General

Question 1

What is the Centor criteria and what is it used for?

Answer 1

1. Hx of fever
   
   2. Tonsilar exudates
   3. Tender anterior cervical adenopathy
   4. Absence of cough
   5. Age >45y.o subtract 1 point
      Used to estimate likelihood of GAS infection
      -1-0 pts: 1%
      1pt:10%
      2pts 17%
      3pt 35%
      4pts 51%

Question 2

List risk factors for cadida bezoar.

Answer 2

• DM or immunodepressed
• Neurogenic bladder
• Antibiotic use
  Indwelling catheter

Question 3

Which cat/dog and human bites can be sutured?

Answer 3

Cat: none except face
Dog: all except hand
Human: all except hand

Question 4

What is prophylaxis of choice for dog/cat or human bite

Answer 4

amox-clav 500mg bid x 5d

Question 5

What is treatment of choice for infected dog/cat or human bite

Answer 5

Dog: 3rd gen cephalosporin eg ceftriaxone OR Pip Tazo+flagyl

Cat: cefuroxime
Human: cefuroxime or Pip Tazo

Question 6

How is pasteurella treated?

Answer 6

· Beta lactams cover it but clavulin is recommended to cover anaerobes that are often present as well.
· Fluoroquinolones, 3rd generation cephalosporins

Question 7

What is the importance of Capnocytophagia canimorsus?

Answer 7

Fastidious gram-negative rod in the normal flora of both dogs and cats that has the ability to cause overwhelming sepsis

Question 8

List risk factors for infection from Capnocytophagia canimorsus.

Answer 8

• Alcoholic liver disease
• Functional or surgical asplenia
• Lung disease
• Steroids
• *40% no underlying illness

Question 9

Describe the clinical presentation of illness from Capnocytophagia canimorsus.

Answer 9

• Begins within 2 – 3 days of exposure – severe illness and MOF
  o Hypotension
  o DIC
  o Renal failure
  o Purpura (face) and petechiae
  o Symmetric peripheral gangrene
  o Cutaneous gangrene at the site of bite or scratch
  o Waterhouse-Friderichsen syndrome (adrenal hemorrhage with cutaneous ecchymosis)
  o Metastatic infection (endocarditis, meningitis, pericarditis, pneumonitis)

Question 10

List characteristics of infection from Pasteurella multocida.

Answer 10

• Distinctly early onset – rapidly progressive cellulitis that may be apparent within 6 hours and easily identifiable at 24 hours
  o Erythema, warmth, swelling, and tenderness
  o Purulent drainage
  o Lymphangitis
  o Adenopathy

Question 11

List complications of infection of pasteurella multocida.

Answer 11

• Abcess
• Tenosynovitis
• Joint infections
• Osteomyelitis
• Seeding of arthritic joints
• Endocarditis
• Menigitis
• Pericarditis

Question 12

What is of a particular concern in bites from “Old World macaque monkeys” (rhesus macaques, cyanomolgus, other Asiatic macaques)?

Answer 12

• B virus
• One of 35 herpes virus in non-primates
• Fatal to humans if not treated early (case fatality rate 70%)

Question 13

What is the presentation of B virus infection in humans?

Answer 13

• Vesicles at site of injury
• Tingling, pain, numbness
• Flu like illness
• Peripheral or CNS symptoms
  o Paresthesias
  o HA
  o Confusion
  o CN palsies
  o Hemiparesis
  o Coma
  o Death

Question 14

What species cause bites at high risk of infection

Answer 14

Cat, human, primate, pig, camel and dog(only on hand)

Question 15

List indications for prophylactic antibiotics for dog bites.

Answer 15

• Hands
• High risk wounds
  o Deep punctures
  o Heavy contamination
  o Significant tissue destruction
  o > 12 hours old
  o Joint, tendon, or bone involvement
• High risk patients
  o DM
  o PVD
  o Corticosteroid use

Question 16

What is the importance of Eikenella corrodens?

Answer 16

• Facultative anerobic gram-negative rod (human dental plaque)
• > 25% of CFIs
• Acts synergictically with oral aerobes increasing morbidity