clinical consdirations of fever- tyler's HY Flashcards
most common source of bacteremia
skin and soft tissue infection, central venous catheters + other intravascuar devices, bone and joint infections, pneumonia endocarditis
not obvious in 25% cases
lab changes seen with bacteremia and sepsis
leukocytosis and left shift of hemogram
what are SOFA and qSOFA
SOFA = organ dysfunction score, identify pts who potentially have a high risk of dying from infection
qSOFA= predicts chance of sepsis for patients admitted to medical foor
risk factors leading to sepsis
ICU admission bacteremia age >/= 65 immunosuppression DM and obesity CA community acquired pneumonia previous hospitalization in last 30 days, received abx
vital signs and clinical manifestations of sepsis
arterial hypotension SBP<90, MAP<70
Temp either >38.3 or <36 C
HR >90 bpm
tachypnea, RR >20 bpm
end organ manifestations in sepsis
warm flushed skin in early phases
progress to shock with cool skin, dec cap refill, cyanosis, or mottling
hypoperfusion= AMS, obtunded, restless, oliguria/anuria
end stage sign of end-organ hypoperfusion= ILEUS or ABSENT BOWEL SOUNDS –> indicates upcoming sepsis
labs in sepsis
signs and sx
increased: glucose, plasma CRP, Cr, coag time, total bilirubin, serum lactate
decreased: urine output, plts
sx: abdrupt onset hyperventilation with respiratory ALKALOSIS,
late finding= hypotension and shock, poor prognosis
staph bacteremia
-risk
-sx
-risk: breaks in skin (cellulits, folliculitis, trauma), intravac catheter, cardiac device, ortho hardware in joint ot spine
30% have systemic infection= bone/joint pain, fever+sweats (associated w endocarditis) abd pain (LUQ-splenic infarct) CVA tenderness (pyelonephritis, psoas abscess) HA (meningitis, intracranial infection, septic emboli)
most common hospital acquired infection that affects multiple systems
MRSA
MRSA
- traditional population
- presentation
- culture
- skin manifestations
- in hospitalized patients who are immunocompromised
- often at long term wounds: wound will have local erythemia w induration and purulent drainage, abscesses are common
pus = G+ cocci in clusters
-skin:
erysipelas (superficial red, well defined borders)
cellulits (deeper, edema and lymphangitis)
both (painful, nonlocal, warm)
if cultures of pus around a wound are positive for S. aureus, where should you focus your workup
endocarditis
osteomyelitis
deep seated systemic infections (epidural abscess, discitis, abscess)
risk factors for community acquired MRSA
how does prognosis fair compared to hospital acquired
community MRSA is more aggressive and invasive
risk: contact sports, military service, incarceration, injection drug use
MRSA infection may complicate ___ ____, and is commonly implicated in _______
osteomyelitis due to MRSA may be associated with (3)
surgical incisions
diabetic foot infection
(3) fixation device/prosthesis + hematogenous infection in children + nonhealing foot ulcers in DM or peripheral A ds
Group A strep bacteremia:
- most common bug
- presentation in neonates vs kids/teens vs adults
what sx in kids with a sore throat increase the likelihood of Group A Strep (tho not diagnostic)
strep pyogenes
neonates: maternal-fetal transmission
kids/teens: most common cause of tonsillopharyngitis, also impetigo or secondary infection of skin
adults: pharyngitis
sx: scarlatiniform rash (sandpaper like appearance), palatal petechiae, tonsillar enlargement , vomiting, tender cervical nodes
group B strep bacteremia
- bug
- -presentation in neonates vs pregnant Fs vs nonpregnant adults
strep agalactiae
neonates: acquired in utero or during passage- mostly present as sepsis, pneumonia, and/or meningitis
pregnant Fs= UTI, chorioamnionitis, postpartum endometritis
nonpregnant adults: MOST COMMON STREP PATHOGEN IN ADULTS, bacteremia, sepsis, soft tissue infections, endocarditis
sx , CXR, risk factors of TB
who is likely to present atypically
sx: productive cough most common, also blood streaked sputum, weight loss, fever+night sweats
CXR: non-specific, post-tussive apical rales are classis
risk: household exposure, incarceration, recreational drugs, travel to an endemic area
atypical ~ elderly, HIV+
TB: primary infections vs latent vs reactivation
primary: airborn droplets, person to person transmission
latent: bacilli are contained within granulomas, become active ds if the person’s immune function becomes impaired
reactivation= immune system because weak and no longer able to contain the latent bacteria so they become active and active infection ensues
-associated with gastrectomy, silicosis, DM, HIV, immunosuppressive drugs
what are the risk factors for drug resistance to T
immigration from regions with drug-resistant TB,
close contact with patients infected w drug-resistant TB
unsuccessful prior anti-TB therapy
pt noncompliance
influenza
- virus type, transmission
- pandemics are usually associated with which antigenc subtye
- common sx
orthomyxovirus, respiratory droplets
pandemics= type A with major antigenic shift
resemble other viral illnesses,
GI sx common in young children with Flu B infection
fever lasts 3-5 days typically
leukocytosis may be marker of SECONDARY complications
HIV
associated CA
neuro manifestations
mean time btwn HIV infection and AIDS
NHL
3- dementia, aseptic meningitis, neuropathy
10 yrs
