Extrapulmonary Infections Flashcards
5 reasons to get CT before LP
Hx of CNS disease
New onset seizures within the last week
Papilledema
Focal neuro deficits
Altered mentation
Most common cause of bacterial meningitis
Strep pneumoniae
Top 5 causes of bacterial meninigitis
Strep pneumo
N. Meningitidis
Group B Strep
H influ
Listeria
Serotype of strep that is not covered by the typical pneumonia vaccine
Serotype B
Typical abx regimen for meninigitis
vanc and 3rd gen ceph
Patients who get ampicillin for meninigitis
Pregnancy and patients > 50 years old
Covers Listeria
Abx regimen for meningitis if immunocompromised
Vanc + (Cefepime or Meropenem) + ampicillin
Abx regimen for meningitis if recent neurosurgery or penetrating trauma
Vanc + (Cefepime or meropenem or ceftazidime)
How are steroids started in meningitis
Start dexamethasone empirically
Stop if confirmed to not be strep pneumo
Continue for 4 days if confirmed strep pneumo
3 viral causes of aseptic meningitis in the summer/fall
Coxsackievirus
Echovirus
Poliovirus
4 causes of viral encephalitis in the summer/fall
West Nile virus
Eastern equine encephalitis virus
Western equine encephalitis virus
St. Louis encephalitis virus
2 causes of aseptic meningitis in the winter/spring
Mumps
Lymphocytic choriomenigitis virus
2 causes of aseptic meningitis that can occur at any time of the year
HIV
HSV-2
2 causes of viral encephalitis in the winter/spring
Mumps
Measles
2 causes of viral encephalitis that can occur at any time of the year
HIV
HSV-1
Location of brain abnormalities on imaging with HSV encephalitis
temporal lobe
Treatment for HSV encephalitis
14-21 days of IV acyclovir
Treatment for west nile virus encephalitis
supportive
Patient with fever, ocular abnormalities, neuroinvasive disease in the summer/fall
West Nile encephalitis
Dx in a patient with altered mentation, proximal to distal paralysis, no sensory issues, and pleiocytosis on CSF
West Nile Virus paralysis
3 infectious reasons that CSF opening pressure is elevated.
Bacterial
TB
Fungal
Glucose is low in CSF on what 2 infectious etiologies?
Bacterial
TB
2 pathogen classes covered for any head and neck infection
GNR’s
Oral beta-lactamase producing anaerobes
Ludwig’s angina
Infection of the submandibular space
Lemierre’s syndrome
septic embolic appearing as a clot in the jugular vein
Bacteria responsible for Lemierre’s syndrome
Fusobacterium necrophorium
Do you anticoagulate a patient with an IJ blockage from Lemierre’s syndrome
No
3 options for regimen in typical head and neck infections
Augmentin
Rocephin and flagyl
Clindamycin and levoquin
Duration of treatment for paravertebral space infection
2-3 weeks, longer if for osteo as well
Score to show severity in necrotizing skin and soft tissue infections
Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC)
LRINEC score with a 92% PPV and 96% NPV for necrotizing skin infection
6 or more
Most common cause of staphylococcal toxic shock syndrome
Tampons or nasal packing
Most common cause of streptococcal toxic shock syndrome
Trauma
Postpartum
Possible NSAIDs
Does staph or strep toxic shock syndrome have the higher mortality
Strep
Does staph or strep toxic shock syndrome get IVIG for treatment
Strep only
Abx regimen for staph toxic shock syndrome
MRSA: Vanc + clindamycin
MSSA: nafcillin + clindamycin
Abx regimen for strep toxic shock syndrome
Pen G + clindamycin
IVIG
Bacteria that causes gas gangrene in trauma
Clostridium perfringes
Bacteria that causes gas gangrene spontaneously
Clostridium septicum
Treatment for gas gangrene from clostridium
Surgical debridement
Pen G + clindamycin
Patient with myasthenia gravis appearance and use of black tar heroin infected with what?
Clostridium botulinum
2 differences in presentation of botulism to myasthenia gravis
Dilated pupils
non-fluctuating muscle weakness
Treatment for patients with botulinum toxin infection
Antitoxin (from CDC)
Penicillin (first line)
flagyl if pcn allergic
Class of drugs to not give in C. botulinum infection
Aminoglycosides as it worsens paralysis
2 reasons to do valve replacement in left sided endocarditis
- Vegetation size > 10 mm
- Location on the anterior leaflet of the mitral valve
