EH: Infectious Disease Flashcards by James Wren

Meningitis, Most Common Bugs?

Tx?

Strep Pneumo, H. Influenza, N. meningitidis

(tx w/ Ceftriaxone and Vanco)

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Meningitis

In old and young?

Strep Pneumo, H. Influenza, N. meningitidis

(tx w/ Ceftriaxone and Vanco)

Add Lysteria. (tx w/ Ampicillin)

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Meningitis

In ppl w/ brain surg?

Add Staph auerus

(tx w/ Vanco)

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Meningitis

Randoms?

TB (RIPE + ‘roids) and Lyme (IV ceftriazone)

Rifampin + Isoniazid + Pyrazinamide ± Ethambutol or Streptomycin

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Meningitis

Best 1st step?

Start empiric treatment (+ steroids if you think it is bacterial), Exam for elevated ICP/CT, then LP

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Meningitis

Diagnostic test?

+Gram stain, >1000 WBC is diagnostic.

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Meningitis

Roommate of the kid in the dorms who has bacterial meningitis and petechial rash?

Rifampin

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Pneumonia

Classic sxs… best 1st step?

CXR

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Pneumonia

Most common bug all comers?

Strep Pneumo.

Tx w/ M, FQ, 3rd ceph

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Pneumonia

Most common bug in in Young, Healthy People?

Mycoplasma

A/w cold agglutinins

Tx: w/ M, FQ, and Doxy

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Pneumonia

Old smokers w/ COPD?

H. influenzae. Tx w/ 2nd-3rd ceph

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Pneumonia

Alcoholics w/ current jelly sputum?

Klebsiella. Tx w/ 3rd ceph

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Pneumonia

Old men w/ HA, confusion, diarrhea and abd pain?

Legionella

Dx w/ urine antigen.

Tx w/ M, FQ, doxy

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Pneumonia

Just had the flu?

MRSA.

Tx w/ vanc

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Pneumonia

Just delivered a baby cow and have vomiting and diarrhea?

Q-fever. Coxiella burnetti.

Tx w/ doxy

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Pneumonia

Just skinned a rabbit?

Franciella tularensis.

Tx w/ streptamycin, gentamycin

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If a patient is symptomatic best test is ?

CXR

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TB for Screening?

For screening

>15mm
>10mm if prison
Healthcare, nursing home, DM, ETOH, Chronically ill,
>5mm for AIDS, Immune suppressed

– If + PPD –> do CXR.

– If + CXR –> do a acid fast stain of sputum.

– If CXR negative, or + CXR & 3 negative sputums

– If positive –> Tx w/ 4 drug RIPE Regimen for 6mo (12 for meningitis and 9 if pregnant)

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Side effects of Rifampin?

Body fluids turn orange/red, induces CYP450

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Side effects of Isoniazid (INH)?

Peripheral Neuropaty and Sideroblastic anemia

Prevent by giving B6. Hepatitis w/ mild bump in LFTs

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Side effects of Pyrazinamide?

Benign hyperuricemia

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Side effects of Ethambutol ?

Optic neuritis, other color vision abnormalities.

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Acute endocarditis most common bug?

Staph aureus seeds native valves from bacteremia

Subacute Native valve endocarditis-

Most common valve?

Mitral Valve (MVP is MC predisposition)

Subacute Native valve endocarditis- Most common bug?

Viridens group strep

Intravenous Drug Use (IVDU) Most common valve?

Tricuspid Valve (murmur worse w/ inspiration)

IVDU Most common bug?

Staph Aureus

IVDU Diagnosis?

Blood cx TTE then TEE Transthoracic Ecocardiography then Transesophogeal Echocardiography Major and Minor Criteria

IVDU Complications?

CHF #1 cause of death, septic emboli to lungs or brain

IVDU Treatment?

Strep Viridens = 4-6 wks PCN Staph = Naf + gent or vanco

IVDU Prophylaxis?

If prosthetic valve, hx of Endocarditis (EC), or uncorrected congenital lesion

What if you find Strep bovis bacteremia?

Colonoscopy

Suspect for HIV?

* If a patient **“travels a lot for work”**that means they have sex with lots of strangers and are at risk for HIV * **Acute retroviral syndrome** = 2-3 wks s/p exposure but 3wks before seroconversion.  ie, ELISA neg * Fever, fatigue, lymphadenopathy, headache, pharyngitis, n/v/d +/- aseptic meningitis * A young patient with new/**bilateral Bell’s Palsy.** * A young patient with **unexplained thrombocytopenia and fatigue**. * A young patient with **unexplained weight loss \>10%** * A young patient with **thrush, Zoster, or Kaposi sarcoma**

Start HAART when ?

CD4 \< 350 or Viral load \>55,000 (except preggos get tx \>1,000 copies)

HAART and GI, leukopenia, macrocytic anemia ?

Zidovudine

HAART Pancreatitis, Peripheral Neuropathy?

Didanosine

HAART – HS rash, fever, n/v, muscle aches, SOB in 1st 6wks. D/C and Never USE again

Abacavir

HAART Nephrolithiasis and hyperbilirubinemia ?

Indinavir

HAART Sleepy, Confused, Psycho

Efavirenz

HIV Post-exposure prophylaxis ?

If stuck w/ known HIV pt AZT Lamivudine and Nelfinavir for 4wks

HIV+ patient with DOE, dry cough, fever, chest pain Best Test?

After CXR Do Bronchoscopy w/ BAL to visualize bug

HIV+ patient with DOE, dry cough, fever, chest pain ? 1st line Treatment? 2nd line Treatment? Prophylaxis?

1st: **Trim-sulfa** 2nd: **Trim-dapsone** or **Primaquine-Clinda**, or **Pentamidine** 3rd- **Atovaquone** 4th- **Aerosolized Pentamidine** (causes pancreatitis!)

Tx HIV+ patient with diarrhea CMV-(\<50) ?

Tx w/ Gancicylovir (neutropenia) or Foscarnet (renal tox)

Tx HIV+ patient with diarrhea MAC-(\<50)?

Diarrhea, wasting, fevers, night sweats. – Tx w/ Clarithromycin and Ethambutol +/- Rifampin – Prophylax w/ azithromycin weekly

Cryptosporidium- (\<50) and HIV?

- Transmitted via dog poo, swimming pools – Watery diarrhea w/ mucus, Oocysts are acid fast

HIV + Neuro + If multiple ring enhancing lesions?

Think Toxo. Do empiric Pyramethamine sulfadiazine (+ folic acid) for 6wks. If no improvement in 1wk, consider biopsy for CNS lymphoma. Assoc w/ EBV infxn of B- cells. Tx w/ HAART.

HIV + Neuro + If seizurew/dejavu aura and 500 RBCs in CSF?

Think HSV encephalitis. (predisposed for temporal lobe). Give Acyclovir as SOON as suspected.

HIV + Neuro + If s/s of meningitis?

Think Crypto. + India ink. Tx w/ Ampho B IV for 2wks then Fluconazole maintenance

HIV + Neuro + If hemisensory loss, visual impairment, Babinski?

Think PML. (Progressive Multifocal Leukoencephalopaty) JC polyomavirus demyelinates at grey-white jxn. Brain bx is gold standard dx

HIV + Neuro + If memory problems or gait disturbanc?

Think AIDS-Dementia complex. Check serum, CSF and MRI to r/o treatable causes

NEVER do a ____ on a neutropenic patient!

NEVER do a **DRE** on a neutropenic patient!

Target rash, fever, VII palsy, meningitis, AV block ?

Lyme! Tx w/ doxy (amox for \<8). Heart or CNS dz needs IV Ceftriaxone

Rash @ wrists & ankles (palms & soles), fever and HA.

Rickettsia! Tx w/ doxy.

Tick bite, no rash, myalgia, fever, HA, ↓plts and WBC, ↑ALT

Ehrlichiosis! Can dx w/ morulae intracell inclusion. Tx w/ doxy

Immune suppressed, cavitary lung dz (purulent sputum) + weight loss, fever. Gram + aerobic branching partially acid fast

Nocardia! Tx w/ trim-sulfa

Neck or face infection w/ draining yellow material (+sulfur granules). Gram + anaerobic branching

Actinomyces! Tx w/ high dose PCN for 6-12wks