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Gram - Infections Flashcards

1
Q

E coli gastroenteritis

Where do you get infection from?

A

originates from fecal matter, but then gets contaminated into meat at processing plants.
raw flour unpasteurized products, contaminated leafy greens.

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2
Q

E coli gastroenteritis

Enterotoxigenic E Coli (ETEC)

A

Heat stable or heat labile toxin
Important source of traveler’s diarrhea

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3
Q

E coli gastroenteritis

Enteroinvasive E. Coli (EIEC)

A

Invade cells leading to bloody diarrhea and dysentery
Uncommon in US

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4
Q

E coli gastroenteritis

Shiga toxin-producing E. Coli (STEC)

A

E. Coli O157:H7 most common in US.

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5
Q

E coli gastroenteritis

What are symptoms of STEC- (5)?
Who is most likely to have complications?

A

Asymptomatic carrier stage
Nonbloody diarrhea
Hemorrhagic colitis
Hemolytic-uremic syndrome (HUS)- rare
Thrombotic thrombocytopenic purpura (TTP)
small vessel clots that cause organ problems
worst cases in geriatric and pedicatric pts.

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6
Q

E coli gastroenteritis

what is Hemolytic-uremic syndrome (HUS)

A

RBCs are lysed and damage kidneys upon filtration of blood.
HUS can be caused by any hemolytic anemia.

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7
Q

E coli gastroenteritis

What is Thrombotic thrombocytopenic purpura (TTP)?

A

small vessel clots that cause organ problems

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8
Q

STEC

how do we Dx?

A

get stool culture and check for specific shiga toxin.

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9
Q

STEC

how do we Tx?

A

supportive care
antibiotics shorten clinical course, Ciprofloxacin 500mg 2x daily

REQUIRES REPORTING TO HEALTH DEPARTMENT

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10
Q

Salmonellosis

how is it contracted?

A

ingestion via food or drink

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11
Q

Salmonellosis

what spp is most common in causing salmonella in humans?

A

Salmonella enterica

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12
Q

Salmonella

Enteric fever

A

Typhoid fever

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13
Q

salmonella

what spp causes enterocolitis?

A

S. typhimurium subspecies

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14
Q

salmonella

what spp causes sepsis?

A

S choleraesius subspecies

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15
Q

Salmonella

Enteric (typhoid) Fever patho & incubation

A

6-30day incubation
ingested then infects small intestine wall, then* can* enter lymphatic system which can lead to sepsis.
Some people are carriers (in lymph without symptoms)

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16
Q

Salmonella

Symptoms

A

wax and waning symptoms- may release up tp 2 weeks after fever resolves in 15% of cases.

Prodromal stage (7-10 days) - malaise, headache, cough, sore throat, abd pain, constipation or pea soup poop, fever that increases over time

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17
Q

Salmonella

Later Sx with typhoid

A

Splenomegaly (lymph infection)
Abdominal distention/tenderness.
Relative bradycardia.
Meningismus.
Rash “rose spots” 2nd week
Typically on trunk
Pink papule 2-3mm that fades with pressure
Resolves in 3-4 days

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18
Q

Salmonella

how do we Dx typhoid fever?

A

leukopenia, blood cultures(+ result in 80% in 1st week of illness, 25% by 3rd week.

stool cultures are unreliable, may be + w/o typhoid fever

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19
Q

salmonella

Complications of typhoid

A

2% mortality rate in treated patients
Occurs in 30% of untreated cases
Intestinal hemorrhage
Intestinal perforation

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20
Q

salmonella

less common complications of typhoid

A

Pneumonia, thrombophlebitis, myocarditis, psychosis, cholecystitis, nephritis, osteomyelitis, meningitis

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21
Q

Salmonella

how do we Tx symptomatic typhoid?

A

Levofloxacin (Levaquin) 750mg PO twice daily or once daily
5-7 days for uncomplicated
10-14 days for severe infections

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22
Q

Salmonella

How do we Tx typhoid carriers?

A

Ciprofloxacin (Cipro) 750mg PO twice daily for 4 weeks

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23
Q

Salmonella

how do we prevent Typhoid fever?

A

consider immunization, multi-dose oral vaccine or single dose parenteral vaccine
adequate waste disposal
protect food and water supplies
carriers CANNOT work as food handlers.

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24
Q

Salmonella

Acute enterocolitis Sx

A

Fever +/- chills
Nausea/vomiting
Cramping abdominal pain
Diarrhea, may be bloody (3-5 days)

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25
# Salmonella how long is the incubation for salmonella gastroenteritis?
8-48 hours
26
# salmonella How do we treat critically ill salmonella gastroeneteritis? Dx?
Diagnosis by stool culture Typically, self limited Rarely may cause bacteremia with localization to joints Critically ill patients Ciprofloxacin (Cipro) 500mg PO twice daily for 7-14 days
27
# Yersinia What disease is caused by Yersinia?
Bubonic Plague (80-95% of cases)
28
# Yersinia how is it spread? Incubation?
wild rodents and ticks organism spreads through lymphatics 7-10 day incubation. spreads between humans via droplets (pneumonic plague)
29
# yersinia what are complications of infection?
spread from lymph to lungs or meninges
30
# Yersinia Signs of bubonic plague
* Tachypnea Productive cough Blood-tinged sputum Cyanosis Meningeal signs Lymphadenopathy (LAD) Purpuric spots Due to disseminated intravascular coagulation(DIC)- purple spots
31
# yersinia symptoms of bubonic plague
Sudden onset High fever Malaise Tachycardia Intense headache Delirium-pneumonic plague Severe myalgias
32
# Yersinia how do we Dx?
aspirate buboes(lymph node) or antibody titer
33
# yersinia how do we Tx bubonic plague? Prophylaxis?
Immediate with any suspicion Streptomycin 1gm IV every 12 hours x 10 days Respiratory isolation if pneumonia Antibiotic prophylaxis for any exposure Doxycycline (Vibramycin) 100mg PO twice daily x 7 days
34
# Haemophilus are likely to colonize ...?
upper respiratory tract in patients with COPD (and w/o)
35
# Haemophilus what can haemophilus cause?
upper resp infect. sinusitis, otitis, bronchitis, epiglottitis, pneumonia, cellulitis, arthritis, meningitis, and endocarditis
36
# Haemophilus how do we Tx Haemophilus?
Non beta-lactamase producing strains Amoxicillin Beta-lactamase producing strains (more common in children) Amoxicillin-Clavulonate (Augmentin) PCN allergic: Cefuroxime
37
# Moraxella catarrhalis where does it colonize? and what does it cause?
respiratory tract causing Sinusitis, bronchitis, and pneumonia sometimes bacteremia and meningitis in immunocompromised patients
38
# moraxella catarrhallis how do you treat?
because it produces beta-lactamase you use Amoxicillin-Clavulanate
39
# bordetella pertussis what disease does it cause?
whooping cough (can lead to failure to thrive in infants)
40
# bordetella pertussis how is it transmitted?
by respiratory droplets Sticks to cilia and respiratory epithelia
41
# bordetella pertussis how long is incubation?
7-17 days
42
# bordetella pertussis who is mostly affected?
infants <2yo Pertussis in 3rd trimester or 1st year after delivery poses huge risk to infant. Can be fatal.
43
# bordetella pertussis what are the 3 stages? and how long does infection typically last?
Catarrhal stage (1-2 weeks) Paroxysmal stage (acute, rapid) convalescent stage (4 weeks after onset/ recovering) total of 6 weeks, can have lasting damage
44
# bordetella pertussis Catarrhal stage
**Most infectious** Lacrimation Sneezing Coryza Hacking cough at night that becomes diurnal Malaise Anorexia
45
# bordetella pertussis Paroxysmal stage
(acute, rapid) Rapid consecutive coughs followed by deep high-pitched inspiration
46
# bordetella pertussis Convalescent stage
Decrease in frequency and severity of cough
47
# Bordetella pertussis how do we Dx whooping cough?
nasopharyngeal culture using Bordet-Gengou agar some may have PCR assay
48
# bordetella pertussis how do we Tx exposure?
Erythromycin 500mg PO QID x 7 days If macrolide allergy, use TMP-SMX
49
# bordetella pertussis how do we treat sympomatic pts?
Supportive Care- Maintain hydration and nutrition, maintain airway, control secretions Admit- Consider referral to infectious disease Droplet precautions/standard precautions
50
# bordetella pertussis when do we admit pts? ICU?
Admit if sustained hypoxia, failure to thrive, encephalopathy, or seizures. Consider ICU for: infants < 3 months, infants 3 - 6 mo with severe paroxysms, premature infants, infants with underlying cardiac, pulmonary, neuromuscular disease
51
# Bartonella what diseases can it cause?
Cat scratch disease
52
# bartonella what is cat scratch disease?
Acute infection of children and young adults by Bartonella henselae Transmitted by cat scratch or bite Within several days, a papule or ulcer forms at injury site 1-3 weeks later, develops fever/HA/malaise. Regional LAD occurs.
53
# bartonella how do we Dx and Tx?
Typically, a clinical diagnosis Bartonella cultures available Self limited disease but can treat with ABX (azithromycin)
54
# Legionella what diseases does it cause?
1.Legionnaires disease 2.amoung top 4 causes of community acquired pneumonia 3.atypical pneumonia
55
# legionella where do you get it? who is at risk?
contaminated water underlying chronic lung disease, tobacco use, immunocompromised
56
# Legionella what is unique about gram staining this organism?
Gram stain of sputum does not show organism
57
# legionella what are the symptoms of legionnaires disease?
High fever Pleurisy Purulent sputum Toxic appearance Nausea/vomiting/diarrhea SOB muscle fatigue
58
# Legionella what are signs of infection?
Elevated liver enzymes Elevated creatine kinase Culture of Legionella 80-90% sensitivity Urine antigen an option but less sensitive More recently, sputum by PCR
59
# legionella How do we Tx?
Azithromycin 500mg once daily x 10-14 days 21 days for immunocompromised patients
60
# Neisseria Meningitidis which group is most common for epidemic in US?
Group C
61
# Neisseria Meningitidis what are symptoms?
High fever/chills Nausea/vomiting Extremity pain Rapidly developing confusion, delirium, seizures, and coma Petechial rash lower extremities Extremity pain
62
# Neisseria Meningitidis what are the signs of infection?
Nuchal and back rigidity + Kernig sign Pain in hamstrings upon extension of knee with hip at 90-degree flexion + Brudzinski sign Flexion of knee in response to flexion of the neck
63
# Neisseria Meningitidis what is Kernig's sign?
64
# Neisseria Meningitidis what is Brudzinski's sign?
65
# Neisseria Meningitidis How do we Dx?
Lumbar puncture will be cloudy or purulent CSF, increased pressure, increased protein, decreased glucose Culture and smear CSF Oropharynx Blood Aspirated petechiae
66
# Neisseria Meningitidis how do you Tx
**Hospitalization** *Must obtain blood cultures before antibiotic administration is begun* Ok to start prior to LP Aqueous Penicillin G 4 million units IV every 4 hours Increasing resistance PCN allergic: Ceftriaxone (Rocephin) 2gm IV every 12 hours Continue treatment until afebrile >5 days
67
# Neisseria Meningitidis how do we prevent infection?
4 types of infection depending on age.
68
# Shigella what disease does it cause?
dysentery (shigellosis) is most common
69
# Shigella what is the most common spp in the US? and which is the close second?
S. sonnei is the leading cause (followed by S. flexneri) in the US
70
# Shigella what spp is likely to cause serious and potentially fatal dysentery?
S. dysenteriae
71
# Shigella what is mode of transmission?
Fecal oral route contaminated food/water
72
# Shigella what are the symptoms of infection?
Abrupt onset Diarrhea, often with blood & mucus Crampy lower abdominal pain Tenesmus(urge to poop without anything coming out) Fever/chills Anorexia Malaise Headache HUS - hemolytic uremic syndrome
73
# Shigella what are the signs of infection?
Abdomen is tender Sigmoidoscopic exam reveals: Inflamed, engorged mucosa with punctate Sometimes large ulcerations in large intestine.
74
# Shigella how do we Dx?
Stool has many leukocytes and RBCs Usually stool culture + for Shigellae <5% + blood cultures
75
# Shigella What are some complications of infection?
Temporary lactose intolerance Reactive arthritis Hemolytic-uremic syndrome
76
# Shigella How do we Tx infection?
usually supportive care consider antibiotics in severe cases, geriatrics, malnourished. Ciprofloxacin (Cipro) 750mg orally twice daily for 7-10 days Levofloxacin (Levaquin) 500mg PO once daily for 3 days High amoxicillin resistance rates
77
# Vibrio cholerae what illness is produced and what are risks?
acute diarrhea, cholera, toxin mediated, death due to hypovolemia
78
# Vibrio cholerae what is the pathophysiology?
Attaches to small intestine epithelial cells **Triggers secretion of chloride and inhibition of sodium chloride absorption ** Massive fluid secretion into small intestine (*‘water follows salt’*) Up to 15L/day
79
# Vibrio cholerae where do epidemics occur?
Epidemics occur with crowding, war, famine, or with inadequate sanitation
80
# Vibrio cholerae what are signs and symptoms?
Sudden onset severe frequent watery diarrhea Up to 1L/hr Diarrhea is gray and turbid **“rice water stool”** No fecal odor, blood, or pus Typically, afebrile Rapid development of dehydration and hypovolemia
81
# Vibrio cholerae How do we Tx cholera?
Replace fluid and solute losses Tx with antibiotics shortens course of illness Doxycycline (Vibramycin) orally or IV (route dependent on sx) or azithromycin orally single dose
82
# Vibrio cholerae how do we Dx?
Stool culture should be + Rapid antigen tests of stool

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