INFECTIOUS DISEASE Flashcards
What would you expect to see in Chagas Dx.
-cardiomyopathy
-conduction abnormalities
-esophageal dysfunction
*Undergo testing for Chagas dx with serologic testing for T. cruzi
Does CTX cover pseudomonas reliably? T/F
FALSE.
Describe the findings for:
-acute pharyngitis
-retropharyngeal abscess
-peritonsillar abscess
-epiglottis
ACUTE PHARYNGITIS
-sore throat
RETROPHARYNGEAL ABSCESS
-sore throat, fever, drooling, stridor
-NECK STIFFNESS w/hyperextended
PERITONSILLAR ABSCESS
-2/2 grp A strep or anaerobes
-p/w high fever, severe throat pain, hot potatoe voice
-DEVIATION of uvula laterally away from abscess
EPIGLOTTIS
-drooling, hot potatoe voice,
-NO neck stiffnes. NO deviation of uvula
Treatment of cellulitis?
1) Purulent vs non-purulent
2) Severity
PURULENT: usu staph
-mild (no systemic sx): TMP/SMX
-mod: doxycyline or TMP/SMX
-severe: IV MRSA (vanc, linezolid, daptomycin, ceftaroline)
NON-PURULENT: usu strep
-mild: PCN , 1st gen cephalsporin (cephalexin), clindamycin
-mod: CTX, IV PCN, (cefazolin, clindamycin)
-severe: r/o nec fascitis –>vanc + picperacillin/tazobactam
What is 1st line treatment for CDI
INITIAL treatment for CDI
-ORAL fidaxomicin (oral vanc 2nd line)
- both fidaxomicin and vanc have similar cure rates, but relapse LOWER for fidaxomicin!
What diarrheal pathogen is lactoferrin detectable
SHIGELLA
-invasive bacteriall diarrheas and IBD have lactoferrin
Desc lab abnormalities for Legionalla? Sx? Tx?
LEGIONELLA (aerobic GNBs)
-hyponatremia
-hypophosphatemia
-CNS sx (HA, delirium, confusion)
-Tx: macrolide, fluorquinolone. Add rifampin for severe dx
What 2 enteric diarrheal illnesses do NOT receive abx
1) EHEC (E coli O157:H7). This is because abx tx increasing risk of developing HUS–>killing large numbers of orgs releases large amounts of Shiga-like toxins
2)Salmonella (diarrhea but NO fever)
-does NOT shorten illness, prolongs carrier state, promotes AMR. Abx given for >50yrs w/severe dx or who are hospitalized. Tx with fluroquinolone.
What enteric diarrheal illness is SIDEROPHILLIC
SIDEROPHILLIC
-conditions with iron overload increase its pathogenicity
DX: YErsinia (inc w/ SCD –becs of frequent blood transfusions), hemochromatosis, deferoxamine
*Yersinia causes mesenteric adenitis–so prsentation similar to appendicitis
What 5 tick-borne dx should you think about:
1) lyme
-erythema migrans lesions
-tx: doxy–IV CTX. Pregnant (amoxcillin/AZM)
2) STARI (Southern tick–associated rash)
p/w erythema migrans lesions identical to those seen in Lyme disease but without clinical progression or complications.
-tx: doxy
3) rocky spotted fever
-fever, rash wrists/ankle
-tx: doxy
4) babesiosis
-hemolytic anemia, maltese cross
-tx: atovaquone + aZM. In severe disease, select clindamycin plus quinine.
5) ehrlichiosis & anaplasmosis
-labs: low WBC, PLTs, and increased AST/ALT
-inclusion bodies/ morales
-tx: doxy
What 3 conditions do you see strawberry tongue?
1) staph
2) kawasacki
3) sarclet fever
Desc bacteria that are 5/6 gram-negative rods
1) clostridia: SSTI
2) erysipelothrix: cutaneous inoculation
3) b anthrax: widened mediastinum
4) corynebacterium: cause of line sepsis
5) nocardia/actinomyces: rods in branching chains
Does septicemia/shock or super-infection w/chicken pox occur with staph or step
STREP infx
What are all the conditions that strep infx causes?
1) pharyngitis (fever, no cough, exudative, anterior cervical lymph nodes, sore throat)
2) Scarlet fever (strawberry tongue)
3) Skin: eripseleyas, impetigo, cellulitis, nec fascitis
4) acute rheumatic fever (AFTER pharyngitis)
5) infection-related glomerulonephritis
6) toxic shock syndrome (chicken pox, sepsis)
7)
What is treatment of SEVERE malaria?
SEVERE Malaria
-IV artesunate
What is ppx tx for malaria when pregnant?
Mefloquine
For meningitis when do you give:
-ampicillin
-dexamethasone
-Ampicillin: >50 yrs
-Dexamethasone: 1st dose of empiric antibiotic therapy for bacterial meningitis but should be discontinued promptly if the cause is not Streptococcus pneumoniae.
Desc dx of bacterial meningitis testing
CT of the head is indicated before proceeding with LP if signs
What is most common EYE feature for Marfarns? AD true or false?
MYOPIA
TRUE
What should you think of for:
- subacute cough characterized by paroxysms of severe coughing and posttussive emesis.
Bordetella pertussis infection should be considered in patients with subacute cough characterized by paroxysms of severe coughing and posttussive emesis.
What should you think of for:
- subacute cough characterized by paroxysms of severe coughing and posttussive emesis.
Bordetella pertussis infection should be considered in patients with subacute cough characterized by paroxysms of severe coughing and posttussive emesis.
Describe complement system
Complement deficiencies can be divided into deficiencies in early or activating components (C2, C3, C4) and late or terminal components (C5-C9).
Early component deficiency, especially C4, is associated with increased rates of systemic lupus erythematosus and increased risk of infection with encapsulated organisms. Patients with early complement deficiency present similarly to patients with CVID, with recurrent sinopulmonary infections.
Terminal complement protein defects lead to an inability to form the membrane attack complex and typically present with recurrent infections of Neisseria species, particularly meningococcal meningitis. N. meningitidis infection in this population tends to be less severe than in immunocompetent persons, perhaps owing to uncommon serogroups. A personal or family history of recurrent Neisseria infections is an indication to test the total hemolytic complement (CH50) level because any defect in the classical complement pathway will result in a low total level.
Discuss necrotizing fasciitis treatment
V. vulnificus–associated
-ceftazidime + doxycycline
Aeromonas hydrophila–associated
-Ciprofloxacin + doxycycline
STREP OR Clostridium perfringens–associated
-PCN + clindamycin
Polymicrobial
-vancomycin + piperacillin-tazobactam/ imipenem/meropenem
How do you treat SSTI–moderate severity
Empiric treatment of erysipelas OR moderate severity nonpurulent cellulitis (fever, tachycardia, leukocytosis) includes intravenous penicillin, ceftriaxone, cefazolin, or clindamycin. STREP
Empiric antibiotic treatment of moderate severity purulent cellulitis (with systemic signs of infection) includes oral doxycycline or trimethoprim-sulfamethoxazole. STAPH
