the abx treatment for MSSA scalded skin syndrome
MSSA- nafcillin or oxacillin
32
What is the abx treatment for MRSA scalded skin syndrome
High risk of MRSA- vancomycin
33
How do you confirm your dx of scalded skin syndrome?
skin biopsy and culture
34
Staphylococcal Food Poisoning is due to ??? What are the s/s?
ingestion of the S. aureus exotoxin
N/V/D, abdominal cramps: 2-8 hours after ingestion
35
Beta-hemolytic strep group A is known as _____
S. pyogenes
36
Beta-hemolytic strep group B is known as _____
S. agalactiae
37
Beta-hemolytic strep group D is known as _____
S. bovis
38
Which strep group is most common in pharyngitis?
S. pyogenes- Group A
39
Whichh strep group is most common in skin infections?
pyogenes- Group A
40
Which strep group is most common in normal vaginal and intestinal flora?
Group B: S. agala
41
Which strep group can cause septic abortion & illness in neonates?
Group B
42
Which strep group is most common in prosthetic valves and endocarditis?
S. bovis (group D)
43
What are the common causes (not specific bacteria) of pharyngitis?
Strep throat
Peritonsillar abscess
Scarlet fever
44
What are the common causes (not specific bacteria) of skin infections?
Impetigo
Erysipelas
Cellulitis
45
What can cause delayed systemic complications of GABHS?
Rheumatic fever
Acute glomerulonephritis
46
Strep Pyogenes (GABHS) - Pharyngitis is most common in what age population?
Most common between ages of 5 and 15
47
Abrupt onset fever, malaise, nausea
Sore throat, odynophagia
Tonsillar hypertrophy with erythema
Tonsillar exudates possible
Beefy red uvula
Palatal petechiae
Tender anterior cervical lymphadenopathy
May have sandpaper rash
What are some common s/s of Strep Pyogenes (GABHS) - Pharyngitis?
48
What are the steps to diagnosing strep pyogenes?
Diagnosis made by clinical presentation
then
rapid strep test
49
What do you do if you suspect a bacterial infection but the rapid strep test is negative?
perform throat culture if high suspicion of bacterial infection
50
What is the treatment of choice for a strep GABHS infection?
benzathine PCN G (IM)
or
penicillin VK (oral)
or
amoxicillin
51
What do you prescribe for a strep infection to a pt with a PCN allergy?
Cephalosporin
52
What is Scarlet fever caused by?
producing exotoxin may cause scarlet fever in susceptible persons
53
Describe the rash of a scarlet fever pt?
Diffusely erythematous rash resembling a sunburn with superimposed fine red papules (“sandpaper rash”)
Blanches on pressure, may become petechial, and fades in 2–5 days, leaving a fine desquamation
Face is flushed, with circumoral pallor
Tongue is coated with enlarged red papillae (“strawberry tongue”)
54
What abx have strep become resist to?
macrolides aka Z- pack aka arithromycin
55
A focal, vesicular, pustular lesions with a thick, honey-colored crust with a "stuck-on" appearance
What is the classic presentation of impetigo?
56
What two bateria can impetigo be caused by?
GABHS Strep pyogenes
S. aureus
57
What is the treatment for impetigo if you do NOT suspect MRSA?
topical mupirocin (Bactroban)
cephalexin (Keflex)
dicloxacillin
58
What is the treatment for impetigo if you DO suspect MRSA?
sulfamethoxazole/trimethoprim (Bactrim)
doxycycline
clindamycin
59
_____ A painful superficial cellulitis with dermal lymphatic involvement that frequently involves the face. What is the most common pt population?
erysipelas
older people
60
What two bacteria are erysipelas caused by?
GABHS Strep pyogenes
S. aureus
61
What is the outpatient treatment for erysipelas w/o systemic involvement?
*penicillin - Pen VK
*amoxicillin
dicloxacillin
cephalexin
clindamycin / erythromycin
62
What is the inpatient treatment for erysipelas WITH systemic involvement?
vancomycin if severe and S. aureus suspected
cefazolin (Ancef)
ceftriaxone (Rocephin)
clindamycin
63
What bacteria is cellulitis caused by?
GABHS or S. aureus
64
How do you treat cellulitis?
Empiric treatment directed at coverage for both organisms and based on severity of infection
65
What pt population is Necrotizing fasciitis commonly found in?
Common in IV drug users
66
______ is routinely screened for during pregnancy, may lead to neonatal sepsis
Strep Agalactiae – Group B Strep
67
If a pregnant pt treats positive for Strep Agalactiae – Group B Strep what do you do?
treat prophylaxicaly with PCN G or ampicillin
cefazolin (Ancef)
Alternative - clindamycin or vancomycin
68
Upper and lower respiratory tract infections are associated with what bacteria?
S. pneumoniae
incomplete hemolytic (alpha-hemolytic) Strep
69
meningeal infections are associated with what bacteria?
S. pneumoniae
70
normal oral flora is what kind of bacteria?
S. viridans
71
endocarditis of a native valve is associated with _______
S. viridans
72
________ is the #1 cause of meningitis and #1 cause of CAP
S. pneumoniae
73
_____ are colonized in the respiratory tract and spread via airborne droplets
Strep Pneumoniae
74
**What are 5 common diseases associated with Strep Pneumoniae?
**Otitis media
**Sinusitis
**Pneumonia
Meningitis
Endocarditis
75
**What are the 3 common causes of acute otitis media? (Name the bacteria)
S. pneumoniae
M. catarrhalis
H. influenzae
76
Otitis media is most common in children between ____ and ____
2 and 14
77
What are some risk factors for otitis media?
smoking in the household
Family history
Bottle feeding
78
What are some s/s of otitis media?
Otalgia (pulling at ear), hearing loss
Fever, nausea, vomiting, irritability, Erythematous, bulging TM
Absence/displacement of light reflex, poor mobility
Otorrhea with TM rupture
79
What is the treatment for otitis media?
Amoxicillin 80-90mg for 10 days
Augementin
Omnicef
80
How does acute sinusitis commonly start out?
starts out as viral
81
Name 5 bacteria that can cause acute sinusitis
S. pneumoniae
S. aureus
H. influenzae
M. catarrhalis
82
What are some risk factors for acute sinusitis?
Allergic rhinitis
Structural abnormalities
Nasal polyps
83
What are some s/s of acute sinusitis?
Purulent rhinorrhea/PND
Sinus pressure/HA
Nasal congestion
Erythematous, swollen nasal turbinates and mucosa
Maxillary/frontal sinus pressure
84
What is first line abx for acute sinusitis?
Augementin
Doxy
Clindamycin
85
_____ most common cause of CAP (⅔ of bacterial isolates in CAP)
S. pneumoniae
86
High fever, chills
Early onset rigors (shaking chill)
Productive cough
Rust colored sputum
Shortness of breath
Pleuritic chest pain
**Bronchial breath sounds early, then crackles in affected lobe ISOLATED IN ONE LUNG AREA**
What are some s/s of pneumonoccal pneumonia?
87
When would you need to obtain sputum culture on a patient with suspected Pneumococcal Pneumonia?
in an inpatient setting and/or if they have comorbidities
DO NOT NEED TO OBTAIN SPUTUM CULTURE IN OTHERWISE HEALTHY OUTPATIENT TREATMENT
88
How do you dx Pneumococcal Pneumonia?
chest x ray
89
what is the treatment for Pneumococcal Pneumonia?
Determine the need for hospitalization: Pneumonia Severity Index
Empiric antibiotic treatment
90
What is first line outpatient treatment for Pneumococcal Pneumonia?
amoxicillin
doxycycline
azithromycin (Zithromax) - only in areas w/ <25% resistance
91
When treating Pneumococcal Pneumonia in a patient with COPD/comorbidities or with recent antibiotic treatment for pneumonia within the last 3 months. What is first line?
levofloxacin (Levaquin)
Combo:
{amoxicillin/clavulanate (Augmentin) or cephalosporin} + {Zmax or doxycycline}
92
What is the treatment for Pneumococcal Pneumonia INPATIENT
TREATMENT for a pt with comorbities?
levofloxacin (Levaquin)
or
macrolide (Zmax) + beta-lactam (amoxicillin or can use ceftriaxone)
93
How do you determine if a Pneumococcal Pneumonia pt is in or out pt?
94
What questions are on the CURB 65 screening? ___ or higher needs to be inpatient
Confusion
BUN > 19
Respiratory Rate greater or equal to 30
Systolic BP < 90 or Diastolic < or equal to 60
65 years old or older
2 points or higher
95
How do you prevent Pneumococcal Pneumonia?
Pneumococcal Vaccine
96
meningitis in a patient who is ≥1 month old - <3 months old with be caused by _____
Group B strep
97
meningitis in a patient who is ≥3-month-old - <10 y/o with be caused by _____
S. pneumoniae
98
meningitis in a patient who is ≥10 y/o - <19 y/o with be caused by _____
Neisseria meningitidis
99
What kind of bacteria is associated with meningitis and a penetrating head trauma?
S. aureus
100
What are the 3 types of bacteria associated with meningitis in adults?
S. pneumoniae
S. aureus
N. meningitidis (less common here)
101
What are the 3 types of bacteria associated with meningitis in elderly pts?
S. pneumoniae
S. aureus
Listeria monocytogenes
102
If the patient is immunocompromised and has meningitis, _____, ____ and _____ must also be considered
Pseudomonas, Listeria, and Gram -
103
What are two enterococcus species?
E. faecalis
E. faecium
104
____ are a normal part of the intestinal flora
enterococcus
105
Name some common infections that are commonly associated with enterococcus.
UTI
Bacteremia
Endocarditis
Intra-abdominal infections
Wound infections
106
What is the treatment for endocarditis?
ampicillin + gentamicin
107
What is the treatment for enterococcus
skin/wound/UTI infections?
ampicillin or vancomycin
108
What is the treatment for VRE?
linezolid
daptomycin
109
Name three gram + rods
Bacillus
Listeria
Corynebacterium
110
What is the disease associated with B. anthracis?
anthrax
111
What is the disease associated with B. cereus?
food poisoning
112
_____ Encapsulated, toxin producing bacteria
Bacillus Anthracis
113
What are the 3 forms of Bacillus Anthracis? What is the most common form? Most fatal form?
Cutaneous- most common
Ingestion
Inhalation - Most fatal
114
Painless black eschar
Regional adenopathy
Fever, malaise, HA
Occurs within 2 weeks of exposure to toxin
What are the s/s of cutaneous Bacillus Anthracis?
115
What causes ingested Bacillus anthracis?
inadequately cooked meat in animals infected with organism
116
Fever, N/V, bloody diarrhea
Ingested spores cause lesions and bleeding in GI tract
GI bleeding
Ulcerations from oral mucosa throughout intestine
Obstruction
Perforation
What is the presentation of ingested Bacillus anthracis?
117
Insidious onset of flu-like symptoms
Progresses to chest pain and severe respiratory distress
Severe hypoxemia
Shock
Associated mediastinitis and pleural effusion
Can lead to septicemia and spread to meninges
What is the presentation of inhaled Bacillus anthracis?
118
How do you dx Bacillus anthracis?
Culture/biopsy
Gram stain
Nasal swab for spores if suspect inhalation
CXR if pulmonary symptoms
LP if systemic
119
What is the treatment for Bacillus anthracis?
Ciprofloxacin
doxycycline
120
Listeria monocytogenes most infects ____, ____ and _____
neonates, elderly and immunocompromised persons
121
Listeria monocytogenes is important during pregnancy because ___ and ____
Spontaneous abortion
Neonatal meningitis
122
Bacteremia
High fever
Multi-organ involvement
Meningitis
Dermatitis
Oculoglandular symptoms
Retinitis
Lymph node enlargement
What is the presentation of Listeria Monocytogenes?
123
How do you dx Listeria monocytogenes?
Blood culture
CSF
124
What is the treatment for Listeriosis?
ampicillin and gentamicin - synergistic first few days, then
amoxicillin - outpatient for at least 2-3 weeks
125
Corynebacterium Diphtheriae clinical pearl is _____
gray membrane covers the tonsils and pharynx.
126
a gray membrane covers the tonsils and pharynx. Mild sore throat, fever, and malaise are followed by toxemia and prostration.
Nasal infection – produces few symptoms other than a nasal discharge.
What are the s/s of Corynebacterium Diphtheriae?
127
What is the treatment for Corynebacterium Diphtheriae?
Diphtheria equine antitoxin
PCN or erythromycin
128
Susceptible persons exposed to Corynebacterium Diphtheriae
need to be treated with _____
should receive a booster dose of diphtheria toxoid as well as a course of PCN or erythromycin
129
What are the gram - cocci
Acinetobacter
Moraxella
Neisseria
130
______ Opportunistic infections in hospitalized, critically ill and immunocompromised patients
acinetobacter infections
131
_____ are the most common infection around trach sites
Acinetobacter Infections
132
Moraxella catarrhalis is common in _____, ______ and ______ (conditions)
Acute otitis media (AOM)
Acute and chronic sinusitis
COPD exacerbations
133
________ are spread via person to person and outbreaks are common in military camps, college dorms and schools/daycares.
Meningococcal Meningitis
134
Fever, HA, stiff neck
N/V, photophobia, lethargy
Changes in mental status
Maculopapular rash, petechiae
Positive Kernig and Brudzinski signs
Can progress to meningococcemia with organ failure, shock, and DIC
What is the clinical presentation of Meningococcal Meningitis?
135
How do you dx Meningococcal Meningitis?
gram stain and culture
lumbar puncture with CSF analysis
blood
136
What is the treatment for Meningococcal Meningitis?
PCN G
ceftriaxone (Rocephin)
Close contacts to receive prophylactic antibiotics
137
_____ covers strains A C Y W and B
Penbraya:
Meningococcal Meningitis vaccine
138
May be asymptomatic
Yellow-green purulent discharge
Erythematous cervix
What is the clinical presentation of Neisseria gonorrhoeae?
139
How do you dx Neisseria Gonorrhoeae?
gram stain and culture
140
What is the treatment for Neisseria Gonorrhoeae? Do you need to report it to the local health department?
ceftriaxone (Rocephin) - single dose
YES!
141
_____ is often found to be the cause of otitis externa, UTIs and dermatitis
Pseudomonas aeruginosa
142
_____ is the #1 pathogen in
Otitis externa
Corneal ulcers from bacterial keratitis in contact lens wearers
ICU-related pneumonia
Osteochondritis after puncture through tennis shoe
Pseudomonas
143
hot tub folliculitis is due to _____
Pseudomonas
144
**What is the outpatient treatment for Pseudomonas?
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
145
What is the inpatient treatment for Pseudomonas?
**pip/taz (Zosyn)
ceftazidime (Fortaz)
cefepime (Maxipime)
meropenem
aztreonam
146
B. pertussis causes _____
whooping cough
147
H. flu causes what 4 things?
Pneumonia
Bronchitis
OM
Sinusitis
148
Legionella causes ____
Pneumonia
149
Klebsiella causes ____ and _____
pneumonia and UTI
150
What are the 3 stages of whooping cough?
Catarrhal
Paroxysmal
Convalescent
151
What happens during the Catarrhal phase?
Insidious onset
Sneezing, coryza, cough
152
What happens during the paroxysmal phase of whooping cough?
Worsening cough
Forceful coughing fits
“Whooping” gasps for breath
153
What happens during the Convalescent stage of whooping cough?
Symptoms diminish
Cough may continue for months
154
How do you diagnosis whooping cough?
NP culture
155
What is the treatment for whooping cough?
azithromycin
156
**During whooping cough, If the patient has an allergy to azithromycin or cannot tolerate it. What is the alternative?
Bactrim
157
_____ colonize the upper respiratory tract in patients with COPD and frequently cause purulent bronchitis.
Haemophilus sp
158
_____ Classically caused by Legionella pneumophila. Commonly causes CAP
Legionnaires Disease
159
_____ is more common in immunocompromised persons, smokers, and those with chronic lung disease
Legionnaires Disease
160
Legionnaires Disease outbreaks are usually associated with what kind of conditions?
contaminated water sources, such as showerheads and faucets in patient rooms and air conditioning cooling towers
161
Scant sputum production, pleuritic chest pain, high fever, toxic appearance
focal patchy infiltrates or consolidation
How does Legionnaires Disease
usually present? What will the CXR look like?
162
What is the treatment for Legionnaires Disease?
macrolide (azithromycin, clarithromycin)
fluoroquinolone (Levaquin)
163
_____ is a normal intestinal flora that typically only causes diseases in ____, ____ and ____ type of patients
Klebsiella Pneumoniae
Alcoholics
Diabetics
HIV
164
Pneumonia symptoms - severe
SOB, pleuritic CP
Red, currant-jelly sputum
Can progress to lung abscess
** What is the clinical presentation of Klebsiella Pneumoniae?
165
How do you dx Klebsiella Pneumoniae?
CXR
sputum culture
166
What is the treatment for Klebsiella Pneumoniae?
Respiratory fluoroquinolone (Cipro/Levaquin)
Carbapenem
167
What is the bacteria associated with Traveler's diarrhea?
Escherichia Coli
168
An urgent need to defecate
Abdominal cramps
N/V
Fever
Bloating
Moderate to severe dehydration, persistent vomiting or a high fever are possible
How does traveler's diarrhea present?
169
Under what conditions would you need to give a pt with Traveler's diarrhea abxs?
severe sx or 3+ loose stools w/in 8 hrs
Cipro for 3-5 days
170
_____ most common of the campylobacter species – an important cause of diarrheal disease
C. jejuni
171
____ One of the main causes of bacterial foodborne illness
Campylobacter Jejuni
172
What is the treatment for Campylobacter Jejuni?
ciprofloxacin (Cipro) empiric tx - (increasing resistance) - single dose
azithromycin (Zithromax)
173
_____ abrupt onset of diarrhea, often with blood and mucus, associated with lower abdominal pain and cramping, and tenesmus
Shigellosis
174
What is tenesmus?
the feeling of needing to use the bathroom, even when your bowels are empty.
175
What is the treatment for Shigellosis?
Rehydration to treat hypotension is life saving in severe cases
ciprofloxacin (Cipro) - single dose
TMP-SMX DS (Bactrim)
176
How is cholera acquired?
ingestion of contaminated food or water
177
____ an acute diarrheal disease - sudden onset of severe, voluminous diarrhea – stool is liquid, gray, turbid, and without fecal odor, blood, or pus ("rice water stool")
Vibrio cholerae
178
How do you dx cholera?
Diagnosis with stool culture
Rapid onset of marked dehydration
179
What is the treatment for cholera? What do you need to order?
tetracycline / doxycycline
TMP-SMZ DS (Bactrim)
azithromycin - single dose
quinolones - Cipro
susceptibility testing
180
How do you treat non-cholerae vibrio infections?
doxy or cipro
181
What is enteric fever caused by?
by Salmonella typhi / enterica
182
During the prodromal stage of enteric fever, what would you expect to see?
malaise, HA, cough, sore throat, N/V, abdominal pain
183
Exhaustion
N/V
Abdominal cramps
Bloody “pea soup” diarrhea
HA
Rose spots
Fever
If no complications, gradual improvement over 7-10 days
Blood, stool, and urine culture positive for _____
Name some s/s of enteric fever?
184
What is the treatment for enteric fever?
ciprofloxacin (Cipro) / levofloxacin (Levaquin)
ceftriaxone (Rocephin)
azithromycin
185
Pet turtles and reptiles carry _____
salmonelle- enterocolitis
186
For a salmonella enterocolitis uncomplicated case, what do you do?
supportive care
abx do NOT hasten recovery
187
For a salmonella enterocolitis severe illness, what do you do?
ciprofloxacin
ceftriaxone
azithromycin
TMP-SMX (Bactrim)
188
What is the difference between UTI and pyelonephritis?
pyelonephritis is an untreated UTI spread to kidneys and can cause permanent kidney damage
UTI just stays in the urinary system
189
What bacteria causes most UTIs?
Escherichia coli (E coli). Also, Klebsiella, Proteus mirabilis, Enterobacter
190
What is the treatment for a UTI?
Bactrim:
nitrofurantoin
fosfomycin
cephalosporins - cephalexin / cefdinir
ciprofloxacin
191
What UTI treatments would you not want to give to a pregnant pt?
Bactrim: not in 1st trimester
Nitrofurantoin: increased risk of jaundice in the last trimester
192
What abx would you want to give to a last trimester UTI pt?
cephalosporins- cephalexin/cefdinir
193
What is the treatment for pyelonephritis?
ciprofloxacin
levofloxacin (Levaquin)
ceftriaxone X 1 dose plus one of the following Bactrim / Augmentin / or Omnicef
194
What bacteria causes bubonic plague?
Yersinia pestis
195
What are the 3 main forms of the bubonic plague?
Pneumonic
Septicemia
Bubonic Plague
196
Profoundly ill - sudden onset of high fever, malaise, severe myalgias, prostration
Bubo**
Tachypnea, productive cough, blood-tinged sputum, cyanosis occur with pneumonia
With hematogenous spread, the patient may rapidly become toxic and comatose, with purpuric spots (black plague) on the skin
What are s/s of the bubonic plague?
197
What is the treatment for bubonic plague?
streptomycin
gentamicin
doxycycline
fluoroquinolone
198
What do you give a pt who has been in contact with a person with confirmed bubonic plague?
Give prophylactic therapy to any person who encountered the patient (doxycycline and ciprofloxacin x 7 days)
199
Tularemia is caused by _______
Francisella tularensis
200
_____ is associated with history of contact with rabbits, rodents, and ticks in endemic areas
Tularemia
201
Fever, HA, nausea, prostration. Regional lymphadenopathy. Papule progressing to ulcer at site of inoculation
What does tularemia present like?
202
What is the treatment of tularemia?
streptomycin
gentamicin
doxycycline
fluoroquinolones
203
**_____ is considered a fever in Fahrenheit
100.4 degrees
204
____ is considered a fever in celsius
38 degrees
205
What is the definition of a fever of unknown origin?
Fever >38.3 degrees C (101.9 degrees F) on several occasions taken with an oral thermometer
lasts longer than 3 weeks
Failure to make diagnosis despite 1 week of inpatient investigation
206
What are some common causes of noninfectious fever of unknown origin.
Connective Tissue Diseases
Vasculitis
Granulomatous Disorders
Examples: Giant cell arteritis, SLE, RA
207
What are some infectious options for fever of unknown origin?
TB, Cat-scratch, EBV
208
How do you evaluation a pt for a fever of unknown origin?
detailed HPI and ROS
Full family, social (exposure, travel, occupation, drug, sexual contact, animals, etc.), maintenance (immunizations, dental dz), surgical hx
Pattern of the fever
209
What labs need to be ordered of a FUO pt?
CBC with diff
Peripheral blood smear
CMP - along w/ Hepatitis A,B,C w/ any abnormal liver studies
ESR or SED rate
UA and Cx
Blood cultures - at least 3 sets from different sites drawn several hours apart
HIV serology
TB serology
CXR
210
What is Systemic Inflammatory Response defined as ?
having 2 or more of the following
Fever >38℃ (100.4℉) or less than 36℃ (96.8℉)
Heart rate >90 bpm
Resp rate >20 bpm or arterial carbon dioxide tension (PaCO2)<32 mmHg
Abnormal WBC
>12,000 or
<4,000 or
>10% bands
211
What is the most common cause of bacteremia?
Respiratory infection, usually a pneumonia of some sort
212
What are some sepsis risk factors?
ICU admission
Bacteremia
older than 65
immunosuppression
diabetes and cancer
CAP
previous hospitalizations
genetic factors
213
Hypotension
Elevated temperature (>38 degrees Celsius) or hypothermia
Heart rate
tachypnea
warm, flushed skin
altered mental status
absent bowel sounds
What is the clinical presentation of sepsis?
214
What is rating system associated with sepsis? What are the criteria?
qSofa score greater than or equal to 2
Resp rate ≥22 / min
Altered mentation
Systolic BP ≤100 mmHg
215
What is the treatment for sepsis?
Antibiotic therapy should be initiated within 1 hr. of suspected diagnosis
Multiple empiric antibiotics used to depend on the source of the infection
IV Fluids
vasopressors
central lines
other means of organ perfusion
216
_____ is the lowest mortality type of sepsis
UTI
217
_____ is the highest mortality type of sepsis
ischemic bowel
