ID Flashcards
(19 cards)
LRTI causes
Viruses = COVID-19, influenza, RSV, parainfluenza
- viral pneumonia = widespread patchy appearance CXR + diffuse pneumonitis
Bacteria = strep/klebsiella pneumoniae, haemophilus influenzae
- cough, purulent sputum, pain when breathing in, pleural effusion
Atypical bacteria = M. pneumoniae, legionella
- diffuse picture
Tuberculosis
- chronic picture, haemoptysis
LRTI Mx
Sampling + imaging
Oxygen
Fluids
Physiotherapy (chronic lung disease)
Abx:
- amoxicillin
- co-amoxiclav
- cephalosporins
- macrolides (azithro, clarithro, erythromycin = community, penicillin allergy, mainstay tx for atypical bacteria e.g. mycoplasma and legionella)
- tetracyclines (rescue pack for COPD)
- fluoroquinolones (levofloxacillin = hospital, penicillin allergy)
- co-trimoxazole (hospital)
severity assessment for pneumonia
Confusion MTS<8
Urea >7mmol/l
RR >30/min
BP (<60mmHg diastolic, <90mmHg systolic)
Age >65
- 0-1 low risk (<3% mortality) HOME tx
- 2 medium risk (3-15% mortality) ADMIT to hospital (short stay inpatient, hospital supervised outpatient)
- 3-5 high risk (>15% mortality) IV abx, supportive care, admit to ICU
UTI
cystitis
lower UTI
pyelonephritis
renal abscess
pain, fever, frequency, dysuria
Causes of UTI
E.coli, enterococcus, Group B strep, Klebsiella sp, proteus, other coliforms, candida
women>men
age
abnormal renal tract
urinary catheter
dehydration
calculi (more in neonates, cancer and obstruction of urinary tract)
diabetes
UTI mx
sampling and imaging (exclude renal abscess e.g. severe pyelonephritis and not improving)
fluids
obstruction removal
prevention
Abx:
- nitrofurantion
- trimethoprim
- amoxicillin (preg)
- cephalosporin (preg)
- pivmecillinam
- fosfomycin
- fluoroquinolones (ciprofloxacin) = pyelonephritis
skin and soft tissue infections (SSTI)
impetigo
- common and highly contagious skin infection that mainly affects infants and young children.
- Impetigo starts with red sores or blisters, but the redness may be harder to see in brown and black skin. The sores or blisters quickly burst and leave crusty, golden-brown patches. The patches can: look a bit like cornflakes stuck to your skin.
erysipelas
- an infection of the upper layers of the skin (superficial). The most common cause is group A streptococcal bacteria, especially Streptococcus pyogenes. Erysipelas results in a fiery red rash with raised edges that can easily be distinguished from the skin around it.
cellulitis
- cellulitis makes your skin painful, hot and swollen. The area usually looks red, but this may be less obvious on brown or black skin.
- Your skin may also be blistered, and you can also have swollen, painful glands.
infected ulcers/wounds
myositis
necrotising fasciitis
- Early symptoms can include: a small but painful cut or scratch on the skin, intense pain that’s out of proportion to any damage to the skin, a high temperature (fever) and other flu-like symptoms
- After a few hours to days, you may develop: swelling and redness in the painful area – the swelling will usually feel firm to the touch, diarrhoea and vomiting, dark blotches on the skin that turn into fluid-filled blisters
- can lead to TOXIC SHOCK SYNDROME
redness, pain, heat, swelling
bacteria for SSTI
staph aureus = cellulitis, resistance to flucoaxcillin
streptococcus pyogenes = necrotising fasciitis
streptococcus dysgalactiae
pseudomonas = gram -ve, cellulitis, water activities, in diabetes and immunosuppression
mx of SSTI
sampling and imagin
debridement = ulceration, diabetic wound
tx underlying cause
elevation = lymphatic drainage
abx:
- flucloxacillin
- clindamycin
- tetracyclines
- co-trimoxacole
- vancomycin
- daptomycin
- linezolid
febrile patient clinical evaluation
raised temperature?
infection? if yes, what/where is it?
will it kill them if I do not do anything soon?
- severity = sepsis recognition and mx
- site = critical organs e.g. pneumonia with resp failure, meningitis
what is sepsis?
identifying sepsis
life threatening organ dysfunction from dysregulated host response to infection
identifying sepsis = high, moderate-high, low risk criteria
sepsis screening tool
sepsis six
- high flow O2 = via non-rebreathe mask
- take blood cultres = and consider source control
- give IV abx = according to local protocol
- start IV fluid resuscitation = Hartmann’s or equivalent
- check lactate
- monitor hourly urine output = consider catheterisation
WITHIN 1 HOUR
ID Hx: sx
fever = how long, when did it start, sweats/rigors and shivering, recorded?
rash = patches, spots, skin colour/erythema
sore throat, sore eyes, swollen glands (mucus membranes) =
weight loss, anorexia
respiratory = sputum, blood
GI tract = abdo pain, diarrhoea (watery, darker, blood), vomiting
urogenital = dysuria, colour, smell, frequency, discharge (period with women)
localised pain = joint pain (arthritis), general myalgia (dengue, influenzae), headache /neck stiffness(CNS)
ID Hx: fever
infective
viral
- CMV can be 3 weeks
- EBV
bacterial
- typhoid 10-14 days
- abscesses (few months)
- endocarditis (few months)
- brucellosis (bone/joint + travel)
toxoplasmosis
fungal infection but very unusual
non-infective
- cancer esp lymphoma
- connective tissue disease SLE, PMR
- multiple pulmonary emboli
- haematoma/infarcted tissue
- drug fever e.g. abx
ID Hx: exposure
travel
- return-sx onset
- duration of trip
- reason for trip
- who travelled
- accomodation
- prophylaxis
- exposures as below
contact
water
kids
animal/pets
surgery, trauma, implants
injecting drug use
ID Hx: Past ID hx
routine vaccination
hx
longer term travel hx
abx hx (what and when)
TB (self or family)
pneumonia, hepatiis
STD history/testing
sexual partner(s)
injecting drug use
incubation periods worth knowing
