ID Flashcards
Epiglottitis: most common organisms and treatment?
Strep pneumo, Staph aureus, beta-hemolytic strep, non-HiB
100% humidified O2, ENT,
vanc/ceftriaxone
Bloody diarrhea + marked pallor, periorbital edema with fever, lower blood pressures. Check a __ to diagnose ___. Most common bacteria?
CBC with peripheral smear; HUS 2/2 Shiga toxin–producing Escherichia coli (STEC). Stool cultures are usually positive before HUS begins.
Reservoir for E coli O157:H7 (most common in US) is the gastrointestinal tract of cattle, sheep, and goats, and it is transmitted via uncooked meat, unpasteurized milk, or fecal contamination of produce.
Shigella dysenteriae type 1 associated HUS is more severe (India, South Africa).
Microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury - no diarrhea. What can this be associated with?
Diarrhea-negative HUS is more likely to have an insidious or a relapsing clinical course, increased risk for end-stage renal failure, poorer prognosis.
Associated with malignancy, medications (cyclosporine, tacrolimus), systemic lupus erythematosus, pregnancy, and genetic mutations leading to uncontrolled activation of the alternate complement pathway.
Treatment for giardiasis in children?
Metronidazole, nitazoxanide or tinidazole + a low lactose diet.
Uncomplicated Neisseria gonorrhoeae - treatment guidelines?
What if they have an allergy to mainstay therapy?
When do you do test of cure?
Increased dose of ceftriaxone, NO azithromycin - alternatively, can do oral or IV gentamicin + azithromycin.
Test of cure in 2 weeks if using an alternate regimen to treat PHARYNGEAL gonorrhea
If the IGRA is positive and no signs of active TB - need to decide if to treat for (latent) TB or not based on risk factors.
Treatment for latent TB? (3 regimens)
isoniazid+rifapentine weekly x 3 months; 4 months rifampin daily; 3 months isoniazid+rifampin
…alternatively isoniazid x9 months
Infection with Bordetella pertussis provides ___ protection against future pertussis infection.
Short-term infection - thus, a documented infection should not alter the standard immunization schedule.
Swimming pools + multiple people infected with a watery diarrhea = most likely organism?
Empiric antimicrobial treatment options for severe disease in children include __ and __ in adults
Swimming-related Shigella outbreaks have been well described in the United States due to inadequately disinfected pools and use of the pools by individuals with diarrhea. Inadvertent swallowing of even a small amount of infected water can cause infection because the inoculum dose for Shigella is very low; fewer than 10 organisms can result in transmission. The organisms can survive for up to 6 months in water and 1 month in food.
The typical incubation period of shigellosis is 1 to 3 days. The large intestine is often infected, causing an illness characterized by watery or mucoid stools and/or dysentery, nausea, emesis, abdominal pain, and tenesmus. Infants with Shigellosis can develop high fever, severe dehydration, and self-limited seizures. In some cases, the illness may be severe, resulting in hospitalization. Shigella species can be isolated from stool culture, but more sensitive molecular detection with multiplex polymerase chain reaction platforms is frequently used for rapid diagnosis of Shigella and other bacterial, viral, and parasitic pathogens.
S sonnei infection is self-limited in most cases. While mild cases do not require antimicrobial therapy, treatment is recommended for immunocompromised individuals or those with severe illness. Given high rates of resistance of Shigella isolates in the United States to ampicillin (25%) and trimethoprim-sulfamethoxazole (43%), empiric antimicrobial treatment options for severe disease in children include azithromycin or ceftriaxone and ciprofloxacin in adults. Outbreaks of multidrug-resistant S sonnei gastroenteritis in daycare centers has been reported. Shigella strains with reduced susceptibility to azithromycin are a major concern among adults, especially men who have sex with men.
Other frequently reported pathogens causing recreational water–associated outbreaks include Cryptosporidium, Giardia, norovirus, and Escherichia coli O157:H7.
Benign tumor that characteristically present in adolescent boys and cause symptoms including nasal obstruction, mucopurulent nasal discharge, and severe epistaxis
juvenile nasopharyngeal angiofibromas
Leukopenia+ thrombocytopenia + elevated LFTs+ hiking in the southeast but does not improve on doxycycline
Heartland virus, a newly described Bunyavirus transmitted by the same vector as E. chaffeensis, is clinically indistinguishable from HME and should be suspected when no improvement is seen within 48 hours of starting doxycycline therapy.
