Infectious Flashcards
Name the bacteria which cause acute Bacterial RHINOSINUSITIS
Streptococcus pneumoniae (~30%),
non-typeable Haemophilus influenzae (~30%),
Moraxella catarrhalis (~10%)
What are the dx features of Acute bacterial RHINOSINUSITIS?
Sever Symptoms with High Grade Fever, facial pain and purulent nasal discharge
OR
Persistent Sx >10 days w/o improvement
OR
Worsening Sx >5 days after initially improving Viral URTI
What are the finding of Sinusitis?
Findings of sinusitis:
sinus opacification,
mucosal thickening
and/or air fluid levels
Important point of acute bacterial RHINOSINUSITIS
Pseudomonas aeruginosa is common in nosocomial sinusitis, especially in immunocompromised patients with nasal tubes or catheters.
S.aureus may be a cause of chronic sinusitis (> 12wks) but not a cause of acute
What is Centor Criteria?
tonsillar exudates,
tender anterior cervical adenopathy
fever
and absence of cough
If Centor Criteria is 2-3 then what to do?
Do rapid strep antigen test for strep pharyngitis
If positive then give Oral penicillin Or amoxicillin
If Centor Criteria is 4 then what to do?
Do rapid strep antigen test for strep pharyngitis
If positive then give Oral penicillin Or amoxicillin
Or
Give Empiric oral penicillin Or amoxicillin
How Viral pharyngitis presents?
SxS of pharyngitis plus cough, conjunctivitis, rhinorrhea and oral ulcers
How bacterial pharyngitis presents?
Bacterial pharyngitis plus presence of exudates, edema, palatal petechiae:
And absence of viral SxS
What are the underlying factors in adult which increase the risk of complications due to influenza?
Age more than 65 with morbid obesity
Immunosuppression with native Americans
Nursing home or chronic care facility residents
Pregnant or up to 2wks of postpartum
Any co morbid
Name the bacteria which cause pneumonia in children and adult due to cystic fibrosis
S. Aureus in children
P.aeruginosa in adult
Triad of Retropharyngeal abscess
Pre existing URTI seen in children age 6 months to 6 years
With dysphagia, inability to extend neck, muffled voice and trismus
X Ray shows wide prevertebral space and prevertebral soft-tissue space should be narrower than the vertebral bodies.
Why incidence of Retropharyheal abscess decreases after 6 years of age?
Incidence ↓ after age 6 years due to a combination of retropharyngeal lymph node regression and fewer viral upper respiratory infections.
Triad of Toxic shock syndrome
Hx of use of tampons and Nasal packing
High grade fever
SxS of shock
What are the cause of B/L acute cervical adenitis in children?
Adenovirus
(LAD + pharyngoconjunctivits)
EBV/CMV
(LAD + mononucleosis)
Name the bacteria In children which cause U/L cervical LAD with hx of papular nodular at the site of of cat scratch Or bite
Bartonella henselae
Name the bacteria In children which cause U/L cervical LAD and Sx of periodontal diseases and dental caries
Anaerobic bacteria (Prevotella buccae)
Name the bacteria In children which cause U/L cervical LAD with pronounced erythema and tenderness
Staph aureus
Strept pyogenes
Triad of Tularemia
Francisella tularensis
zoonosis (rabbits, hamsters, or blood-sucking arthropods)
acute, u/l cervical LAD, fever, chills, headache, and malaise
Name the ABx used in different stage of Lyme diseases
Early localised stage:::
Oral doxycyline is the DOC for this condition in non-pregnant and pts >8 yr old.
Oral amoxicillin OR cefuroxime is given to pts <8 yrs, pregnant and lactating women
EARLY DISSEMINATED AND LATE DISEASE::
IV ceftriaxone is also very effective in early disease but it is reserved for early disseminated and late disease
used for cardiac and neurologic manifestations of Lyme disease
Important point of Lyme diseases
Serology is not recommended for early disease as it is very insensitive and usually negative
Serology however should be performed in pts with signs of early disseminated or late disease.
Name the drug prophylactically given in Lyme diseases
doxycycline
What are the prophylactic criteria for Lyme disease?
Tics attached for >36 hours or engorged
Prophylaxis started within 72 hours after after tics removal
Attach tics is adult or deer tick
Local Lyme diseases infection rate>20%
No contraindications of doxcyline
What is treatment and post exposure prophylactic treatment of BORDETELLA PERTUSSIS in age less than 1 month?
Azithromycin for 5 days
What is treatment and post exposure prophylactic treatment of BORDETELLA PERTUSSIS in age more than 1 month?
Azithromycin for 5 days
Or
Clarithromycin for 7 days
Or
Erythromycin for 14 days
How to dx Pertusis?
culture and/PCR from nasopharyngeal secretions with <1 month of Sx.
Sx >1 month require serology to confirm diagnosis
Triad of EHRLICHIOSIS
Prodromal with neurological symptoms
No rash with decrease in WBC and lymphocytes
Dx test shows intracytoplasmic morulae in monocytes
What is the treatment of EHRLICHIOSIS?
Empiric doxycycline while awaiting confirmatory testing
What is the gold standard test of Infective Endocarditis?
TEE
What is the common cause of death in Infective endocarditis?
Valvular insufficiency
Important point of Infective endocarditis
Staph infection is the MCC of health care associated Infective endocarditis
Strept infection is the MCC of community acquired infective endocarditis
What are the t/m options of latent TB?
Rifampin for 4 months
Isoniazid and rifampin for 4 months
Isoniazid monotherapy for 6-9 months
Isoniazid and rifapentine weekly for 3 months under DOT
What are the patient whom to treat if PPD is >5mm?
HIV +ve patient
Recent contact of known TB
Nodular or fibrotic changes on CXR consistent with previously healed TB
Organ transplant patient with immunosuppression
What are the patient whom to treat if PPD is >10mm?
Recent immigrants from Tb endemic area
Injection drug users
Working in high risk setting
TB lab worker
Higher risk for Tb reactivation
Child age less than 4 yrs of age OR those exposed to adults in high risk categories
How to give medications of active pulmonary Tb?
RIPE for 2 months
Then R and I for 4 months
So total 6 months
Name the empiric Abx for Infective Endocarditis
Vancomycin in most cases
Empiric therapy in a native valve should cover methicillin susceptible and methicillin resistant staph, strep and enterococci
Name the STDs organisms whose initial lesion is painful
Haemophilus ducreyi
HSV 1/2
How organisms arrange in Haemophilus ducreyi?
Clump in long parallel strands (school of fish)
Name the STDs which presents with ulcer without LAD
Klebsiella granulomatosis
What is the MCC of mucopurulent cervicitis?
Most common cause of mucopurulent cervicitis is Chlamydia trachomatis, followed by N. gonorrhoea
Name the test which d/f Chlamydia trachomatis and N. gonorrhea
NAAT more sensitive than gram staining
Important point
Non fungal organisms causing vaginal discharge will have normal pH Viz gardnerella and Trichomoniasis
Triad of PHYSIOLOGIC LEUKORRHEA
Copious white or yellow discharge, non-malodorous
No abnormality on physical exam
Microscopic exam may show squamous cells and polymorphous leukocytes
What are the t/m regimes for syphilis in d/f stages?
Primary:::
IM penicillin G—->if allergic then give doxycycline 14 days
2nd:::
IM penicillin G—->if allergic then give doxycycline 14 days
Latent::
IM 2 doses penicillin G—->if allergic then give doxycycline 28 days
Tertiary:::
IM 14 days penicillin G—->if allergic then give ceftriaxone 14 days
Name the test specific for syphilis
Non-treponemal (RPR/VDRL)::
-ve result in early infection
Quantitative
Decrease in titers confirm treatment
treponemal(FTA ABS / TP/EIA)::
Greater sensitivity in early infection
Qualitative
Positive even after treatment
Important point of syphilis
Treatment empirically it even negative screening serology but strong clinical evidence of primary syphilis
What to check if there is recurrent DISSEMINATED GONOCOCCAL INFECTION?
Terminal complement activity
How to t/m DISSEMINATED GONOCOCCAL INFECTION?
IV ceftriaxone 1g/day for 14 days—>then switch to PO cefixime when clinically improved
Also give medicine against chlamdiya
T/m sexual partners too
Triad of PID
Fever with Purulent cervical discharge
Adnexal tenderness and Cervical motion tenderness
Lower abdominal tenderness
What are the complications of PID?
Remember:: TAPS
Tubo-ovarian abscess
Abscess rupture
Pelvic peritonitis
Sepsis
What are the t/m options for PID?
Hospitalised Patient:::
cefoxitin or cefotetan/doxycycline and clindamycin/gentamicin (all IV) Hospitalization
non-hospitalized patients:::
IM cefoxitin + oral probenecid and oral doxycycline,
or IM ceftriaxone and oral doxycycline.
What are the causes/ Risk factors for VULVOVAGINITIS IN PREPUBERTAL CHILDREN?
infections, congenital abnormalities, trauma,
dermatological conditions
lack of labial development,
unestrogenized thin mucosa
poor hygiene / bubble baths
shampoos, obesity and certain choices of clothing.
What are the causes of Neonatal conjunctivitis on the basis of age of onset?
Chemical induced occur less than 24 hours
Gonococcal induced occur with 2-5 days after birth
Chlamydial induced occur with 5-14 days after birth
Triad of chlamydial induced conjunctivitis
Occur after 5-14 days after birth
Discharge (watery/bloody/mucopurulent) with eye swelling and chemosis
T/m is oral erythromycin
Triad of Gonococcal conjunctivitis
Occur with 2-5 days after birth
Marked eye swelling with profuse purulent discharge
IV OR IM ceftriaxone / Cefotaxime
What is the best Rx to dx the cause of urethritis?
NAAT
What is the t/m of uncomplicated pyelonephritis?
Mild to moderate= Septran-DS/Quinolones
Severe= Ceftriaxone / Septran-DS / Quinolone
What is the t/m of complicated pyelonephritis?
Mild to moderate= ceftriaxone / cefepime /Quinolones
Severe = ampicillin-sulbactam / Tanzo / mero / imipenem /azteronam
Name the organism in which vomiting pre-dominant in foodborne diseases
Staph-aureus
Bacillus Cerus
Noroviruses
Name the organism in which diarrhoea pre-dominant in foodborne diseases
C-perfringens
E. coli
Enteric virus
Cryptosporidium
Cyclospora
Intestinal tapeworm
What is the source of c-perfringens?
Associated with undercooked Or unrefrigerated food
Name the bugs causing travellers diarrhoea with long term illness (>2 wks)
Giardia
Cyclospora
Cryptosporidium
Cystoisospora
Name the bugs causing travellers diarrhoea with short term illness
Rotavirus/ norovirus
E. coli
Campylobacter
Salmonella
Shigella
How to dx C.Difficile colitis?
PCR detection of toxin gene In stool
Or
Enzyme immunoassay
Triad of mil-moderate C-difficile colitis
WBC <15k
Cr less than 1.5 time baseline
T/m metronidazole
Triad of Severe C-difficile
WBC >15k with Cr >1.5 time baselines and serum albumin <2.5g/dL
Give oral vancomycin
If ileus —> then add IV metronidazole and switch to rectal vancomycin
Important point of c-difficile colitis
Fidaxomicin is a bactericidal antibiotic usually reserved for recurrent colitis or as initial therapy for patients with severe colitis who cannot tolerate oral vancomycin
What is neutropenia?
Neutropenia is defined as absolute neutrophil count <1500/uL (severe neutropenia is <500/uL)
Monotherapy with anti-pseudomonal beta lactam antibiotic (e.g. cefepime, meropenem, piperacillintazobactem) provide both Gram+ and -ve coverage and is recommended initially.
How to d/f EBV and Group A strep pharyngitis?
EBV::
Tonsillar exudates
Fever with diffuse cervical LAD
HSM
Group A strep pharyngitis::
Tonsillar exudates
Fever with anterior cervical LAD
No HSM
Triad of aphthous stomatitis
No fever
No systemic symptoms
Recurrent ulcers on anterior oral mucosa
What is the d/f between herpangina and herpetic stomatitis?
HERANGINA::
Due to coxsackie A virus
Fever
Vesicles & ulcer on posterior oropharynx
HERPETIC::
Due to HSV 1
Fever
Vesicles & ulcers on anterior oral mucosa and around mouth
Name the organism which cause meningitis in age group of 2-50 years
N.meninigitis
S.pneumonia
Name the organism which cause meningitis in age group of >50 years
N.meninigitis
S.pneumonia
Listeria
Name the organism which cause meningitis in patient with Neurosurgery/shunt
Gram negative rods
S aureus
Coagulase -ve staphylococcus
Name the organism which cause meningitis in immunocompromised patient
Listeria
N meningitis
Pneumococcus
Gram -ve rods
Name the organism which cause meningitis with trauma to head
S aureus
Gram -ve rods
Coagulase -ve staphylococcus
Triad of meningococcal meningitis
Fever with SxS of meningitis
Petechial/purpuric rash
Multi organ failure viz adrenal haemorrhage
Important of meningitis
In neonates =28 days, give cefotaxime instead of ceftriaxone as it displaces bilirubin from albumin and ↑ risk of kernicterus.
This is not the case in children > 28 days as hyperbilirubinemia is unlikely
What is neonatal sepsis?
Systemic bacterial infection that occurs in infants <28 days old
Important point of neonatal sepsis
Group B staph is most common in term neonates
and
E. coli in preterm neonates
Name the cause of neonatal sepsis which occur due to inDWELLING IV catheter
Coagulase negative staphylococcus
Name the cause of neonatal sepsis which has association with skin / bone / or joint infection
Staphylococcus aureus
Important point of neonatal sepsis
Neutrophilia with a significant left shift (bands of >700/µL or a band to total neutrophil count ratio >0.16) usually indicates neonatal sepsis from bacterial infection.
Name the bacteria causing Septic arthritis from birth to 3 months
And
How to t/m them?
Staphylococcus/ Group B streptococcus and gram -ve bacilli
Abx: antiStaphylococcus agents (nafcillin Or vancomycin)
Plus Gentamycin or Cefotaxime
Name the bacteria causing Septic arthritis in older than 3 months
And
How to t/m them?
Staphylococcus/ Group A streptococcus and strep- pneumonia
Nafcillin / clindamycin
Cefazolin / vancomycin
Important point of septic arthritis
Debridement and irrigation of joint space is the most important intervention in preventing long-term disability.
even a delay of 4-6 hours can lead to femoral head necrosis
Important point of septic arthritis
If the patient remains febrile or fails to improve after arthrocentesis and 48 hours of appropriate antibiotic therapy,
MRI should be performed to evaluate for concomitant osteomyelitis
Difference between Early and late onset prosthetic joint infection
Early:::
Within 3months of Primary arthroplasty
Wound drainage, erythema, swelling often with fever
Implant removal/exchange, may consider debridement and implant retention
Late::
>3 months of primary arthroplasty
Sinus tract formation /implant loosening / persistent joint pain
Implant removal /exchange generally recommended
Name the organism causing EARLY ONSET PROSTHETIC JOINT INFECTION (less than 3 months)
S.aureus
Gram negative rod
Anaerobes
Name the bacteria causing late onset prosthetic joint infection
Coagulase -ve staphylococcus
Propionibacterium Species
Enterococcus
S-epidermis
Triad of CAT SCRATCH DISEASE
Bartonella henselae
Papule at scratch /bite site with LAD and fever
Azomax recommended in disseminated disease Or for immunocompromised hosts
Triad of Nocardia
Sxs Mimics like Tb
fever with FNDs due to brain abscess
Tx are Spetran-ds and meropenem, linezolid as alternate.
Important point of Actinomycosis
Clindamycin is an alternative for pts allergic to pencillin
Triad of Legionella
High Grade fever with bradycardia
Neurological and GIT Sx like diarrhea
Sputum gram stain showing many neutrophils but few or no micro-organisms.
Name the diagnostic test for Legionella
urine antigen test and culture from bronchoscopy
What is VAP?
VAP is a type of nosocomial pneumonia that usually develop >48 hours after intubation.
Name the cause of OSTEOMYELITIS in less than 2months of age.
Group B strept /E coli
Name the cause of OSTEOMYELITIS in 2months-4yrs of age.
kingella kingae
Name the cause of OSTEOMYELITIS in age more than 4 years
staphl aureus
Name the cause of OSTEOMYELITIS in patient with UTI or urinary tract instrumentation
P. aeruginosa and Klebsiella
Name the cause of OSTEOMYELITIS in patient with hx of NAIL PUNCTURE WOUND.
P. aeruginosa
What are the diabetic foot factors which progress to OSTEOMYELITIS?
Long standing wounds with Sxs
Large ulcer size (>2cm) with increase ESR
presence or paplation of bone in the ulcer base.
What is the most reliable sign of vertebral OSTEOMYELITIS?
Exquisite focal tenderness on percussion at the posterior spinous process of the
affected vertebra,
increased muscle spasm in the contiguous area,
and decreased range of motion in the back.
Important point of imaging of vertebral OSTEOMYELITIS
(MRI) is the modality of choice for patients with suspected vertebral osteomyelitis. It can also detect epidural abscess and cord compression.
Radionuclide bone scanning using gallium is an alternate for patients who can’t undergo MRI.
Computed tomography (CT)-guided aspiration and culture of infected intervertebral disc space or bone are needed to confirm the diagnosis.
Triad of Ameboic liver abscess
Hx of dysentry prior to RUQ pain
fever with RUQ pain
Serologic testing for E. histolytica confirms the diagnosis.
How to t/m ambeoic liver abscess?
Metronidazole is the DOC for amebic liver abscess
paromomycin is also used for eradication of intestinal infection
Drainage is done when there is mass effect, imminent rupture, no response to therapy or when diagnosis is uncertain.
Triad of fetal infeection due to TOXOPLASMA GONDII
microcephaly with microphthalmia
chorioretinitis with diffuse petechiae
intracranial calcifications
Name the antimalarial medications given in area with chloroquine susceptible P falciparum
Chloroquine
Hyrdoxychloroquine
Name the antimalarial medications given in area with chloroquine resistance P falciparum.
atovaquone-proguanil
doxycycline
Mefloquine
Name the antimalarial medication safe in pregnancy
.
Mefloquine
what will be seen in peripheral blood smear of BABESIOSIS?
Thin blood smear->Ring inside RBCs (maltese cross)
Name the parasite causing cutaneous larva migrans
Hookworm larvae
Triad of Cutaneous larvae migrans
hx of barefoot walk viz at sea side
intensely pruritic, migrating, serpiginous reddish brown track
Normal count of eosinophils in CBC
Triad of TRICHINELLOSIS
myalgias
periorbital edema
eosinophilia
Name the sensitive and specific test for HISTOPLASMOSIS
Urine Or Serum Antigen
How to t/m Histoplasmosis?
Mild to moderate Pulmonary infection in Immunocompetent:: No t/m OR Itracanzole
Severe / Immunocompromised/disseminated disease:: Amphotericin followed by Itracanzole
Important point of Histoplasmosis
Histoplasmosis should be considered when a pt with suspected sarcoidosis deteriorates following immunosuppressive therapy.
What’s the presentation of Rash of BLASTOMYCOSIS?
Skin lesions have a characteristic presentation of heaped up verrucous or nodular lesions with a violaceous hue that may evolve in to microabscesses.
What’s the t/m of BLASTOMYCOSIS?
Mild pulmonary disease in Immunocompetent host:: not need of t/m
Mild to moderate Pulmonary disease with mild dissemination:: PO Itracanzole
Severe / immunocompromised/severe dissemination:: IV amphotericin
Name the medication for CRYPTOCOCCAL MENINGOENCEPHALITIS
Amphotericin B with flucytosine with fluconazole as maintenance drug
What are the alternate regimen for the PCP beside Septran-DS?
IV pentamidine
Atovaquone
TMP-Dapsone
Clindamycin+primaquine
Important point
Anti-retroviral treatment is started after PCP treatment to reduce drug interaction, pill burden and risk of immune reconstitution syndrome
What are the risk factors for neonatal HSV infection?
Primary maternal infection & Preterm birth
Longer duration of rupture of membranes
Vaginal delivery with active lesions
Impaired skin barrier as fetal scalp electrodes
What are the indications of C-section in HSV infection?
All women who are in labor with active genital HSV lesions or prodromal symptoms
And
With positive Hx–>should receive prophylactic acyclovir or valacyclovir beginning at 36 weeks of pregnancy
What is the PEP management of varicella if patient has positive Hx of VZV?
Observation
What is the PEP management of varicella if patient has negative Hx of VZV?
If immunocompromised–>immunoglobulin within 10days of exposure
If Immunocompetent–>varicella vaccine
How CMV presentation d/f from rubella?
Deafness is u/l in CMV with Blindness due to chorioretinitis and Heart is unaffected.
Name the test to dx b19 virus?
NAAT in immunocompromised
B19 IgM Ab in Immunocompetent
How to test for reactivation of previous b19 virus?
NAAT to detect b19 virus
Triad of CHIKUNGUNYA FEVER
Fever with pain multiple joints
Maculopapular rash with LAD
Decrease in lympho with PLT and increase in LFT
How Croup patient presents?
Inspiratory strider with barking
cough seal like in age 6months to 3 years
Hoarse voice
Steeple sign on CXR
How to t/m croup?
Mild (no stridor at rest) ::: steroids
Moderate/severe (stridor at rest) ::: steroid and Nebs with epinephrine
Endotracheal intubation if above method fails and patient also deranged
How rabies infected patients present?
Paralytic—>ascending flaccid paralysis
Encephalitis SxS with hydrophobia
When to suspect patient is having acute flare of chronic HBV?
HbSAg and HBV DNA positive
AntiHbc IgM and IgG positive
HbeAg likely positive
Define Window period in Hepatitis B?
Window period:
time lag between disappearance of HBs antigen and appearance of anti-HBs
Name the medication for Hepatitis B
Interferon->short term t/m in younger patient with compensated liver disease
Lamivudine:: limit
Cause of Post operative fever
Wound—>surgical site infection
Wind—>PE / pneumonia / aspiration
Water—>UTI
Walk—>DVT
Wonder drugs
Cause of Post op fever within 2hrs
Blood products
Malignant hyperthermia
Prior Trauma OR infection
Cause of Post op fever after 24hr but within 1wk (ACUTE)
If non infections—>PE / DVT / MI
If infection—>Group A strept OR C.perfingens (SSI)
Cause of Post op fever after 1wk but within less than 1month (sub ACUTE)
If non infection—>drug /DVT /PE
If infection—>c.difficle / SSI / catheter site infection
Cause of Post op fever after 1 month
SSI due to indolent infection
Viral infections
How to do screening of HIV infection?
HIV p24 antigen and HIV antibodies—>if positive—>HIV1/2 antibody
Important point of HIV
Plasma HIV RNA testing is recommended for those with –ve serologic testing and high clinical suspicion of acute HIV
Name the ART causing myopathy
Integrase Inhibitors (“Gravir”)
Name the ART causing lipid dystrophy , dyslipidemia and insulin resistance
Protease Inhibitors (NAVIR)
Name the ppx med for PCP
If CD count less than 200—->TMX-SM
Name the ppx med for histoplasmosis
If CD count less than 150—>Itraconazole
Name the ppx med for toxoplasmosis
If CD count less than 100—>TMX-SM
Name the ppx med for MAC
If CD count less than 50—>AZOMAX
Name the organisms causing Diarrhea in HIV
CMV and MAC
Cryptosporidium
Microspordium / isospordium
what organisms causing watery diarrhoea HIV
All three except CMV—>it causes bloody Diarrhea
Classified the HIV induced diarrhea on the basis of CT count
MAC and CMV— less than 50
Cryptosporidium—>Less than 180
Microspordium / isospordium —> less than 100
What to do if patient received more than 3 doses of tetanus toxoid?
No TIG regardless of wound is dirty or clean
Give tetanus toxoid containing vaccine only
What to do if patient received less than 3 doses of tetanus toxoid or immune status in unknown Or unimmunized ?
> TT vaccine in both dirty or clean wound
But TIG only in dirty Or severe wound
Whom to Give PED HIV drugs?
Exposure of Blood or body fluid mixed with blood
Or
Exposure of mucous membrane, non intact skin or percutaneous exposure
Name the PEP drugs in HIV
The prefer meds are Tenofovir-Emtricitabine and Raltegravir
Otherwise Two nucleotides/nucleoside and other HIV meds
What are the risk Factors of HIV in infancy?
Breast feeding by infected mother
High maternal viral load
Name the extra hepatic manifestation of HCV
Increase risk of diabetes
P.cutanea tarda, lichen planus
Membranoproliferative glomerulonephritis
Essential mixed cryoglobulinemia
Name the vaccine given in HIV patients
HBV if not immunised
Flu annually
N.meningitis in all age groups
TDap follow be booster dose afte a decade
HPV in 11-26 yrs only
Strep.Pnuemonia PCV13 followed by PPSV 23
Whom to give HAV vaccine in HIV?
Homesexual
IVDU
CLD due to HBV and HCV
Important point Of HIV and vaccine
All live vaccine are contraindicated if CD count less than 200
Name the factors which increase the risk of VAP
Supine position
Acid suppression
Excessive patient movement and vent setting alteration
Pool sub glottic secretions
Excessive use of paralytics and sedations
How can the risk of VAP decrease?
Bed elevation
Frequent suctioning
Minimal alteration of vent settings
Limited used of gastric acid suppressors
Minimal movement of patient
Name the vaccine given in CLD patients
Flu annually
Strep.Pnemonia vaccine
HAV and HBV
TDaP
Name the vaccine given in Asplenic patient
Strep.pneumonia
H.Influenza
N.meningitis
Flu
HAV HBV
TDaP
What is the recommended age for N.meningitis vaccine?
At age 11-12 yrs
Booster at age 16-21 if primary vaccination at age less than 16 yrs
Name the condition in which vaccine given against N.meningitis even after 18 years of age
Complement deficiency
Asplenia
College students or military
Travel to endemic area
What are the contraindications of Rota virus vaccine?
Hx of Intussusception
Anaphylaxis to vaccine ingredients
SCID
Hx of un correct congenital GIT structures
What are the contraindications of DTaP?
Anaphylaxis hx
In case of pertusis—> Progressive NEUROLOGIC disorder and
Encephalopathy with previous dose
Name the STI which shows MULTIPLE small group ulcer with shallow Erythematous Base
HSV
Name the STI which have MULTIPLE deep ulcers with irregular borders and shows gray yellow exudates
H.Ducreyi
Name the STI which show single indurated ulcer with clean base
Syphils
Name the STI which shows small and shallow ulcers with fluid filled swelling of Lad (buboes)
Chlamydia
Important point of HIV associated dysphagia
Odynophagia without dysphagia seen in virus such as CMV and Herpes
Dysphagia± odynophagia —> Candidia
What to do if patient has positive screening test of TB?
Get CXR and decide Latent Vs active Tb
What does mean by latent TB?
Positive screening test with negative CXR and asymptomatic Patient
Triad of Lung Abscess
Fever with night sweats and Wt loss
Putrid sputum in cough
Cavitary imaging with air fluid levels on imaging
How to treat lung abscess?
Mero / sulbactum / Imipenem
Alternative—-> Clindamycin
No use of culture as condition cause by multiple bacteria
Important point CAT bite and scratch
Cat bite leads to pasturella which t/m via augmentin
Cat scratch leads to bartonella which t/m via azomax
How to approach Rabies PEP if bitten by PETS like dog, Cat or ferret?
Is animal available for Quarantine?
If no—-> stat PEP
If yes—-> 10 days observation and No PEP if animal is healthy
How to approach Rabies PEP if bitten by high risk wild animal like bat, racoons, shunk, fox and coyote?
Is animal available for testing?
If no —-> stat PEP
If yes—-> Euthanize and test; if test positive give PEP
How to How to approach Rabies PEP if bitten by (1) low risk animal like rabit rat mouse chipmunk and Squirrel
or (2) livestock or unknown wild animal?
First case—> NO PEP
2nd case —-> contact public health department
Name the organism causing DELAYED ONSET PROSTHETIC JOINT INFECTION (3-12 months)
Typical sxs like No fever or increase WBC but implant loosening or sinus tract formation
Coagulase negative staphylococci (epidermis)
Enterococci
Propionibacterium species
Name the organism causing LATE ONSET PROSTHETIC JOINT INFECTION ( >12 months)
Patient had Infection at distant site then bacteria infects joints via blood
S.aureus
Gram negative rod
B-Hemolytic strep
What are the risk Factors of Splenic Abscess?
HIT
H hemoglobinopathy like Sickle cell dis
I IV drug abuser ; Immunosuppression; Infection like Infective Endocarditis which spread via blood
T trauma
Triad of Splenic Abscess
Fever
LUQ pain with left sided pleuritic chest pain
Increase WBC count with pleural effusion
How to dx and manage Splenic Abscess?
Dx via CT scan
Tx viz ABx with removal of spleen
Or
percutaneous drainage in poor surgical candidates
What are the causes of Meningitis in less than 1 month baby?
GBS
E. coli and other gram -ve
Listeria
HSV
What are the causes of meningitis in more than 1 month baby?
Strept-pneumonia
N-meningitis
How to manage suspected Or confirmed flu Infection?
1) If w/o risk Factor for it complications—>no testing and symptomatic tx
2) If with risk Factor ( like age ≥65 yrs, Comorbids, pregnancy) or those without riskf factor reach hospital within 48 hrs —> Osetlamivir
How Lemierre Syndrome present?
Cause is fusobacterium Necrophorum
Oropharyngeal sxs sore throat, dysphagia, fever or neck pain and swelling
(due non exudative tonsillitis or pharyngitis)
Follow by involvement of neurovascular structures like internal jugular vein thrombosis—>septic emboli form which particularly involved lungs
How to dx and t/m Lemierre Syndrome?
Culture of Blood or pus
Tx:
IV Abx with airway secured
Surgery incase of refractory to Abx
