Fever Flashcards
What are the most common sources of bacteremia?
Skin and ST infections Central venous catheters and other intravascular devices Bone and joint infections Pneumonia Endocarditis
Clinical manifestations of bacteremia
Fever Fatigue and malaise NV loss of appetite Dehydration Myalgia and arthralgia Lab evidence of leukocytosis and left shift hemogram Needs empiric ab tx
What is septicemia?
Inflammatory response to bacteremia
Early sepsis -> sepsis -> septic shock
SOFA for sepsis
Organ dysfunction score! Identifies pt who have high risk of dying from infection
not diagnostic and does not identify if organ dysfunction is due to infection
qSOFA for sepsis
Based on RR >22/min, altered mentation, and systolic BP <100 mmHg
Predicts chance of sepsis in pt admitted
What are 8 risk factors for sepsis?
ICU admission Bacteremia Age >65 Immunosuppression DM and obesity Cancer CAP Previous hospitalizations
Clinical manifestations of sepsis
Symptoms and signs specific to infectious source Arterial hypotension of SBP <100 mmHg Temp >38.3 or <36 HR >90 BPM RR >20
What are signs of end organ perfusion abnormalities?
warm, flushed skin in the beginning that progresses to cool due to redirection of blood flow
Decreased cap refill, cyanosis, mottling
altered mental status, obtundation, oliguria, anuria
Absent bowel sounds/ileus
Lab eval for sepsis
Leukocytosis or leukopenia Normal WBC w/ >10% immature Hyperglycemia w no DM Plasma CRP >2 standard dev above normal value Arterial hypoxemia Acute oliguri Creatinine increase >0.5 mg/dL
How do you get a staph infection?
skin or soft tissue infection due to a break in skin integrity, IV catheters, cardiac devices, orthopedic hardware
Sx of a systemic staph infection
Bone or joint pain Fever or sweats (endocarditis) Abd pain (LUQ) CVA tenderness HA
MRSA
hospitial acquired and involved in long term, recurrent wounds
Common in immunocompromised
Local erythema w induration and pus
Is MRSA gram + or -?
Gram positive cocci in clusters
What should you focus on in culture positive s. aureus bactermia?
Endocarditis, osteomyelitis, and deep seated systemic infections (epidural abscess, discitis, abscess formation)
Erysipelas
superficial skin infection associated w staph.
well defined borders
Cellulitis
Deeper skin infection w dermis and subQ fat
associated w lymphangitis, edema, swelling
Erysipelas and cellulitis have what features in common?
Painful, warm, indurated, erythematous, non-localized
Can have lymphangitis
risk factors for community acquired MRSA
Contact sports
Military
Incarceration
IV drugs
MRSA is common in what situations?
Surgical incisions
Diabetic foot infections
What are unusual MRSA infections?
Joint infections (bacteremia or instrumentation usually)
What is osteomyelitis due to MRSA associated with?
Fixation device, prosthesis, hematogenous infection in kids, nonhealing foot ulcers in pt w DM or peripheral artery dz
Group B Strep in neonates
In utero or passage through vagina
presents as bacteremia w/o focus, sepsis, pneumonia, or meningitis
Group B strep in pregnant women
UTI
Chorioamnionitis
Postpartum endometriosis
Bacteremia
Group B strep in non pregnant adults
MC strep pathogen inadults
Bacteremia w/o focus!!!
Sepsis, ST infection, endocarditis
Group A strep
MC cause of bacterial pharyngitis in kiddos
likely sx: scarlatiniform rash, palatal petechiae, tonsillary enlargement, vomiting, tender cervical nodes
Risk factors for TB
Household
Incarceration
Drug use
Travel to endemic area
Main sx of TB
Productive cough hemoptysis Fatigue Weight loss Fever Night sweats
Latent TB (LTBI)
Bacilli are contained w/in granulomata
Non-transmissible but can be if it becomes active
Reactivation of TBI and RF
individuals immune system becomes weak and can’t contain latent bacteria
RF: gastrectomy, silicosis, DM, HIV, immunosuppression drugs
RF for drug resistant TB
interact w people who have it
Unsuccesful prior TB tx
Pt noncompliance
Which influenza type produces the mildest symptoms?
Influenza C
What are influenza pandemics normally due to?
Type A antigenic shifts
What are conditions that are suggestive of HIV?
Hairy leukoplakia on tongue
Disseminated kaposi sarcoma
Cutaneous bacillary angiomatosis
Generalized LAD early in an infection
What is the biggest difference between CMV and infectious mono?
CMV doesn’t present w pharyngeal sx normally
CMV seroprevalence increases w
Age Lower SES # of sex partners Hx of STI Employment in child care
CMV infection v CMV disease
Infection doesnt have to have symptoms
Disease has infection w signs and symptoms (viral or tissue-invasive)
Perinatal CMV infection sx (8)
Jaundice, HSM, thrombocytopenia, purpura, microcephaly, CNS calcifications, mental retardation, motor disability
Perinatal CMV acquired in what manner is likely to be benign?
Breast feeding or blood products
What does CMV look like in immunocompetent patients?
Mononucleosis but w negative heterophil antibodies
Fever, malaise, myalgias, arthralgias, splenomegaly, atypical lymphocytes, abnormal liver fxn
Cutaneous rashes
CMV in immunocompromised persons?
CMV retinitis in advanced aids
Aids/high dose chemo can lead to GI and hepatobiliary CMV w esophagitis, small bowel inflamm., colitis, or cholangiopathy
Transplants/AIDs- pneumonitis
What are neurologic manifestations of CMV in immunocompromised persons?
Polyneuropathy, transverse myelitis, encephalitis
Histoplasmosis in immunocompromised v. immunocompetent persons?
Immunocompromised can become dissemninated and lead to a poor prognosis (dx w blood and bone marrow cultures). CD4 is normally <100
Immunocompetent is asymptomatic or a mild respiratory illness
Which pt can present with chronic progressive pulmonary histoplasmosis?
Older patients w COPD
How does progressive histoplasmosis affect the mucous membranes, liver, spleen, and GI system?
Ulcers on mucous membranes of oropharynx
HSM
GI can mimic IBD
What are some of the general sx of histoplasmosis?
Cough, dyspnea
Fever, weight loss, prostration
CNS invasion in 5-10% of pt
Sx of disseminated histoplasmosis?
Fever and multiple organ system involvement
Can be fulminant presentation looking like septic shock
What causes coccidioidomycosis?
Inhalation of coccidioides immitis or coccidioides posadasii (molds in soil of US, mexico, central and south america)
Primary coccidioidomycosis incubation period and symtpoms?
incubates 10-30 days
Sx in 40% of pt, and are nasopharyngitis with fever and chills.
Arthralgias (esp knees and ankles)
Can cause CAP in endemic areas
Which disease can cause erthyema nodosum 2-10 days after sx onset?
Primary Coccidioidomycosis
Disseminated coccidioidomycosis in immunocompromised pt
If untreated, can lead to fungemia with diffuse miliary infiltrates on CXR and an early death
General sx of disseminated coccidioidomycosis
Productive cough
enlarged mediastinal LN
Lung abscesses, empyema
Skin and bone infections
Meningitis that can result in chronic basilar meningitis
Subcutaneous abscesses and verrucous skin lesions
Lymphadenitis progressing to suppuration
General sx of plasmodium species malaria
Intermittent attack of fever, chills, and sweating
HA, mylagia, vomiting, splenomegaly, anemia, and thrombocytopenia
Which plasmodium species is responsible for most severe infections?
P falciparum (F=bad)
Which plasmodium species don’t cause severe illness?
P ovale and P malariae
Acute malaria sx
Prodrome of HA and fatigue, followed by fever.
W/o tx, fever becomes regular (48 or 72 hr cycles)
Myalgia, arthralgia, chest and abd pain, anorexia, N/V
Which plasmodium disease causes 48 hr cycles and which causes 72 hr cycles?
48 -p vivax and p ovale
72 - P malariae
