Infection CPC Flashcards
What is in keeping with pneumocystis jiroveci?
Ground glass changes on x Ray
Start in co trimoxazole, side fx of rash
What should you test for with PCP?
HIV.
Didn’t do it when patient first came in, made assumption that he wouldn’t have it.
Hypoxia is hallmark for PCP
Second line treatment for PCP? Clinda and primiquine
What is given for candiadisis?
Fluconazole
What is PCP classified as?
Fungus
What tests do you do for PCP?
Histo staining
Immunofluroscence
In descending order of cd4 count what conditions are likely with HIV?
Bacterial skin infection, herpes simplex, fungal infection Kaposi sarcoma Hairy leukoplakia, TB PCP, cryptococcus, toxoplasmosis Cmv, lymphoma
How can patients who are immunocompromised differ from normal patients?
Type of infectious agent
Speed of progression
Atypical presentation
What are the causes of immunodeficiency?
Inherited
Acquired- iatrogenic, steroid, chemo, radiotherapy
HIV
Chronic illness- diabetes group b strep, cancer
Malnutrition
What type of infection would you get with T cell defect?
Sepsis
CMV, EBV, VZV, resp and intestinal
Candida, PCP
Aggressive, opportunistic
What type of infection would you get with B cell defect?
Strep, staph, haemophilus
Enteroviral encephalitis
Giardia
Recurrent sinopulmonary infections
What type of infection would you get with neutrophil defect?
Staph, pseudo
Candida, nocardia, aspergilus
What type of infection would you get with complement defect?
Neisserial, childhood
What organism is typically associated with alcoholic?
Actinomyces
Slow growing, lung abscess, discharge
Long course of tx, 1 year, specific growth media
Basophilic granules, long gram positive rods
Why is rifampcin given along with fluclox for deep seated s aureus infection?
Activity against biofilm formation, useful with prosthesis
Why could the same bacteria be present with the same sensitivity?
Inadequate debridement, tried to keep ankle function
What are the most important factors in recovery of prosthetic joint infection?
Removal of prosthesis
Adequate debridement and drainage of abscess
Abx play a role
Damaged bone prone to infection, or walled off abscess, fibrous capsule. Not well vascularised, low ph inactivated abx like gentamicin.
What can central line insertion predispose to?
Endocarditis
What abx given for chronic leg ulcer?
Vanco- mrsa
Cefuroxime- allergic to penicillin, for staph and strep
Metro- chronic nature of ulcer
Cipro- antipseudo
What can be done to remove c diff spores from hand?
Chlorine
Hand wash to remove spores, not gel
What is the c diff severity score? 1 for each of the following
Temp more than 38.5
Hr more than 90
WBC more than 15
Rising creatinine
Clinical signs of severe colitis/radiology mega colon, ileus no diarrhoea
Failure to respond to therapy at 72 hours
Why should vanco be given orally in c diff?
Too big to get into colon via iv. Not absorbed orally, so if you give oral their is high intra colonic levels
What type of c diff is severe, has outbreaks in Quebec and U.S.?
Ribotype 027 Produces 16 times more toxin a and 23 times more toxin b Quebec- fluoroquinolones were found to be the class of antimicrobials most prone to induce c diff associated diarrhoea. Traditionally its clindamycin and cephalosporins
Pathogenesis for pseudomembranous colitis.
Destruction of Tight junction in epithelium
Neutrophil inflammatory response
Cytotoxic effect on cells
What is given to severe CAP?
Co amoxiclav and clarithromycin
