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Gram Negative Infections Flashcards

1
Q

E. Coli

bacteria most often causes what type of illness?

A

GI

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2
Q

E. Coli

bacteria most often comes from what?

A

un/undercooked meats, raw flour, unpasteurized products, leafy greens, unwashed fruits

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3
Q

E. Coli

ETEC

A

Enterotoxigenic E. Coli

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4
Q

E. Coli

EIEC

A

Enteroinvasive E. Coli

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5
Q

E. Coli

Describe ETEC

A

heat stable toxin
common source of traveler’s diarrhea

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6
Q

E. Coli

Describe EIEC

A

invades cells leading to bloody diarrhea & dysentery
uncommon in the US

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7
Q

E. Coli

STEC

A

shiga toxin producing E. Coli

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8
Q

E. Coli

complications of STEC

A

hemorrhagic colitis
HUS
thrombotic thrombocytopenic purpura

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9
Q

E. Coli

Dx STEC

A
  • Generic cultures not helpful, should specifically culture for O157:H7 and Shiga-toxin
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10
Q

E. Coli

Tx for STEC

A

DO NOT USE ABX, increases risk for HUS
if you must:
* Cipro, 500mg PO, Q12hrs

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11
Q

Salmonellosis

most common subspecies infection

A

enterica

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12
Q

Salmonellosis

Which subspecies causes enteric fever?

A

typi/paratyphi

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13
Q

Salmonellosis

which subspecies causes acute enterocolitis?

A

typhimurium

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14
Q

Salmonellosis

which subspecies causes septicemic type?

A

choleraesius

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15
Q

Salmonellosis typhi

MOA of infection

A
  1. organism breaches mucosal epithelium of intestines
  2. organism invade & replicate in macrophages in Peyer patches, mesenteric lymph, and spleen
  3. bacteremia results in infection localizing to lymp tissue of SI
  4. Peyer patches inflame leading to ulceration
  5. Organism dissemiates throughout body
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16
Q

Salmonellosis typhi

incubation period

A

6-30 days

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17
Q

Salmonellosis typhi

general clinical presentation

A

GI & constitutional sx

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18
Q

Salmonellosis typhi

Prodromal stage sx

7 things

A
  1. malaise
  2. headache
  3. cough
  4. sore throat
  5. abd pain
  6. constipation
  7. fever
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19
Q

Salmonellosis typhi

how long is prodromal stage?

A

first 7-10 days of being sx

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20
Q

Salmonellosis typhi

Later signs of typhi

5

A
  1. splenomegaly
  2. abd distension/tenderness
  3. bradycardia
  4. meningismus
  5. rash
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21
Q

Salmonellosis typhi

describe associated rash

onset, location, color, size, resolution

A
  1. 2nd wk
  2. on trunk
  3. pink papule
  4. 2-3mm
  5. resolves in 3-4 days
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22
Q

Salmonellosis typhi

what have people usually done before infection?

A

travelled

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23
Q

Salmonellosis typhi

dx

3 components

A
  1. leukopenia on CBC
  2. pos blood cultures
  3. pos stool cultures (not always reliable)
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24
Q

Salmonellosis typhi

when are people with typhi positive on blood cultures?

1st wk vs 3rd wk

A
  1. 80% pos in 1st week of sx
  2. only 25% pos by 3rd wk of sx
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25
# Salmonellosis typhi complications | mortality, 2 most common
1. 2% mortality when treated 2. 30% mortality when untreated 3. intestinal hemorrhage 4. intestinal perforation
26
# Salmonellosis typhi Tx in sx pts | doage, frequency, duration
levofloxacin, 750mg PO, Q12/Q24 * 5-7 days for uncomplicated * 10-14 days for severe infection
27
# Salmonellosis typhi tx for carriers
ciprofloxacin, 750mg PO, Q12, 4 wks
28
# Salmonellosis typhi Prevention
1. vaccination (contact, travel, outbreaks) 2. proper waste disposal 3. minimize food/water contamination 4. ill persons/carriers cannot work as food handlers
29
# Salmonellosis- General Gastroenteritis incubation period
8-48 hrs
30
# Salmonellosis- General Gastroenteritis sx
1. fever, chills 2. n/v/d (d may be bloody), 3-5 days duration 3. abd pain/cramping
31
# Salmonellosis- General Gastroenteritis dx
* stool PCR or culture may not require abx, typically self limiting
32
# Salmonellosis- General Gastroenteritis abx
Cipro, 500mg PO, Q12 hrs, 7-14 days
33
# Yersinia AKA
bubonic plague
34
# Yersinia zoonotically, how do people become ill with yersinia?
wild rodents are infected with yersinia and then bitten by fleas. when fleas contact humans, they can become infected.
35
# Yersinia P2P, how is Yersinia spread?
resp droplets
36
# Yersinia incubation period
7-10 days
37
# Yersinia infection pathophys
1. enters via lymphatics to lymph nodes 2. lymph nodes enlarge (buboes) 3. can spread to bloodstream/organs 4. fatal if meningitis or pneumonia develop
38
# Yersinia Where is this most commonly seen in the world? Where is it endemic in the US?
1. 75% of cases in Madagascar 2. CA, AZ, NV, NM
39
# Yersinia Sx | timing, 6 sx
sudden onset 1. high fever 2. malaise 3. tachycardia 4. intense headache 5. delirium- if meninges are involved 6. myalgias
40
# Yersinia signs | 7 things
1. tachypnea 2. productive cough 3. blood-tinged sputum 4. cyanosis 5. meningeal signs 6. lymphadenopathy (LAD) 7. purpuric spots
41
# Yersinia Dx
1. lymph node aspiration w/ culture 2. Ab titer
42
# Yersinia Tx
1. **immediate** upon suspicion 2. Streptomycin 1g IV, Q12 hrs, 10 days 3. Respiratory isolation if pneumonia
43
# Yersinia Prophylaxis for Contacts | Abx prescribed
Doxy, 100mg PO, Q12 hrs, 7 days
44
# Yersinia Prevention
avoid exposure to rodents/flears in endemic areas
45
# Haemophilus colonize where in who?
upper resp tract in pts with COPD
46
# Haemophilus Risk factors | 5 things
1. alcoholism 2. tobacco use 3. advanced age 4. chronic lung disease 5. HIV infection
47
# Haemophilus can cause what type of infections ? | 9 types
1. sinusitis 2. otitis 3. bronchitis 4. epiglottitis 5. pneumonia 6. cellulitis 7. arthritis 8. meningitis 9. endocarditis
48
# Haemophilus Tx for non beta-lactamase producing strains
amoxicillin
49
# Haemophilus tx for beta-lactamase producing strains who is this more common in?
amoxicillin-clavulonate (augmentin) children
50
# Haemophilus tx in PCN allergy
cefuroxime
51
# Moraxella colonizes where? produces what?
1. respiratory tract 2. beta-lactamase
52
# Moraxella When to consider tx? | with what lab result?
if primary isolate from culture
53
# Moraxella General population- causes infections where? | 3 types
sinusitis bronchitis pneumonia
54
# Moraxella immunocomproised pts- infections can also develop where? | 2 things
bacteremia meningitis
55
# Moraxella Tx when indicated
Augmentin
56
Augmentin
Amoxicillin-Clavulanate
57
# Bordetella Pertussis pathophys of infection
1. sticks to cilia and respiratory epithelia 2. produces toxins that paralyze cilia 3. causes inflammation of resp. tract, impairs secretions
58
# Bordetella Pertussis AKA
whooping cough
59
# Bordetella Pertussis type of infection, mode of transmission
URI respiratory droplets
60
# Bordetella Pertussis who is usually infected?
infants < 2 y/o immunocompromised
61
# Bordetella Pertussis incubation period
7-17 days
62
# Bordetella Pertussis when is risk greatest to an infant?
1. 3rd trimester of pregnancy 2. within 1st year of life
63
# Bordetella Pertussis Stages of Sx | stages & timing
1. catarrhal stage (1-2 wks, most infectious) 2. paraoxysmal stage (2-4 wks after onset) 3. convalescent stage (4 wks after onset)
64
# Bordetella Pertussis Sx in catarrhal stage
lacrimation sneezing coryza hacking cough, becomes diurnal malaise anorexia
65
# Bordetella Pertussis sx in paroxysmal stage
cough followed by "whoop"
66
# Bordetella Pertussis sx in convalescent stage
reduced freq and severity of cough
67
# Bordetella Pertussis Dx
* Np swab (PCR or culture) * CBC will show leukocytosis
68
# Bordetella Pertussis Vaccination recs | routine, adult, preg
1. routine: age 11-18 yrs, single dose 2. adults: booster every 5-10 yrs (Tdap) 3. pregnant women: booster 27-36 wks of pregnancy, during each pregnancy
69
# Bordetella Pertussis Prophylaxis Tx
1. Erythromycin, 500mg PO, QID, 7 days 2. if macrolide allergy, use TMP-SMX
70
# Bordetella Pertussis Tx in sx pts
Supportive care * maintain hydration/nutrition * maintain airway * control secretions
71
# Bordetella Pertussis what to consider for admission
* pt placed on droplet/standard precautions * consider referal to ID * consider ICU admission
72
# Bordetella Pertussis when to consider ICU admission | who? what circumstances?
1. all infants < 3 mo 2. infants 3-6 mo with severe paroxysms 3. premature infants 4. infants with underlying cardiac, pulm, or neuromusc diseases
73
# Bordetella Pertussis when to admit any ill pt | 4 things
1. sustained hypoxia 2. failure to thrive 3. encephalopathy 4. seizures
74
# Bartonella Cat Scratch Disease- species causing infection
henselae
75
# Bartonella Cat Scratch Disease- transmitted via?
cat scratch/bite
76
# Bartonella Cat Scratch Disease- what forms at injury site? after how long?
1. papule/ulcer 2. several days
77
# Bartonella Cat Scratch Disease- what develops 1-3 wks later? | sx!!!, 4 of them
1. fever 2. headache 3. malaise 4. LAD
78
# Bartonella Cat Scratch Disease- dx
culture
79
# Bartonella Cat Scratch Disease- tx
N/A, self limiting
80
# Legionella causes what disease?
legionnaires
81
# Legionella among top 4 causes of ____
community acquired pneumonia
82
# Legionella more common in ? | 3 populations
1. underlying chronic lung disease 2. tobacco use 3. immunocompromised host
83
# Legionella outbreaks associated with?
contaminated water
84
# Legionella what does atypical pneumonia mean?
gram stain of sputum does not show organism
85
# Legionella Sx | 5 things
1. high fever 2. pleurisy 3. purulent sputum 4. toxic appearance 5. n/v/d
86
# Legionella signs on lab results | 2 things
1. elevated LFTs 2. elevated creatine kinase
87
# Legionella dx
1. culture (standard, 80-90% sensitivity) 2. urine antigen (less sensitive) 3. sputum PCR
88
# Legionella Tx in most patients vs in immunocomp
1. Azithromycin, 500mg, Q24 hrs, 10-14 days 2. same med but for 21 days in immunocomp
89
# Neisseria meningitidis most common epidemic source in US
group C
90
# Neisseria meningitidis what % of population are nasopharyngeal carriers?
40%
91
# Neisseria meningitidis causes what diseases?
meningitis meningococcemia
92
# Neisseria meningitidis describe meningococcemia
septicemia w/out meningitis
93
# Neisseria meningitidis patients with complement deficiency or who are asplenic may develop what?
rash arthritis
94
# Neisseria meningitidis sx | 5 groups, 10 total sx
1. high fever, chills 2. n/v 3. extremity pain 4. confusion, delirium, seizures, coma 5. rash lower extremities
95
# Neisseria meningitidis signs | 3 things
1. nuchal and back rigidity 2. +Kernig sign 3. +Brudzinski sign
96
# Neisseria meningitidis pos Kernig sign
pain in hamstrings upon extension of knee with hip at 90deg flexion
97
# Neisseria meningitidis pos Brudzinski sign
flexion of knee in response to flexion of the neck
98
# Neisseria meningitidis Dx
1. Lumbar Puncture 2. Culture/Smear
99
# Neisseria meningitidis Dx with Lumbar Puncture | findings of CSF/tap- 4
1. cloudy/purulent 2. increased pressure 3. increased protein 4. decreased glucose
100
# Neisseria meningitidis Dx with culture/smear | culture what types of samples? 4
1. CSF 2. Oropharynx 3. Blood 4. Aspirated petechiae
101
# Neisseria meningitidis Tx
1. Hospitalization 2. obtain blood cultures prior to beginning abx course 3. PCN 4 mil units IV, Q4 hrs (increasing resistance) 4. PCN allergy: Ceftraixone, 2mg IV, Q12 hrs 5. Continue tx until afebrile (> 5 days)
102
# Neisseria meningitis get what prior to treating with abx?
* at least a pos smear * preferably pos culture * if CSF is cloudy/purulent, suspect meningitis & treat empirically
103
# Neisseria meningitidis Prevention
vaccination- 4 types are available
104
# Shigella Most common subspecies? most serious subspecies? | 2 common, 1 serious
1. sonnei, flexneri 2. dysenteriae
105
# Shigella mode of transmission
1. fecal oral 2. contaiminated water 3. sexual contact
106
# Shigella sx | 8
1. rapid onset 2. diarrhea (bloody, mucus) 3. abd pain, cramping 4. tenesmus (urge to poop, but no poop left) 5. fever/chills 6. anorexia 7. headache 8. malaise
107
# Shigella signs | 2 categories, elaborate on scopic exam findings
1. abd tender 2. sigmoidoscopic exam reveals: inflamed, engorged mucosa w/ punctate, sometimes large ulcerations
108
# Shigella Dx
* stool has many leukocytes and RBCs * stool culture + for *Shigella* spp * blood cultures not usually pos
109
# Shigella complications | 3
* temporary lactose intolerance * reactive arthritis * HUS
110
# Shigella Tx
* supportive care (treat dehydration, hypotension) * Cipro, 750mg PO, Q12 hrs, 7-10 days * Levo, 500mg PO, Q24 hrs, 3 days * Resistance is an increasing problem
111
# Shigella who to consider abx for?
* severe disease * older population * malnourished pts * pts w/ many comorbidities * those in communal settings
112
# Cholera caused specifically by what?
vibrio cholerae
113
# Cholera mode of transmission
contaminated food/water
114
# Cholera pathophys
* attches to small intestine epithelial cells * triggers secretion of chloride & inhibition of sodium chloride absorption * massive fluid secretion into SI (bc water follows sodium)
115
# Cholera most common reason for death?
hypovolemia
116
# Cholera epidemics occur with? | 4 things
1. crowding 2. war 3. famine 4. inadequate sanitation
117
# Cholera signs & sx
1. sudden onset severe frequent watery diarrhea (up to 1L/hr) 2. diarrhea is gray and turbid (no odor, blood, or pus) 3. afebrile 4. rapid development of dehydration & hypovolemia
118
# Cholera buzzword to describe stool | PPP
rice water stool
119
# Cholera dx
* stool culture pos * rapid antigen of stool
120
# Cholera tx
* rehydration (oral or IV) * doxy (oral or IV), azithromycin PO
121
# Cholera components of oral rehydration
1L water 1 tsp salt 4 tsp sugar
122
# Cholera what to use for IV hydration?
lactated ringers
123
# Cholera prevention
* clean water/food sources * proper waste disposale * vaccination

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