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CMT-uno > Gram - Infections > Flashcards

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
Q

Salmonella

how long is the incubation for salmonella gastroenteritis?

A

8-48 hours

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26
Q

salmonella

How do we treat critically ill salmonella gastroeneteritis? Dx?

A

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

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27
Q

Yersinia

What disease is caused by Yersinia?

A

Bubonic Plague (80-95% of cases)

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28
Q

Yersinia

how is it spread? Incubation?

A

wild rodents and ticks
organism spreads through lymphatics
7-10 day incubation.
spreads between humans via droplets (pneumonic plague)

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29
Q

yersinia

what are complications of infection?

A

spread from lymph to lungs or meninges

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30
Q

Yersinia

Signs of bubonic plague

A
  • Tachypnea
    Productive cough
    Blood-tinged sputum
    Cyanosis
    Meningeal signs
    Lymphadenopathy (LAD)
    Purpuric spots
    Due to disseminated intravascular coagulation(DIC)- purple spots
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31
Q

yersinia

symptoms of bubonic plague

A

Sudden onset
High fever
Malaise
Tachycardia
Intense headache
Delirium-pneumonic plague
Severe myalgias

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32
Q

Yersinia

how do we Dx?

A

aspirate buboes(lymph node) or antibody titer

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33
Q

yersinia

how do we Tx bubonic plague? Prophylaxis?

A

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
Q

Haemophilus

are likely to colonize …?

A

upper respiratory tract in patients with COPD (and w/o)

35
Q

Haemophilus

what can haemophilus cause?

A

upper resp infect.
sinusitis, otitis, bronchitis, epiglottitis, pneumonia, cellulitis, arthritis, meningitis, and endocarditis

36
Q

Haemophilus

how do we Tx Haemophilus?

A

Non beta-lactamase producing strains
Amoxicillin
Beta-lactamase producing strains (more common in children)
Amoxicillin-Clavulonate (Augmentin)
PCN allergic: Cefuroxime

37
Q

Moraxella catarrhalis

where does it colonize? and what does it cause?

A

respiratory tract

causing Sinusitis, bronchitis, and pneumonia

sometimes bacteremia and meningitis in immunocompromised patients

38
Q

moraxella catarrhallis

how do you treat?

A

because it produces beta-lactamase you use Amoxicillin-Clavulanate

39
Q

bordetella pertussis

what disease does it cause?

A

whooping cough (can lead to failure to thrive in infants)

40
Q

bordetella pertussis

how is it transmitted?

A

by respiratory droplets
Sticks to cilia and respiratory epithelia

41
Q

bordetella pertussis

how long is incubation?

A

7-17 days

42
Q

bordetella pertussis

who is mostly affected?

A

infants <2yo

Pertussis in 3rd trimester or 1st year after delivery poses huge risk to infant. Can be fatal.

43
Q

bordetella pertussis

what are the 3 stages?
and how long does infection typically last?

A

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
Q

bordetella pertussis

Catarrhal stage

A

Most infectious
Lacrimation
Sneezing
Coryza
Hacking cough at night that becomes diurnal
Malaise
Anorexia

45
Q

bordetella pertussis

Paroxysmal stage

A

(acute, rapid)
Rapid consecutive coughs followed by deep high-pitched inspiration

46
Q

bordetella pertussis

Convalescent stage

A

Decrease in frequency and severity of cough

47
Q

Bordetella pertussis

how do we Dx whooping cough?

A

nasopharyngeal culture using Bordet-Gengou agar

some may have PCR assay

48
Q

bordetella pertussis

how do we Tx exposure?

A

Erythromycin 500mg PO QID x 7 days
If macrolide allergy, use TMP-SMX

49
Q

bordetella pertussis

how do we treat sympomatic pts?

A

Supportive Care- Maintain hydration and nutrition, maintain airway, control secretions

Admit- Consider referral to infectious disease
Droplet precautions/standard precautions

50
Q

bordetella pertussis

when do we admit pts? ICU?

A

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
Q

Bartonella

what diseases can it cause?

A

Cat scratch disease

52
Q

bartonella

what is cat scratch disease?

A

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
Q

bartonella

how do we Dx and Tx?

A

Typically, a clinical diagnosis
Bartonella cultures available
Self limited disease but can treat with ABX (azithromycin)

54
Q

Legionella

what diseases does it cause?

A

1.Legionnaires disease
2.amoung top 4 causes of community acquired pneumonia
3.atypical pneumonia

55
Q

legionella

where do you get it?
who is at risk?

A

contaminated water

underlying chronic lung disease, tobacco use, immunocompromised

56
Q

Legionella

what is unique about gram staining this organism?

A

Gram stain of sputum does not show organism

57
Q

legionella

what are the symptoms of legionnaires disease?

A

High fever
Pleurisy
Purulent sputum
Toxic appearance
Nausea/vomiting/diarrhea
SOB
muscle fatigue

58
Q

Legionella

what are signs of infection?

A

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
Q

legionella

How do we Tx?

A

Azithromycin 500mg once daily x 10-14 days
21 days for immunocompromised patients

60
Q

Neisseria Meningitidis

which group is most common for epidemic in US?

A

Group C

61
Q

Neisseria Meningitidis

what are symptoms?

A

High fever/chills
Nausea/vomiting
Extremity pain

Rapidly developing confusion, delirium, seizures, and coma
Petechial rash lower extremities
Extremity pain

62
Q

Neisseria Meningitidis

what are the signs of infection?

A

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
Q

Neisseria Meningitidis

what is Kernig’s sign?

A
64
Q

Neisseria Meningitidis

what is Brudzinski’s sign?

A
65
Q

Neisseria Meningitidis

How do we Dx?

A

Lumbar puncture will be cloudy or purulent CSF, increased pressure, increased protein, decreased glucose

Culture and smear
CSF
Oropharynx
Blood
Aspirated petechiae

66
Q

Neisseria Meningitidis

how do you Tx

A

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
Q

Neisseria Meningitidis

how do we prevent infection?

A

4 types of infection depending on age.

68
Q

Shigella

what disease does it cause?

A

dysentery (shigellosis) is most common

69
Q

Shigella

what is the most common spp in the US? and which is the close second?

A

S. sonnei is the leading cause (followed by S. flexneri) in the US

70
Q

Shigella

what spp is likely to cause serious and potentially fatal dysentery?

A

S. dysenteriae

71
Q

Shigella

what is mode of transmission?

A

Fecal oral route
contaminated food/water

72
Q

Shigella

what are the symptoms of infection?

A

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
Q

Shigella

what are the signs of infection?

A

Abdomen is tender
Sigmoidoscopic exam reveals:
Inflamed, engorged mucosa with punctate
Sometimes large ulcerations in large intestine.

74
Q

Shigella

how do we Dx?

A

Stool has many leukocytes and RBCs
Usually stool culture + for Shigellae
<5% + blood cultures

75
Q

Shigella

What are some complications of infection?

A

Temporary lactose intolerance
Reactive arthritis
Hemolytic-uremic syndrome

76
Q

Shigella

How do we Tx infection?

A

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
Q

Vibrio cholerae

what illness is produced and what are risks?

A

acute diarrhea, cholera, toxin mediated, death due to hypovolemia

78
Q

Vibrio cholerae

what is the pathophysiology?

A

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
Q

Vibrio cholerae

where do epidemics occur?

A

Epidemics occur with crowding, war, famine, or with inadequate sanitation

80
Q

Vibrio cholerae

what are signs and symptoms?

A

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
Q

Vibrio cholerae

How do we Tx cholera?

A

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
Q

Vibrio cholerae

how do we Dx?

A

Stool culture should be +
Rapid antigen tests of stool

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