GERIATRIC INFECTIONS

Question 1

what are the main features of age-related alterations in immune function?

Answer 1

depressed T-cell responses & depressed T-cell/mphage interactions

Question 2

what are the 3 most marked deficits of immunity in the elderly?

Answer 2

1. drying and thinning of skin & mucous membranes
2. poor antibody production
3. decreased production of IL-2 & T-cell help

Question 3

what are the definitions for fever in elderly nursing-home residents?

Answer 3

1. Temperature >2 F (1.1C) over baseline or
2. oral temp > 99 F (37.2C) or
3. Rectal temp > 99.5F (37.5C)

Question 4

elderly pts with bacteremia are less likely than younger adults to have what 3 signs/symptoms?

Answer 4

Chills, sweating, fever

Question 5

mortality with pneumonia is _______x to _______x that compared to younger pts.

Answer 5

3-5x

Question 6

what is the strongest independent predictor of mortality with pneumonia?

Answer 6

comorbidity

Question 7

what kinds of sources of bacteremia are more common in elderly pts compared to younger adults?

Answer 7

GI & genitourinary

Question 8

what is the treatment for community acquired pneumonia in elderly pts?

Answer 8

beta-lactam/beta-lactamase combo or adv. gen. cephalosporin (ceftriaxone or cefotaxime) w/ or w/o macrolide

alt: newer fluorquinolones (e.g. levofloxacin)

Question 9

regarding HCAP: MRSA-colonized pts or pts in units w/ high rates of MRSA, initial regimens should include what antibiotics until MRSA is excluded?

Answer 9

vancomycin or linezolid

Question 10

what are some ways to reduce the risk of pneumonia in elderly pts?

Answer 10

1. immunization
2. smoking cessation
3. aggressive tx of comorbidities (e.g. min. aspiration risk in post-stroke pts, limit use of sedatives)
4. system changes w/ attention to infection control may be effective in nursing home

Question 11

the flu vaccine is recommended for all adults over what age?

Answer 11

50 yrs

Question 12

treatment w/ M2 inhibitors or neuraminidase inhibitors is most effective if initiated when?

Answer 12

within 24 hrs of symptoms onset

Question 13

regarding UTIs: older adults are more likely to have resistant isolates like what?

Answer 13

Pseudomonas aeruginosa
gram positives (enterococci, coag-neg. staph. & GBS)

Question 14

overall what microbes are the MCC of UTIs?

Answer 14

gram negative bacilli (e. coli)

Question 15

how do we treat asymptomatic bacteriuria?

Answer 15

NO TREATMENT RECOMMENDED

Question 16

what is the treatment for lower tract UTI (cystitis) in older women?

Answer 16

3 days of therapy sufficient for uncomplicated cystitis

-FQs more effective than TMP-SMX

Question 17

what is the treatment for upper-tract UTI (pyelonephritis ) in older women?

Answer 17

7-21 days therapy

-IV abx for urosepsis

Question 18

what is the clinical presentation of pyelonephritis in older women?

Answer 18

fever
chills
Nausea
flank pain
also lower tract symptoms

Question 19

what is the underlying etiology that may predispose older men to get UTIs?

Answer 19

obstructive prostatic dz or functional disability

-need >14 days of therapy

Question 20

how long is therapy required in setting of prostatitis w/ UTI in older men?

Answer 20

6 wks

Question 21

most cases of TB infection are due to what?

Answer 21

reactivation in older adults

Question 22

elderly pts with TB are more likely than younger pts to have what additional findings?

Answer 22

extrapulmonary dz (virtually any body structure can be involved)

Question 23

what is the prophylactic treatment for asymptomatic elderly TB pts?

Answer 23

9 months of prophylactic isoniazid

Question 24

why are the elderly more prone to infective endocarditis?

Answer 24

elderly more likely to have degenerative valvular disorders and prosthetic valves

Question 25

how can you cure prosthetic device infections?

Answer 25

for full functionality: removing the device + abx for 6-8 wks, then reimplantation

Question 26

what is the most likely pathogen involved in septic arthritis?

Answer 26

staph. aureus

Question 27

what do you have to do to exclude infection in septic arthritis?

Answer 27

early arthrocentesis

Question 28

what is the predominant pathogen in osteomyelitis?

Answer 28

staph. aureus

Question 29

infections of pressure ulcers & diabetic foot infections commonly require what for treatment?

Answer 29

require surgical consult + aggressive antmicrobials aimed at mixed aerobic & anaerobic bacteria

Question 30

what is the primary mode of HIV transmission in elderly people?

Answer 30

heterosexual activity

Question 31

what is the most treatable infectious cause of dementia and is much more likely to reverse with therapy than syphilis?

Answer 31

HIV

Question 32

what is the treatment for bacterial meningitis in the elderly?

Answer 32

ceftriaxone or cefotaxime, + vancomycin used for empiric therapy until specific isolate can be tested for susceptibility

Question 33

what is the drug of choice for listeria?

Answer 33

ampicillin

Question 34

what is the major risk factor for zoster (shingles?)

Answer 34

old age

Question 35

what is the most disabling complication of zoster virus?

Answer 35

post-herpetic neuralgia

Question 36

what are 3 pathogens that can cause Bell's palsy?

Answer 36

HSV Varicella-zoster Borrelia burgdorferi

Question 37

how would you treat bell's palsy caused by varicella zoster virus?

Answer 37

start antiviral treatment with corticosteroids

Question 38

what is the clinical definition of fever of unknown origin?

Answer 38

temp. >38.3C for at least 3 wks, undiagnosed after 1 wk of medical evaluation

Question 39

collagen vascular dzs are more common causes of what, in elderly pts as compared to younger pts?

Answer 39

fever of unknown origin