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Clinical Medicine I > Bacterial infectious diseases > Flashcards

Bacterial infectious diseases Flashcards

1
Q

What are key features of scarlet fever?

A

rash resembling sunburn most commonly in groin and axillary, strawberry tongue, fine red papules, blanches, petechial, circumoral pallor

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2
Q

What is associated with scarlet fever and treatment should be tailored as such?

A

Pharyngitis -> penicillin

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3
Q

What criteria is key for diagnosing acute rheumatic fever?

A

Jones criteria
Major - polyarthritis, carditis, chorea, rash (subq nodules, erythema marginatum)
Minor - fever, arthralgia, inflammatory markers, PR segment prolongation

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4
Q

What is the Jones criteria?

A

two major criteria or one major and two minor criteria for acute rhuematic fever

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5
Q

What helps diagnose acute rheumatic fever in patient history?

A

recent GAS infection; strep

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6
Q

What helps diagnose acute rheumatic fever?

A

bacterial culture, rapid strep, elevated anti-strep antibodies

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7
Q

How do you treat acute rheumatic fever?

A

penicillin

Consider prevention of continuous course of antimicrobial prophylaxis - penicillin, erythromycin, or IM penicillin G benziathine

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8
Q

When should you add antibiotics (orally) for skin and soft tissue infections?

A
  • severe or extensive disease
  • symptoms/signs of systemic illness
  • purulent cellulitis/wound
  • comorbidities or age extreme (young/old)
  • abscess in difficult area to drain
  • associated septic phlebitis
  • lack of response to I&D
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9
Q

How do you treat skin and soft tissue purulent infections (first line)?

A

I&D

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10
Q

What antibiotics do you add for skin/soft tissue infections in “special situations”?

A

dicloxacillin or clindamycin

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11
Q

What antibiotics do you use for skin/soft tissue infections for MRSA?

A

clindamycin, bactrim, doxycycline

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12
Q

What antibiotics do you use for skin/soft tissue infections for sepsis?

A

IV nafcillin, cefazolin
MRSA - vancomycin or daptomycin

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13
Q

How do you treat skin and soft tissue non-purulent infections?

A

amoxicillin, cephalexin, clindamycin

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14
Q

How do you treat severe skin/soft tissue non-purulent infections?

A

IV nafcillin, cefazolin, vancomycin, daptomycin

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15
Q

What is hematogenous osteomyelitis?

A

sudden onset of high fever, chills, pain, tenderness of involved bone

Older patients may have low grade fever, worsening bone pain, neurologic abnormalities

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16
Q

What should you consider to help diagnose osteomyelitis?

A

isolation of organism, blood cultures, bone biopsy and culture indicated if blood cultures are negative

Imaging - x-ray for soft tissue swelling, deminerilization –> CT to locate abscesses –> bone scan for bone infection –> US to diagnose effusion

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17
Q

What should you always check for with the following symptoms: fever, severe back/neck pain, radicular pain, spinal cord compression + vertebral osteomyelitis?

A

epidural abscess

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18
Q

What’s your test of choice when epidural abscess is suspected?

A

MRI

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19
Q

what makes hematogenous osteomyelitis more likely in a patient?

A

If they are/have: DM, IV catheters, indwelling urinary catheters, IV drug users, sickle cell anemia, old age

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20
Q

How can you differentiate contiguous osteomyelitis?

A

high fever, localized signs of inflammation
with all other signs of toxicity absent

Generally from surgery, trauma, joint replacement

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21
Q

How can you differentiate vascular insufficiency osteomyelitis?

A

commonly on foot or ankle; hip/sacrum; bone pain often absent or muted by neuropathy

also NO FEVER
think - stasis dermatitis

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22
Q

What’s the best bedside clue of vascular insufficiency osteomyelitis?

A

ability to advance a sterile probe to bone through a skin ulcer

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23
Q

How do you treat osteomyelitis (first line)?

A

IV cefazolin, nafcillin, oxacillin
MRSA: IV vancomycin or daptomycin

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24
Q

How can you shorten IV therapy with osteomyelitis?

A

oral levofloxacin/ciprofloxacin + rifampin after 2 weeks of IV

MRSA = bactrim, doxycycline, clindamycin

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25
Q

When is surgery indicated for osteomyelitis?

A

staphylococcal osteomyelitis w/ epidural abscess/spinal cord compression, other abscesses, extensive disease, recurrent/persistent infection

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26
Q

What should you think with staphylococcal bacteremia?

A

endocarditis, osteomyelitis, other deep infection

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27
Q

What do you need to rule out infective endocarditis?

A

transesophageal ecg; maybe transthoracic if lower risk

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28
Q

How does toxic shock syndrome present?

A

abrupt onset of high fever, vomiting, watery diarrhea, sore throat, myalgias, headache
- can have diffuse macular erythematous rash, nonpurulent conjunctivitis, desquamation of palms/soles

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29
Q

What’s weird about TSS in blood cultures?

A

cultures will be negative! It’s not systemic.

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30
Q

How can you treat TSS?

A

rapid rehydration, anti-staph therapy, manage organ failure, remove toxin source

IV clindamycin to inhibit toxin production, maybe IV immune globulin

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31
Q

What is a coagulase-negative staph infection?

A

presenting with purulent or serasanguineous drainage, erythema, pain, tenderness at site, and joint instability/pain, commonly following surgery

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32
Q

How do you treat a coagulase-negative staph infection?

A

remove device!
IV vancomycin (for normal kidney function)

If valve endocarditis (MRSA) = vanc+rifampin+gentamicin

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33
Q

How does tetanus present?

A

early - pain/tingling at site, spasticity of muscles, jaw/neck stiffness, dysphagia, irritability
late - hyperreflexia, trismus, rigidity, spasm, convulsions, spasms
death

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34
Q

Who are at risk for tetanus?

A

unvaccinated, older adults, migrant workers, newborns, IV drug users

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35
Q

How do you prevent tetanus?

A

active immunization; booster Tdap every 10 years (and given with each pregnancy)
If >5 years after dose you need a booster in a risk situation

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36
Q

How are unvaccinated individuals treated when dealing with tetanus?

A

passive immunization (250) AND active tetanus toxoid as well

37
Q

How do you treat tetanus (vaccinated)?

A

human tetanus 500 immune globin IM within 24 hours + debride wound, metronidazole IV or PO abx; optional penicillin IV

Keep muscles relaxed, sedation often needed to prevent contraction

38
Q

What are common symptoms of botulism?

A

visual disturbances, dry mouth, dysphagia, dysphonia, nausea, vomiting
Symmetric descending paralysis

39
Q

How can you manage botulism?

A

contact state!

Equine serum heptavalent botulism antitoxin within 24 hrs and establish airway
- intubation, mechanical ventilation, fluids

40
Q

What is diptheria?

A

can be nasal (discharge), laryngeal (upper airway/bronchial obstruction) or pharyngeal (MC) = mild sore throat, fever, malaise –> toxemia, prostration; patches on the back of throat

41
Q

How can you diagnose diptheria?

A

DO NOT WAIT – EMERGENCY but can culture, PCR

42
Q

How can you manage diptheria?

A

antitoxin, removal of membrane, isolate

All contacts should recieve booster or complete series + PCN/erythromycin

43
Q

What is listeriosis?

A

illness from contaminated dairy
* can cause miscarriage in pregnancy and if not miscarriage, neonatal listeriosis:
* neonatal infection, high mortality rate –> bacteremia, meningitis
LOTS of complications

44
Q

How do you diagnose listeriosis?

A

lumbar puncture
Stool, blood, meningitis, transplacental infection
MRI if focal brain abscess
CT/US if liver abscess suspected

45
Q

How do you manage listeriosis?

A

Prevent exposure!!!
Ampicillin IV
can + gentamicin IV
PCN allergy = trimethoprim/sulfamethoxazole IV

46
Q

What is the presentation of pertussis?

A

catarrhal stage of insidious onset lacrimation, sneezing, hacking cough, anorexia, malaise –> paroxysmal stage - rapid, consecutive coughs with high-pitch inspiration –> convalescent stage of decreasing severity

47
Q

How to diagnose pertussis (whooping cough)?

A

elevated WBC, other labs are normal

Diagnosis = isolating organism from nasopharyngeal culture

48
Q

How do you treat pertussis?

A

azithromycin, clarithromycin, bactrim

also for contacts to active case exposed

49
Q

How can you prevent pertussis?

A

vaccine, with significant exposure = prophylaxis + macrolide (erythromycin)
vaccination of adults to stop reservoir

50
Q

What should you consider with otitis, sinusitis, and meningitis?

A

haemophilus

51
Q

What is haemophilus?

A

otitis, sinusitis, epiglottitis, meningitis causer

52
Q

How do you treat haemophilus?

A

amoxicillin, augmentin, cefuroxime, fluoroquinolones, azithromycin

IV ceftriaxone or fluoroquinolones

53
Q

What is typhoid fever?

A
  • malaise
  • headache
  • cough
  • sore throat
  • abdominal pain, constipation, “pea soup” diarrhea
  • –> plateau and exhaustion
54
Q

How can you recognize a complication from typhoid fever?

A

high HR

55
Q

How do you handle carriers of typhoid fever?

A

ciprofloxacin and cholecystectomy

56
Q

How can you diagnose typhoid fever?

A

splenomegaly, abdominal distention/tenderness, bradycardia, meningismus
Rash = rose spots
Best diagnosed by blood culture, low WBC

57
Q

How do you treat typhoid fever?

A

azithromycin or ceftriaxone

If visited Pakistan = meropenem

Hospitalized = combo of ceftriaxone/meropenem + azithro

critical = dexamethasone

58
Q

What should you watch for in salmonella gastroenteritis even when it’s self-limited?

A

observe for bacteremia in joints/bones

59
Q

What is salmonella bacteremia?

A

prolonged or recurrent fevers w/ bacteremia and local infection (complication of salmonella gastroenteritis), common in immunocompromised

May have mycotic aortic aneurysms

60
Q

How do you treat salmonella bacteremia?

A

systemic antimicrobial therapy + drainage of abscesses -> ciprofloxacin or levofloxacin
OR
ceftriaxone, trimethoprim-sulfamethoxazole, amoxicillin, azithromycin

61
Q

What is shigellosis?

A

abrupt onset of diarrhea, lower abdominal cramps, tenesmus (rectal urge)
stool = blood and mucus
systemic = fever, chills, anorexia, malaise, headache

62
Q

How can you diagnose shigellosis?

A

tender abdomen, sigmoidoscopy = inflamed, engorged mucosa with punctate and large areas of ulceration
Stool culture = many leukocytes + red cells

63
Q

How do you treat shigellosis?

A

no treatment for mild disease! - treat dehydration/hypotension

abx for severe cases/immunocompromised: fluoroquinolones (ciprofloxacin or levofloxacin) or ceftriaxone

64
Q

What is cholera?

A

acute onset of severe, frequent and watery diarrhea
“gray, turbid, watery, rice water” - deadly from dehydration and hypotension

65
Q

How can you diagnose cholera?

A

stool culture, rapid antigen + PCR testing

66
Q

How can you treat cholera?

A

oral rehydration
IV fluids for severe
severely ill - tetracyclines, macrolides, fluoroquinolones

67
Q

What is campylobacter jejuni?

A

fever, muscle pain, malaise, headache –> crampy abdominal pain, diarrhea (watery, bad-smelling, bloody)

can cause a toxic megacolon!

68
Q

How do you treat campylobacter jejuni?

A

hydration and correction; self-limited
severe = azithromycin, ciprofloxacin/levofloxacin

69
Q

What are the plague presenting symptoms?

A

sudden onset high fever, malaise, tachycardia, intense headache, delirium, myalgia
pneumonia can form with tachypnea, productive cough, bloody sputum, cyanosis

70
Q

What can help you diagnose the plague?

A

axillary, inguinal, cervical nodes “buboes”
Hematogenous spread = purpuric spots

Buboe spreads
Cultures, CSF, sputum

71
Q

What is the treatment for anyone with risks of plague?

A

doxycycline, ciprofloxacin, levofloxacin, moxifloxacin

72
Q

What is the treatment of the plague?

A

fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) OR aminoglycosides (streptomycin, gentamycin) OR doxycycline

73
Q

What is urethritis?

A

dysuria, serous/milky discharge with urethral pain, discharge (yellow, creamy, profuse) – can regress or progress to involve more anatomy with painful inflammation (consider

74
Q

What is urethritis usually caused by?

A

gonorrhea

75
Q

How can you diagnose urethritis?

A

nucleic acid amplification tests; first catch AM urine

76
Q

How can you treat urethritis/cervicitis?

A

IM ceftriaxone (daily for arthritis/dermatitis syndromes)
Co-treat with doxycycline (non-pregnant) and azithromycin (pregnant)

PCN allergic = gentamicin + azithromycin

77
Q

How do you manage a hospital-complicated infection of urethritis/cervicitis?

A

IV ceftriaxone + doxycycline + metronidazole

Outpatients = ceftriaxone IV, cefoxitin IM + doxycycline & metronidazole

78
Q

What are the symptoms of cervicitis?

A

dysuria, urinary frequency, urgency, purulent discharge, inflammation of bartholin glands…may be asymptomatic

Inflamed cervix with discharge

79
Q

What is the triad of disseminated disease of gonorrhea?

A

rash, tenosynovitis (hands, wrists, feet, ankles) and polyarthralgia

80
Q

What is chancroid?

A

vesicopustule develops – painful, soft ulcer with necrotic base, surrounding erythema
associated lymphadenopathy with overlying erythema
fever, chills, malaise

81
Q

How do you treat chancroid?

A

azithromycin PO or ceftriaxone IM

82
Q

What is cat scratch disease?

A

regional lymphadenitis, papule/ulcer at inoculation site
then fever, headache, malaise with regional lymphadenopathy
Do they have a history of a bite/scratch?

83
Q

How do you treat cat scratch disease?

A

z-pak! azithromycin

84
Q

What is lymphogranuloma venereum?

A

initial papular/ulcerative lesion on external genitalia –> inguinal or femoral buboes post exposure
breakdown of draining sinuses, extensive scarring

85
Q

How can you diagnose lymphogranuloma venereum?

A

positive nucleic amplification test!

LGC-specific molecular tests (but take awhile)

86
Q

How can you treat lymphogranuloma venereum?

A

doxycycline, erythromycin, azithromycin

87
Q

How can you differentiate between chlamydia and gonorrhea?

A

chlamydia is less painful, purulent, and more watery
often no symptoms!

88
Q

When should you screen for chlamydia?

A

sexually active <25 women
Women >25 with risk for STIs
pregnant women
people with HIV
men with risk of STIs

89
Q

How do you treat chlamydia?

A

doxycycline, azithromycin or levofloxacin (pregnancy)

presumptive gonoccocal therapy!

Clinical Medicine I (33 decks)

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