Clinical Considerations in Fever Flashcards
What is the SOFA criteria?
it is an organ dysfunction score
it is NOT diagnostic of sepsis
Helps to identify patients who potentially have a high risk of dying from infection
What is the qSOFA criteria?
Predicts chance of sepsis in patients admitted to medical floor
based on:
RR >22/min
AMS
Systolic BP <100mmHg
What are some sepsis risk factors?
ICU admission
bacteremia
age <65y/o
Immunosuppression
DM and obesity
cancer
CAP
previous hospitalizations in last 90 days requiring ABx therapy
What are the clinical manifestations of sepsis
S/S specific to infectious source
arterial hypotension (SBP <90, MAP <70)
Temperature >38.3 or <36
HR >90bpm
tachypnea, RR >20bpm
What is end-organ manifestations of sepsis
Warm, flushed skin transitioning to cool as blood flow is redirected
decreased cap refill, cyanosis, mottling
AMS, obtunded/restless, oliguria/anuria
ileus/absent bowel sounds
What is a key hallmark lab in sepsis?
Hyperlactatemia
serum lactate elevated >2mmol/L as a sign of hypoperfusion and a sign of a poor prognosis
Where are staphylococcal infections likely to arise?
skin and soft tissue breaks
IV/PICC lines, central lines, permanent catheters
Pacers, AICDs
joint and spine hardware
What are some signs of staphylococcal infections?
bone/joint pain, fever, abdominal pain, CVA tenderness, HA
All depends on where the infection is located
MRSA is common in which populations?
Immunocompromised patients
typically effect multiple systems and will have wounds with pus
What is erysipelas?
What is cellulitis?
superficial skin infections with well defined boarders
deeper skin infection involving dermis and subQ fat with lymphangitis, edema
both are warm, painful, can be strep or staph related
What are risk factors for community acquired MRSA infections?
contact sports
military service
incarceration
injection drug use
What are some clinical pearls for MRSA?
may complicate surgical incisions
implicated in diabetic foot ulcers
joint infections are unusual but can occur
osteomyelitis usually associated with prosthesis, hematogenous infections in kids, or nonhealing foot ulcers
What does streptococcus pyogenes cause?
Who is most affected?
causes tonsilpharyngitis commonly in children and adolescents
What does streptococcus agalactiae cause in pregnant women?
UTI
chorioamnionitis
postpartum endometritis
bacteremia
What is the most common cause of bacterial pharyngitis in children and adolescents?
Streptococcus pyogenes
What are the main symptoms of tuberculosis?
productive cough
hemoptysis
fatigue
weight loss
fever
night sweats
What are the risk factors for acquisition of tuberculosis?
household exposure
incarceration
drug use
travel to endemic areas
note: latent TB can reactivate if immune system is weakened
What are the risk factors for reactivation of TB?
gastrectomy
silicosis
DM
HIV
immunosuppressive drugs
What are risk factors for drug resistance?
immigration from areas with drug resistant TB
close contact with pt’s infected with DR TB
unsuccessful prior anti-TB therapy
noncompliance with treatment
What are the clinical manifestations of TB?
cough, productive and blood-streaked (unlikely to be frank blood)
slowly progressing constitutional symptoms
chronically ill appearance
chest exam nonspecific, post-tussive apical rales are classic
atypical presentations common in elderly/HIV pts
What kind of virus is Influenza?
What are the three types?
Which type is most likely to cause pandemics?
Orthomyxovirus, spread by resp. droplets
A, B and C with C being milder
Type A can undergo antigenic shift and is most likely to cause pandemics
How does acute acquired CMV compare to mononucleosis caused by EBV?
CMV unlikely to cause pharyngeal symptoms
Describe acute CMV infection
virus isolation or detection of viral proteins or nucleic acid in any body fluid or tissue specimen regardless of signs or symptoms
Describe CMV disease
evidence of CMV based on signs or symptoms
may manifest as a viral syndrome or as a tissue-invasive disease
course and prognosis is different than acute
What symptoms do you see with perinatal CMV disease?
jaundice
hepatosplenomegaly
thrombocytopenia
purpura
microcephaly
CNS calcifications
MR
motor disability
hearing loss in 50%
most asymptomatic at birth, but may develop sx later on
A CMV infection in an immunocompetent person will look like mononucleosis but will have (positive or negative) heterophil Ab?
Negative heterophil Ab
What are the key symptoms we should know related to primary coccidioidomycosis?
Arthralgias with periarticular swelling of knees and ankles
Erythema nodosum within 2-20 days after symptoms onset
What is a key feature of disseminated coccidioidomycosis in patients with HIV?
more often show pulmonary miliary infiltrates, LAD, and meningitis
rarely skin lesions
What are the symptoms of acute malaria?
HA, fatigue, cyclic fevers, myalgias, cough, chest pain, abdominal pain, anorexia, n/v/d, Sz
48 hour cycles for P. vivax and P. ovale
72 hour cycles for P. malariae
What are some physical exam findings for malaria?
anemia
jaundice
hepatosplenomegaly
hypotension
Sz
How do you tell the difference between Multiple Myeloma and Waldenström’s macroglobulinemia?
they are similar but WM will NOT have lytic bone lesions
What are the clinical manifestations of Multiple Myeloma?
Sx of anemia
bone pain
lytic bone lesions
kidney failure
soft tissue masses
(CRAB-hyperCalcemia, Renal abn, Anemia, Bone lytic lesions)
What is the most common HIV-related malignancy?
Kaposi Sarcoma
related to HHV-8 infection
red, purple lesions or nodules on cutaneous and mucosal surfaces
What are the sicca components of Sjögren’s Syndrome?
dry eyes and mouth with or without other AI diseases, like RA or other CT diseases
