EH: Infectious Disease Flashcards
Meningitis, Most Common Bugs?
Tx?
Strep Pneumo, H. Influenza, N. meningitidis
(tx w/ Ceftriaxone and Vanco)
Meningitis
In old and young?
Strep Pneumo, H. Influenza, N. meningitidis
(tx w/ Ceftriaxone and Vanco)
Add Lysteria. (tx w/ Ampicillin)
Meningitis
In ppl w/ brain surg?
Add Staph auerus
(tx w/ Vanco)
Meningitis
Randoms?
TB (RIPE + ‘roids) and Lyme (IV ceftriazone)
Rifampin + Isoniazid + Pyrazinamide ± Ethambutol or Streptomycin
Meningitis
Best 1st step?
Start empiric treatment (+ steroids if you think it is bacterial), Exam for elevated ICP/CT, then LP
Meningitis
Diagnostic test?
+Gram stain, >1000 WBC is diagnostic.
Meningitis
Roommate of the kid in the dorms who has bacterial meningitis and petechial rash?
Rifampin
Pneumonia
Classic sxs… best 1st step?
CXR
Pneumonia
Most common bug all comers?
Strep Pneumo.
Tx w/ M, FQ, 3rd ceph
Pneumonia
Most common bug in in Young, Healthy People?
Mycoplasma
A/w cold agglutinins
Tx: w/ M, FQ, and Doxy
Pneumonia
Old smokers w/ COPD?
H. influenzae. Tx w/ 2nd-3rd ceph
Pneumonia
Alcoholics w/ current jelly sputum?
Klebsiella. Tx w/ 3rd ceph
Pneumonia
Old men w/ HA, confusion, diarrhea and abd pain?
Legionella
Dx w/ urine antigen.
Tx w/ M, FQ, doxy
Pneumonia
Just had the flu?
MRSA.
Tx w/ vanc
Pneumonia
Just delivered a baby cow and have vomiting and diarrhea?
Q-fever. Coxiella burnetti.
Tx w/ doxy
Pneumonia
Just skinned a rabbit?
Franciella tularensis.
Tx w/ streptamycin, gentamycin
TB
If a patient is symptomatic best test is ?
CXR
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)
Side effects of Rifampin?
Body fluids turn orange/red, induces CYP450
Side effects of Isoniazid (INH)?
Peripheral Neuropaty and Sideroblastic anemia
Prevent by giving B6. Hepatitis w/ mild bump in LFTs
Side effects of Pyrazinamide?
Benign hyperuricemia
Side effects of Ethambutol ?
Optic neuritis, other color vision abnormalities.
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
