infections Flashcards
calcific periarthritis
calcifications near joint. Not infection. Treat with NSAIDS
Sweets syndrome
acute febrile neutrophilic dermatosis
mycobacterium culture
Ziehl-Neelsen stain and culture at 28-32C in Lowenstein Jensen medium
fungi culture
- K-OH prep (enhance with chlorazol black Estain)
- periodic acid-Schiff stain
herpes culture
tzank smear (giant cells)
antibiotics perioperative indications
> 2 hour case
flouroquinolone complication
tenosynovitis, especially >60 years old or h/o steroid use
onychomycosis treatment
distal 1/4 nail -> topical ciclopirox
1/2-3/4 dermatophyte -> oral terbiafine 6 weeks or fluconazole
total nail involved/recurrent -> topical and systemic treatment with surgical avulsion
candida treatment
itrazonazole
septic arthritis bacteria
- s. aureus and s. pyogenes most common
- adolescent then concern N gonorrhea
- treat with I&D and 2-4 weeks of IV antibiotics
fight bite
strep, staph, eikenella
anaerobic (provotella, fusobacterium)
cat bites
- 30-50% infected
- Pasturella
- Treat with unasyn/augmentin (in penicillin allergy then bactrim and clindamycin)
antibiotics to avoid in kids
doxycycline and fluoroquinolones
necrotizing fasciitis
20% amputation rate - group b hemolytic strep treat with penicillin G and clindamycin high risks if: CRP > 150 4pts WBC < 15 0 pts Hgb > 13.5 0 pts Na < 135 2 pts Glu > 180 1 pts low <5 points moderate 6-7 points high >8 points
mycobacterium marinum
caseating and noncaseating granulomas
treat with 16 weeks - 2 years clarthromycin, sulfonamids, bactrim, ethambutol and/or rifampin
herpes simplex
I cold sores
II genital
valtrex can help if within 48 hours
sporotrix
gardeners (roses)
nodular lesions along lymphatics
filamentous hyphae on PA strain
treat with potassium iodide
aeromonas hydrophilia
leeches and cat fish sting
gram - anaerobic rods
bactrim, cipro, ceftriaxone
MRSA
most common community acquired infection
deep spaces
middle metacarpal to fascia is separated by a fascial band called the mid-palmar septum.
flouroquinolone complications
- collagen-associated complications include aortic aneurysm, retinal detachment, tendinopathy/rupture
- inhibit tendon cell proliferation via moducation of inflammatory mediators and upregulation of metalloproeinases.
- occur within 1 month of use
- increased risk in men, >60 years, chronic renal disease, organ transplant, or use with steroids, statins or aromatase inhibitors
lyme diesese
- spirochete Borrelia burgdorferi, transmitted through the bite of a tick
- characteristic erythema migrans rash that begins at the site of the bite and expands, often with central clearing resulting in a target or “bulls-eye” appearance. The rash may be accompanied by fever, chills, headache, fatigue, muscle and joint aches, and lymphadenopathy.
- If untreated, patients may go on to develop headaches, joint pain/swelling (typically affecting larger joints), facial palsy, heart palpitations, and/or intermittent musculoskeletal and nerve pain.
- Doxycycline 100mg twice daily for 10-21 days is the preferred treatment in adults.
Rocky Mountain Spotted Fever (RMSF)
- Rickettsia rickettsii is transmitted by ticks
- headache, fever, and often a rash. The rash associated with RMSF often appears as small disseminated dots or hemorages, but can often be larger splotches.
babesiosis
- Babesia microti causes another tick-borne illness
tularemia
- Francisella tularensis
- carried by rabbits and can be transmitted to humans by ticks
- high fever
- skin ulceration where bite occurred and lymphadenopathy
ehrlichiosis
- Ehrlichia chaffeensis
- Tick bites are the primary route of infection in humans. People with ehrlichiosis will often have fever, chills, headache, muscle aches, and sometimes upset stomach
- A rash may be present 1/3 of the time; red splotches or pinpoint dots
quaternary ammonium solution sterilization
- used in developing countries
- inexpensive, low chemical method
- may not kill mycobacterium
- more effective sterilization uses ethylene oxide or autoclaving
west nile virus
a mosquito borne disease, has become endemic in the 48 contiguous United States. It is most prevalent during the months of July to September. The incubation period is two to fourteen days; the condition may be mild or asymptomatic in up to 60 percent of patients. Typical symptoms include the sudden onset of a headache, fever, malaise, chills, vomiting, and eye pain lasting a few days. As these symptoms abate, a painless, diffuse, maculopapular rash may appear on the chest, back, and arms. Extrapyramidal symptoms, similar to Parkinsonism, are fairly common. A minority of patients develop an asymmetric flaccid paralysis, usually evident within 48 hours of the onset of symptoms. In rare instances, diaphragmatic and intercostal paralysis may produce respiratory failure. Diagnosis is made by the presence of IgM antibody in the serum or cerebrospinal fluid of affected individuals. Treatment is expectant.
It is estimated that only 37% of affected individuals are symptom-free at one year following the acute illness. For those who develop acute flaccid paralysis, one-third will recover almost normal strength, one-third will have some improvement, and one-third will have no improvement. Virtually all motor recovery appears to occur within the first six to eight months.
cat scratch disease
- bartonella henselae
- cat bite or scratch
- fever, headache, fatigue, poor appetite, lymphadenopathy
- cultures may be negative, IgM antibody titers and PCR diagnostic
- may resolve spontaneously, can treat with azithromycin
aeromonas hydrophilia
common in leaches. Treat prophylactically with ciprofloxacin or bactrim
erysipeloid (fish handlers disease)
- caused by erysipelothrix rhusiopathiae
- gram + rod
- occur from open wound contact with fish
- bright red, itchy, painful rash with clear blisters
- lymphadenopathy
- can get endocarditis
- treat with penicillin
