Infection Flashcards
What treatment may be considered in a subset of patients at risk of aspiration pneumonia after stroke?
ACE inhibitors may reduce the risk of AP in Chinese and Japanese patients after stroke if no other contra-indications
What is the estimated hospital mortality of patients treated for aspiration pneumonia?
10-15%
At what measurement of peak cough flow should further investigation/cough augmentation be considered?
Peak Cough Flow of <270L/min should lead to further assessment of cough +/- teaching of cough augmentation
How would you treat a patient will allogenic transplant who contracts RSV infection?
Nebulised Ribavirin (antiviral). Can be oral if nebulised unavailable. Should also give IVIG
What are the features and treatment of cryptococcal pneumonia?
Often in immunocompromised patients. Fungal infection with pulmonary nodules and masses +/- cavitation. Usually Cryptococcus neoformans.
Treatment is with Amphotericin B or fluconazole
What are the criteria for which NICE recommend discharge is not safe after pneumonia?
How many of these are required?
Resp rate >24
Heart rate >100
Temperature >37.8
Systolic BP <90
Oxygen sats <90%
Abnormal mental status
Inability to maintain PO intake
Any 2 of the above
What might you expect on diagnostic aspiration of a pleural effusion caused by proteus mirabilis?
Raised pH
Often parapneumonic effusions have a higher pH, which may be attributed to ammonia produced by Proteus organisms
When should treatment failure be considered in the management of NTM infection?
If the patient remains culture positive after at least 6 months of treatment
What are the features of nocardia infection?
What is the usual treatment?
Rare infection but more common in IMMUNOCOMPROMISED. Gram positive bacillus usually opportunistic infection. Found in soils, decomposing vegetation and organic matter. Filamentous with BRANCHING HYPHAE on microscopy.
Non-productive cough, fatigue, SOB, chest pain, fever night sweats.
CO-TRIMOXAZOLE is the most commonly used treatment.
Amikacin or imipenem can be used if particularly unwell
What is a typical history for melioidosis infection?
How is it treated?
Caused by Burkholderia Pseudomallei. Commonly found in Southeast Asia and Australia. Present in the water and soil and transmitted through inhalation/direct contact.
Causes pneumonia that may be chronic.
Treat with IV CEFTAZIDIME or MEROPENEM
What treatment (and duration) for S.pneumoniae infection in patients with and without penicillin allergy?
First line amoxicillin 500mg-1g TDS for 2 WEEKS
If penicillin allergic/second line then
Doxycyline 100mg BD for 2 WEEKS
What is Lemierre’s Syndrome? What is the likely causative organism?
Acute, severe oropharyngeal infection with secondary thrombophlebitis of the internal jugular vein. Pneumonia and empyema are common associated complications.
The most common causative organism is FUSOBACTERIUM NECROPHORUM
What are the 30 day mortality rates associated with each CURB-65 score?
0 = 0.6%
1 = 2.7%
2 = 6.8%
3= 14%
4 = 27.8%
5 = 27.8%
What is the most appropriate treatment of PJP in a patient with G6PD deficiency? Why?
IV pentamidine with high dose oral steroids.
First line treatment is usually co-trimoxazole with primaquine or dapsone second line but these can cause oxidative stress in patients with G6PD.
High dose oral steroids should be given if PaO2 <9.3 or Sats <92%
What is the treatment for severe PCP infection if co-trimoxazole not tolerated?
IV pentamidine isethionate.
The main S/Es to look out for are hypoglycaemia/hypotension immediately after the infusion
What is the treatment of choice for bronchiectasis patients with pseudomonas colonisation?
1st Line: Inhaled colomycin
2nd line: Inhaled gentamicin as an alternative
3rd line: Oral azithromycin or erythromycin
What needs to be checked in a patient receiving inhaled aminoglycosides?
Hearing- can cause hearing loss
Check for balance issues- use with caution
Renal function- should be avoided if CrCl <30
When would cyclical IV antibiotics be considered in bronchiectasis patients?
Step 5 of treatment. If patient has 5 OR MORE exacerbations per year despite INHALED AND ORAL long term antibiotics (usually colomycin and azithromycin)
What is mucormycosis?
A fungal infection more commonly seen in patients after COVID-19/diabetics. Can present with mucosal involvement e.g. black lesions in the mouth. Usually resistant to voriconazole/echocandins so may treat with IV amphotericin
What is the most common tracheobronchial abnormality in GPA (Wegeners)?
Subglottic stenosis.
Other features include URTI features and renal involvement.
May get hoarseness, stridor or wheezing. Can get weight loss, fatigue and loss of appetite. May get nasal congestion/bleeding
