Infectious Disease Flashcards
Capsofungin
Class of Echinocandins
Inhibit glucan synethase
Infection suspect in patients with cardiac surgery with fever, pain, redness, fatigue, heat/pus at surgical site, night sweats, weight loss, abdo pain, nausea or vomiting
- Non-tuberculous mycobacterium identified amycobacterium chimaera
IRIS - organisms
Organisms: CMV, herpes zoster, mycobacterium alium complex, pneumocystis pneumonia, mycobacterium tuberculosis
Immune reconstitution inflammatory syndrome - scenarios
1) unmasking of an occult opportunistic infection
2) Paradoxical symptomatic relapse of a prior infection despite microbiologic treatment success
COVID treatment - Dexamethasone
Reduced mortality with covid-19 requiring oxygen
COVID - Prone positioning
Potential treatment strategy for refractory hypoxaemia
COVID - Remdesivir
Reduce time to clinical recovery
Covid - Baricitinib
Janus kinase inhibitor - reduce recovery time and accelerate improvement in clinical status esp when combined with remdesivir
COVID - Tocilizumab
Reduce likelihood of progression to need for mechanical ventilation, not improved survival
Did not result in significantly better clinical status or lower mortality for severe covid-19
Antibiotics do not cross BBB (so not for brain abscess)
- Aminoglycosides
- Erythromycin
- Tetracyclines
- Clindamycin
- First gen cephalosporin
Brain abscess or subdural empyema
IV metronidazole and ceftriaxone
Ceftazidime - when complicate a neurosurgical procedure or abscess culture grew P.aeruginosa
Vancomycin - abscess follow penetrating head trauma or craniotomy
Carbapenums (imipenum, meropenum, Ertapenum)
- Against aerobic and anaerobic gram -ve bacilli including p.aeruginosa
- Excellent against anaerobic and gram +Ve
Ertapenum HAS no activity against P.aeruginosa - Carbapenum generally inactive against MRSA, VRE, Enterococcus faecium, mycoplasma, chlamydia and stenotrophonomas maltophilia
Fidaxomicin
First line treatment for c.diff as an alternate to vancomycin
(Metronidazole is not longer first line)
Multi-drug resistant TB
- Isoniazid
- Rifampicin
- Rifabutin
- Thioacetazone
- Amoxicillin - clavulanate
- Macrolide antibiotics
Xpert MTB/RIF (GeneXpert)
Automated molecular test for mycobacterium tuberculosis and resistance to rifampin
- sens 98.2% for smear positive TB
- 72.5% for smear negative TB
S.pneumoniae
For meningitis
- IV vancomycin + ceftriaxone or cefotaxime
- If allergic -> IV moxifloxacin + vancomycin
Gram negative resistance with linezolid
Efflux pump
Addition of metronidazole in aspiration pneumonia indication
- Putrid sputum
- Severe periodontal disease
- History of chronic hazardous alcohol consumption
- Development of lung abscess, empyema or necrotising pneumonia
- Do not respond to initial therapy
Addition of metronidazole in aspiration pneumonia indication
- Putrid sputum
- Severe periodontal disease
- History of chronic hazardous alcohol consumption
- Development of lung abscess, empyema or necrotising pneumonia
- Do not respond to initial therapy
Daptomycin
inhibit by surfactant so not useful for pneumonia
Beta-lactamases class
Class A: plasmid-mediated resistance
Class B: metalloenzymes (MBL) -> can hydrolyze penicillins, cephalosporins, carbapenems
Class C: intrinsically resistant to betalactamase inhibitor
Class D: Oxacillin hydrolysing enzyme
Middle East respiratory syndrome (MERS)
- Cough, fever, SOB
- Mortality rate 30%
- Recommend BAL, sputum, tracheal aspirates
Management mainly supportive
Bordetella pertussis
Gram negative coccobacilli
Specific test for pertussis
Culture from nasopharyngeal secretions - gold standard
Dex in meningitis
- diminish rate of hearing loss and other neuro complications
- Only continue if CSF reveals S.pneumonia
Right sided IE
- Indication for surgery
- Large vegetation ≥ 20mm
- Recurrent septic pulmonary emboli
- Presence of a highly resistant organism
- Persistant bacteriaemia
Most consistently observed RF for hospital acquired VRE
- Previous treatment of antimicrobials
Most common cause of aseptic meningitis
- Enterovirus
Necrotising fasciitis secondary to a GAS
- Clindamycin + penicillin G
IE organisms
- Dental disease - strep viridans
- Prolonged Indwelling vascular catheter + IVDU - S.aureus
- Procedures involving gut and perineum - enterococcus faecalis
- Bowel - S. bovis
- Soft tissue infection - Staphlococci
Culture negative endocarditis
- Coxiella
- Burnetti
- Bortenella
- Chlamydia
- Legionella
Prophylaxis against endocarditis indication
- A prosthetic heart valve
- History of IE
- Many congenital (from birth) heart abnormalities e.g. single ventricle states, TGA, and TOF, even if the abnormality has been repaired.
- PFO, the most common congenital heart defect, does not require prophylaxis
Most common fungal infection in immunosuppresive
Candida
Highest mortality rate in immunocompromised
Invasive aspergillosis
Fever in traveller fever
- Malaria
- Dengue fever
- Enteric fever
Most common in returned traveller
- Malaria
Most virulent form of malaria
- Plasmodium falciparum
36M with swallowing difficulty. Been traveled to Argentina, Brazil, Bolivia. Has had swollen R eye which now resolved. Barium swallow showed a bird’s beak appearance of the oesophagus
A. African trypanosomiasis
B. Visceral leishmaniasis
C. Giardiasis
D. Cryptosporidiosis
E. American Trypanosomiasis
E
General S/B of NRTI
Peripheral neuropathy
Tenofovir side effects
Renal impairment and osteoporosis
Integrase inhibitors (-gravir)
Raltegravir, dolutegravir
Block integrase (enzyme inserts the viral genome into the DNA of the host cell)
