Fungal and sepsis Flashcards

Question

Pneumocystis jirovecii pneumonia

Answer 1

"yeast like"- inhalation colonizer of human airway **low virulence-> can cause lethal pneumonia immunocompro** * seen in **HIV** and sporadic **sick infants** * SXS gradual: * fever, **nonproductive cough, SOB esp DOE** * bilateral rales on exam * cxr shows symmetric "ground glass" pattern from hila outward * Hypoxia in 3-4 wks and death * DX: cysts in BAL washings

Answer 2

MC Life threatening invasive fungal disease inhalation of pigeon bird droppings C. neoformans-> in hiv pts C. gattii-> less dx Pulmonary infection: * asymp * **pneumonia** * fever, cough, SOB, headache, night sweats Extrapulmonary infxn: CNS-> **meningitis** or skin-> subcutaneous nodules DX: serum cryptococcal ag

Answer 3

Southwest US- inhale spores **immunocomp-> mild flu like, no need to tx** **immunocompromised-> more severe pneumonia and disseminated dx** DX: skin test for CMI response SYNDROME OF SEVERE PNEUMONIA + ERYTHEMA NODOSUM + ARTHRALGIAS= "VALLEY FEVER"

Answer 4

Endemic= OHIO/MISSISSIPPI RIVER VALEYS Acute sympt= flu like sxs Progressive pulmonary dx= **resembles TB- SPUTUM, WT LOSS, NIGHT SWEATS, LUNG CAVITIES** Disseminated dx- immunocomp- **painless ulcers on mucous membranes- involve CNS**

Answer 5

**east central and Great lakes region** **landscapers and farmers high risk-> bc spores from moist soil** **immunocomp->w/ collagen vascular dx high risk** sequelae 1. Asymp/mild sxs-> self limiting w/ mild fever and cough 2. Acute or chronic pneumonia 3. Exrapulmonary/dissem dx-> any organ->**skin lesions mc**

Answer 6

**pruritic, eczematous dermatitis**- btwn epidermis and dermis away from actual starting place **MC causes: Dermatophyte (tinea) infxns of feet or stasis dermatitis** Not specific to fungi

Answer 7

#1 cause of death from infxn Focus on: 1. early recognition 2. timely assessment and follow up 3. prompt action and tx Organ failure is the primary cause of mortality

Answer 8

incidence increasing due to: * increased awareness and tracking * aging population * immunosuppression * antibiotic resistant infxn

Answer 9

**systemic inflammatory response syndrome (SIRS): up to 7% of mortality figures** lowest risk-> UTI source HIghest risk-> GI, Lung, or unknown

Answer 10

**sepsis-> dysregulated host immune response to infection -> exists on a continuum** organ dysfunction- SOFA score-increased 2 or more points related to organ failure Sepsis= dynamic state-> frequent reassessment for changes

Answer 11

1. Early sepsis-> infxn or bacteremia-> SOFA and NEWS 2. Sepsis-> Life threatening organ dysfunction caused by dysreg host 3. Septic shock- circulatory, cellular, and metabolic abnormalities 4. MODS (multifunction organ dysfunction syndrome)- progressive organ dysfunction without homeostasis and intervention

Answer 12

1. Binding of TLRs on surface of immune cells-> cascade signals 2. increased transcription of inflamm mediators 3. Proinflamm cyto incide direct cytopathic injury-> tissue injury 4. Nitric oxide released-> vasodilation-> ischemia and shock

Answer 13

1. Binding of TLRs on surface of immune cells-> cascade signals 2. increased transcription of inflamm mediators 3. Proinflamm cyto incide direct cytopathic injury-> tissue injury 4. Nitric oxide released-> vasodilation-> ischemia and shock

Answer 14

Alterations in vitals: * arterial hypotension-> systol 90, MAP <70, Temp >38.3 or <36, **tachycardia >90 bpm or tachypnea>20 bpm** * Sigs of end organ perfusion * **Decreased cap refil/cyanosis/mottling, atlered mental status, obtundation, Ileus**

Answer 15

* hyperglycemia- glucose>140 * arterial hypoxemia * acute oliguria- urine output<0.5 ml/kg/hour * creatinine over .05 * thrombocytopenia * hyperbilirubinema>4 * hyperlactatemia-> sign of acidosis-> sign of organ hypperfusion * Procalcitonin high

Answer 16

**Calcitonin**-from thyroid-> decreases Calcium by inhib clasts **Procalcitonin- not detectable in healthy individuals** Elevated plasma procalc-> **occurs when tissue control of calcitonin breaks down and ProCT secreted** * **bacterial sepsis triggers * severe localized bacterial infxn * major burns, severe trauma, acute multiorgan failure, major abdominal or cardiothoracic surgery** * medullary thyroid carcinoma Viral: block TNFalpha blocking the release of procalc

Answer 17

1.PaO2/FiO2 ratio- comparison btwn O2 level in blood and conc breathing 2.platelet count 3.bilirubin 4.hypotension 5.glasgow coma score 6.creatinine

Answer 18

1. tachypnia- greater than 22 RR 2. Altered mental status- GCS 15 or less 3. Hypotension- sbp less than 100 one point each: 0-1= not high risk 2-3= high risk

Answer 19

#1= Pneumonia cause of sepsis icu admission recent hospitalization- pt tx with antibiotic bacteremia extremes of age immunosuppression- diabetes, HIV Malignancy CAP inappropriate antibiotic use especially broad spectrum genetic factors/innate immuno factors Covid 19 maternal/perinatal period trauma/burns

Answer 20

RF: debillitated condition of pts, colonization of environ inpatient sepsis-> from skin contaminants with UTIS, CENTRAL LINES, MECHANICAL VENTILATION/PNEUMONIA G+ organisms increasing follow protocols for indwelling devices: 1. CLABSI- central lines replaced no more fre than every 4 days but no longer than 7 2. CAUTI-urinary catheter should be 3-8 days | cauti- catheter assoc uti Clabsi- central line assoc bloodstream infxn

Answer 21

Cardiovascular- Endocarditis, myocarditis, injxn drug use HEENT- sore throat/pharyngitis LUNGS- CF SKIN- hospitalized pts

Answer 22

- 1. E. coli- uti and prostatitis 2. Klebsiella pneumoniae- uti pneumonia 3. enterobacter species- uti 4. **pseudomonas aeruginosa- infected burns/pneumonia in CF/ ALL pts/diabetes- highest mortality rate** 5. Proteus mirabilis- utis 6. bacteroides fragilis- peritoneal infxn + 1.**streptococcus pneumoniae- pneumonia and meningitis-> MC cause of pneumonia and meningitis in adults** 2.streptococcus pyogenes- skin and soft tissue infection-> super antigen 3.staphylococcus aureus- skin and soft tissue infection-> superantigen 4.enterococcus species- utis

Answer 23

INFXN - common cause RF: * extensive trauma, hemorrhage, burns * thromboembolism (PE) * anaphylaxis * MI/CABG/surgery * autoimmune * addison's disease all trigger dysregulated inflamm response ## Footnote DOES NOT MEAN THERE IS AN INFECTION

Answer 24

need 2 or more: 1. temp >38 or <36 2. heart rate >90 bpm 3. respiratory rate >20 bbp 4. WBC >12K

Answer 25

emphasis on inflamm ocmponents without considering dysregulation-> many sxs are adaptive (fever, tach, wbcs) sepsis definition: **life threatening organ dysfunction caused by dysregulated response to infection (maladaptive)** ## Footnote TOO LOOSE

Answer 26

Sepsis is a coagulation trigger-> release pro inflamm cytokines **increases PA-1: plasminogen activator**

Answer 27

Sepsis is a coagulation trigger-> release pro inflamm cytokines **increases PA-1: plasminogen activator**

Answer 28

1. release of tissue factor is critical-> bleeding more likely in acute DIC, thrombosis in CHRONIC 2. Clotting factors rapidly consumed 2ndary to: * infection * extensive trauma * malignancies * OB complications difficult to recognize until late stages consumptive of clotting factors lead to excessive bleeding-> shock, hypotension, increased vascular permeability excessive clotting- ischemia, impaired organ perfusion, end organ damage

Answer 29

1. Clotting:**PE, DVT, MI, renal failure, ischemic stroke** 2. Bleeding: **petechiae, blood oozing, accumulation of blood in serous vacities, hematuria, hemorrhagic stroke**

Answer 30

* Circulatory, cellular, and metabolic abnormalities assoc w/ greater risk of mortality than with sepsis alone Clinically: * vasopressor requirement to maintain MAP greater than 65 * lactate level higher than 2 in abscence of hypovolemia Hospital mortality rates over 40% **sock and hypoxemia may result in transient tranaminitis**

Answer 31

1 hour bundle: 1. measure lactate 2. obtain blood culture b4 ab 3. administer broad spec ab 4. rapid administration of cystalloid for hypotension 5. apply vasopressors if hypotensive

Answer 32

Neonatal up to 3 months: Group B strep E. coli

Answer 33

* fluids- crystalloids- maintain BP * pressors- norepinephrine to maintain BP * steroids-when fluids and pressors are insuff exept in peds * albumin- controversial

Answer 34

BO= COxPR vasoconstriction increased renin increased chronotropic and ionotropic effects

Answer 35

PRBC for HB<7 Platelets <10,000 Enoxaparin if dvt considered glucose: insulin for BG>180 monitor frequently to ensure stability

Answer 36

* remove foreign bodies, drain abscesses, remove infected tissues * use ab prophylactic in pts with liquid tumors * topical agents prophylactic in burn pt * indwelling catheters should be properly cared for and frequently examined for the possibility of infection