Bacterial infectious diseases Flashcards
What are key features of scarlet fever?
rash resembling sunburn most commonly in groin and axillary, strawberry tongue, fine red papules, blanches, petechial, circumoral pallor
What is associated with scarlet fever and treatment should be tailored as such?
Pharyngitis -> penicillin
What criteria is key for diagnosing acute rheumatic fever?
Jones criteria
Major - polyarthritis, carditis, chorea, rash (subq nodules, erythema marginatum)
Minor - fever, arthralgia, inflammatory markers, PR segment prolongation
What is the Jones criteria?
two major criteria or one major and two minor criteria for acute rhuematic fever
What helps diagnose acute rheumatic fever in patient history?
recent GAS infection; strep
What helps diagnose acute rheumatic fever?
bacterial culture, rapid strep, elevated anti-strep antibodies
How do you treat acute rheumatic fever?
penicillin
Consider prevention of continuous course of antimicrobial prophylaxis - penicillin, erythromycin, or IM penicillin G benziathine
When should you add antibiotics (orally) for skin and soft tissue infections?
- 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
How do you treat skin and soft tissue purulent infections (first line)?
I&D
What antibiotics do you add for skin/soft tissue infections in “special situations”?
dicloxacillin or clindamycin
What antibiotics do you use for skin/soft tissue infections for MRSA?
clindamycin, bactrim, doxycycline
What antibiotics do you use for skin/soft tissue infections for sepsis?
IV nafcillin, cefazolin
MRSA - vancomycin or daptomycin
How do you treat skin and soft tissue non-purulent infections?
amoxicillin, cephalexin, clindamycin
How do you treat severe skin/soft tissue non-purulent infections?
IV nafcillin, cefazolin, vancomycin, daptomycin
What is hematogenous osteomyelitis?
sudden onset of high fever, chills, pain, tenderness of involved bone
Older patients may have low grade fever, worsening bone pain, neurologic abnormalities
What should you consider to help diagnose osteomyelitis?
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
What should you always check for with the following symptoms: fever, severe back/neck pain, radicular pain, spinal cord compression + vertebral osteomyelitis?
epidural abscess
What’s your test of choice when epidural abscess is suspected?
MRI
what makes hematogenous osteomyelitis more likely in a patient?
If they are/have: DM, IV catheters, indwelling urinary catheters, IV drug users, sickle cell anemia, old age
How can you differentiate contiguous osteomyelitis?
high fever, localized signs of inflammation
with all other signs of toxicity absent
Generally from surgery, trauma, joint replacement
How can you differentiate vascular insufficiency osteomyelitis?
commonly on foot or ankle; hip/sacrum; bone pain often absent or muted by neuropathy
also NO FEVER
think - stasis dermatitis
What’s the best bedside clue of vascular insufficiency osteomyelitis?
ability to advance a sterile probe to bone through a skin ulcer
How do you treat osteomyelitis (first line)?
IV cefazolin, nafcillin, oxacillin
MRSA: IV vancomycin or daptomycin
How can you shorten IV therapy with osteomyelitis?
oral levofloxacin/ciprofloxacin + rifampin after 2 weeks of IV
MRSA = bactrim, doxycycline, clindamycin
When is surgery indicated for osteomyelitis?
staphylococcal osteomyelitis w/ epidural abscess/spinal cord compression, other abscesses, extensive disease, recurrent/persistent infection
What should you think with staphylococcal bacteremia?
endocarditis, osteomyelitis, other deep infection
What do you need to rule out infective endocarditis?
transesophageal ecg; maybe transthoracic if lower risk
How does toxic shock syndrome present?
abrupt onset of high fever, vomiting, watery diarrhea, sore throat, myalgias, headache
- can have diffuse macular erythematous rash, nonpurulent conjunctivitis, desquamation of palms/soles
What’s weird about TSS in blood cultures?
cultures will be negative! It’s not systemic.
How can you treat TSS?
rapid rehydration, anti-staph therapy, manage organ failure, remove toxin source
IV clindamycin to inhibit toxin production, maybe IV immune globulin
What is a coagulase-negative staph infection?
presenting with purulent or serasanguineous drainage, erythema, pain, tenderness at site, and joint instability/pain, commonly following surgery
How do you treat a coagulase-negative staph infection?
remove device!
IV vancomycin (for normal kidney function)
If valve endocarditis (MRSA) = vanc+rifampin+gentamicin
How does tetanus present?
early - pain/tingling at site, spasticity of muscles, jaw/neck stiffness, dysphagia, irritability
late - hyperreflexia, trismus, rigidity, spasm, convulsions, spasms
death
Who are at risk for tetanus?
unvaccinated, older adults, migrant workers, newborns, IV drug users
How do you prevent tetanus?
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
How are unvaccinated individuals treated when dealing with tetanus?
passive immunization (250) AND active tetanus toxoid as well
How do you treat tetanus (vaccinated)?
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
What are common symptoms of botulism?
visual disturbances, dry mouth, dysphagia, dysphonia, nausea, vomiting
Symmetric descending paralysis
How can you manage botulism?
contact state!
Equine serum heptavalent botulism antitoxin within 24 hrs and establish airway
- intubation, mechanical ventilation, fluids
What is diptheria?
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
How can you diagnose diptheria?
DO NOT WAIT – EMERGENCY but can culture, PCR
How can you manage diptheria?
antitoxin, removal of membrane, isolate
All contacts should recieve booster or complete series + PCN/erythromycin
What is listeriosis?
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
How do you diagnose listeriosis?
lumbar puncture
Stool, blood, meningitis, transplacental infection
MRI if focal brain abscess
CT/US if liver abscess suspected
How do you manage listeriosis?
Prevent exposure!!!
Ampicillin IV
can + gentamicin IV
PCN allergy = trimethoprim/sulfamethoxazole IV
What is the presentation of pertussis?
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
How to diagnose pertussis (whooping cough)?
elevated WBC, other labs are normal
Diagnosis = isolating organism from nasopharyngeal culture
How do you treat pertussis?
azithromycin, clarithromycin, bactrim
also for contacts to active case exposed
How can you prevent pertussis?
vaccine, with significant exposure = prophylaxis + macrolide (erythromycin)
vaccination of adults to stop reservoir
What should you consider with otitis, sinusitis, and meningitis?
haemophilus
What is haemophilus?
otitis, sinusitis, epiglottitis, meningitis causer
How do you treat haemophilus?
amoxicillin, augmentin, cefuroxime, fluoroquinolones, azithromycin
IV ceftriaxone or fluoroquinolones
What is typhoid fever?
- malaise
- headache
- cough
- sore throat
- abdominal pain, constipation, “pea soup” diarrhea
- –> plateau and exhaustion
How can you recognize a complication from typhoid fever?
high HR
How do you handle carriers of typhoid fever?
ciprofloxacin and cholecystectomy
How can you diagnose typhoid fever?
splenomegaly, abdominal distention/tenderness, bradycardia, meningismus
Rash = rose spots
Best diagnosed by blood culture, low WBC
How do you treat typhoid fever?
azithromycin or ceftriaxone
If visited Pakistan = meropenem
Hospitalized = combo of ceftriaxone/meropenem + azithro
critical = dexamethasone
What should you watch for in salmonella gastroenteritis even when it’s self-limited?
observe for bacteremia in joints/bones
What is salmonella bacteremia?
prolonged or recurrent fevers w/ bacteremia and local infection (complication of salmonella gastroenteritis), common in immunocompromised
May have mycotic aortic aneurysms
How do you treat salmonella bacteremia?
systemic antimicrobial therapy + drainage of abscesses -> ciprofloxacin or levofloxacin
OR
ceftriaxone, trimethoprim-sulfamethoxazole, amoxicillin, azithromycin
What is shigellosis?
abrupt onset of diarrhea, lower abdominal cramps, tenesmus (rectal urge)
stool = blood and mucus
systemic = fever, chills, anorexia, malaise, headache
How can you diagnose shigellosis?
tender abdomen, sigmoidoscopy = inflamed, engorged mucosa with punctate and large areas of ulceration
Stool culture = many leukocytes + red cells
How do you treat shigellosis?
no treatment for mild disease! - treat dehydration/hypotension
abx for severe cases/immunocompromised: fluoroquinolones (ciprofloxacin or levofloxacin) or ceftriaxone
What is cholera?
acute onset of severe, frequent and watery diarrhea
“gray, turbid, watery, rice water” - deadly from dehydration and hypotension
How can you diagnose cholera?
stool culture, rapid antigen + PCR testing
How can you treat cholera?
oral rehydration
IV fluids for severe
severely ill - tetracyclines, macrolides, fluoroquinolones
What is campylobacter jejuni?
fever, muscle pain, malaise, headache –> crampy abdominal pain, diarrhea (watery, bad-smelling, bloody)
can cause a toxic megacolon!
How do you treat campylobacter jejuni?
hydration and correction; self-limited
severe = azithromycin, ciprofloxacin/levofloxacin
What are the plague presenting symptoms?
sudden onset high fever, malaise, tachycardia, intense headache, delirium, myalgia
pneumonia can form with tachypnea, productive cough, bloody sputum, cyanosis
What can help you diagnose the plague?
axillary, inguinal, cervical nodes “buboes”
Hematogenous spread = purpuric spots
Buboe spreads
Cultures, CSF, sputum
What is the treatment for anyone with risks of plague?
doxycycline, ciprofloxacin, levofloxacin, moxifloxacin
What is the treatment of the plague?
fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) OR aminoglycosides (streptomycin, gentamycin) OR doxycycline
What is urethritis?
dysuria, serous/milky discharge with urethral pain, discharge (yellow, creamy, profuse) – can regress or progress to involve more anatomy with painful inflammation (consider
What is urethritis usually caused by?
gonorrhea
How can you diagnose urethritis?
nucleic acid amplification tests; first catch AM urine
How can you treat urethritis/cervicitis?
IM ceftriaxone (daily for arthritis/dermatitis syndromes)
Co-treat with doxycycline (non-pregnant) and azithromycin (pregnant)
PCN allergic = gentamicin + azithromycin
How do you manage a hospital-complicated infection of urethritis/cervicitis?
IV ceftriaxone + doxycycline + metronidazole
Outpatients = ceftriaxone IV, cefoxitin IM + doxycycline & metronidazole
What are the symptoms of cervicitis?
dysuria, urinary frequency, urgency, purulent discharge, inflammation of bartholin glands…may be asymptomatic
Inflamed cervix with discharge
What is the triad of disseminated disease of gonorrhea?
rash, tenosynovitis (hands, wrists, feet, ankles) and polyarthralgia
What is chancroid?
vesicopustule develops – painful, soft ulcer with necrotic base, surrounding erythema
associated lymphadenopathy with overlying erythema
fever, chills, malaise
How do you treat chancroid?
azithromycin PO or ceftriaxone IM
What is cat scratch disease?
regional lymphadenitis, papule/ulcer at inoculation site
then fever, headache, malaise with regional lymphadenopathy
Do they have a history of a bite/scratch?
How do you treat cat scratch disease?
z-pak! azithromycin
What is lymphogranuloma venereum?
initial papular/ulcerative lesion on external genitalia –> inguinal or femoral buboes post exposure
breakdown of draining sinuses, extensive scarring
How can you diagnose lymphogranuloma venereum?
positive nucleic amplification test!
LGC-specific molecular tests (but take awhile)
How can you treat lymphogranuloma venereum?
doxycycline, erythromycin, azithromycin
How can you differentiate between chlamydia and gonorrhea?
chlamydia is less painful, purulent, and more watery
often no symptoms!
When should you screen for chlamydia?
sexually active <25 women
Women >25 with risk for STIs
pregnant women
people with HIV
men with risk of STIs
How do you treat chlamydia?
doxycycline, azithromycin or levofloxacin (pregnancy)
presumptive gonoccocal therapy!
