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Infectious Disease > Bacterial Infections I > Flashcards

Bacterial Infections I Flashcards

1
Q

What are the gram + cocci

A
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2
Q

S. aureus
S. epidermidis
S. saprophyticus
S. lugdunensis

A

What are the 4 kinds of Staphylococcus?

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3
Q

Which staph is the most pathogenic?

A

S. aureus

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4
Q

Which staph is the most common on skin?

A

S. epidermidis

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5
Q

Which staph is responsible for hospital acquired infections?

A

S. epidermidis

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6
Q

Which staph is responsible for urinary tract infections?

A

S. saprophyticus

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7
Q

Which staph is commonly found in foreign body and prosthetic device infections?

A

S. lugdunensis

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8
Q

Which staph is coagulase positive? How does it work?

A

S. aureus

Produces enzyme = ability to clot blood

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9
Q

Which staph species are coagulase negative?

A

S. epidermidis, S. saprophyticus, S. lugdunensis

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10
Q

How is staph usually transmitted?

A

through direct tissue invasion

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11
Q

What are some additional common forms of staph?

A

Skin and soft tissue infections
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis

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12
Q

What does severe local infection sometimes lead to ?

A

bacteremia

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13
Q

**Staph exotoxin production is associated with what 3 syndromes?

A

Staphylococcal food poisoning
Toxic Shock Syndrome
Scalded Skin Syndrome

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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

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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)

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16
Q

Staph skin infection with low risk of MRSA, what abx do you give?

A

cephalexin (Keflex)
dicloxacillin

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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

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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!!

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19
Q

60% of all osteomyelitis cases caused by _____

40% is caused by _____

A

S. aureus

Strep

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20
Q

What kind of infection results from extension of deep soft tissue infection or direct inoculation (open fracture or wound)?

A

Staphylococcal Osteomyelitis

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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

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22
Q

Staphylococcal Osteomyelitis that comes back as MSSA, what is the treatment?

A

nafcillin IV / oxacillin / cefazolin

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23
Q

Staphylococcal Osteomyelitis that comes back as MRSA, what is the treatment?

A

vancomycin IV

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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

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25
Q

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

A

What is the clinical presentation of Toxic shock sydrome?

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26
Q

What do you need to monitor on a patient with TSS?

A

hepatic and renal function

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27
Q

What is the abx treatment for TSS?

A

vancomycin plus clindamycin plus 1 of the following: pip/taz or cefepime (Maxipime) or carbapenem (imipenem or meropenem)

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28
Q

Scalded skin syndrome is most common in ____ and _____. Why?

A

infants and young children.

Transmitted via birth canal or
Hands of adult carriers

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29
Q

What is scalded skin syndrome due to ?

A

S. aureus toxins

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30
Q

Widespread bullae with sloughing

Epidermis peels easily

Fever, malaise

Can lead to sepsis & electrolyte abnormalities

A

What are the s/s of scalded skin syndrome?

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31
Q

What is the abx treatment for MSSA scalded skin syndrome

A

MSSA- nafcillin or oxacillin

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32
Q

What is the abx treatment for MRSA scalded skin syndrome

A

High risk of MRSA- vancomycin

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33
Q

How do you confirm your dx of scalded skin syndrome?

A

skin biopsy and culture

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34
Q

Staphylococcal Food Poisoning is due to ??? What are the s/s?

A

ingestion of the S. aureus exotoxin

N/V/D, abdominal cramps: 2-8 hours after ingestion

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35
Q

Beta-hemolytic strep group A is known as _____

A

S. pyogenes

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36
Q

Beta-hemolytic strep group B is known as _____

A

S. agalactiae

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37
Q

Beta-hemolytic strep group D is known as _____

A

S. bovis

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38
Q

Which strep group is most common in pharyngitis?

A

S. pyogenes- Group A

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39
Q

Whichh strep group is most common in skin infections?

A

pyogenes- Group A

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40
Q

Which strep group is most common in normal vaginal and intestinal flora?

A

Group B: S. agala

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41
Q

Which strep group can cause septic abortion & illness in neonates?

A

Group B

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42
Q

Which strep group is most common in prosthetic valves and endocarditis?

A

S. bovis (group D)

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43
Q

What are the common causes (not specific bacteria) of pharyngitis?

A

Strep throat

Peritonsillar abscess

Scarlet fever

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44
Q

What are the common causes (not specific bacteria) of skin infections?

A

Impetigo

Erysipelas

Cellulitis

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45
Q

What can cause delayed systemic complications of GABHS?

A

Rheumatic fever
Acute glomerulonephritis

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46
Q

Strep Pyogenes (GABHS) - Pharyngitis is most common in what age population?

A

Most common between ages of 5 and 15

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47
Q

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

A

What are some common s/s of Strep Pyogenes (GABHS) - Pharyngitis?

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48
Q

What are the steps to diagnosing strep pyogenes?

A

Diagnosis made by clinical presentation

then

rapid strep test

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49
Q

What do you do if you suspect a bacterial infection but the rapid strep test is negative?

A

perform throat culture if high suspicion of bacterial infection

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50
Q

What is the treatment of choice for a strep GABHS infection?

A

benzathine PCN G (IM)
or
penicillin VK (oral)
or
amoxicillin

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51
Q

What do you prescribe for a strep infection to a pt with a PCN allergy?

A

Cephalosporin

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52
Q

What is Scarlet fever caused by?

A

producing exotoxin may cause scarlet fever in susceptible persons

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53
Q

Describe the rash of a scarlet fever pt?

A

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”)

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54
Q

What abx have strep become resist to?

A

macrolides aka Z- pack aka arithromycin

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55
Q

A focal, vesicular, pustular lesions with a thick, honey-colored crust with a “stuck-on” appearance

A

What is the classic presentation of impetigo?

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56
Q

What two bateria can impetigo be caused by?

A

GABHS Strep pyogenes

S. aureus

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57
Q

What is the treatment for impetigo if you do NOT suspect MRSA?

A

topical mupirocin (Bactroban)
cephalexin (Keflex)
dicloxacillin

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58
Q

What is the treatment for impetigo if you DO suspect MRSA?

A

sulfamethoxazole/trimethoprim (Bactrim)
doxycycline
clindamycin

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59
Q

_____ A painful superficial cellulitis with dermal lymphatic involvement that frequently involves the face. What is the most common pt population?

A

erysipelas

older people

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60
Q

What two bacteria are erysipelas caused by?

A

GABHS Strep pyogenes

S. aureus

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61
Q

What is the outpatient treatment for erysipelas w/o systemic involvement?

A

*penicillin - Pen VK
*amoxicillin
dicloxacillin
cephalexin
clindamycin / erythromycin

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62
Q

What is the inpatient treatment for erysipelas WITH systemic involvement?

A

vancomycin if severe and S. aureus suspected
cefazolin (Ancef)
ceftriaxone (Rocephin)
clindamycin

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63
Q

What bacteria is cellulitis caused by?

A

GABHS or S. aureus

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64
Q

How do you treat cellulitis?

A

Empiric treatment directed at coverage for both organisms and based on severity of infection

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65
Q

What pt population is Necrotizing fasciitis commonly found in?

A

Common in IV drug users

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66
Q

______ is routinely screened for during pregnancy, may lead to neonatal sepsis

A

Strep Agalactiae – Group B Strep

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67
Q

If a pregnant pt treats positive for Strep Agalactiae – Group B Strep what do you do?

A

treat prophylaxicaly with PCN G or ampicillin
cefazolin (Ancef)

Alternative - clindamycin or vancomycin

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68
Q

Upper and lower respiratory tract infections are associated with what bacteria?

A

S. pneumoniae

incomplete hemolytic (alpha-hemolytic) Strep

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69
Q

meningeal infections are associated with what bacteria?

A

S. pneumoniae

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70
Q

normal oral flora is what kind of bacteria?

A

S. viridans

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71
Q

endocarditis of a native valve is associated with _______

A

S. viridans

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72
Q

________ is the #1 cause of meningitis and #1 cause of CAP

A

S. pneumoniae

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73
Q

_____ are colonized in the respiratory tract and spread via airborne droplets

A

Strep Pneumoniae

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74
Q

**What are 5 common diseases associated with Strep Pneumoniae?

A

**Otitis media
**Sinusitis
**Pneumonia
Meningitis
Endocarditis

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75
Q

**What are the 3 common causes of acute otitis media? (Name the bacteria)

A

S. pneumoniae
M. catarrhalis
H. influenzae

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76
Q

Otitis media is most common in children between ____ and ____

A

2 and 14

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77
Q

What are some risk factors for otitis media?

A

smoking in the household
Family history
Bottle feeding

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78
Q

What are some s/s of otitis media?

A

Otalgia (pulling at ear), hearing loss
Fever, nausea, vomiting, irritability, Erythematous, bulging TM
Absence/displacement of light reflex, poor mobility
Otorrhea with TM rupture

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79
Q

What is the treatment for otitis media?

A

Amoxicillin 80-90mg for 10 days
Augementin
Omnicef

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80
Q

How does acute sinusitis commonly start out?

A

starts out as viral

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81
Q

Name 5 bacteria that can cause acute sinusitis

A

S. pneumoniae
S. aureus
H. influenzae
M. catarrhalis

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82
Q

What are some risk factors for acute sinusitis?

A

Allergic rhinitis
Structural abnormalities
Nasal polyps

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83
Q

What are some s/s of acute sinusitis?

A

Purulent rhinorrhea/PND
Sinus pressure/HA
Nasal congestion
Erythematous, swollen nasal turbinates and mucosa
Maxillary/frontal sinus pressure

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84
Q

What is first line abx for acute sinusitis?

A

Augementin
Doxy
Clindamycin

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85
Q

_____ most common cause of CAP (⅔ of bacterial isolates in CAP)

A

S. pneumoniae

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86
Q

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

A

What are some s/s of pneumonoccal pneumonia?

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87
Q

When would you need to obtain sputum culture on a patient with suspected Pneumococcal Pneumonia?

A

in an inpatient setting and/or if they have comorbidities

DO NOT NEED TO OBTAIN SPUTUM CULTURE IN OTHERWISE HEALTHY OUTPATIENT TREATMENT

88
Q

How do you dx Pneumococcal Pneumonia?

A

chest x ray

89
Q

what is the treatment for Pneumococcal Pneumonia?

A

Determine the need for hospitalization: Pneumonia Severity Index
Empiric antibiotic treatment

90
Q

What is first line outpatient treatment for Pneumococcal Pneumonia?

A

amoxicillin
doxycycline
azithromycin (Zithromax) - only in areas w/ <25% resistance

91
Q

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?

A

levofloxacin (Levaquin)
Combo:
{amoxicillin/clavulanate (Augmentin) or cephalosporin} + {Zmax or doxycycline}

92
Q

What is the treatment for Pneumococcal Pneumonia INPATIENT
TREATMENT for a pt with comorbities?

A

levofloxacin (Levaquin)
or
macrolide (Zmax) + beta-lactam (amoxicillin or can use ceftriaxone)

93
Q

How do you determine if a Pneumococcal Pneumonia pt is in or out pt?

94
Q

What questions are on the CURB 65 screening? ___ or higher needs to be inpatient

A

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
Q

How do you prevent Pneumococcal Pneumonia?

A

Pneumococcal Vaccine

96
Q

meningitis in a patient who is ≥1 month old - <3 months old with be caused by _____

A

Group B strep

97
Q

meningitis in a patient who is ≥3-month-old - <10 y/o with be caused by _____

A

S. pneumoniae

98
Q

meningitis in a patient who is ≥10 y/o - <19 y/o with be caused by _____

A

Neisseria meningitidis

99
Q

What kind of bacteria is associated with meningitis and a penetrating head trauma?

100
Q

What are the 3 types of bacteria associated with meningitis in adults?

A

S. pneumoniae
S. aureus
N. meningitidis (less common here)

101
Q

What are the 3 types of bacteria associated with meningitis in elderly pts?

A

S. pneumoniae
S. aureus
Listeria monocytogenes

102
Q

If the patient is immunocompromised and has meningitis, _____, ____ and _____ must also be considered

A

Pseudomonas, Listeria, and Gram -

103
Q

What are two enterococcus species?

A

E. faecalis

E. faecium

104
Q

____ are a normal part of the intestinal flora

A

enterococcus

105
Q

Name some common infections that are commonly associated with enterococcus.

A

UTI
Bacteremia
Endocarditis
Intra-abdominal infections
Wound infections

106
Q

What is the treatment for endocarditis?

A

ampicillin + gentamicin

107
Q

What is the treatment for enterococcus
skin/wound/UTI infections?

A

ampicillin or vancomycin

108
Q

What is the treatment for VRE?

A

linezolid
daptomycin

109
Q

Name three gram + rods

A

Bacillus
Listeria
Corynebacterium

110
Q

What is the disease associated with B. anthracis?

111
Q

What is the disease associated with B. cereus?

A

food poisoning

112
Q

_____ Encapsulated, toxin producing bacteria

A

Bacillus Anthracis

113
Q

What are the 3 forms of Bacillus Anthracis? What is the most common form? Most fatal form?

A

Cutaneous- most common
Ingestion
Inhalation - Most fatal

114
Q

Painless black eschar
Regional adenopathy
Fever, malaise, HA
Occurs within 2 weeks of exposure to toxin

A

What are the s/s of cutaneous Bacillus Anthracis?

115
Q

What causes ingested Bacillus anthracis?

A

inadequately cooked meat in animals infected with organism

116
Q

Fever, N/V, bloody diarrhea
Ingested spores cause lesions and bleeding in GI tract
GI bleeding
Ulcerations from oral mucosa throughout intestine
Obstruction
Perforation

A

What is the presentation of ingested Bacillus anthracis?

117
Q

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

A

What is the presentation of inhaled Bacillus anthracis?

118
Q

How do you dx Bacillus anthracis?

A

Culture/biopsy
Gram stain
Nasal swab for spores if suspect inhalation
CXR if pulmonary symptoms
LP if systemic

119
Q

What is the treatment for Bacillus anthracis?

A

Ciprofloxacin
doxycycline

120
Q

Listeria monocytogenes most infects ____, ____ and _____

A

neonates, elderly and immunocompromised persons

121
Q

Listeria monocytogenes is important during pregnancy because ___ and ____

A

Spontaneous abortion
Neonatal meningitis

122
Q

Bacteremia
High fever
Multi-organ involvement
Meningitis
Dermatitis
Oculoglandular symptoms
Retinitis
Lymph node enlargement

A

What is the presentation of Listeria Monocytogenes?

123
Q

How do you dx Listeria monocytogenes?

A

Blood culture

CSF

124
Q

What is the treatment for Listeriosis?

A

ampicillin and gentamicin - synergistic first few days, then
amoxicillin - outpatient for at least 2-3 weeks

125
Q

Corynebacterium Diphtheriae clinical pearl is _____

A

gray membrane covers the tonsils and pharynx.

126
Q

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.

A

What are the s/s of Corynebacterium Diphtheriae?

127
Q

What is the treatment for Corynebacterium Diphtheriae?

A

Diphtheria equine antitoxin

PCN or erythromycin

128
Q

Susceptible persons exposed to Corynebacterium Diphtheriae
need to be treated with _____

A

should receive a booster dose of diphtheria toxoid as well as a course of PCN or erythromycin

129
Q

What are the gram - cocci

A

Acinetobacter
Moraxella
Neisseria

130
Q

______ Opportunistic infections in hospitalized, critically ill and immunocompromised patients

A

acinetobacter infections

131
Q

_____ are the most common infection around trach sites

A

Acinetobacter Infections

132
Q

Moraxella catarrhalis is common in _____, ______ and ______ (conditions)

A

Acute otitis media (AOM)
Acute and chronic sinusitis
COPD exacerbations

133
Q

________ are spread via person to person and outbreaks are common in military camps, college dorms and schools/daycares.

A

Meningococcal Meningitis

134
Q

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

A

What is the clinical presentation of Meningococcal Meningitis?

135
Q

How do you dx Meningococcal Meningitis?

A

gram stain and culture
lumbar puncture with CSF analysis
blood

136
Q

What is the treatment for Meningococcal Meningitis?

A

PCN G
ceftriaxone (Rocephin)

Close contacts to receive prophylactic antibiotics

137
Q

_____ covers strains A C Y W and B

A

Penbraya:
Meningococcal Meningitis vaccine

138
Q

May be asymptomatic
Yellow-green purulent discharge
Erythematous cervix

A

What is the clinical presentation of Neisseria gonorrhoeae?

139
Q

How do you dx Neisseria Gonorrhoeae?

A

gram stain and culture

140
Q

What is the treatment for Neisseria Gonorrhoeae? Do you need to report it to the local health department?

A

ceftriaxone (Rocephin) - single dose

YES!

141
Q

_____ is often found to be the cause of otitis externa, UTIs and dermatitis

A

Pseudomonas aeruginosa

142
Q

_____ 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

A

Pseudomonas

143
Q

hot tub folliculitis is due to _____

A

Pseudomonas

144
Q

**What is the outpatient treatment for Pseudomonas?

A

ciprofloxacin (Cipro)
levofloxacin (Levaquin)

145
Q

What is the inpatient treatment for Pseudomonas?

A

**pip/taz (Zosyn)
ceftazidime (Fortaz)
cefepime (Maxipime)
meropenem
aztreonam

146
Q

B. pertussis causes _____

A

whooping cough

147
Q

H. flu causes what 4 things?

A

Pneumonia
Bronchitis
OM
Sinusitis

148
Q

Legionella causes ____

149
Q

Klebsiella causes ____ and _____

A

pneumonia and UTI

150
Q

What are the 3 stages of whooping cough?

A

Catarrhal
Paroxysmal
Convalescent

151
Q

What happens during the Catarrhal phase?

A

Insidious onset
Sneezing, coryza, cough

152
Q

What happens during the paroxysmal phase of whooping cough?

A

Worsening cough
Forceful coughing fits
“Whooping” gasps for breath

153
Q

What happens during the Convalescent stage of whooping cough?

A

Symptoms diminish
Cough may continue for months

154
Q

How do you diagnosis whooping cough?

A

NP culture

155
Q

What is the treatment for whooping cough?

A

azithromycin

156
Q

**During whooping cough, If the patient has an allergy to azithromycin or cannot tolerate it. What is the alternative?

157
Q

_____ colonize the upper respiratory tract in patients with COPD and frequently cause purulent bronchitis.

A

Haemophilus sp

158
Q

_____ Classically caused by Legionella pneumophila. Commonly causes CAP

A

Legionnaires Disease

159
Q

_____ is more common in immunocompromised persons, smokers, and those with chronic lung disease

A

Legionnaires Disease

160
Q

Legionnaires Disease outbreaks are usually associated with what kind of conditions?

A

contaminated water sources, such as showerheads and faucets in patient rooms and air conditioning cooling towers

161
Q

Scant sputum production, pleuritic chest pain, high fever, toxic appearance

focal patchy infiltrates or consolidation

A

How does Legionnaires Disease
usually present? What will the CXR look like?

162
Q

What is the treatment for Legionnaires Disease?

A

macrolide (azithromycin, clarithromycin)
fluoroquinolone (Levaquin)

163
Q

_____ is a normal intestinal flora that typically only causes diseases in ____, ____ and ____ type of patients

A

Klebsiella Pneumoniae

Alcoholics
Diabetics
HIV

164
Q

Pneumonia symptoms - severe
SOB, pleuritic CP
Red, currant-jelly sputum
Can progress to lung abscess

A

** What is the clinical presentation of Klebsiella Pneumoniae?

165
Q

How do you dx Klebsiella Pneumoniae?

A

CXR
sputum culture

166
Q

What is the treatment for Klebsiella Pneumoniae?

A

Respiratory fluoroquinolone (Cipro/Levaquin)

Carbapenem

167
Q

What is the bacteria associated with Traveler’s diarrhea?

A

Escherichia Coli

168
Q

An urgent need to defecate
Abdominal cramps
N/V
Fever
Bloating
Moderate to severe dehydration, persistent vomiting or a high fever are possible

A

How does traveler’s diarrhea present?

169
Q

Under what conditions would you need to give a pt with Traveler’s diarrhea abxs?

A

severe sx or 3+ loose stools w/in 8 hrs

Cipro for 3-5 days

170
Q

_____ most common of the campylobacter species – an important cause of diarrheal disease

171
Q

____ One of the main causes of bacterial foodborne illness

A

Campylobacter Jejuni

172
Q

What is the treatment for Campylobacter Jejuni?

A

ciprofloxacin (Cipro) empiric tx - (increasing resistance) - single dose
azithromycin (Zithromax)

173
Q

_____ abrupt onset of diarrhea, often with blood and mucus, associated with lower abdominal pain and cramping, and tenesmus

A

Shigellosis

174
Q

What is tenesmus?

A

the feeling of needing to use the bathroom, even when your bowels are empty.

175
Q

What is the treatment for Shigellosis?

A

Rehydration to treat hypotension is life saving in severe cases
ciprofloxacin (Cipro) - single dose
TMP-SMX DS (Bactrim)

176
Q

How is cholera acquired?

A

ingestion of contaminated food or water

177
Q

____ 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”)

A

Vibrio cholerae

178
Q

How do you dx cholera?

A

Diagnosis with stool culture
Rapid onset of marked dehydration

179
Q

What is the treatment for cholera? What do you need to order?

A

tetracycline / doxycycline
TMP-SMZ DS (Bactrim)
azithromycin - single dose
quinolones - Cipro

susceptibility testing

180
Q

How do you treat non-cholerae vibrio infections?

A

doxy or cipro

181
Q

What is enteric fever caused by?

A

by Salmonella typhi / enterica

182
Q

During the prodromal stage of enteric fever, what would you expect to see?

A

malaise, HA, cough, sore throat, N/V, abdominal pain

183
Q

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 _____

A

Name some s/s of enteric fever?

184
Q

What is the treatment for enteric fever?

A

ciprofloxacin (Cipro) / levofloxacin (Levaquin)
ceftriaxone (Rocephin)
azithromycin

185
Q

Pet turtles and reptiles carry _____

A

salmonelle- enterocolitis

186
Q

For a salmonella enterocolitis uncomplicated case, what do you do?

A

supportive care

abx do NOT hasten recovery

187
Q

For a salmonella enterocolitis severe illness, what do you do?

A

ciprofloxacin
ceftriaxone
azithromycin
TMP-SMX (Bactrim)

188
Q

What is the difference between UTI and pyelonephritis?

A

pyelonephritis is an untreated UTI spread to kidneys and can cause permanent kidney damage

UTI just stays in the urinary system

189
Q

What bacteria causes most UTIs?

A

Escherichia coli (E coli). Also, Klebsiella, Proteus mirabilis, Enterobacter

190
Q

What is the treatment for a UTI?

A

Bactrim:
nitrofurantoin
fosfomycin
cephalosporins - cephalexin / cefdinir
ciprofloxacin

191
Q

What UTI treatments would you not want to give to a pregnant pt?

A

Bactrim: not in 1st trimester
Nitrofurantoin: increased risk of jaundice in the last trimester

192
Q

What abx would you want to give to a last trimester UTI pt?

A

cephalosporins- cephalexin/cefdinir

193
Q

What is the treatment for pyelonephritis?

A

ciprofloxacin
levofloxacin (Levaquin)
ceftriaxone X 1 dose plus one of the following Bactrim / Augmentin / or Omnicef

194
Q

What bacteria causes bubonic plague?

A

Yersinia pestis

195
Q

What are the 3 main forms of the bubonic plague?

A

Pneumonic
Septicemia
Bubonic Plague

196
Q

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

A

What are s/s of the bubonic plague?

197
Q

What is the treatment for bubonic plague?

A

streptomycin
gentamicin
doxycycline
fluoroquinolone

198
Q

What do you give a pt who has been in contact with a person with confirmed bubonic plague?

A

Give prophylactic therapy to any person who encountered the patient (doxycycline and ciprofloxacin x 7 days)

199
Q

Tularemia is caused by _______

A

Francisella tularensis

200
Q

_____ is associated with history of contact with rabbits, rodents, and ticks in endemic areas

201
Q

Fever, HA, nausea, prostration. Regional lymphadenopathy. Papule progressing to ulcer at site of inoculation

A

What does tularemia present like?

202
Q

What is the treatment of tularemia?

A

streptomycin
gentamicin
doxycycline
fluoroquinolones

203
Q

**_____ is considered a fever in Fahrenheit

A

100.4 degrees

204
Q

____ is considered a fever in celsius

A

38 degrees

205
Q

What is the definition of a fever of unknown origin?

A

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
Q

What are some common causes of noninfectious fever of unknown origin.

A

Connective Tissue Diseases
Vasculitis
Granulomatous Disorders
Examples: Giant cell arteritis, SLE, RA

207
Q

What are some infectious options for fever of unknown origin?

A

TB, Cat-scratch, EBV

208
Q

How do you evaluation a pt for a fever of unknown origin?

A

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
Q

What labs need to be ordered of a FUO pt?

A

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
Q

What is Systemic Inflammatory Response defined as ?

A

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
Q

What is the most common cause of bacteremia?

A

Respiratory infection, usually a pneumonia of some sort

212
Q

What are some sepsis risk factors?

A

ICU admission
Bacteremia
older than 65
immunosuppression
diabetes and cancer
CAP
previous hospitalizations
genetic factors

213
Q

Hypotension
Elevated temperature (>38 degrees Celsius) or hypothermia
Heart rate
tachypnea
warm, flushed skin
altered mental status
absent bowel sounds

A

What is the clinical presentation of sepsis?

214
Q

What is rating system associated with sepsis? What are the criteria?

A

qSofa score greater than or equal to 2

Resp rate ≥22 / min
Altered mentation
Systolic BP ≤100 mmHg

215
Q

What is the treatment for sepsis?

A

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
Q

_____ is the lowest mortality type of sepsis

217
Q

_____ is the highest mortality type of sepsis

A

ischemic bowel

Infectious Disease (16 decks)

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