CH31: Bacterial, Fungal, Spirochetal, Parasitic Infections Flashcards
Most common spontaneous or community-acquired pathogenic organisms (p. 719)
S pneumoniae, N meningitidis, group B strep, Listeria monocytogenes, Staphylococcus
Most common spontaneous or community-acquired pathogenic organisms in neonates (p. 719)
E. coli, group B strep
Most common spontaneous or community-acquired pathogenic organisms in infants(p. 719)
H influenzae
Released by macrophages believed to stimulate and modulate the local immune response affecting neurons (p. 721)
interleukin-1, TNF
Most prominent finding in the later stages in meningitis (p. 721)
infiltration of the subependymal perivascular spaces
Most significant factor in the pathogenesis of meningitis in infants and newborns (p. 723)
Maternal infection
Pressure over approximately what value suggest the presence of brain swelling and potential for cerebellar herniation (p. 724)
350mmH20
Cell counts of more than what value raise the possibility of a brain abscess having ruptured into a ventricle? (p. 724)
50,000
Cutoff for protein and glucose in bacmen?
higher than 45mg.dL protein, 40mg/dL glucose of 40% of blood glucose concentration
A clinical prediction rule was made to classify children at very low risk for bacmen if the have the following (p. 725)
negative CSF gram stain
CSF absolute neutrophil count under 1,000 cells/ mL
CSF protein under 80mg/dL
peripheral absolute neutrophil count under 10,000 cells/ mL
no history of seizure
blood cultures positive up to how many percent of patients w H influenza, meningococcal and pneumococcal meningitis? (p. 725)
40-60%
Most specific and sensitive test for CSF otorrhea and rhinorhea (p. 726)
b2- transferrin
Recurrent meningitis, iridocyclitis, depigmentation of hair and skin (p. 726)
Vogt- Koyanagi- Harada
Best initial therapy for the three major types of community acquired meningitis (p. 727)
Ceftriaxone + Vancomycin
Corticosteroids decrease this in patients with H influenza meningitis (p. 728)
sensorineural hearing loss
How to give steroids is bacmen (p. 728)
Dexamethasone 10mg IV now theN Q6 FOR 2 DAYS
Prophylaxis for meningococcal exposure (p. 728)
Single dose of Ciprofloxacin or daily oral dose of rifampin 600mg q12 in adults, 10mgq12 in children for 2 days
Osler triad carrying high fatality rate (p. 729)
pneumococcal meningitis, pneumonita, endocarditis
Etiologic agent of Melioidosis (p.731)
Burkholderia pseudomallei
Treatment for melioidosis (p. 631)
Ceftazidime for 10 to 14 dyas then Cotrimoxazole
Unilateral axillary or cervical adenopathy occuring after a seemingly innocuous scratch (p. 732)
Catscratch fever
Treatment for catscratch fever (p. 732)
Azithromycin or doxycycline
Treatment for Anthrax (p. 732)
Ciprofloxacin with clindamycin, rifampin or meropenem
Ingestion of raw milk (p. 732)
Brucellosis
Most common areas of subdural empyema (p. 733)
Frontal or ethmoid
Most common areas of brain abscess (p. 736)
frontal and sphenoid
Percent of congenital heart disease complicated by brain abscess; percent of brain abscess associated with congenital heart disase (p. 737)
5%, 60%
Most common cardiac anomaly associated with brain abscess (p. 737)
Tetralogy of Fallot
CT scan finding of brain abscess (p. 738)
capsule of abscess is not uniform; medial paracentricular aspect is thinner
Mycobacterium associated with neurosurgical procedures and cranial trauma (p. 740)
Mycobcaterium fortuitum
Used to document previous or current TB infection (p. 741)
interferon-gamma-release assay
Alternative treatment for TB (p. 743)
INH, PZA, high dose RMP, Moxifloxacin
Single most effective drug for TB (p. 743)
INH
Except for which drug , all anti-Kochs can be given via stomach tube (p. 743)
INH
Meningitis occurs in how many percent of all cases of syphilis (p. 744)
25%
If CNS not involved in 2 years, 5 years, how many percent chance of developing neurosyphillis? (p. 744)
5% then 1%
Early clinical syndromes of syphilis (p. 744)
aseptic meningitis, meningovascular syphilis
Late or secondary syphilis (p. 744)
vascular syphilis
Tertiary syphilis ( p. 744)
general paresis, tabes dorsalis, optic atrophy, subacute myelitis
CSF findings in syphillis (p. 745)
pleocyctosis 100cells/ mm3, elevation of gamma globulin, elevation of TP 40 to 200mg/dL, positive serologic tests
Most reliable but expensive to perform diagnostic modality for syphillis (p. 745)
T pallidum immobilization
Most common form of neurosyphilis (p. 745)
Meningovascular syphilis
Most common area of infarction for MV syphilis (p. 745)
distal territories of medium and small caliber LS branches that arise from the stems of the MCA and ACA
Paretic neurosyphilis syndrome– prominent focal signs, unilateral frontal or temporal lobe disease (p. 746)
Lissauer cerebral sclerosis
Most prominent feature of Tabtic neurosyphilis (p. 747)
Ataxia
Treatment of syphilis (p. 745)
PenG IV 18 to 24M units daily for 10 to 14 days [4M q4]
painful lymphocytic meningoradiculotis in Borreliosis (p. 749)
Bannwarth syndrome
Treatment for Cyrptococcal meningitis (p. 752)
Amphothericin B 0.7 to 1.0 mg/kg/day or 3-4 mg/kg/day liposomal amphthericin. Add Flucytosine 100mg/kg/day
Associated with chronic sinusitis with osteomyelitis at the base of the skull (p. 753)
Aspergillosis
Treatment for Aspergillosis (p. 753)
Itraconazole
Most common rickettsial disease (p. 754)
Rocky Mountain spotted fever
Important diagnostic sign in scrub typhus (p. 754)
necrotic ulcer and eschar at the site of attachment of infected mite
Treatment for rickettsial disease (p. 754)
Doxycycline or chloraphenicol
Treatment for Toxoplasmosis ( p.755)
Sulfadiazine and Pyrimethamine. Add Leucovorin (15 to 20mg daily)
Trypanosomiasis: characteristic feature of posterior cervical adenopathy of subsequent CNS infection (p. 756)
Winterbottom sign
Trypanosomiasis: sign pronounced pain at sites of minor injury (p. 756)
Kerandel hyperesthesia
Multiple calcified lesions in the thigh, leg and shoulder (p. 758)
Cystecircosis
Schistosomiasis: cerebral hemisphere (p. 759)
S. japonicum
Schistosomiasis: spine (p. 759)
S. mansoni
S. mansoni location in the spine (p. 760)
conus medullaris
