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Infectious Disease > Gram Negative Bacteria > Flashcards

Gram Negative Bacteria Flashcards

1
Q

In the US, 3 serogroups of Neisseria meningiditis account for most infections. Which are they?

A

B, C, and Y

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2
Q

Which age groups have the highest incidence of meningococcal infection?

A

Infants

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3
Q

In additional to treating the infection of a patient with meningococcus, what lab assay should be performed as further workup and why?

A

CH50 or CH100 to look for terminal complement deficiency

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4
Q

What is the treatment of choice in meningococcal infection?

A

Pen G

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5
Q

In the US meningococcal vaccination has a gap in coverage for which serogroup?

A

B. Remember that B, C, and Y each account for about 30% of cases. But the vaccine doesn’t cover B.

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6
Q

Prophylaxis for meningococcus should be give for CLOSE, intimate contacts who had contact with the patient… but in what timeframe?

A

7 days of illness onset.

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7
Q

What is the prophylaxis medication and dose for meningococcal exposure in:

  • Children
  • Adolescents
  • Adults
  • Pregnancy women
A
  • Rifampin 10 mg/kg q12h x 2 days OR ceftriaxone 125 mg IM if 15
  • Cipro 500 mg in adults > 18
  • Ceftriaxone is the drug of choice in pregnant women.
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8
Q

Under what circumstances should medical personnel taking care of meningococcus patient take prophylaxis?

A

Only if s/he had intimate contact with secretions as with intubation.

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9
Q

Complement deficiency is associated with meningococcal disease. So is another deficiency. What is it?

A

Properdin deficiency. It’s a positive regulator of complement activation.

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10
Q

As of 2013, routine meningococcal vaccination is recommend in infants > 2 months of age if they have certain conditions. What are they?

A

Asplenia
Functional asplenia (as with sickle cell)
Complement deficiency
Properdin deficiency
Travel to countries where meningococcal disease is hyperendemic.

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11
Q

What is properdin deficiency? What is its inheritance pattern?

A

Deficiency of properdin which is a positive regulator of complement cascade.

X-linked

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12
Q

True or false: A father with properdin deficiency can pass on the disease to his daughter.

A

False. It is x-linked.

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13
Q

A 5 year old presents with neisseria gonorrheoeae infection. What should you suspect?

A

Sexual abuse

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14
Q

For infants with ophthalmia due to gonorrhaoea, what is the typical presentation in terms of time course and symptoms?

A

2-7 days after delivery, bloody, green, or serosanguineuos discharge from eyes.

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15
Q

If eye discharge occurs in

A

Less likely. It takes a few days for the infection to present. This is more likely chemical reaction from eye prophylaxis.

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16
Q

What if eye discahrge occurs 10 days after birth? Is this more or less likely to be gonorrhea?

A

Less likely. > 7 days, think of Chlamydia trachomatis.

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17
Q

True or false? Infants with culture-proven gonococcal eye infection do not require further sepsis workup.

A

False. Need to do a full sepsis workup including lumbar puncture.

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18
Q

What is the treatment for gonoccocal ophthalmia?

A

Ceftriaxone 50 mg/kg IM or IV x 1

BUT: infants usually get treated for longer because they’re getting a sepsis rule-out.

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19
Q

What is usually responsible for eye discharge in the following time intervals after birth?

-

A
  • Chemical irritation
  • Gonorrhea
  • Chlamydia
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20
Q

What is the infectious cause of “hot tub rash?” What is the treatment?

A

Pseudomonas. Observation because it is usually self-limited.

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21
Q

Ecthyma gangrenosum is a rash associated with what organism? What situation makes it more likely to occur?

A

Pseudomonas. It often requires the host to be immunosuppressed as in neutropenia.

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22
Q

You are treating an immigrant adoptee from southeast asia for bactermia who has not been improving on gentamicin. The culture grew an organism tha tused to be classified as a pseudomonal species. What organism are you likely dealing with?

A

Burholderia, probably pseudomallei (melioidosis). Switch to meropenem. But this bacteria can be difficult to treat.

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23
Q

You are treating a 6 year old child with bacterial sinusitis growing moraxella catarhalis. Which antiobiotic should you NOT use?

A

Amoxicillin alone will not work because 100% isolates produce penicillinase. You need Augmentin, bactrim, azithro, or some other drug.

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24
Q

True or false? Most moraxella species produce beta-lactamase.

A

True. You can’t treat with amox or PCN. You need at least amox-clav or bactrim or azithro or if age appropriate, quinolone.

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25
Q

True or False: For UNCOMPLICATED diarrhea attributed to salmonella, it is still important to treat with antibiotics.

A

FALSE. This just increases the carrier state. So long as it’s uncomplicated, don’t give antibiotics.

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26
Q

In a couple of scenarios you SHOULD treat salmonella diarrhea with antibiotic. What are they?

A
  • Infants less than 3 months of age

- Children with immunocompromise

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27
Q

What makes salmonella typhi able to persist in carrier state?

A

It seeds in gallstones.

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28
Q

Which is more communicable: salmonella or shigella?

A

Shigella, by far, with on 10-100 organisms required for transmission.

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29
Q

A fever presents with fever and new-onset seizures. Blood cultures have been obtained, LP is being performed, and antibiotics are ready to hang. While performing the LP the baby has a bloody BM. What should you consider?

A

Shigella. This is a classic scenario for shigella presentation in an infant.

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30
Q

Can shigella cause HUS?

A

Yes, along with E coli.

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31
Q

Should salmonella infection be treated with antibiotics? Should shigella be treated?

Why?

A

No
Yes

The difference is that treatment for salmonella doesn’t shorten disease course AND it prolongs carrier state. With shigella, it DOES shorten course AND decreases transmission.

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32
Q

When can a child treated for shigella return to daycare?

A

When diarrhea has stopped > 24 hours and when stool culture is negative.

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33
Q

True or false: Cefdinir is effective for treatment of shigella.

A

False. Oral cephalosporins aren’t useful.

34
Q

What is the treatment of choice for shigella?

A

bactrim or ampicillin but watch out for resistance, increasing to as much as 50% in 2009.

35
Q

You are seeing a 10 year old returning from summer camp with copious mucoid diarrhea. He has been ill for 4 days. CBC shows leukocytosis and bandemia. He was known to frequent the reptile exhibit at camp and played with an iguana. Which is more likely: Shigella or salmonella?

A

Tough one… the iguana exposure makes you think salmonella but the diarrhea description and bandemia are strongly suggestive of shigella.

36
Q

A child with bloody diarrhea was found to have EHEC. What is EHEC? Should it be treated with antibiotic? Why or why not?

A

EHEC = Enterohemorrhagic E coli, usually O157:H7.

  • No, don’t treat
  • Increases risk of HUS.
37
Q

Children may not return to daycare after O157:H7 infection until meeting what criteria?

A

TWO negative stool cultures.
Diarrhea resolution.

This is different than shigella where you only need 1 negative culture.

38
Q

Surprisingly in infants, 80% of H. influenza infections occur within what time frame?

A

First day of life!

39
Q

A newborn is promptly identified and treated for H flu meningitis. In addition to cephalosporin, what other medication should be added?

A

Dexamethasone 0/6 mg/kg/day x 2 days to decrease incidence of neuro sequelae such as hearing loss.

40
Q

You are seeing a 4 year old in the ED that is unimmunized. He looks very ill. He has stridor, leans forward frequently, and his neck is hyperextended. He is quite fussy. What illness do you suspect? What is important NOT to do in this scenario?

A

H flu epiglottitis.

Do NOT force an oropharyngeal exam since he is not cooperative. This could really exacerbate his breathing.

41
Q

What is the antibiotic of choice for H flu meningiitis?

A

cephalosporin, either ceftriaxone or cefotaxime.

42
Q

In a child with buccal cellulitis, what organism was most likely associated historically?

A

H flu, but this illness is now fairly rare. Think of this in a kid with cheek swelling, very ill appearing, purplish in color.

43
Q

Is a child with buccal cellulitis due to H flu more or less likely to be bacteremic?

A

More likely.

44
Q

How is occult bacteremia with H flu different than with pneumococcus?

A

Pneumococcal occult bacteremia tends to resolve even without therapy. H flu on the other hand is very dangers with 30-50% developing meningitis or other deep focal infection.

45
Q

Up to 1/3 of pneumonia in pediatrics used to be attributed to H. flu but not so with vaccination. If found, however, what is the treatment of choice?

A

Ceftriaxone or cefotaxime… 3rd generation cephalosporin, as with H. flu meninigitis.

46
Q

The rules of prophylaxis in an H flu infection are complicated. In general on the exam, you SHOULD give prophylaxis. What is the medication and dose?

A

Rifampin 20 mg/kg (max 600/day) x 4 days, especially anyone who is not yet fully immunized.

47
Q

The rules of prophylaxis in an H flu infection are complicated. In general on the exam, WHO should get prophylaxis?

A

ALL household members if the household has at least 1 contact

48
Q

What is the most common cause of BACTEREMIC periorbital cellulitis?

A

It used to be Hib but now it’s pneumococcus.

49
Q

A 9 year old girl presents with preseptal cellulitis after suffering a bug bit on her eyelid 6 days prior. What is the more likely organism… pneumococcus (which is the MOST common cause of bacteremic orbital cellulitis) or something else?

A

Something else… this is more likely staph or group A strep.

50
Q

True or False: You should treat all occult bacteremia due to H influenzae with parenteral antbiotics.

A

TRUE! Unlike with occult pneumococcus, H flu is likely to seed elsewhere.

51
Q

What is the drug of choice for Otitis media? What if that fails? What if you think it is H flu?

A

Amoxicillin

If that fails, you may have a beta-lactamase producing organism such as H flu. In that case, switch to amox-clav or bactrim or azithro or cefalosporin.

52
Q

Tularemia and plague (yersinia pestis) present similarly on exams as adenopathy developing after hunting. What will help you tell the difference?

A

Geography:
Plague = Southwest
Tularemia = Missouri, Arkansas, Oklahoma

53
Q

You are seeing a 15 year old male for generalized illness, markedly swollen lymph nodes in his groin. He recently picked over some roadkill on a hike in Arizona. What illness would you suspect? What if the location had been Missouri?

A 
Yersinia pestis (plague)
Think more along the lines of tularemia
54
Q

True or False: Yersinia and tularemia are treated with the same drugs.

A

True, both have gent or streptomycin as first line agents followed by cipro or doxy.

55
Q

A 15 year old develops fever and RLQ abdominal pain. He has diarrhea as well. History is notable for working on a family hog farm and recently helping his father slaughter a pig, even preserving intestines for chitterlings. What is in the differenital?

A

Appendicitis, sure, but think of yersinia pseudotuberculosis or yersinia enterocolitica which can present as an appendicitis-like illness.

56
Q

Reactive arthritis and erythema nodosum in adults can be associated with what gram negative infection?

A

Yersinia. This is especially more likely in someone with HLA-B27.

57
Q

What factors make bacteremia with yersinia more likely?

A
  • Iron overload, as in those with transfusion-dependent diseases.
  • The very young,
58
Q

A 16 year old female returns from a whitewater rafting trip. Her raft capsized and she had some aspiration but returned from the trip seemingly OK. She developed a severe respiratory illness featuring diarrhea, confusion, kidney injury. She had hyponatremia as well. What illness should you suspect?

A

Legionella

59
Q

A daycare center in a commune that does not allow immunizations has had two cases of H flu meningitis. What should the other children in the day care receive?

A

2 cases is the threshold for prophylaxis, so they should get rifampin. 20 mg/kg/day x 4 days.

60
Q

A 17 year old male works part time in a beef slaughter house. He has developed endocarditis but the blood cultures are negative. What is the proper treatment regimen?

A

This is possibly brucellosis.

 Doxy x 6 weeks minimum PLUS aminoglycoside x 2 weeks.
 OR doxy + rifampin x 6 weeks
61
Q

A 16 year old female contracted brucellosis from unpasturized milk. She was treated with cipro x 4 weeks. She had a relapse. True or False: This is most likely due to developing resistance.

A

FALSE. It’s probably due to the fact she got monotherapy. With brucellosis you can’t treat with quinolone alone, you ahve to add doxy or rifampin.

62
Q

For children

A

4-6 weeks of bactrim + rifampin

63
Q

What is a typical vector for tularemia?

A

Ticks, blood sucking flies.

64
Q

True or False: Tularemia can only be contracted via bit of an infected flea, tick, or fly.

A

False on two accounts. Fleas aren’t really associated. And it can be inhaled or ingested.

65
Q

What is the treatment for tularemia?

A

Gent or streptomycin x 10 days. Can also use quinolone or doxy but with doxy, treat x 14 days because relapses are more common.

66
Q

You are seeing a patient in ID follow-up who had bacillary angiomatosis. What organism causes this infection?

A

This is bartonella. Think cat scratch.

67
Q

You are seeing a patient in ID follow-up who had bacillary angiomatosis. What organism causes this infection? Which was more likely the cause of innoculation with the causative organism?

A Dog bite
B Flea bite in the desert southwest
C Tick bite from an infected rabbit
D Tick bite from an infected deer
E Cat scratch
F Cat poop
G Unpasturized milk
H Chitterlings
I Attending a conference in a 50 year old building
J Living near a cattle feed lot
A

C, cat scratch. This is due to bartonella

A pasturella
B yersinia pestis
C tularemia
D lyme (borellia burgdorgeri)
E Bartonella (and this disease, bacillary angiomatosis)
F toxoplasma
G brucella, listeria
H yersinia enterocolitica (pseudo-tuberculosis)
I Legionella
J Brucella
68
Q

What organism is responsible for Parinaud’s disease? What is this condition?

A

Oculoglandular form of bartonella (cat scratch). It’s the most common atypical presentation.

69
Q

What is the most common atypical presentation of cat scratch disease? What are some other less common presentations?

A

Parinaud’s disease (oculoglandular)

Splenic granuloma
neuronitis
encephalopathy
aseptic meningitis
osteomyelitis
endocarditis
FUO
70
Q

True or False: Lymph node of a child suspected of having cat scratch disease should be I&D’d for confirmatory culture.

A

False. This will likely cause a chronically draining tract.

71
Q

A 17 year old handled a feral cat and was scratched numerous times. He developed bacillary angiomatosis. What was the causative organism? What other infection should you suspect?

A

Bartonella

HIV

72
Q

A 7 year old with PCN allergy was bitten by a cat and has a deep puncture wound that otherwise appears uncomplicated. What antibiotic regimen should be given?

A

Bactrim PLUS clinda. You need oral anaerobic coverage as well as the bactrim which will kill pasteurella.

73
Q

For dog and cat bites, what is the typical treatment of choice?

A

Amox-clav

74
Q

In children under 5, kingella is associated with what infections, most commonly?

A

Osteomyelitis and supperative arthritis

75
Q

As a gram negative organism, is Kingella susceptible to amp-sulbactam?

A

Yes, usually.

76
Q

What infection is the most common trigger for Guillain-Barré?

A

Campylobacter jejunii

77
Q

True or False: A 16 year old with campylobacter diarrhea can be treated with cipro.

A

False. Quinolones are not FDA approved in kids

78
Q

What is the treatment of choice for campylobacter diarrhea?

A

Azithro or erythromycin

79
Q

An premature infant born to a mother with who used IV drugs has been found to have Citrobacter in his blood. What test must you also perform in this infant as part of his infectious workup?

A

CT or MRI to look for brain abscess. Citrobacter is associated with brain abscesses.

80
Q

Aside from citrobacter, what other organisms are associated with brain abscesses in neonates?

A

Enterobacter sakazakii and Serratia marcescens

Infectious Disease (11 decks)

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