Clinical Questions - Infectious Disease Flashcards
What is the empiric treatment for osteomyelitis
IV Vancomycin
Fluoroquinolone - good bone penetration - cipro or levaquin
3rd gen cephalosporine - ceftazidine
4th gen cefepime
Surgical debridement
Hyperbaric O2
Negative pressure wound therapy
septic arthritis - presentation and steps to diagnosis
Risk factors: Hx of IV drug use, multiple sexual partners
Presentation: painful joint, fever
Labs: elevated WBC and ESR
Arthrocentesis with joint fluid analysis
- WBC count >50K
- GS and Cx
- Histology
Exam findings of bacterial endocarditis and treatment
Fever New murmur Osler's nodes Janeqay lesions Splinter hemorrhages (non specific) Roth Spots on fundoscopy - hemorrhages
Tx:
Empiric Abx - IV vans 4-6 weeks
Valve replacement
Recommended pix for infective endocarditis prior to dental procedures
Criteria: Prosthetic cardiac valve Prior infectious endocarditis Congenital heart disease - Unrepaired cyanotic congenital heart defect -Palliative shunts/conduits -repaired with prosthetic material Cardiac transplant with valvulopathy
Abx: 2g amok x1 30-60 min prior to procedure
Testing for syphilis
screening: RPR, VDRL Confirm with FTA-Abs, MHA-TP Spirochete identification: Dark field microscopy of chancre Fluorescent Ab testing of lesions
Malaria prophylaxis
Many areas show drug resistance to chloroquine, use primaquine except in G6PD patients
Lyme disease - presentation and treatment
Classic presenting symptom is target lesion - erythema migrant
Tx:
Doxy
Amox
Ceftriaxone
Treatment of choice for rocky mountain spotted fever (RMSF)
Doxycycline
However in pregnant patients give chloramphenicol (toxicity -> gray baby sn)
Neutropenic fever
Typically seen in chemotherapy patients
Definition:
ANC less than 500
Temp of 101 F (38.3) or 100.4 (38) for longer than 1 hr
Start broad spectrum antibiotics
Criteria for ppx and agents used in HIV pt for Cryptococcus neoformans meningitis
No pix - treat with IV amphotericin and flucytosine
Criteria for ppx and agents used in HIV pt for Histoplasma capsulatum
CD4 less than 150 - itraconazole
Criteria for ppx and agents used in HIV pt for Mycobacterium avid complex
CD4 less than 50 - azithromycin
Criteria for ppx and agents used in HIV pt for PJP
CD4 less than 200 - bactrim or dapsone, pentamidine
No bactrim or dapsone in G6PD deficiency
Criteria for ppx and agents used in HIV pt for toxoplasma gondii
CD4 less than 100 - bactrim
Criteria for ppx and agents used in HIV pt for candida albicans
no ppx, tx with fluconazole or nystatin
