dif to remember Flashcards
common cause of pneumonia in neonates (less than 4 weeks)
- S. agalactiae
2. E. coli
common cause of pneumonia in children (4wks - 18yr) (in order)
- viruses (RSV)
- mycoplasma
- C. trachomatis (infants - 3 years)
- C. pneumoniae (school-aged children)
S. pneumoniae
common cause of pneumonia in adults (18-40yr) (in order)
- mycoplasma
- C. pneumoniae
- S. pneumoniae
- viruses (eg. influenza)
common cause of pneumonia in adults (40-65yr) (in order)
- S. pneumoniae
- H. infuenzae
- Anaerobes
- viruses
5, Mycoplasma
common cause of pneumonia in elderly (in order)
- S. pneumoniae
- Influenza virus
- Anaerobes
- H Influenzae
- Gram (-) robs
Carbapenems - toxicity
- GI distress
- skin rash
- CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)
progressive disseminated histoplasmosis - how to diagnose
urine or serum histoplasma antigen
also pancytopenia
- cultures takes 4-6 wks
progressive dissaminated histoplasmosis - treatment
amphotericin B for 1 week –> after clinical improvement –> oral intraconazole for 1 year
Amphotericin B - toxicity
- fever/chills (shake and bake)
- Hypotenesion
- nephrotoxicity
- arrhythmias
- anemia
- IV phlebitis
Malaria - treatment for every situation
- Chloroquine (for sensitive species)
- Mefloquine or atovaquone/proquanil (for resistant)
- IV quinidine or artesunate (If life threatening) –> test for G6PD
- P. vivax/ovale add primaquine for hypnozoite –> test for G6PD
treatment for all protozoal infections (except malaria)
Giardiasis –> Metronidazole
amebiasis –> metronidazole, iodoquinol for asymptomatic cyst passers
cryptosporidium –> prevention by filtering city water supplies, nitazoxanide in immunocompetent, no clear treatment for aids
Toxoplasma gondi –> Sulfadiazine+pyrimethamine
Naegleria fowleri –> Amphotericin B
Trypanosoma brucei –> Suramin for blood-borne disease or melarsoprol for CNS penetration
Babesia –> atovaquone + azithromycin
Tripanosoma cruzi –> Benzidazole or nifurtimox
Leishmania donovavi –> amphotericin sodium stibogluconate
trichomonas vaginalis –> Metronidazole for patient and partner (prophylaxis)
Babesia - treatment
- atovaquone + azithromycin
- Quinine + clindamycin (if severe)
malaria prevention
travelers new to endemic areas require chemoprophylaxis
atovaquone - proguanil, doxycycline or melfoquine (2 weeks prior to travels, continued during statyy, discont 4 weeks after returning
other measures to protect from mosquitos
Antihelmintihic therapy - drugs
- Menbendazole
- Pyrantel paomate
- Ivermectin
- Diethylacarbamazine
- Praziquantel
neurocysticercosis - presentation and treatment
1. seizures 2. focal neurological deficit hydrocephalus treatment: 1. seizure/ICH management 2. antiparasaitic: albendazole 3. corticosteroids
Echinococcus granulosus - treatment
albendazole
percutaneous therapy (if more than 5 cm or septations)
- if rupture: surgery
pediatric septic arthritis - organisms and treatment
- 0-3 momths:staph, agalacte, gram (-) bacilli): antistaphylococcal + GEentamicin or cefotamice
- older than 33 months: staph, Strep pyogenus, strep pneumoneia: nafcillin, clindamycin, cefazolin or vancom
neonatal sepsis - diagnosis / treatment
blood, urine, CSF culture
parenteral antibiotic therapy (eg. ampicillin + gentamycin)
endocarditis - viridans susceptivle to penicillin - next step
treated with IV penicillin G or IV ceftriaxone for 4 wks
never oral in the beginning
vaccines for adults with HIV
- HBV
- HAV: chronic liver disease, men sex men, IV drugs
- HPV if 11-26
- influenza: inactivated, annually
- Mening: all
- Pneumonioc: PCV13 once, PPSV23 8 ks later, 5 yyears later + at age 65
- Tdap as needed and each pregnancy
HIV Protease inhibitors - toxicity
- hyperglycemia
- GI tolerance (nausea, vomiting)
- Lipodystrophy (Cushing-like syndrome)
- Nephropathy (indinavir)
- hematuria (indinavir)
- inhibit cytochrome P-450 (ritonavir)
Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - side effects
- Bone marrow suppression
- peripheral neuropathy
- lactic acidosis (nucleosides)
- anemia (ZDV)
- pancreatitis (didanosine)
Non-nucleoside reverse transcriptase inhibitors (NNRTI) - toxicity
- rash
- hepatotoxicity
- vivid dreams (efavirenz)
- CNS sympoms (efavirenz)
- contraindicated in pregnancy (Delavirdine and efavirenz)
TB - PPD - when is (+) at 5 or more mm
- HIV (+),
- recent contacts of known TB case
- Nodular of fibrotic changes on chest x-ray (previous healed TB)
- organ transplant or other immune
leprosy - diagnosis and treatment
diagnosis: full thickness biopsy of skin lesion
treatment: dapsone + rifampin, add clofazimine if sever
M. intracellulare-avium - prophylaxis and treatment
prophylaxis: azithromycin, rifabutin
treatment: Azithromycin or clarithromycin + ethambutol
Can add rifabutin or ciprofroloxacin
human monocytic ehrlichiosis - labs
leukopenia + thrombocytopenia
- elevated liver enzymes + LDH
high risk wild animals for rabies
- bat
- racoon
- skunk
- fox
- coyote
low risk wild animals for rabies
- squirrel
- chipmunk
- mouse/rat
- rabbit
vibrio vulnificus - treatment
empiric in those with likely illness as highly fatal
IV ceftriaxone + doxycycline
vibrio vulnificus - diagnosis
blood + wound cultures
Legionella - clinical clues
- fever (higher than 39)
- Bradycardia relative to high fever
- neurological symptoms (esp confusion)
- GI symptoms (esp diarrhea)
- Uneresponsive to beta lactam + aminoglycoside
Legionella - Labs
- low Na+
- hepatic dysfunction
- hematuria + proteinuria
- Sputum gram stain showing many neutrophils, but few or no organisms
PCV - recommended vaccines for adults
- if 65 or older: 1 dose of PCV13 followed by PPSV23 at 6-12 months later
- 19-64: PPSV23 alone in heart or liver disease, DM, smoker, alcoholic
OR both (LIKE OLDER THAN 65) in very high risk: CSF leak, cochlear implants, SCD, aspenia, immne, kidney disease, HIV
Hospital acquired pneumonia treatment
vancomycin + tazosin
MRSA pneumonia - people?
superinfection in young people with inf infection
- rapidly progressive necrotizing pneumonia, often fatal
- malitlobular cavitary infiltrates
- often causes leukopenia
bacterial mengitis empiric therapy in older than 50 … (common organisms)
S. pneum, N. menig, Listeria
vancom + 3rd gener ceph + Ampicillin
bacterial mengitis empiric therapy in immonocompromised … (common organisms)
S. pneum, N. menig, Listeria, gram (-) robs
vancom + Ampicillin + cefepime
alternative to cefepime: meropenem or ceftazidime
bacterial mengitis empiric therapy in neurosurgery/penetrating skull trauma … (common organisms)
Gram (-) robs, MRSA, coagulase (-) staph
Vancom + cefepime
