ID: Bacterial diseases Flashcards
1
Q
how long do you wash hands with soap and water
A
at least 20 seconds
2
Q
vast majority of infections are causd by
A
microbes from normal flora
3
Q
general stages of an infection (7)
A
- transmission
- evasion of host
- adherence to mucous mems
- colonization by growth of bacteria at the site of adherence
- disease s/s start and inflammation rxn
- host responses during steps 3-5
- progression or resolution of dz
4
Q
MC site of entry for microbes
A
mucosal surfaces
5
Q
mycobacterium is?
A
intracellular pathogen
6
Q
what are direct and indirect measures for the acute phase response of an infection
they are very ____ but not ____ ?
which do you check weekly and which is daily?
A
ESR–erythrocyte sedementation rate—-weekly because its slow
CRP–C reactive protein—daily
assess PTs level of inflammation
very sensitive, not specific
7
Q
staph
- morpholoy
- coagulase pos or neg
A
gram + cocci
coagulase + (contains the enzyme coagluase)
8
Q
what does coagulase enzyme activate
A
thrombin— causes clotting
9
Q
why are most staph aureus resistant to penicillin
A
because they contain the enzyme penicillinase—this inactivates PCN but not antibitoics like methicillin or naficillin—— aka Methicillin SENSITIVE staph aureus (MSSA)
10
Q
how can MRSA be acquired
A
hospital or community
11
Q
where can MRSA live in the body
A
nasal passages throat skin ***areas of colonization*** -these people can be carriers
12
Q
PTs with MRSA have:
- higher ____
- longer _____
- higher ____
A
higher mortality
higher healthcare costs
longer hosp stays
13
Q
HA-MRSA
- RF (8)
- when can you get it
- complications
- resistance to?
- transmission
- tx
A
RF:
- ABX use (esp fluoroquinolones, cephalosporins)
- prolonged hosp stay
- ICU stays
- hemodialysis
- proximity to others with MRSA
- chronic wound—-diabetes
- discharge with a central venous catheter or invasive device
- discharge to nursing home
> 48 hours after hospitalization or w/in 12MO of exposure to a HC setting
comps:
- bacteremia
- pneumonia
- skin/soft tissue damage–surgical site infections
Multi-drug resistant (more so than CA-MRSA)
transmission: via HC workers–contamination of hands and surfaces
TX:
1. IV vancomycin **
or
2. Linezolid
14
Q
what is the leading cause of surgical site infection
A
HA-MRSA
15
Q
CA-MRSA
- define it
- MC in?
- sensitive to?
- RF (10)
- transmission
- tx
A
MRSA infection w/o hx of HC setting exposure
MC in:
- young, healthy
- initially it was reported in IV drug users
- prisons, sports, childcare centers, military
sensitive to: beta-lactam ABXs
RF:
- skin trauma
- bbody shaving
- incarceration
- equipment sharing
- close contact with person with MRSA colonization or inf
- necrotizing pneumonia
- osteomylitis
- UTI
- endocarditis
- sepsis
transmission: surfaces that are contaminated
tx:
1. I/D for abscess
2.** PO clindamycin 300mg TID x7-10days
or
3. ***PO Trimethoprim-Sulfamethoxazole 1-2 tabs DS x 7-10days
or
4. Doxycycline 100mg BID x 7-10days
16
Q
what is the most frequent cause of skin and soft tissue infections presenting to the ER
A
CA-MRSA
17
Q
What causes the abscess formation seen with MRSA
A
protein seen with CA-MRSA
18
Q
sepsis
vs
septic shock
A
SEPSIS:
uncontrolled inflammatory response
dysregulated host response to infection
life threatening organ dysfunction
SEPTIC SHOCK:
- subset of sepsis
- circulatory, cellular and metabolic dysfunction
- assoc with higher risk of mortality
19
Q
septic shock -what s/s order--MC manifestation? -steps of progression -what is an indirect marker? -diagnosis? -etiologies--MC? -RF (9) -
A
hypotension–>tissue perfusion
lactate level= indirect marker for tissue perfusion
FEVER=MC MANIFESTATION
infection–>bacteremia–>sepsis–>septic shock–>multiple organ dysfunction–>death
clinical diagnosis
etiology: resp, GI, GU, and skin/soft tissue infections are MC sources
* **Pneumonia is MCC sepsis
RF:
- bacteremia
- > 65YO
- immunosupp
- DM
- obesity
- CA
- CAP
- previous hospitalizations
- genetics
20
Q
SIRS criteria
-stands for
-
A
systemic inflammatory response syndrome (SIRS)
no longer part of sepsis guidelines
but stil can identify acute infections
21
Q
SIRS criteria
A
requires at least 2 of the 4:
- body temp less than 36 C or greater than 38 C
- Hr>90
- RR > 20/min
- WBC < 4,000 or greater than 12,000 OR greater than 10% bands
22
Q
what repalced SIRS?
-used for? not used for?
A
Quick SOFA (aSOFA)---outside ICU SOFA--ICU
*used to predict mortality
NOT to diagnose sepsis
23
Q
qSOFA criteria
A
must meet 2 of the following:
- new or worsened mentation
- RR > or equal to 22/min
- SBP < or equal to 100 mmHg
24
Q
gram+ shock resutls from?
- leads to?
- etiologies
A
eXOtoxins–>fluid loss
- staph
- strep
25
gram - shock caused by??
| -etiologies
enDOtoxins
* e coli
* klebsiella
* proteus
* pseudomonas
26
Neoantes
- susceptible to what bacteria
- how to tx
GBS****
E. coli
Klebsiella
TX:
Ampicillin + gentamycin
and/or
cefotaxime is added if gram- meningitis suspected
27
Children susceptible to what bacteria
| tx?
```
H. influenzae
pneumococcus
meningococcus
TX:
3rd gen cephs
vancomycin
Clindamycin
```
28
adults are susceptible to what bacteria
gram+ cocci
aerobic bacilli
anaerobes
29
IVDU susceptivle to what bacetria
| tx?
S. aureus
| ***VANCOMYCIN
30
Asplenic PT susceptible to what bacteria
pneumococcus
H. influ
meningococcus
31
Line associated infections?
skin flora
| *coag negative staph
32
two sepsis biomarkers?
lactate levels
| procalcitonin
33
when do procalcitonin levels rise in sepsis
| -peaks?
w/in four hrs after onset of infection
| PEAK at 12-48 hours
34
when do lactate levels rise in sepsis?
| -what is a diagnostic level
secondary to tissue hypoxia
| >18 is diagnostic for septic shock
35
what kind of acid-base disorders would you find with sepsis
respiratory alkalosis with a metabolic acidosis
36
how many sets of blood cultures do we need with a septic PT
two
| *including a set from a central venous cath
37
tx sepsis
ID and remove cause of infection
PT MC will need ICU admission
1. fluid resuscitation is priority in early mng---IV crystalloid at 30mL per kg w/in first three hours
2. empiric ABX within one hour---- Piperacillin-tazobactam + vancomycin for adults
3. vasopressors: if hypotensive after fluid resuscitation-----norepinephrine is DOC
4. send blood cultures (draw b4 ABX tx)
5. remove all existing caths, IV lines and central lines
38
what is the target MAP for septic pt
>65 mmHg
39
scarlet fever:
- define
- bacteria involved?
- what kind of rxn
- CM
- population MC affected
- % of PT who get it
- diagnose
- tx
diffuse skin eruption
etiology: Group A streptococcus (strep. pyogenes) infections
Type IV (delayed) hypersensitivity rxn to a pyrogenic strain---pyrogenic exotoxins
CM:
1. fever, chills, PHARYNGITIS*****
2. rash: diffuse erythema that blanches with pressure + multiple small (1-2 mm) papular elevations with a SANDPAPER texture (very very small diffuse papular rash)
- rash will spare the palms and soles
- start at neck/upper trunk and groin-->spreads to extrems and trunk----eventually will desquamate
3. flushed face with circumoral pallor and strawberry tongue
4. Pastia's lines: linear petechial lesions seen with pressure points, axillary, antecubital, abdominal or inguineal areas
MC affects kids 5-15YO
peak incidence: winter and spring
develops in <10% of streptococcal throat infections (less common since development of PCN)
diagnose: rapid antigen test and throat cx
TX:
1. PCN first line (po or im)
* ****Macrolide (azithromycin) or clindamycin if PCN allergic
2. Amoxicillin
40
when can a child return to school if thye have scarlet fever
24 hours after start of ABX tx
41
Diphtheria
- bacteria?
- transmission
- host
- incubation
- toxin?
- can lead to?
- diagnosis
- tx
- prophylaxis for close contacts?
- prevention
Corynebacterium diphtheriae: gram+ rod
transmission=
1. aerosol droplets causes respiratory diphtheria
2. skin contact causes cutaneous diphtheria
Humans are the ONLY HOST
incubation: 2-5 days
* *exotoxin causes the inflammatory response
```
CM
RESPIRATORY:
1. pseudomembranous pharyngitis--- grayish-white membrane that is friable (will bleed if scraped)
+sore throat
+fever
+malaise
+nasopharyngeal s/s
2. severe lymphadenopathy--bulls neck
```
CUTANEOUS:
1. initial papule-->chronic non-heling ulcer
*can lead to systemic toxemia: Myocarditis, arrhythmias, neuronal tissue damage, renal tubular necrosis--- all secondary to the exotoxin
diagnosis:
1. throat swab sent for gram stain and culture-->gram+ rods with blue and red metachromatic granules
2. Positive Elek test for toxin
TX:
1. Diphtheria antitoxin immunoglobulin (horse serum)---GIVEN PROMPTLY--- most important*******
DO NOT WAIT FOR CULTURES TO COME BACK---GIVE ANTITOXIN IMMEDIATELY
2. Erythromycin IV or PCN IM x2 weeks--switched to PO when PT can tolerate
3. PT needs to be placed in isolation room
4. cardiac monitoring
```
PREVENTION:
1. DTaP sched: 5 doses given at
2MO
4MO
6 MO
b/w 15-18MO
b/w 4-6 Yrs
```
Tdap booster:
11-12 YO
pregnant mothers and those around them
10 year intervals after 11-22 yrs of age OR after any major injury if the last booster was 5 yrs ago or longer
42
DTaP vs Tdap
DTap= combo of diphtheria, tetanus and pertussis vaccine
Tdap= booster for the same three-- lower dose vs the initial vaccine
43
when can a diphtheria PT come off respiratory isolation
until 2 consecutive cultures 24 hours apart are negative
44
Tetanus
- bactiera?
- CM
- MC initial symp adult and neonate?
- transmission---MC infection site in adults?
- diagnosis
* *Clostridium tetani: gram+ rod anaerobe spore forming
* *produces a powerful NEUROTOXIN: tetanospasmin--blocks neuron inhibition by blocking release of inhibitory GABA and glycine---causing severe muscle spasms
**completely preventable with vaccine
Transmission:
* 20-30% of adult cases have no visible wound
* superficial abrasions to the limbs are the MC infection sites in adults
CM:
1. MC initial symp= trismuss
2. muscle pain and stiffness
3. back pain--opisthotonos---- arched back
4. aphagia
NEONATES: diff feeding is the usual presentation
Diagnosis:
* **clinical
* can also do cultures or serum tests
TX:
1. entry wound should be ID, cleaned and debrided of necrotic material
2. IM Human tetanus immune globulin (TIG) EARLY ON
3. Metronidazole DOC---alterntive is PCN
4. Benzos like Diazepam for spasms
5. IV mag has been shown to improve muscle spasm
6. airway protection
Prevention:
1. DtaP vaccine
* 2MO
* 4MO
* 6MO
* b/w 15-18 MO
* b/w 4-6 TO
2. Tdap booster
* 11-12 YO
* then every 10 yrs
45
what does a PT get if they never had any vaccination for tetanus
- 1 dose Tdap (First dose should always be Tdap)
- followed by 2nd dose Td or Tdap 4 wks later
- 3rd dose Td or Tdap 6-12 MO after 2nd dose
then every 10 yrs get the tDap
46
Td vs DT
Td= diphtheria and tetanus toxoid
DT= diphtheria and tetanus vaccine
47
Botullism
- bacteria?
- transmission for adults, infants
- CM adults and infants
- diagnosis
Clostridium botulinum--anaerobic, gram+ spore forming
Produces a NEUROTOXIN---inhibits ACH release at NMJ---weakness, flaccid paralyss and respiratory arrest
Transmission:
adult: ingestio of preformed toxin in canned, smoked and vacuum packed foods
infant: honey ingestion
wound: very rare----IVDU
CM:
1. symmetric cranial nerve palsies
2. descending flaccid paralysis of voluntary muscles ---starts proximal muscles weakness---progresses distally
3. Cranial neuropathies: four D's
* diplopia
* dysarthria--muscles for speech are weak/paralyzed
* Dysphonia
* dysphagia
4. dilated fixed pupils
5. dry mouth
6. GI s/s
7. ptosis
8. ophthalmoplegia
9. facial paralysis
10. impaired gag reflex
INFANTS: floppy baby syndrome, lethargy, weakness, feeding difficulties, hypotonia,*** weak cry***
Diagnosis:
***clinical
TX:
1. Antitoxin first line tx
* if >1 YO: equine-derived heptavalent antitoxin
* if <1 YO: human-derived botulism immune globulin (BIG-IV)
2. NO ABX for foodborne or infantile ************
3. YES ABX for wound botulism
48
DtAP goes to?
kids
49
Tdap goes to?
adults
| pregnant
50
what age can parents safely give kids honey
at least 12MO
51
why do we not give ABX to foodborne or infantile botulism
bc the abx can worsen dz via toxin release from lysis of bacteria
52
```
Clostridial Myonecrosis
also called?
bacteria?
-toxin?
-etioloiges
```
Gas Gangrene
* LT****
- traumatic inculation with CLostridium perfringens---anaerobe gram + rod
* *produces Alpha toxin (Lecithinase)
* *they double in number every 7 minutes*****
etiologies:
* crush injuries or penetrating trauma that devitalizes tissue
* this creates an anaerobic envir
CM: very rapid progression
1. sudden intense pain is FIRST symp
2. skin changes: red/purple---->black)
3. tenderness
4. Bullae formation
5. crepitus--gas
6. untreated can lead to bacteremia, hypotension, MOF
Diagnosis:
* clinical
* blood cultures
* obtain Xrays=air in soft tissues, want proximal views tooo
TX
1. IV ABX-- PCN + Clindamycin (metronidazole and tetracycline for PCN allergic OR just clindamycin alone)
2. emergent surgical debridement
3. possible amputation
4. hyperbaric O2 can improve survival
53
Cholera
- bacteria
- toxin?
Vibrio Cholerae---gram negative rod
transmissino: fecal-oral from conaminated water and food
**shellfish
**shrimps
**oysters
releases ENTEROTOXIN--choleragen
CM:
1. large volumes of watery diarrhea--rice water stool
2. dehydration can lead to electrolyte imablances-->cardiac and renal failure
3. acidosis and hypoK
4. matter of hours if untx.... can be profoundly dehydrated and die
diagnosis:
- culture of stool
tx:
1. prompt and adequate water and electrolyte replacement
2. ABX: tetracyclines, fluoroquinolones or macrolides not really necessary but shorten the duration of s/s
54
Lyme Dz
- bacteria
- incubation pd
- CM for the stages
- diagnosis
Borrelia burgdofrgeri gram- spirochete
*deer tick-->lxodes scapulris
MC spring and summer
incubation= 3-30 days
CM:
1. early localized/stage 1/ (7-10days) : erythema migrans (90%)--expanding, warm, annular, erythematous rash that has central clearing---bulls eye or target appereance
after tick bite
+/- viral like syndrome--fatigue HA fever malaise arthralgias etc
2. Early disseminated/stage 2 (1-12 weeks):
-neurologic: bilateral cranial nerve palsy--CNVII aka facial nerve palsy MC aka bells palsy, HA, meningitis, weakness, neuropathy
-cardiac: AV block MC, pericarditis, arrhythmias
-multiple erythema migrans lesions
"Key LYME pie to the FACE"
F=acial nerve palsy
A=arthritis
C=Cardiac block
E=erythema migrans
3. Late dz or stage 3:
- intermittent or persistent arthritis MC--esp large joints
- -->knee MC
- persistent neurological symptoms: subtle cognitive changes, distal paresthesias, spinal radicular pain, subacute encephalitis
Diagnosis:
***mc clinical--esp in early stage with the rash--- these PT will be seroNEGATIVE
***serologic testing:
1. ELISA-->if postiive then do a Western Blot for confirmation
2. only done in patients who meeet the following criteria:
A. reside or travel to an endemic area
B. risk factor for tick exposure
C. Symps consistent with early disseminated or late lym dz
55
which stage of the ticks life cycle transmits the dz more often nd why
Nymphal stage---they feed in the SUMMER which accounts for the highest rate of dz May-september
***size of a poppy seed and bites are rarely noticed*****
more so than the larval and adult stages
56
how long does a tick need to feed to transmit infectious "dose"
24-48 hours
57
list the states MC for lyme
NJ
PA
NY
CT
58
can serologic testing for lyme determine if the infection is acute or past?
no
| once someone has lyme.. they will show up positive
59
how long does it take for a + to show on serologic testing for lyme
weeks
60
what diseaes can cause a false positive serologic test for lyme
syphilis
lupus
***other spirochetal dz
61
tx for lyme disease
1. early disease
2. late or severe
3. prophylaxis
* *prregnant?
1. early dz
*Doxycycline BID x 10-21 days for early localized
*Doxycycline BID x 14-28 days for early disseminated
*Amoxicillin and Cefuroxime are alternative*
PREGNANT: Amoxicillin x 14-21 days
can also use Azithromycin or Erythromycin
2. Late or severe (heart block, syncope, dyspnea, CP, CNS symps)
* IV Ceftriaxone
3. Prophylaxis---given w/in first 72 hours of tick removal if tick present for >36 hours and in endemic area
* Doxycycline 200mg X1 dose
* if allergic to doxy or cannot be used, no prophylaxis given
DOXY IS CONTRA IN PREGNANCY
62
what serologic test confirms diagnosis of lyme and when is it done
Western Blot Immunoblot assay
| **done after a + ELISA test
63
when would you administer lyme dz prophylaxis (3)
1. tick is known lxodes scapularis
2. tick attached >36 hours
3. pt in endemic area
must get doxy within 72 hrs of bite
64
tx for early disseminated lyme dz
- what is the s/s
- tx?
s/s= erythema migrans rash
tx= doxycycline
contra to doxy--- give Amoxicillin ** or Cefuroxime
65
tx for facial nerve palsy and/or joint involvement phase of lyme dz
tx= doxycycline
| contra to doxy--- give Amoxicillin ** or Cefuroxime
66
cardiac and neuro manifestations for lyme dz-- what is tx
IV ceftriaxone
67
reinfection with lyme dz tx?
tx= doxycycline
| contra to doxy--- give Amoxicillin ** or Cefuroxime
68
Rocky Mounted Spotted Fever:
- bacteria?
- has affinity for what kind of cells
- what states
- vector? SE states? western states?
- CM
- diagnosis
- tx
Rickettsia rickettsia--gram neg short rod
obligate intracellular bacteria
affinity for vascular endothelial cells---causes the vascular injury
occurs primarily in South East states---NOT the rocky mountains
Vector in SE States= DOG TICKS... Dermacentor variabilis
Vector in Western US= wood tick...Dermacentor andersoni
***Can be fatal is left untx***
CM:
1. abrupt onset of HA, fever, chills, malaise, mylagias, arthraligias, N/V, lethargy
2. 2-6 days later: rash that starts as macules then progresses to pretechiae---rash FIRST appears on PALMS AND WRISTS AND SOLES AND ANKLES-->then moves inward to trunk---basically starts distal and moves inward
3. as rash progresses it can cause edema, encephalitis, cardiac and bleeding disorders, delirium coma and death
diagnosis:
**clinical: fever+ rash + hx of tick exposure
**serologies: indirect immunofluorescent antibody test
LABS: thrombocytopenia, pancytopenia, hyponatremia my occur
CSF: low glucose and pleocytosis (incr cell count)
*******dont wait for serology to tx*********
TX:
Doxycycline DOC
Chloramphenicol is 2nd line and for pregnancy
69
```
Gonorrhea
-bacteria?
-transmission
*what parts can it infect
*RF (7)
CM for men and women...MC?
CM for DGI
incubation pd--m and w
```
Neisseria gonorrhoeae
gram -
trans:
* sexually
* newborns can get it from infected mom
Can infect: genital tract, anorectal and pharyngeal
RF
* new or multiple partners
* unprotected sex
* substance abuse
* low education level
* low socioeconomic status
* MSM
* hx of STI
incbation pd:
men: 2-7 days
women: <10 days
CM for men:
1. MC is urethritis
2. mucopurulent/copious urethral discharge
3. epididymitis
4. prostatitis
5. balanitis
CM women:
1. mucopurulent vaginal discharge
2. intermestrual bleeding
3. urethritis
4. bartholin gland infection
5. PID
6. lower abd pain and tenderness
7. fever
8. CMT--- sign of PID
9. Adnexal tenderness
10. Perihepatitis-- also called Fitz-Hugh-Curtis Syndrome
CM for Disseminated Gonococcal infections:
* septic arthritis
* MCC in Men <30 YO
* can also go to anorectcal, throat and eyes
* anus infection= usuall asympto.... but can cause bloody and purulent discahrge
70
Perihepatitis-- also called Fitz-Hugh-Curtis Syndrome
- define
- s.s
occurs in 4% of women with gonorrhea
associ with PID and inflammation of the liver capsule
causes right upper quadrant abdominal pain, fever, nausea, and vomiting, often mimicking biliary or hepatic disease
71
Diagnosis for Gonorrhea
Nucleic acid amplification tests--NAATS via urine or vaginal swab
gram staining---- >90% urethral sample from men and 50% for endocervical sample from W
72
Tx for gonorrhea
| tx for gonococcal arthritis
Gonorrhea:
1. Ceftriaxone 250 mg IM****** and Azithromycin 1gram PO once
2. if suspected PID: ceftriaxone + doxycycline x1 week
3. Partner is tx as well
Disseminated gonococcal infection:
1. IV Ceftriaxone
**condoms MAY limit transmissino
73
Syphilis
- bacteria?
- transmission
- CM
Treponema pallidum
gram - spirochete VERY SLOW GROWING
transmission:
- sex
- pregnant women to fetus
CM: three phases bc it is muli-stage dz
- can present at any stage
- sometimes not show s/s for years
1. PRIMARY
* chancre= PAINLESS ulcer w/ raised indurated edges
* heals spontaneoulsy within 3-4 weeks
* nontender regional lymphadenopathy near chancre lasting 3-4 weeks
2. Secondary Syphilis "great imitator"
* s/s occur few weeks-6MO
* maculopapular rash= diffuse bilaterally +soles +palms
* Condyloma lata= wart like, moist lesions involving mucous membranes and other moist areas--VERY contagious
* constitutional symps= fever, maliase, HA, wt loss, lymphadenopathy, alopecia
***about 1/3 of primary and secondary syphilis will resolve on their own w.o tx******
3. Tertiary or late syphilis
* may occur 1-20 years after initial or secondary infection
* Gumma= noncancerous granulomas on skim and body tissues
* Neurosyphilis= HA, meningitis, dementia, vision/hearing loss, Tabes Dorsalis (demyelination of posterior spinal columns) leads to ataxia, areflexia, "lightening like" burning pain and weakness
* Argyl-Robertson pupil= small irreg. pupil that constricts with accomidation but is NOT reactive to light
* cardiovascular= aoritis, aortic regurg, aortic aneurysms
74
Tabes Dorsalis
demyelination of posterior spinal columns) leads to ataxia, areflexia, "lightening like" burning pain and weakness
**teritary syphilis
75
gumma
noncancerous granulomas on skim and body tissues
**tertiary syphilis
76
Argyl-Robertson pupil
small irreg. pupil that constricts with accomidation but is NOT reactive to light
77
screening for syphilis
| -false positives occur frm what dz?
1. rapid plasma reagin (RPR)
2. venereal disese research laboratory (VDRL)
* *these tests looks for titers to non-treponemal antigens
results are + in most cases of primary syphilis
***false + can occur bc does not test for treponemal antigens.... in dz like: leprosy, hep B, EBV, autoimmune dz
78
confirmatory testing for syphilis
1. Fluorescent treponemal antibody absoprtion (FTA-ABS) ***specific for Treponema pallidum antibodies
remain positive for life--even after effective treatment
**more expensive and difficult to perform vs the screening tests
2. Darkfield microscopy--direct visualization
79
tx for syphilis
PCN is DOC for all stages
1. primary, secondary or early latent
* **PCN G Benzathine IM one dose
* *PCN allergic: Doxycycline (PO) or ceftriaxone (IM/IV)
2. Late
* **PCN G Benzathine IM once weekly x3 weeks
3. neurosyphilis
* **IV PCN G potassium x10-14 days
80
which can be given IV
| PCN G BEnzathine or PCN G Potassium
potassium
Benzathine will cause cardiac arrest
81
Jarish-Herxheimer rxn
acute self limiting febrile rxn
| occurs within first 24 hours after receiving therapy for a spirochetal infection (syphilis, lyme dz)
82
chlamydia
- bacteria
- what else can the bacteria cause
- CM--women, men, newborns
- diagnosis
- tx
Chlamydia trachomatis--very small, intracellular obligate
*causes: conjunctivitis, genital tract infections (urethritis, lymphogranuloma venreme)
PTs infected with this bacteria co-infected with N. gonorrhoeae in 10-30% of cases
CM: almsot 1/2 cases are asympto ****
Women: cervicitis, urethritis, salpingitis, PID
Men: urethritis, epidimyitis, procitis
*conjuncivitis can occur via touching gentiles then eyes or in newborns
*reactive arthritis-->arthritis, urethritis, and uveitis=triad MC in men---THIS IS NOT SEPTIC ARTHRITIS
*Fitz-Hugh curtis syndrome: perihepatits... MC with this vs gonorrhea
Newborns: Ophthalmia neonatorm
Diagnosis:
-nucleic acid amplification tests NAATs--urine or vag swab
TX
1. Azithromycin 1gm PO
OR
Doxycycline 100mg BID x10 days
2. partner is tx too--- no sex for 7 days after taking meds
3. high risk PT--consider gonorrhea tx too
83
what are the three types of Chlamydia bacteria
1. Chlamydia trachomatis (STD)
2. Chlamydia psittaci (parrots)
3. Chlamydia pneumoniae
84
watery, mucopurulent discharge with pruritis and dysuria
urethritis
85
Ophthalmia neonatorum
- etiologies?
- whch is most visually threatening and which is MC?
Chlamydia trichomatis and Neisseira Gonorrhea
Gonorrhea is Most visualy threatening but chlamydia is MC
86
septic arthritis vs reactive arthritis
septic arthrits-- occurs with gonorrhea infection
Reactive arthritis-- occurs with chalymida and has the triad of
- arthralgia
- uveitis
- urethritis
* cant see cant pee cant climb a tree*
* this is also auto-immune related
87
what states is the expedited partner therapy for chlamydia not allowed
kentucky
west virginia
south caroline
88
Lymphogranuloma Venereum (LGV)
- bacteria
- MC seen where
- CM
- diagnosis
- tx
caused by Chlamydia trichomatis L1-L3 immunotypes
MC seen in tropical and subtropical areas of world
CM:
1. painless genital ulcer at the site of inoculation
2. second phase appears 2-6 wks later--painful inguinal and/or femoral lymphadenopathy
diagnosis is clinical
tx: doxy bid 100 mg x 21days
89
Trichomoniasis
- organism?
- transmission
- CM
- diagnosis---best test?
PROTOZOA---trichomonas vaginalis
transmission: sexual contact
primarly located in vagina and prostate
***most prevalent nonviral STI in US
CM
1. women can have malodorous, frothy yellow/green vaginal discharge
2. vaginal itching
3. dysuria
4. cervical petechiae--strawberry cervix
MEN ARE USUALLY ASYMPTO
Diagnosis: NAAT (best test) OR saline wet mount---will see flagellated protozans
**vaginal PH is very alkaline
TX:
1. Metronidazole 2g PO once OR 500mg BID x7 days (best this route if recurrent)
2. partner needs to be tx
3. condoms MAY limit transmission
