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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
Q

Salmonellosis typhi

complications

mortality, 2 most common

A
  1. 2% mortality when treated
  2. 30% mortality when untreated
  3. intestinal hemorrhage
  4. intestinal perforation
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26
Q

Salmonellosis typhi

Tx in sx pts

doage, frequency, duration

A

levofloxacin, 750mg PO, Q12/Q24
* 5-7 days for uncomplicated
* 10-14 days for severe infection

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27
Q

Salmonellosis typhi

tx for carriers

A

ciprofloxacin, 750mg PO, Q12, 4 wks

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28
Q

Salmonellosis typhi

Prevention

A
  1. vaccination (contact, travel, outbreaks)
  2. proper waste disposal
  3. minimize food/water contamination
  4. ill persons/carriers cannot work as food handlers
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29
Q

Salmonellosis- General Gastroenteritis

incubation period

A

8-48 hrs

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30
Q

Salmonellosis- General Gastroenteritis

sx

A
  1. fever, chills
  2. n/v/d (d may be bloody), 3-5 days duration
  3. abd pain/cramping
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31
Q

Salmonellosis- General Gastroenteritis

dx

A
  • stool PCR or culture

may not require abx, typically self limiting

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32
Q

Salmonellosis- General Gastroenteritis

abx

A

Cipro, 500mg PO, Q12 hrs, 7-14 days

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33
Q

Yersinia

AKA

A

bubonic plague

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34
Q

Yersinia

zoonotically, how do people become ill with yersinia?

A

wild rodents are infected with yersinia and then bitten by fleas. when fleas contact humans, they can become infected.

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35
Q

Yersinia

P2P, how is Yersinia spread?

A

resp droplets

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36
Q

Yersinia

incubation period

A

7-10 days

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37
Q

Yersinia

infection pathophys

A
  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
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38
Q

Yersinia

Where is this most commonly seen in the world? Where is it endemic in the US?

A
  1. 75% of cases in Madagascar
  2. CA, AZ, NV, NM
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39
Q

Yersinia

Sx

timing, 6 sx

A

sudden onset
1. high fever
2. malaise
3. tachycardia
4. intense headache
5. delirium- if meninges are involved
6. myalgias

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40
Q

Yersinia

signs

7 things

A
  1. tachypnea
  2. productive cough
  3. blood-tinged sputum
  4. cyanosis
  5. meningeal signs
  6. lymphadenopathy (LAD)
  7. purpuric spots
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41
Q

Yersinia

Dx

A
  1. lymph node aspiration w/ culture
  2. Ab titer
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42
Q

Yersinia

Tx

A
  1. immediate upon suspicion
  2. Streptomycin 1g IV, Q12 hrs, 10 days
  3. Respiratory isolation if pneumonia
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43
Q

Yersinia

Prophylaxis for Contacts

Abx prescribed

A

Doxy, 100mg PO, Q12 hrs, 7 days

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44
Q

Yersinia

Prevention

A

avoid exposure to rodents/flears in endemic areas

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45
Q

Haemophilus

colonize where in who?

A

upper resp tract in pts with COPD

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46
Q

Haemophilus

Risk factors

5 things

A
  1. alcoholism
  2. tobacco use
  3. advanced age
  4. chronic lung disease
  5. HIV infection
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47
Q

Haemophilus

can cause what type of infections ?

9 types

A
  1. sinusitis
  2. otitis
  3. bronchitis
  4. epiglottitis
  5. pneumonia
  6. cellulitis
  7. arthritis
  8. meningitis
  9. endocarditis
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48
Q

Haemophilus

Tx for non beta-lactamase producing strains

A

amoxicillin

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49
Q

Haemophilus

tx for beta-lactamase producing strains
who is this more common in?

A

amoxicillin-clavulonate (augmentin)
children

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50
Q

Haemophilus

tx in PCN allergy

A

cefuroxime

51
Q

Moraxella

colonizes where? produces what?

A
  1. respiratory tract
  2. beta-lactamase
52
Q

Moraxella

When to consider tx?

with what lab result?

A

if primary isolate from culture

53
Q

Moraxella

General population- causes infections where?

3 types

A

sinusitis
bronchitis
pneumonia

54
Q

Moraxella

immunocomproised pts- infections can also develop where?

2 things

A

bacteremia
meningitis

55
Q

Moraxella

Tx when indicated

56
Q

Augmentin

A

Amoxicillin-Clavulanate

57
Q

Bordetella Pertussis

pathophys of infection

A
  1. sticks to cilia and respiratory epithelia
  2. produces toxins that paralyze cilia
  3. causes inflammation of resp. tract, impairs secretions
58
Q

Bordetella Pertussis

AKA

A

whooping cough

59
Q

Bordetella Pertussis

type of infection, mode of transmission

A

URI
respiratory droplets

60
Q

Bordetella Pertussis

who is usually infected?

A

infants < 2 y/o
immunocompromised

61
Q

Bordetella Pertussis

incubation period

62
Q

Bordetella Pertussis

when is risk greatest to an infant?

A
  1. 3rd trimester of pregnancy
  2. within 1st year of life
63
Q

Bordetella Pertussis

Stages of Sx

stages & timing

A
  1. catarrhal stage (1-2 wks, most infectious)
  2. paraoxysmal stage (2-4 wks after onset)
  3. convalescent stage (4 wks after onset)
64
Q

Bordetella Pertussis

Sx in catarrhal stage

A

lacrimation
sneezing
coryza
hacking cough, becomes diurnal
malaise
anorexia

65
Q

Bordetella Pertussis

sx in paroxysmal stage

A

cough followed by “whoop”

66
Q

Bordetella Pertussis

sx in convalescent stage

A

reduced freq and severity of cough

67
Q

Bordetella Pertussis

Dx

A
  • Np swab (PCR or culture)
  • CBC will show leukocytosis
68
Q

Bordetella Pertussis

Vaccination recs

routine, adult, preg

A
  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
Q

Bordetella Pertussis

Prophylaxis Tx

A
  1. Erythromycin, 500mg PO, QID, 7 days
  2. if macrolide allergy, use TMP-SMX
70
Q

Bordetella Pertussis

Tx in sx pts

A

Supportive care
* maintain hydration/nutrition
* maintain airway
* control secretions

71
Q

Bordetella Pertussis

what to consider for admission

A
  • pt placed on droplet/standard precautions
  • consider referal to ID
  • consider ICU admission
72
Q

Bordetella Pertussis

when to consider ICU admission

who? what circumstances?

A
  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
Q

Bordetella Pertussis

when to admit any ill pt

4 things

A
  1. sustained hypoxia
  2. failure to thrive
  3. encephalopathy
  4. seizures
74
Q

Bartonella

Cat Scratch Disease- species causing infection

75
Q

Bartonella

Cat Scratch Disease- transmitted via?

A

cat scratch/bite

76
Q

Bartonella

Cat Scratch Disease- what forms at injury site? after how long?

A
  1. papule/ulcer
  2. several days
77
Q

Bartonella

Cat Scratch Disease- what develops 1-3 wks later?

sx!!!, 4 of them

A
  1. fever
  2. headache
  3. malaise
  4. LAD
78
Q

Bartonella

Cat Scratch Disease- dx

79
Q

Bartonella

Cat Scratch Disease- tx

A

N/A, self limiting

80
Q

Legionella

causes what disease?

A

legionnaires

81
Q

Legionella

among top 4 causes of ____

A

community acquired pneumonia

82
Q

Legionella

more common in ?

3 populations

A
  1. underlying chronic lung disease
  2. tobacco use
  3. immunocompromised host
83
Q

Legionella

outbreaks associated with?

A

contaminated water

84
Q

Legionella

what does atypical pneumonia mean?

A

gram stain of sputum does not show organism

85
Q

Legionella

Sx

5 things

A
  1. high fever
  2. pleurisy
  3. purulent sputum
  4. toxic appearance
  5. n/v/d
86
Q

Legionella

signs on lab results

2 things

A
  1. elevated LFTs
  2. elevated creatine kinase
87
Q

Legionella

dx

A
  1. culture (standard, 80-90% sensitivity)
  2. urine antigen (less sensitive)
  3. sputum PCR
88
Q

Legionella

Tx in most patients vs in immunocomp

A
  1. Azithromycin, 500mg, Q24 hrs, 10-14 days
  2. same med but for 21 days in immunocomp
89
Q

Neisseria meningitidis

most common epidemic source in US

90
Q

Neisseria meningitidis

what % of population are nasopharyngeal carriers?

91
Q

Neisseria meningitidis

causes what diseases?

A

meningitis
meningococcemia

92
Q

Neisseria meningitidis

describe meningococcemia

A

septicemia w/out meningitis

93
Q

Neisseria meningitidis

patients with complement deficiency or who are asplenic may develop what?

A

rash
arthritis

94
Q

Neisseria meningitidis

sx

5 groups, 10 total sx

A
  1. high fever, chills
  2. n/v
  3. extremity pain
  4. confusion, delirium, seizures, coma
  5. rash lower extremities
95
Q

Neisseria meningitidis

signs

3 things

A
  1. nuchal and back rigidity
  2. +Kernig sign
  3. +Brudzinski sign
96
Q

Neisseria meningitidis

pos Kernig sign

A

pain in hamstrings upon extension of knee with hip at 90deg flexion

97
Q

Neisseria meningitidis

pos Brudzinski sign

A

flexion of knee in response to flexion of the neck

98
Q

Neisseria meningitidis

Dx

A
  1. Lumbar Puncture
  2. Culture/Smear
99
Q

Neisseria meningitidis

Dx with Lumbar Puncture

findings of CSF/tap- 4

A
  1. cloudy/purulent
  2. increased pressure
  3. increased protein
  4. decreased glucose
100
Q

Neisseria meningitidis

Dx with culture/smear

culture what types of samples? 4

A
  1. CSF
  2. Oropharynx
  3. Blood
  4. Aspirated petechiae
101
Q

Neisseria meningitidis

Tx

A
  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
Q

Neisseria meningitis

get what prior to treating with abx?

A
  • at least a pos smear
  • preferably pos culture
  • if CSF is cloudy/purulent, suspect meningitis & treat empirically
103
Q

Neisseria meningitidis

Prevention

A

vaccination- 4 types are available

104
Q

Shigella

Most common subspecies? most serious subspecies?

2 common, 1 serious

A
  1. sonnei, flexneri
  2. dysenteriae
105
Q

Shigella

mode of transmission

A
  1. fecal oral
  2. contaiminated water
  3. sexual contact
106
Q

Shigella

sx

8

A
  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
Q

Shigella

signs

2 categories, elaborate on scopic exam findings

A
  1. abd tender
  2. sigmoidoscopic exam reveals: inflamed, engorged mucosa w/ punctate, sometimes large ulcerations
108
Q

Shigella

Dx

A
  • stool has many leukocytes and RBCs
  • stool culture + for Shigella spp
  • blood cultures not usually pos
109
Q

Shigella

complications

3

A
  • temporary lactose intolerance
  • reactive arthritis
  • HUS
110
Q

Shigella

Tx

A
  • 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
Q

Shigella

who to consider abx for?

A
  • severe disease
  • older population
  • malnourished pts
  • pts w/ many comorbidities
  • those in communal settings
112
Q

Cholera

caused specifically by what?

A

vibrio cholerae

113
Q

Cholera

mode of transmission

A

contaminated food/water

114
Q

Cholera

pathophys

A
  • 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
Q

Cholera

most common reason for death?

A

hypovolemia

116
Q

Cholera

epidemics occur with?

4 things

A
  1. crowding
  2. war
  3. famine
  4. inadequate sanitation
117
Q

Cholera

signs & sx

A
  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
Q

Cholera

buzzword to describe stool

PPP

A

rice water stool

119
Q

Cholera

dx

A
  • stool culture pos
  • rapid antigen of stool
120
Q

Cholera

tx

A
  • rehydration (oral or IV)
  • doxy (oral or IV), azithromycin PO
121
Q

Cholera

components of oral rehydration

A

1L water
1 tsp salt
4 tsp sugar

122
Q

Cholera

what to use for IV hydration?

A

lactated ringers

123
Q

Cholera

prevention

A
  • clean water/food sources
  • proper waste disposale
  • vaccination

CMT (78 decks)

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