infection Flashcards
catheter removal indication in catheter-related blood stream infection
severe sepsis
hemodynamic instability
evidance of metastatic infection
pus at the exit site f the catheter
continued symptoms after 72 hours of empiric therapy
long term more than 14 days ; if the blood culture is s aureus , Pseudomonas or fungai
Lyme disease
erythema migrans < fatigue headache and myalgia and arthralgia,
erly disseminated; erythema migrans, unilateral or bilateral cranial nerve palsy( like & (looks like bells palsy)
meningitis, carditis migratory arthralgia,
late; arthritis encephalitis and peripheral neuropathy
arthritis ( 20,000 neut ( vs bacterial def more than 50,ooo)
28 days of doxycycline and you are disease free
cryptococal meningitis treatment
induction : amphotericin B and flucytosin for two weeks antiviral after this phase)
consolidation ; high dose oral fluconazole for 8 weeks;
maintenance ; low dose fluconazole for more than a year
therapy for necroziting fasciatis
Ab start surgery
piperacilin azobactam or imipenem + vanco+clinda (for toxins)
ART treatment and viral load
4 weeks less than 5000
8-12 weeks less than 500
16-24 less than 50
low and high clostrdiodes difficile infection AB
high; fluoroquinolones , clinda, 3-4 cephal, carbapenem, monobactam
low : cotri, macrolides tetra amino
we can change the AB and extend it till the end of other AB therapy
lyme and pregnancy
no congenital is reported , amoxicilin is the drug of choice and for 14-21 days
cat scratch disease treatment
azthro
corticosteroid use in pneumonia (PCP ) patients
A-a gradiant lmore than 35 or Pa O2 less than 70
breast feeding and doxy
no
aspergilosis biomarkers
galactomannan, beta d glucan
noduled in imaging ( IMP) with ground glass opacities ( halo sign)
voriconazole for treatment
Hi management in pregnancy
viral load montly til undetectable then 3 months
CD4 every 3 mnthes
avoidance of aminocentesis if detectable viral load
avoidance of artificial ROM, scalp electrode, operative vaginal delivery
under 50 art+ vaginal
till 1000 art +zido + vaginal
more than 1000. art + zido+ cesarean
breast feeding contra
active untreated TB
HIV
herpetic breast lesions
active VZV
chemo or radiotherapy
active substance use
meningococcal meningitis AB prophylaxis
who live in the same house or more than 8 hours within 3 feet, secretions( intubation),
child care workers
ecythema gangrenosum
pseudomona , painless red macules rapifly progressive to bullae and then gangrenous ulcers
no treatment for heb b unless
INR more than 1.5 or multiple comorbities(hepc and HIV) prolonged ( more than 4 weeks)
latent tb treatment
isoniazid 609 months
rifampine 4 months or
riphampine +izoniazide 3 months
cystic fibrosis
CFTR gene
AR
recurrent sinopulmonary inf
intestinal obstructions
pancreatic insufficiency and diabetes
male infertility
elevated sweat chloride
abnormal nasal potential difference
nutritional support
airway clearance
AB(staph and pseudo)
VZV IG and Vaccine
if vaccine 2 dose then ok
if not if immunosuppressive we give variIVIG but if not only vaccines
left apical ventricular aneurysm
chagas
drug resistance fosfomycine vancomycin and penicilin and cephalosphorins
fosfomycin; nam nag that inhibits mura : efflux pump or alterations to mura that prevent binding
vanco; d alanin : d lactate
pen and cephal; production of penicilinase ( beta lactam binding )
tetra : eflux or altrations to the ribosome ( binding site)
vaccines for HIV infections
HAV,HBV,HPV,influanza<(inactivated),meningococcal( all 11-18 and people living in military collages and asplenia)
pneumococ:PCV20, PCV15 follow by PPSV23
Tdap
contra( MMR, LIVE, under 200)
serum sickness like reaction
immune complex formation
AB( beta lactamn sulfa)
acute hepatitisB IMP
1-2 week after exposure
fever skin rash polyarthralgia
supportive
and steroids and plasmapheresis if very severe
syphilis treatment
primary or secondary or early latent ; 2.4 im pen
latent more than 12 2.4 benz pen weekly *3
neuro ; 3-4 aqueous pen every 4 hours for two weeks
congenital; aqueous pen 50.000/kg every 8 hr for 10 days
when to give AB to patients with diarrhea and ..
high risk features: bloody or high dose fever, sever disease hospitalized, elderly, immunocompromised, diarrhea more than 7 days
then we do stool stud ; if there was a inflammatory inf that is not shigatoxin producing then we can give AB
complications of diftheria
toxic mediated myocarditis , neuritis, kidney disease
lyme what to do
treat with clinical diagnosis, it can cause bilateral cranial nerve palsy ( like 7) it can be like bells pals
pneumonia treatment
inpatient ; levo or cef + azithro
ICU : cef + azithro or cef+ levo
outpatient; amoxi or doxy +or- macrolide
giardias treatmnet
tinidazole or nitazoxanide , metronidazole for children
adult vaccines
Tdap every 10 after 19
influenza after 19
herpes zoster after 50 2 dose at least 2 month apart
more than 65 pneumo either one 20 or 15+23(after 1 year)
under 65 either 20 or 15 +23(after 8 weeks)
HIV and one chronic inflamatory disease
after a while IRIS(immune reconstition inflammatory sundrome) fever and worsend symptomes(like in TB) nothing to be done
skin papules with central umbilicatio+HIV+hepatosplenomegalyand reticuloendotheliail systme maybe respiratory symptomes
cryptocucus neoformans
neurosyphlis
early: meningitis , ocular; posterio uveitis (most common), decreased visual acuity, ogen with meningitis,
meningocular
late; general paresis . Progressive dementia, tabes dorsalis ; posterio column, pipillary defect, may have normal CSF
antiviral therapy for influanza
under 48 hours
more than 65 years
pregnant to postpartum
chronic disease(cardiovascular, chronic pulmonary, renal ,hepatic,
immunosuppressed
morbidly obese
residents of nursing home or long term facilities
tb drugs adverse effect
rifampin(dna dependent rna polymerase); gastro, rash , red and orange body fluids, cytopenia,
isoniazide*mycolic acid synthesis); neurotoxicity (B6 pyridoxine) hepatotoxicity ,
pyrazinamide(unclear); hepatotoxicity and hyperuricemia
ethambutol (inhibition of arabinosyl transferase; optic neuropathy
Complications of mouth hanf foot disease
myopericarditis , aseptic meningitis, nail dystrophy
dengue fever
flu-like symptoms, pre orbital pain, diffuse maculopapular rash, leukopenia, positive tourniquet test (petechia after sphygmomanometer cuff inflation for 5 min),
warning signs, abdominal pain persistent vomiting, fluid accumulation, mucusal bleeding, lethargy or restlessness, hepatomegaly more than 2 CM, increased hematocrit with rapidly decreasing platlate count
progression: shock , respiratory distress, sever bleeding, sever organ involvement ( last alt , impaired consciousness, organ failure)
chemoprophylaxis
Atovaquone- proguanil
Expensive,Gl disturbance (eg, abdominal pain), 1 liver function tests
Doxycycline Inexpensive Gl disturbance, sun sensitivity, teratogenic
Mefloquine,Neuropsychiatric effects Agent of choice in pregnancy
Weekly dosing
Areas with chloroquine- ine- susceptible P falciparum (in addition to options above)
Chloroquine, hydroxychloroquine, Need to be started 1-2 weeks in advance, Potential exacerbation of some skin conditions
Areas without P falciparum (parts of South America, Mexico, Korean peninsula)
Primaquine, Potential teratogenicity, Hemolysis in patients with G6-PD deficiency
