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IPT: ID > Block 3 - STDs, TB, UTI > Flashcards

Block 3 - STDs, TB, UTI Flashcards

1
Q

Patho of Tb?

A

Tubercle bacilli droplet is inhaled and smaller % enter bloodstream

Within 2-8wks, macrophages ingest them and they form a barrier shell (granuloma) aka latent Tb

If they cant keep it under control, bacilli multiplies

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2
Q

If latent Tb is present, what can it be detected by?

A

TST or IGRA

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3
Q

(T/F) Peeps with latent Tb are infectious

A

False, they dont spread to others

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4
Q

What are the classic CSF findings for Tb meningitis?

A

Hypoglycorrhachia (<45 glucose or ≤0.5 serum glucose of CSF)

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5
Q

What are the risks of developing Tb in someone with normal and weak immune systems?

A

Normal = about 10% will develop Tb in some point in their life

Weak = Untreated HIV individuals will have 7-10%/yr + children <5 have increased risk

Additional RF = diabetes and excessive alcohol use

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6
Q

M. tuberculosis is a (fast/slow) - growing organism that replicates in ____ hours and is visible in the culture at weeks ____

A

Slow growing organism - replicates in 20 hours and visible culture growth at 3-8 weeks

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7
Q

Immune response to Tb?

A

T lymphs are required

CD4 secrete interferon (IFN)-y to activate macrophages

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8
Q

Reactivation of Tb occurs when?

A

~10%; usually in the first 2 years (5%)

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9
Q

Duration of Tb Tx, regardless of AFB or CXR smear

How long is it?

A

2 months

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10
Q

Duration of Tb Tx, if both CXR and AFB smear are negative

How long is it?

A

Additional 4 months (6 months total)

or in some populations an additional 7 months (9 months total)

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11
Q

Duration of Tb Tx, if both CXR and AFB smear are positive

How long is it?

A

If the 2 month culture is negative, addition of 4 months (6 months total)

If 2 months = positive, check cavitation, if negative it’s also an additional 4 months (6 months total)

If that cavitation was present, then additional 7 months (9 months total)

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12
Q

On the Mantoux Tb test, what should you look for?

A

Raised, hard area or swelling

Redness alone isnt part of the rxn

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13
Q

What is the booster effect on the Tb skin test?

A

Pt shows up negative initially but has positive rxn if retested

Immunize them with BCG vaccine

They may have had tuberculosis in the past

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14
Q

≥5mm for TB skin test is positive in what groups?

A

HIV+

Recent contacts of infectious TB

w/ fibrotic changes consistent with prior TB

w/ organ transplant or other immunosuppressed pts

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15
Q

≥10mm for TB skin test is positive in what groups?

A

Recent arrivals in high-prevalence countries

IVDU

High-risk congregate settings (work, etc)

Mycobacteriology personnel

Increased risk for progressing to TB

Children <4yo

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16
Q

≥15mm for TB skin test is positive in what groups?

A

No risk factors for TB

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17
Q

What can cause false-positives in Tb skin tests?

A

NON tuberculous mycobacteria

BCG vaccine

Problems with TST admin

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18
Q

QuantiFERON-TB GOLD (QTF) is used to diagnose what?

A

Latent TB ONLY!

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19
Q

What does a positive TB skin test tell you?

A

That they are infected with TB bacteria. Not if its latent or active

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20
Q

Rifampin MOA?

A

Bactericidal, concentration dependent

Inhibits DNA-dependent RNA polymerase

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21
Q

How should rifampin be taken?

A

Empty stomach

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22
Q

Rifampin AE?

A

Liver damage, rash, orange-red urine

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23
Q

Rifampin DI?

A

Potent INDUCER of CYP450

If given with non nucleoside reverse transcriptase inhibitors (nevirapine or efavirenz) they need their doses increased

Bunch of other drug doses would need to be adjusted as well

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24
Q

Isoniazid MOA?

A

Bactericidal for dividing organisms and bacteriostatic for resting bacteria

Disrupts cell wall synthesis by inhibiting mycolic acid synthesis

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25
Q

How should isoniazid be taken?

A

Empty stomach!!

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26
Q

Isoniazid AE

A

Liver damage

Peripheral neuropathy (take w/ pyridoxine)

Neurotoxicity

Hematologic toxicity

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27
Q

Isoniazid DI?

A

Inhibits certain CYPs

Also interacts with tyramine

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28
Q

Pyrazinamide MOA?

A

Unknown, but bactericidal at acidic pH

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29
Q

Pyrazinamide AE?

A

Liver issues, arthralgia, gout exacerbation and photosensitivity

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30
Q

Ethambutol MOA?

A

Bacteriostatic

Interferes with mycolic acid incorporation into mycobacterium cell wall

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31
Q

Ethambutol AE?

A

Optic neuritis

Decreased visual acuity or red-green discrimination

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32
Q

Ethambutol DI?

A

Dont give w/ antacids

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33
Q

Which Rx are risk factors for UTI?

A

SGLT2 inhibitors (-gliflozin)

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34
Q

Ascending + Descending routes of UTI, what causes them?

A

Ascending (most common) = urethra colonized by fecal flora

Descending = hematogenous from distant infections

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35
Q

Which patient population is considered “complicated” UTI?

A

Pregnant

Males

Children

Diabetics

Any structural abnormalities

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36
Q

Clinical presentation in UTI?

A

Lower = local symptoms, systemic is rare

Upper = local symptoms often not present, but there is systemic effects

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37
Q

In the urinalysis (macroscopic), what should you focus on?

A

Leukocyte esterase (detects presence of WBC)

Nitrite test (only enterobacteriaceae + forms by bacteria that reduces nitrate to nitrite)

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38
Q

In the urinalysis (microscopic), what should you focus on?

A

≥10^5 CFU indicates UTI

≥10^2 is diagnostic in presence of Sx

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39
Q

In uncomplicated UTI, what are the causative organisms?

A

E. coli

+

S. saprophyticus (usually found in young sexually active females)

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40
Q

In complicated UTI, what are the causative organisms?

A

E. coli + Enterococcus spp

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41
Q

What bug causes pH of urine to increase?

A

Proteas (produces urease)

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42
Q

What are the common ESBL organisms for UTI?

A

E. coli + K. pneumoniae

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43
Q

Which bug doesnt reduce nitrate to nitrite?

A

Pseudomonas

44
Q

What are the medications used for asymptomatic bacteriura?

A

≥10^5

Nitrofurantoin, Cephalexin, Augmentin

Bactrim (avoid in 1st and 3rd trimester)

45
Q

What are the Rx for acute uncomplicated cystitis?

A

Nitrofurantoin x 5 days

Bactrim x 3 days (avoid if local resistance >20%)

Fosfomycin x once

46
Q

How do you treat mild/moderate pyelonephritis?

A

FQ are first line (cipro, levo), if resistance >10% use 1g Rocephin or amino

Cipro x 7 days
Levo x 5 days

Could use Bactrim x 14 days

47
Q

How do you treat severe pyelonephritis?

A

IV Abx for 10-14days

3rd/4th Cephs
Extend-spec B-lac
FQs
Aminos
Carbapenems
48
Q

Explain the cipro surrogate marker

A

Levo’s susceptibility can be assumed based off of cipro’s for Enterobacteriaceae only

49
Q

Peeps with recurrent UTI have what minimum of infections /year?

A

3+; start long-term prophylaxis and urine cultures every 1-2 months

50
Q

What is the prophylaxis Tx for recurrent UTI?

A

Bactrim 0.5-1 tablet daily

Nitrofurantoin 50-100mg PO daily

**post-coital therapy = Bactrim 1 tablet after activity

51
Q

What are the parenteral Tx options for complicated UTI?

A 
3rd/4th Cephs
Extend-spec B-lac
FQs
Aminos
Carbapenems
Aztreonam
52
Q

What are the oral Tx options for complicated UTI?

A 
Nitrofurantoin
Bactrim
FQs
Augmentin
Cefdinir or cefpodoxime
Fosfomycin
53
Q

Oral Abx for complicated UTI + AE?

A

Bactrim - rash, hyperkalemia, and increased SCr

Nitro - brown urine

FQ - QTc prolongation, hypo/hyperglycemia, BBW of tendonitis, other CNS stuff

54
Q

How long do you Tx complicated UTI?

A

10-14 days

55
Q

What is catheter-associated UTI?

A

S/Sx of UTI AND ≥10^3cfu in a single urine specimen (previous 48hrs0

56
Q

How do you treat catheter-associated UTI?

A

Asymptomatic - remove catheter and no Abx needed

Symptomatic - remove catheter and treat as complicated infection

Other considerations: bacteriuria ≥48hrs, Abx may be needed

57
Q

How long do you treat catheter-associated UTI?

A

Women <65 w/o upper UTI sx after catheter removal = 3 days

Quick resolution of sx = 7 days unless its levo, then 5 days

Persistent sx = 10-14 days

58
Q

How does acute vs chronic prostatitis present?

A

Acute = systemic effects

Chronic = lower back pain, suprapubic discomfort

59
Q

How long do you treat prostatitis?

A

Acute = 4-6wks

Chronic = 6-12wks

60
Q

Prostatitis Tx?

A

Bactrim, FQs

Zosyn, 3rd Gen cephs, doxy/mino

61
Q

Treating latent TB with Isoniazid, what is the direction?

A

300mg daily for 9 months, give w/ HAART

62
Q

Treating culture positive pulmonary TB, what is the regimen?

A

RIPE for 7 days/week for 8 weeks (initial phase)

R+I only for 7 days/week for 18 weeks

63
Q

Monitoring parameters of specimen for TB?

A

Acid-fast bacilli smear, sample q1-2wks until 3 consecutive smears are negative

Do monthly sputum cultures until 2 consecutive cultures are negative

64
Q

Who receives DOT (direct observation therapy) for Tb?

A

Tx failure, HIV, Drug-R isolate, Positive smear, substance abuse, psychiatric issues, non-adherence

65
Q

What causes gonorrhea and chlamydia?

A

Gonorrhea = N. gonorrhoeae

Chlamydia = Chlamydia trachomatis

66
Q

What bug causes syphilis?

A

T. pallidum

67
Q

What bug causes chancroid?

A

H. ducreyi

68
Q

For frequent co-infections of urethritis or cervicitis, what bugs should the drug regimen cover?

A

Gonorrhea and chlamydia

69
Q

Presentation of gonorrhea?

A

Often asymptomatic (esp in females

Dysuria

Green/white discharge

70
Q

RF for STDs?

A

of partners (#1 greatest RF)

Male on Male

Prostitution

Illicit Rx use

71
Q

Colonizers and bugs in vagina/prostate?

A

Colonizer for vagina only: LAG (lactobacillus, anaerobes, G. vaginalis)

Pathogens for vagina: TEC (T. vaginalis, enteric pathogens, C. albicans)

Pathogens for prostate: PES (UT pathogens + P.aeruginosa, enterococcus spp., S. aureus)

72
Q

How is gonorrhea treated?

A

Ceftriaxone 250mg IM AND azithromycin 1g PO x1

73
Q

How does disseminated gonococcal infection presented?

A

Skin lesions (red/purple spots), asymmetric arthralgia or septic arthritis

74
Q

How is disseminated gonococcal infection treated?

A

Ceftriaxone 1g IM/IV for at least 7 days AND azithromycin 1g PO x1

75
Q

How is chlamydia presented?

A

Often asymptomatic

76
Q

How is chlamydia treated?

A

Azithromycin 1g PO x 1

or

Doxy 100mg PO BID x 7days

77
Q

How is bacterial vaginosis diagnosed?

A

3 of the 4 are required:

Thin, white discharge

Vaginal skin cell + bacteria stuck to edges

pH>4.5

Whiff test positive (fishy odor before or after 10% KOH is added)

78
Q

How is bacterial vaginosis treated?

A

Flagyl 500mg PO BID x7days

Flagyl 5g gel intravaginallydaily x5days

Clinda 5g cream intravaginally at bedtime x7days

79
Q

How is syphilis diagnosed?

A

SCREENED via nontreponemal test (detects anti-cardiolipin ABs or RPR test)

CONFIRMED via treponemal test (detects anti-treponemal or fluorescent AB)

80
Q

Primary syphilis info?

A

10-90 days after infection

Single painless ulcer found where the bacteria entered body

81
Q

Secondary syphilis info?

A

2-8wks after initial infection

Painless skin rash, mucocutaneous lesions, systemic sx

82
Q

Latent syphilis info?

A

Sx of primary or secondary syphilis

Seroconversion in nontreponemal titers for >2weeks

If it occurs within a year = early latent

If >1yr or unknown = late latent

83
Q

Tertiary syphilis info?

A

10-30 yrs after initial infection

Muscle issues or paralysis

Gradual blindness

Dementia

Gumma (soft inflammatory masses)

84
Q

Neurosyphilis info?

A

Occur at any stage

Neurological issues

85
Q

Syphilis Tx?

A

Primary, secondary, early latent syphilis = BENZATHINE Peng G 2.4mil x1

Tertiary, late latent syphilis, or unknown = BENZATHINE Peng G 2.4mil weekly x 3 doses

Neuro or ocular syphilis = Aq crystalline Pen for 10-14 days

86
Q

What is a Jarisch-Herxheimer Rxn?

A

May occur in first few hrs after Pen. is given for syphilis. Treat w/ antipyretics, but dont stop Pen. regimen

87
Q

Pen. allergy + syphilis Tx?

A

Primary/Sec syphilis = Doxy, tetra, ceftriaxone x ~14 days

Latent = Doxy, tetra x28 days

Tertiary = ID specialist

If pregnant or neurosyphilis, do penicillin desensitization

88
Q

Chancroid presentation?

A

Multiple painful genital ulcers w/ or w/o regional lymphadenopathy

89
Q

How is Chancroid treated?

A

Azithromycin 1g PO x1

or

Ceftriaxone 250mg IM x1

or

Cipro 500mg PO BID x3days

Follow up in 3-7days

90
Q

How are HPV genital warts presented?

A

Often asymptomatic

Soft growth on genitals

Types 6 + 11 are the ones that cause genital warts

91
Q

How are genital warts treated?

A

Specific antivirals are not recommended

You can prevent them with HPV vaccine. Recommended at 11-12 yrs old, CDC says 9-26 is okay, now FDA says 27-45 is good too

92
Q

Genital wart vaccine info?

A

Cervarix (bivalent) covers only 16 + 18 (cervical cancer only)

Gardasil (covers 6,11,16,18)

Gardasil-9

All given with 3 dose series over 6 months

93
Q

Genital herpes info?

A

Type 1: usually oral, but can be genital

Type 2: genital

Chronic lifelong infection with painful lesions

94
Q

Genital herpes treatment?

A

First episode: acyclovir 400mg PO TID x7-10days

or

Valacyclovir 1g PO BID x7-10days

Then use suppressive therapy

Pretty much the same above but daily + famciclovir 250 mg PO BID

95
Q

Trichomoniasis presentation?

A

Occurs in males and females

Most prevalent non-viral STD in US

96
Q

Trichomoniasis treatment?

A

Flagyl 2g PO x1

or

Tinidazole 2g PO x 1

Follow up in 3months in women

97
Q

VVC presentation?

A

Painful intercourse, abnormal discharge,

Not usually sexually transmitted, but has STD-like sx

98
Q

Classification of VVC?

A

Recurrent OR severe OR Non-albicans candida OR has DM, immunocompromised or debilition = Complicated

Uncomplicated would be milder versions above and would include “AND” for each item

99
Q

How is uncomplicated VVC treated?

A

OTC = Tioconazole, Miconazole, Clotrimazole

Rx = Fluconazole 150mg x1, butoconazole, terconazole

100
Q

How is complicated VVC treated?

A

Topical therapy for 7-14 days or fluconazole 150 PO every 72hrs (2 doses)

101
Q

What is the expedited partner therapy program?

A

Treat all partners of chlamydia or gonorrhea for the past 60 days (heterosexual)

102
Q

Which PID pt can be treated in outpatient?

A

Temp <38, WBC<11k, minimal evidence of peritonitis, active bowel sounds, and is able to tolerate oral nourishments

103
Q

Outpatient PID tx?

A
  1. Ceftriaxone 250mg IM x1 + doxy 100mg PO BID 14 days
  2. Cefoxitin 2g IM x1 + Probenecid 1g PO x1 + Doxy 100mg PO BID x 14 days
  3. Flagyl 500mg PO BID x14 days can be added for more anaerobic coverage
104
Q

Inpatient Beta lactam regimen for PID?

A

Cefotetan 2g q12h + doxy 100mg q12h

Cefoxitin 2g q6h + doxy 100mg q12h

Unasyn 3g q6 + doxy 100mg q12

**doesnt cover M. genitalium

105
Q

Inpatient Beta lactam free regimen for PID?

A

Clinda 900mg q8h + gent 2mg/kg LD then 1.5mg/kg q8h

**doesnt cover M. genitalium

106
Q

When can pt be switched from IV to PO for PID?

A

After they are stable for 24-48 hrs

107
Q

If tx failure exists for PID, whats next?

A

Check for M. genitalium, then start Moxi 400mg PO daily for 14 days

IPT: ID (11 decks)

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