Clinical Approach to Patient With Infection Flashcards
When to suspect an infection
History of fever or rigours
Recent tropic travels immunodeficiency
Examination findings in infection
Fever
Local evidence of inflammation
Enlarged lymph nodes
Signs of sepsis
Travel- which infections are common in which parts of the world
Africa- malaria
Asia- typhoid
SE Asia- dengue virus common
Travel dates matter?
They matter/incubation periods
Infection usually occurs less than a month from return to onset of illness
Key parts of history?
Infection Travel Exposure The host Physical examination
Priorities when assessing patients with infection
Assess if they have life/organ threatening infection
If so -> rapid assessment
Antimicrobial treatment
Intravenous fluids
Surgery/ ICU
Key features or history of patient
Is the patient ability to fight reduced? E.g Diabetes mellitus Renal transplant Liver cirrhosis
Key features of physical exam
Do they appear ill Signs of sepsis Ears /throat Lymph node enlargement Signs of meningitis Pneumonia Inflamed skin
Difference between sepsis and septic shock
In septic shock you need medication to maintain blood pressure
Key features of of sepsis / shock
Low blood pressure (systolic <100mm Hg)
High respiratory rate (22/min)
Abnormal mentation
Lactate > 2mmol/L
Investigations
Bacterial- blood, urine, throat swab
Viral tests - direct detection using pcr,detection of antibodies
Fungi- antigen detection, antibodies
Parasites- look for bugs in blood !stool! Antibodies
Prognosis of malaria ?
Can be fatal
Treatment for malaria
Lumefantrine (Rainet) orally for 3 days
