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CMT-uno > Gram + Infections > Flashcards

Gram + Infections Flashcards

1
Q

Acute Rheumatic Fever

Describe the Pathophysiology

A

Endocarditis with

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2
Q

Acute Rheumatic Fever

When does it occur?

A

2-3 weeks after initial infection.

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3
Q

Acute Rheumatic Fever

What are the variable presentations of Acute Rheumatic Fever

A

Carditis (50-70%)
Arthritis 35-66%
Chorea 10-30%
Subcutaneous nodule 0-10%
Erythema marginatum <6%

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4
Q

Acute Rheumatic Fever

Which Valves are affected?

A

Mitral valve 75-80%
Aortic valve 30% (usually with other valves)
Tricuspid & Pulmonary valves < 5%

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5
Q

Acute Rheumatic Fever

What criteria is used for diagnosis?

A

JONES

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6
Q

Acute Rheumatic Fever

how do we treat?

A

treat group A strep
Educate about oral health
Salicylates, bed rest for carditis.
continuous antibiotic prophylaxis for years (Pen G IM every 3-4 weeks).

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7
Q

Acute Rheumatic Fever

what are long term implications?

A

valvular stenosis and/or regurgitation.
chronic rheumatic disease.

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8
Q

Acute Rheumatic Fever

Infective Endocarditis and how Dx

A

Fever, evidence of systemic emboli (caused by vegitation in valves), + blood cultures,

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9
Q

Infectious Endocarditis

pathogens

A

Staph (mucoid-producing strains of S aureus).
Strep viridans.
Enterococcus.
Fungal.

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10
Q

Infectious endocarditis

IV drug use

A

More common in males.
S aureas >60% of cases.
Typically R sided valves, esp tricuspid.
Higher recurrence rate.

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11
Q

IE predisposition

A

Valvular heart disease
Congenital heart disease
Prosthetic valve
History of IE
Pacemaker
Hypertrophic cardiomyopathy
prosthetic valve

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12
Q

How to Dx IE

A

Blood cultures
Echocardiography (identifies specific valves)
CXR may show cardiac abnormality
Chest CT may show emboli
Caution with cardiac catheterization

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13
Q

Infective endocarditis

Duke Criteria for Dx

A

2+ major criteria, 1 major + 3 minor, or 5 minor

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14
Q

Infective Endocarditis

Major Criteria

A

Positive blood cultures
Typical microbe in 2 cultures
Persistently + cultures
Single + culture for Coxiella burnetii

Evidence of endocardial involvement
Definite vegetation
Myocardial abscess
New partial dehiscence of prosthetic valve

New or worsening regurgitation murmur

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15
Q

IE

Minor Criteria

A

Predisposition: Heart condition/IV drug abuse.
Fever > 100.4.
Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions.
Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor
Microbiologic evidence (+ blood cult not meeting major criteria).
Echo findings that do not meet major criteria

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16
Q

Acute IE

A

<6 week incubation – can be very rapid course
Toxic presentation (high fevers, CP, SOB, very tired)
Rapid progression fatal if untreated
S. aureus most common

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17
Q

Subacute IE

A

greater than 6 week incubation – can be several months
Less dramatic presentation (low grade fever, night sweats, weight loss)
Gradual progression
Less virulent organisms: S. viridians, enterococcus

18
Q

IE

Treatment for valve destruction

A

Surgery

19
Q

IE

Early surgical indicators

A

Acute heart failure due to valve destruction
Unresponsive to antibiotics
Septal abscess
Sinus of Valsalva involved
Recurrent IE with same organism
Embolism despite treatment
Large mobile vegetation

20
Q

IE

Late surgery indication

A

after antibiotic course is completed

21
Q

IE

Post surgery meds

A

antibiotics, antifungals for 6 weeks, and anticoagulants for life

22
Q

IE

Prognosis if untreated, with treatment, how many will need surgery, what about with fungal infection

A

untreated almost always fatal.
~70% survive w treatment
60% will have surgery
mortality rate higher with fungal infection

23
Q

IE

Valve complications

A

Valve damage/destruction –> Heart failure

24
Q

IE

Peripheral embolization Complications

A

Myocardium  MI
Lungs > Septic PE (R side)
Brain/spinal cord > Stroke/paralysis
Eyes > Blindness
Extremities > Limb ischemia
Spleen/kidney > Infarct

25
Q

IE

when is prophylaxis indicated? (antibiotics)

A

prior hx of endocarditis
vardiac valce disease in a transplanted heart
unrepaired cyanotiv congenital heart disease

26
Q

Staph

MRSA tx

A

Vanco or clindamycin

27
Q

Staph

Types of infections (4)

A
  1. skin/soft tissue
    2.Scalded skin syndrome(peds)
    3.Toxic Shock syndrome(15% fatality)
    4.Enterotoxin food poisoning
28
Q

What are the coagulase - Staph spp?

A

Staphylococcus epidermidis, S. haemolyticus, and S hominis are common and part of normal skin flora.

29
Q

staph

what are coagulase - staph commonly resistant to and how do we Tx?

A

beta-latams.
treat with vanco.

30
Q

Enterococcus

what are the most common spp in infections?

A

Enterococcus faecalis and Enterococcus faecium
(usually from fecal matter)

31
Q

Enterococcus

How do we Tx?

A

Penicillin.
if allergic give Vanco.
if Vanco resistant (VRE) give Linezolid (can cause bone marrow suppresion/thrombocytopenia).
call infectious disease/pharm

32
Q

Pneumococcus

is the most common cause of what disease?

A

community acquired bacterial pneumonia

33
Q

pneumonococcus

How do we Dx?

A

Sputum Culture.
Rapid urine antigen test for Streptococcus Pneumoniae

34
Q

pneumonococcus

complications

A

Parapneumonic effusions, pericarditis, endocarditis, meningitis

35
Q

Pneumonococcus

How do we Tx? Outpatient and inpatient

A

outpatient: amoxicillin, azitromycin(if PCN allergic)
inpatient: Pen G IV, Vanco IV

36
Q

Bacillus

who is commonly infected?

A

Immunocompromised patients, IVDU, and indwelling/implanted catheters

37
Q

Bacillus

How do we Tx?

A

most are PCN and cephalosporin resistant.
Treat with Vanco.

38
Q

What bacteria produce a honey colored crust?

A

Group A Strep

39
Q
A
40
Q

What pathogen causes rheumatic fever?

A

Group A strep

CMT-uno (54 decks)

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