ID Flashcards
Less common g(+) organisms in neutropenia
Corynebacterium P. acnes Bacillus Leuconostoc *some not treated with Vancomycin
Are anaerobic infections common in neutropenia?
NO
What is the danger level for neutropenia?
500 cells/mm (granulocytes)
Most important exam points in febrile neutropenia
upper airway mucosa, teeth, eyes and rectum
Initial lab work in febrile neutropenia…also consider?
CBC, CMP, hepatic fxn, urine/blood cx
Also consider: Chest imaging if respiratory Sx (CXR if low risk, CT if high risk), LP (if confused), fugal markers bronch or open lung bx, skin bx
Choice of empiric therapy for febrile neutropenia in high risk patients (4)? (High risk: pt expected to have ANC 7 days and/or has major CMx or liver/kidney dysfxn)
- Mero
- Imipenem
- Cefepime
- Pip-tazo
When should you add Vanc or Zyvox to empiric coverage in febrile neutropenia? (6)
- Hemodynamic instability or other signs of severe sepsis
- Pneumonia
- Positive blood cultures for gram-positive bacteria while awaiting speciation and susceptibility results
- Suspected central venous catheter (CVC)-related infection
- Skin or soft tissue infection
- Severe mucositis in patients who were receiving prophylaxis with a fluoroquinolone lacking activity against streptococci and in whom ceftazidime is being used as empiric therapy.
Which 3 gram positives are NOT covered by Vanc?
- Leuconostoc
- Lactobacillus
- Pediococcus
Indications for echinocandins (3)?
- Invasive candidiasis
- Salvage therapy for disseminated aspergillosis
- Empiric anti-fungal therapy in febrile neutropenia (some cases)
Can fluconazole be used as empiric antifungal?
NO!
Most common inherited immune deficiency
selective IgA deficiency
recurrent infections for encapsulated organisms recurrent giardiasis food/respiratory allergies associated autoimmune disorders (Hashimoto's, SLE, RA)
IgA deficiency
3 things to be aware of with selective IgA deficiency
- women can have false positive urine pregnancy tests
- higher than normal blood transfusion anaphylaxis rates
- IVIG contraindicated
What types of infections are those with acquired humoral deficiencies susceptible to?
Recurrent, often severe, upper and lower respiratory tract infections with encapsulated bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae)
Chronic diarrhea
What diseases do you get with complement deficiency?
C1, C2, C4
- recurrent bacterial infections (think bacteremia, sinopulm infections, and meningitis), esp w/ encapsulated bugs.
- genetic deficiencies have strong assoc w/ later development of SLE
C3
-severe, recurrent infections with encapsulated bacteria, MC Pneumococcus > H. flu
C5-C9
Recurrent Neisseria infections (meningo and gonococcus)
Screening test of choice for complement deficiency
CH50
Most common complement deficiency
C2
What diseases are T cell deficient people likely to get?
Progressive infections with ordinarily “benign” viruses, opportunistic intracellular pathogens, or fungi. Major examples- CMV, EBV, other herpes viruses, mycobacteria, candida, aspergillus, crypto.
What are the infections & risk time-periods in post solid organ transplant patient?
1 month- donor infections or nosocomial infections
2-6 months - opportunistic infections from immune suppression
>6 months- community acquired infections
Which antibiotic binds to RNA polymerase and blocks transcription of DNA to RNA?
Rifampin
Which antibiotic targets DNA gyrase?
Quinolone
Which antibiotic affects cell membrane function and acts like a quinolone?
Metronidazole
Which antibiotics block folic acid?
Sulfa and trimethoprim
Which antibiotics affect cell wall synthesis?
Beta lactams
Which antibiotic binds reversably to the 30S subunit
Tetracyclines
Which antibiotics bind to to 50S subunit
Macrolides
Which antibiotic binds IRREVERSIBLY to the 30S subunit?
Aminoglycosides
What is the “rule of thumb” regarding MIC and MBC?
MBC is roughly 8-10x the MIC
Which antibiotics exhibit concentration-dependent killing?
Aminoglycosides and quinolones
Which antibiotics exhibit concentration-independent killing (time dependent killing)? What is the significance of this?
Beta-lactams
If you miss a dose, you have higher chance of treatment failure
In time-dependent killing, how long should a patient’s drug concentration be higher than the organism’s MIC?
50% of the dosing inteval
PCN is still the drug of choice for: (6)
- Strep agalactiae (GBS) ppx
- Viridans strep
- PCN sensitive S. pneumo
- Syphilis
- Actinomyces
- N. meningitidis (if PCN-sensitive)
Potential complication of nafcillin and dicloxacillin?
Tubulointerstitial nephritis: fever, eosinophilia and rash
Ampicillin is the drug of choice for: (4)
Listeria meningitis
Salmonellosis (if sensitive)
UTI (if susceptible)
Enterococcal infections
Uses for 1st Gen Cephalosporins
Skin/Soft tissue infxns
Surgical ppx
Oral treatment of mild UTI
Uses for 2nd Gen Cephs (Cefoxitin/Cefotetan)
PID
Post operative abd infections
Facts about 3rd generation cephs
pneumococcal coverage (1st line)
NO staph coverage (better to use 1st gen)
NO anaerobic coverage (better to use 2nd gen)
Ceftazadime is only 3rd generation that covers pseudomonas
3 indicated for Enterobactericacae meningitis: ceftriaxone, cefotetan and ceftazidime
What is one clue to ESBL production
selective susceptibility to Cefipime,
but resistance to all other beta-lactams
Best use for aztreonam
Gram neg coverage and pseudomonal coverage in patient with BETA LACTAM ALLERGY
Potential complication of imipenem use?
Lower seizure threshold
When should you consider using a drug other than Vanc for a staph infection?
If MIC is >1mcg/mL
How do you treat Red Man syndrome?
Slow Vanc infusion time or with antihistamines
Complications of Linezolid?
Reversible thrombocytopenia, anemia, leukopenia
Sensory neuropathy
Serotonin Syndrome
What organ system is Daptomycin ineffective in?
Lungs - interacts with pulmonary surfactant, resulting in
inhibition of antibacterial activity
What are the gaps in coverage for Tigecycline?
Pseudomonas
Proteus
Providencia
What two antibiotics exhibit post-antibiotic effect?
Aminoglycosides and Quinolones
4 facts about quinolones
- Vitamins and laxatives reduce absorption
- Can increase theophylline levels
- Not for kids or pregnant/lactating patients
- Not for MRSA, even if susceptible
Best quinolone to treat pseudomonas?
Cipro…who knew?
Oseltamivir and zanamivir treat which type of Influenza?
Type A and B
Major side effects of Ketoconazole
Hepatitis
***Gynecomastia
Decreased libido
Candida species that are resistant to Fluconzaole
C. krusei
C. glabrata
For Boards, what is the drug of choice for MRSA infection?
Vancomycin
For Boards, should you use Tygacil for MRSA bacteremia coverage?
No (limited data at this time)
Fever, diarrhea, hypotension
hypocalcemia
Diffuse sunburn-like rash or erythema
Multisystem organ failure (kidney, liver, GI, ARDS, coags)
TSS
Menstruating female, post surgical (nasal packing, gauze packed wounds).
Tx: Carbapenem or Pcn with beta lactamase inhibitor + clinda;
narrow to clinda+naf if possible.
IVIG might be helpful.
One major difference between Staph and Strep pyogenes toxic shock?
Blood cx usually negative with staph,
but positive with Strep pyogenes
Most common cause of catheter related bacteremia?
Staph epi
Which states can you see increased infections with encapsulated organsims?
(lack of spleen and/or lack of antibodies): sickle cell extremities of age CLL MM agammaglobulinemia also, alcoholics
3 sx usually found in Strep pharyngitis
Fever
Tender cervical lymphadenopathy
exudative tonsils
What organism should you suspect if patient gets endocarditis or sepsis after GU manipulation?
Enterococcus
Treatment of choice for “simple” enterococcal infections
PCN G, amp, vanc (if susc)
Treatment of choice for suspected enterococcal sepsis or endocarditis
PCN G, amp or vanc+gent (if susc)
Treatment of choice for Listeria
PCN or AMP (add gent if severe or meningitis)
Sx and treatment of choice for Diphtheria?
LOW fever, hoarseness, sore throat, gray-white membrane.
Erythromycin (2nd choice PCN)
Fever, dyspnea, CP
mediastinal widening.
Enlarging, painless ulcer with black eschar surrounded by edema.
Travel to Middle East, AFrica, S America, Asia. Exposure to wool, hides, or animal hair from there.
Inhalational anthrax.
Cutaneous.
To prevent: vaccinate, cipro x 60d.
Tx: IV cipro + 2 additional if severe.
Oral for cutaneous.
Severe nausea and vomiting after fried rice? Treatment
B. cereus
Symptomatic treatment
Contaminated meat or gravy?
Clostridium perfringens
People with complete complement deficiency are prone to which organism?
Meningococcus
can’t kill intracellular organisms
Empiric treatment for suspected meningococcus? What if PCN allergy?
3rd gen cephalosporin + vancomycin (if meningitis)
If PCN allergy, use chloromphenacol
Who should prophylaxis for meningococcus be given to OTHER than the patient?
- People who live in same household
- Contacts at daycare
- People exposed to oral secretions
(i. e. intubation..NOT normal clinical encounters)
What drugs are best to eradicate carrier state for meningococcus in certain populations?
Rifampin (children and non-pregnant adults)
Quinolones (non-pregnant adults)
Ceftriaxone (pregnant adults, children
Which organism should you suspect with nail puncture wounds through tennis shoe?
Pseudomonas
Which organism should you suspect with osteo or endocarditis in IV drug users
Pseudomonas
Which organsim should you suspect in otitis externa in severe diabetics?
Pseudomonas
“Hot tub rash” =
Pseudomonas
“Iguanas and lizards” =
Salmonella
“Recent travel, fever,
“rose spots” on trunk one week after fever,
leukopenia
Typhoid fever
Salmonella typhi
Quinolone, 3rd gen ceph, amp, TMP/SMX
Adenopathy after hunting?
Plague - Yersinia (southwest) or
Tularemia (AK, OK, MO)
Plague dx and treatment?
Aspirate lymph nodes.
Streptomycin (1st line),
Tetracycline or Quinolones (2nd line)
What requires charcoal yeast extract to culture?
Legionella
Diarrhea, delirium, HA, pneumonia
Legionella.
Tx: Azithro, quinolones.
If severe, add rifampin.
Unpasteurized milk culture negative endocarditis orchitis thyroiditis adrenal insufficiency?
Treatment?
Brucellosis
Doxycycline + Aminoglycoside x4 weeks -or- Doxy+Rifampin x 4weeks
Cultures may take 6 weeks to grow!
Can also check acute/convalescent titers.
Treatment for tularemia?
Streptomycin or gent…Tetracycline if not very ill.
Cat scratch fever? Treatment?
Bartonella henslae.
Bacillary angiomatosis in immunocompromised.
Rifampin + (gent or azithro, depending on severity)
Rash (distal extremities first, becomes petechial) Fever headache arthralgia tick exposure. May also present with diarrhea & abd pain. Hyponatremia, Increased LFTs Thrombocytopenia. Increased D-dimer.
RMSF.
SE and S Central US.
Dx clinical, confirm with serology.
Definite dx: do IF staining on biopsy.
Doxy/Tetracycline or Chloramphenicol (if pregnant)
Fever in person who works in slaughterhouse or person who births animals?
Q fever
Inhaling aerosols of infected animals
Tx: Doxy if severe, but usu remits spontaneously.
Pancytopenia fever (can persist for months) HA. tick bite in MO and AR or northeast/upper midwest. No rash (except 40% of HME). Morulae in cytoplasm.
Ehrlichiosis. “Rocky Mtn. Spotless Fever”.
Convalescent seriologic test.
Doxy/tetracycline.
Non healing skin ulceration
(strings of lesions along lymphatic channels)
in people working around fish tanks or
diabetic/immunodeficient.
Mycobacterium marninum
Tx with ethambutol +rifampin
Pleural effusion analysis- lymph 1,000-6,000,
low glc,
high protein,
elevated LDH.
M. tuberculosis
Cervicofacial “sulfur” granules…“lumpy jaw”
Actinomyces
PID in the setting of IUD placement
Actinomyces
Myalgias, rigors, high fever.
Exposure to poultry
pneumonia
splenomegaly.
Chlamydia psittaci.
Ddx: Histoplasma also causes pna & splenomegaly,
assoc with bird & bat droppings.
Pneumonia after pharyngitis.
Severe bronchospasm.
Chlamydia pneumonia
Painless chancre, regional lymphadenopathy
Primary syphilis
Lung cavitary lesion–>chronic neutrophilic meningitis.
Nodular skin lesions.
Aspirate is culture negative.
Nocardia
Note: most chronic meningitis are LYMPHOCYTIC
Tx: high dose TMP/SMX
Amikacin/imipenim if severely ill
Nickel and dime lesions on palms and soles,
generalized lymphadenopathy
cutaneous lesions that look like a number of other things.
Secondary syphilis
Skin lesions “the great imitator”
Personality changes Affect reduced Reflexes abnl Eyes Argyll-Robertson pupil (miotic, irregular, constricts to accommodation but not light) Sensation decreased Intelligence impaired Slurred Speech.
Tertiary syphillis
“PARESIS”
Pt. has +RPR, -MHA-TP for syphilis…Dx?
Early infection or false positive RPR in low risk population, can repeat test in 6 weeks.
Pt. has +RPR, +MHA-TP. Dx?
Infection with syphilis
Pt. has -RPR, +MHA-TP. Dx?
Long standing untreated tertiary disease, or
cross reaction with antibodies from Lyme infection
If VDLR or RPR is negative in tertiary syphilis, does this mean disease is cured?
NO, non-treponemal tests can be negative in tertiary syph…
MHA-TP or FTA-ABS would be positive, however.
What is treatment for syphillis in pregnant woman with PCN allergy?
Densitization and then treatment with PCN.
Fever, myalgia, HA Eventually leading to severe hepatitis renal failure hemorrhagic complications. Also resp failure, myocarditis, rhabdo. *Conjunctival suffusion.* Contact with dog or rat urine.
Leptospirosis. Tropics (Hawaii).
Dx: serology.
Tx: most self-limited, but doxy and pcn to shorten duration or for severe.
How do you diagnose leptospirosis
blood and or CSF clutures within 10d of illness
After 10d: urine cx and serum anti-leptospira IgM
Two disease spready by Ixodes tick in NE
Babesiosis and Lyme disease
Tick bite, followed by irregular erythematous rash with clearing center, arthralgia, myalgia, fever, HA
Stage I Lyme disease
Rash is erythema migrans
Weeks after rash and camping, patient develops neuritis (Bell’s Palsy) and/or lymphocytic meningitis. Also 2nd degree heart block.
Stage II Lyme
Can be 1st, 2nd or 3rd degree block (usually alternates)
Describe stage III Lyme disease
Months to years after stage II
Chronic arthritis
Possibly chronic Neuro sx
Patient shows up with erythema migrans, do you check Lyme serology?
NO, just treat
Fatigue, arthralgia, muscle ache.
Check serologies or treat for Lyme disease?
NO on both counts.
Findings non-specific.
If has Erythema Multiforme, then treat as EM IS specific.
Treatment for Lyme
Early disease or Bell’s Palsy- doxy/amox 10-21 days
Lyme arthritis- doxy/amox 28 days
Cardiac/Neurologic dz:
Ceftriaxone 2gm or PCN G 20 MU x 21 days
Risks for candidal infections
Immunosuppressed
Indwelling caths
Uncontrolled DM
Can candida in a blood culture represent a contaminant?
NO. Always represents disease, even if pt. is asymptomatic.
What exam should a patient with candidemia have?
Dilated eye exam
Should you use lipid ampho B or regular ampho B in urinary candidemal infections?
Regular…lipid ampho B does not penetrate kidneys
immunosuppressed patient
headache, fever
pulmonary lesions.
Increased opening pressure on LP.
Cryptococcal meningitis.
Most common form of meningitis in AIDS.
Dx: antigen in CSF or culture.
OS can be >200 cm H2O - tx with serial LP.
Tx: Ampho B and flucytosine…then fluconazole
Southwest US erythema nodosum or multiforme arthralgias, flu-like sx. 1-3wks after exposure. Consider in pts with pulmonary sx + prolonged constitutional sx. Misdiagnosed as sarcoidosis.
Coccidioidomycosis.
Flu like illness pulmonary infiltrates splenomegaly palate ulcers Midwest residence. Consider in complex pulm dz (nodular, cavitary, LAD)
Histoplasmosis (immunocompetent)
Sepsis syndrome in immunocompromised patients.
Serum/urine test not helpful
Itraconazole if severe localized disease in immunocompetent.
Ampho B followed by itra in immunocompromised
Warty lesions with central ulceration bacterial pneumonia-like syndrome Arkansas and Wisconsin hunters/loggers 4-6wks after exposure. (MS, MO, OH river valleys)
Blastomycosis
Lymphangitis in a gardener.
Sporotrichosis
Tx: potassium iodide or itraconazole.
Black necrotic spot on nose or sinuses in a poorly controlled diabetic
Rhizopus - Zygomycosis
Differences between protozoa and helminths
Protozoa replicate in body & do NOT have eos
Helminths do NOT replicate in body & HAVE eos
Whole township breaks out into watery diarrhea…what is cause?
Crysptosporidium
Raspberries from Guatemala.
Cyclospora- treat with bactrim
“banana shaped gametocytes”
Falciparum malaria
**high rate of chloroquine resistance
1 infected RBC per slide (higher than others)
No schizonts (as opposed to others)
What should you screen for prior to starting malaria treatment
G-6-PD - if deficient, primaquine can induce hemolytic anemia
Months of fever, sweats, myalgias and shaking chills.
Hemoglobinuria.
Severe hemolytic anemia
Jaundice
Renal failure.
Cross-like pattern seen in RBC on peripheral smears. NE US in summer or early fall.
Babesia **aplenic patients have worse disease "Maltese cross" pattern on RBC Hemoglobinuria is predominant sign Tx: quinine and clinda, or atovaquone + azithro.
Treament for amebiasis
Metronidazole, followed by paromomycin or iodoquinol even if stool doesn’t have organisms.
Examine stool or get serology.
Aspirate of liver abscess often shoes no ameba or PMNs.
watery, smelly diarrhea and flatulence
Child in daycare, camper, or immunocompromised person
Giardia
Tx: metronidazole or tinidazole or nitazoxanide.
Albendazole for kids
paromomycin in pregnancy.
3rd degree heart block
achalasia or megacolon
South America and Mexico
Chagas disease (Trypanosoma cruzi).
Most common cause of CHF in Brazil.
Tx: antimonials & arsenicals from CDC.
Multinucleated giant cells on Tzank smear
Herpes virus or Varicella
Temporal lobe seizures (smells burning rubber) focal neuro signs altered MS high CSF protein and RBC erythema multiforme
Herpes encephalitis
When should you not treat neurocystercercosis with antiparisitic drug?
When lots of cerebral inflammation.
Treat with steroids only.
LBPx 10 hours,
zoster infection is suspected but no vescicles present.
What is immediate course of treatement.
Nothing…acyclovir has no effect until vesicles are present.
What age should people get zoster vaccination
60
How is CMV diagnosed
Antibody titers if immunocompetent
Antigenemia if immunosuppressed
Lymphocytosis with >10% atypical lymphocytes. Which antibiotic do you NOT give.
EBV
Ampicillin-causes rash
Cough, corza, conjunctivitis, rash
Koplik spots on buccal mucosa
(white spots with Erythematous base)
Measles
Caver presents with acute delirium, hydrophobia and choking
Rabies
**serology is not helpful
Preventative vaccine indicated for animal worker, caver, vet, anyone who works with bats (NOT hunters)
AIDS patient or sickle cell patient
red rash on cheeks
acute pancytopenia
Bone marrow bx shows giant pronormoblasts
Parvovirus
“Slapped cheek” appearance
Likely in aplastic crisis
Young patient with hemorrhagic pna
thrombocytopenia
increased hematocrit
Hantavirus
Likely develops ARDS
Most common cause of prosthetic valve endocarditis 1 year after surgery
Staph epi
Labs that support infective endocarditis
Blood cx (3/4 positive at least prior to abx) ESR/CRP Thrombocytopenia Proteinuria/RBC casts low complement/cryoglobinemia RPR+ RF (minor)
Indications for TEE in suspected endocarditis
Prosthetic valve
Suspicion for perivalvular abscess
***negative TEE with native valve has neg predictive valvue of almost 100%
Duke criteria diagnosis of endocarditis
2 major
1 major + 3 minor
5 minor
Major
+ blood cx
(typical IE organism, 2cx 12 hrs apart, any cx for Coxiella burnetti, majority of cx + for atypical organism)
Abnormal Echo
Minor
- Predisposing condition (valve dz, IV drug use)
- Fever
- Vascular phenomena
- Immunologic phenomena (osler nodes, roth spots, +RF, acute glomerulonephritis)
- Positive blood cx that does NOT meet major criterion
Empiric treatment for meningitis
3rd Gen Ceph + Vanc
Add ampicillin if neonate or >60 to cover Listeria
Additional tests required for aseptic meningitis
VDRL, acid fast,,
cryptococcal antigen, fungal serology
Meningitis sx after raccoon exposure in California. CSF shows eosiniphilia.
Baylisacaris (nematode)
**no effective tx
6th nerve palsy
basilar enhancement on CT scan
CSF negative for bacteria.
TB meningitis
Pt. with Bell’s palsy, foot drop
Camping in past several weeks
Lyme meningitis Tx: Ceftriaxone or high dose PCN G no doxy (due to penetration)
Empiric tx for brain abscess
PCN (3rd gen ceph if allergic) + metronidazole
Add vanc to cover staph if penetrating trauma or sugery
HAART combos to avoid
d4T+ ZDV (“4 z extra point”)
ddC+ddI (CI for contraindication)
INdinavir + SAquinavir (INSAne to use together)
3TC + d4T (“3, 4, out the door!”)
Sudden F/C, myalgias, arthralgias
followed by an irregular ulcer that may persist for months.
Regional lymphadenopathy that might necrose/suppurate
AR, MO, OK.
Franciscella tularensis - “rabbit fever”.
Transmitted by ticks/flies, but can be ingested/inhaled.
Dx: serologic testing.
Tx: Streptomycin or gent. Tetracycline if not severe.
Malaria prophylaxis
Chloroquine: 1-2wks before + 4-6wks after.
If resistant area: Mefloquine or atovaquone/proguanil. Resistant areas: S. America SE Asia emerging: E Africa
GI sx, hepatomegaly
huge splenomegaly
cutaneous dz in traveler
Leishmaniasis - sand flies.
Tx: Sodium stibogluconate (pentavalent antimony), pentamidine, or ampho B.
Only helminth that replicates in body. Tropical regions, southern US. GI and pulmonary sx eosinophilia. Immunosuppressed: abd pain/distention, neuro & pulm sx, shock.
Strongyloides - infxn can persist for decades.
Dx: serial stool samples
Tx: Ivermectin or albendazole
Fleeting, migratory pulmonary infiltrates, eosinophilia
Visceral larva migrans - Toxocara canis.
Tx: albendazole or mebendazole.
Eosinophilic meningitis in travelers from S. Pacific
Angiostrongylus cantonensis - rat lungworm. Ingestion of snails, vegetables contaminated by snail slime, crabs, shrimp.
Eosinophilic meningitis in kid playing in sandbox
Baylisascaris procyonis - roundworm in raccoon droppings
Mexican immigrant with new onset seizures
Cysticercosis - pork tapeworm.
Tx: Niclosamide, albendazole, or praziquantel;
steroids first if lots of edema/inflammation.
No tx needed for calcified lesions and no h/o clinical dz.
Eating raw fish, biliary obstruction
Clonorchis - Chinese liver fluke.
Praziquantel x 1 day
Travelers diarrhea - 2 months later, fever, lymphadenopathy, marked eosinophilia. Cirrhosis with varicose (not spiders, gyneco, or ascites)
Schistosomiasis “Katayama fever”)
Dx: eggs in stool or urine
Tx: Praziquantel x 1 day
Tetanus booster need?
None if last booster 5 yrs
Arthralgias, Abd pain, Weight loss, Diarrhea.
May have severe malabsorption
neuro sx (lymphatic obstruction)
Skin hyperpig in sun-exposed areas.
Foamy macrophages on PAS stain small bowel biopsy, or PCR CSF.
Tropheryma whippelii
gram + actinomycete.
Ceftriaxone or IV PCN x 14d, then 1 year bactrim.
Ddx: lymphoma
Ertapenem use?
once daily. One of few beta-lactams with good staph coverage and extended spectrum GNR.
No pseudomonas.
Outpt parenteral tx - diabetic feet, infections of abdomen, pelvis, skin/soft tissue.
Drugs that can cause fever
Phenytoin, carbamazepine
Beta lactams, sulfonamides, nitrofurantoin
Allopurinol
How is smallpox different from chickenpox?
Smallpox: rash begins 2-3d after fever
(V: same time)
rash begins on face/arms/legs -> chest/distal
(V: trunk -> face/extremities)
rash in same stage
(V: different stages at any time)
Fatigue, HA, ST
fever with posterior cervical LAD
splenomegaly
atypical lymphocytosis.
Aseptic meningitis/enceph,
hepatitis,
hemolyic anemia, thrombocytopenia.
EBV - infectious mono.
Monospot test. If neg, repeat in 2 wks or EBV serology.
Criteria for +Tb test
> 15mm no risk factors
> 10mm: IVDU, recent arrival, high-risk congregate living, lab workers, high risk for active dz, kids 5mm: HIV, recent contact, old Tb on CXR, transplant, >15mg/d prednisone for >4wks.
Gradual dyspnea + nonproductive cough, HIV
F/C/NS, weight loss
Tachypnea, crackles
Most common cause of pneumothorax in AIDS
Pneumocystis jirovecii Pna - PJP Dx: Silver stain exam of induced sputum or bronch - cysts Tx - bactrim for mild-moderate IV bactrim for mod-severe Steroids if A-a>35 or PO2
Diplopia Dysphonia Dysarthria Dysphagia Descending paralysis (starting with face), 12-72hrs after exposure.
Botulism.
Wound botulism: debride wound.
Trivalent antitoxin from CDC - only stops, can’t reverse progression.
Where do you find chloroquine-resistant malaria?
Thailand Myanmar Cambodia Vietnam. For prophylaxis: atovaquone-proguanil, mefloquine, or doxy.
Osteomyelitis: characteristic organisms in…
-Foot puncture wound through shoe
- sickle cell
- Pseudomonas
- Salmonella and S. aureus
Genital ulcers: multiple 1-2mm tender vesicles or erosions Tender LAD. If immunocompromised - \+ hepatitis esophagitis colitis chorioretinitis acute retinal necrosis tracheobronchitis pna
HSV
Genital ulcers: Single 0.5-1cm painless indurated ulcer
Nontender bilateral inguinal LAD
syphilis
Genital ulcers: ragged, purulent, painful ulcers.
Painful LAD - rapidly get fluctuant and rupture.
Chancroid (H. ducreyi).
Tx: 1 dose IM ceftriaxone or 1g azithro.
Or: 3d cipro or 7d erythro.
Single 0.2-1cm genital ulcer
sometimes painful, disappears in 1-3wks.
2-6 wks later: tender unilateral LAD which my suppurate and fistulae
C. trachomatis - Lymphogranuloma venereum (LGV).
Tx: Doxy or erythro x 21d.
HIV: OI prophylaxis
Encephalitis chorioretinitis pneumonitis focal neurologic syndrome mono-like sx AIDS
Toxoplasmosis.
IgM and IgG serologic testing.
Sulfadiazine, pyrimethamine, and folic acid.
Transplant, first month: -GI perforations and bleeding = pna and resp failure - Reactivation of EBV, polyomaviruses, hep B,C - increased risk of renal graft failure
CMV infection
Prophylaxis: gan, valgan, or high dose acyclovir
What lab must be checked weekly for patients treated with Daptomycin?
CK - risk of severe myopathy, hepatotox
Definition of febrile neutropenia?
Pt w/ ANC 38.3°C (101.0°F) or a temperature of >38.0°C (100.4°F) sustained for >1 hour
Define high vs low risk for febrile neutropenia
Low risk is expected to be neutropenic (
