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Infectious Disease Flashcards

1
Q

Common SBI pathogens in Neonates (8)

A

GBS
Listeria monocytogenes
Salmonella
E. coli
Neisseria meningitides
S. pneumoniae
Haemaophilus influenzae type B
S. aureus

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2
Q

Empiric antibiotic coverage in neonates with a fever

A

Ampicillin + Gentamicin
or
Ampicillin + Cefotaxime
and
Acyclovir for HSV coverage

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3
Q

Fever in Neonate Pearls

A

Normal WBC does not exclude infection
If CSF pleocytosis, send CSF for HSV PCR
If RSV positive, risk for SBI does not change and full eval for SBI is indicated
An identifiable source is not found in most neonates with fever

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4
Q

Fever without a Source

A

Presence of fever when history and physical examination are unable to identify a specific etiology/cause in an acutely ill nontoxic-appearing infant/child <3 years of age

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5
Q

Common bacterial infection in older infants and children

A

S. aureus
Mycoplasma pneumoniae
N. meningitides
Salmonella

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6
Q

Empiric antibiotic coverage in young infants

A

Ampicillin, ceftriaxone, or cefotaxime and vancomycin

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7
Q

Empiric antibiotic coverage in older toxic-appearing infants and children

A

Ceftriaxone or cefotaxime and vancomycin

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8
Q

FWS Pearls

A
  • Approach to FWS is greatly impacted by infant/child’s immunization status
  • Fever >38.5 is not typically associated with teething
  • In older toddlers and children, incidence of occult bacteremia increases with height of temperature
  • Normal CBC and physical exam do not exclude meningitis
  • UTI is the most common cause of SBI in febrile infants
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9
Q

Fever of Unknown Origin

A

Fever >101F or 38.3C lasting for at least 8 days and up to 3 weeks with no apparent clinical diagnosis

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10
Q

Organism & Disease/System
Gram-positive cocci (aerobic)
- Staph. aureus
- Staph. epidermis
- Other staph species

A

Nosocomial: wound, ventilator
Neonatal
UTI
HAI

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11
Q

Organism & Disease/System
Gram-positive enterococcus (aerobic)
- Strep. gordoni
- Strep. pneumoniae
- Strep. mutans
- Strep. viridans

A

Endocarditis
Sepsis
Meningitis
UTI

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12
Q

Organism & Disease/System
Gram-positive cocci (anaerobic)
- Peptostreptococcus

A

Peritonitis; can occur anywhere (e.g., soft tissue, CNS, chest, bone)

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13
Q

Organism & Disease/System
Gram-negative cocci
- N. meningiditis
- M. cattarhalis

A

Meningitis
Myocarditis
Otitis media
Sinusitis

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14
Q

Organism & Disease/System
Gram-positive bacilli
- L. monocytogenes
- C. difficile
- C. botulinum

A

Sepsis & Meningitis (L. monocytogenes); primarily <2mo of age
Antibiotic or hospital-acquired diarrhea (C. difficile)
Flaccid paralysis (C. botulinum)

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15
Q

Organism & Disease/System
Gram-negative bacilli
- E. coli
- Enterobacter
- P. mirabilis
- K. pneumoniae

A

Wound infection
UTI
Meningitis
Bacteremia
Health care-associated infections

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16
Q

Fever and Neutropenia

A

Single temperature >38.3C or 38C for > 1 hour with an ANC <500 or an ANC that is expected to decrease <500 within in next 48hrs

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17
Q

Health Care Associated Infections

A
  • HAI is an infection that is not present upon hospital admission but develops within 48 hours of admission in an acute care setting
  • Infections not present at discharge but apparent within 10 days after discharge are also considered to be of nosocomial origin
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18
Q

Central Line-Associated Bloodstream Infections

A

A primary bloodstream infection in a patient who had a central line infection within 48-hour period before the development of BSI and the BSI is not related to another infected site

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19
Q

Catheter-Associated UTI

A

A UTI in which an indwelling urinary catheter was in place for >2 calendar days when all elements of the CDC UTI infection criteria are present; the indwelling catheter must be in place on the day of, or the day prior to dx

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20
Q

Nosocomial RSV

A

Symptoms of lower respiratory tract infection and RSV antigen >72 hours after hospital admission

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21
Q

Surgical Site Infection

A

Infection occuring within 30 or 90 days after an operative procedure involving the skin, subcutaneous tissue, or deep soft tissues of the incision

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22
Q

Three major groups of fungus

A
  • Yeasts: round/oval, unicellular, reproduce via budding; Ex. Candida
  • Molds: long, floppy, fluffy colonies that have long tubular structures called hyphae, reproduce via forming spore-forming structures called conidia; Ex. Aspergillus and Mucor
  • Dimorphs: change from yeast to mold and back, grow in environment as molds
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23
Q

Clinical Presentation of Invasive Fungal Infections

A

In oncology patients, fever >4 days in neutropenic patient is suggestive of fungal infection
Purulent sinusitis/sinus pain is suggestive of Mucor infection
Persistent tachypnea and lower oxygen saturations suggest Pneumocystis jirovecci pneumonia (PJP)

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24
Q

Broad-spectrum coverage for invasive fungal infections

A
  • Micafungin
  • Amphotericin B
  • Azoles (often have multiple drug interactions)
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25
Treatment of confirmed PJP infection
- IV trimethoprim-sulfamethoxazole (Bactrim) or - IV pentamidine for patient who cannot tolerate Bactrim
26
Meningococcemia
Bacteremia and sepsis caused by the bacteria N. meningitidis, also referred to as meningococcus
27
Multi-resistant Organisms
- Methicillin-resistant Staph. aureus (MRSA) - Drug-resistant Strep. pneumoniae (DRSP) - Vancomycin-resistant enterococcus (VRE) - H. influenzae nontypable - Extended-spectrum B-lactamase (ESBL) producing E. coli and K. pneumoniae
28
MRSA management
Vancomycin, clindamycin, Bactrim, linezolid
29
DRSP management
Vancomycin, clindamycin, high-dose B-lactam, fluoroquinolones
30
VRE management
Linezolid or daptomycin
31
H. influenzae nontypable
Augmentin, extended-spectrum cephalosporins
32
ESBL management
Broad-spectrum antibiotics, carbapenems
33
Clinical Presentation of Meningococcemia
- Initially: fever, malaise, vomiting, diarrhea, headache, myalgias - Later: limb pain, difficulty walking, maculopapular rash, signs of meningitis, including photophobia, nuchal rigidity, lethargy, and seizures - Fulminant: purpura, limb ischemia, shock, coma, death in as little as few hours
34
Antibiotics used for Meningococcemia
- IV ceftriaxone at meningitic doses (100mg/kg/day) for 5-7 days - Cefotaxime is also acceptable - May need to switch to penicillin G - Penicillin-allergic patients; use chloramphenicol or meropenem
35
Prophylactic antibiotics w/in 24 hrs of close contacts of meningococcemia
- Ciprofloxacin 500mg by mouth x1 dose - Ceftriaxone and rifampin are other options
36
Antiviral therapy for Herpes Simplex Virus (HSV)
- acyclovir - famciclovir - valacyclovir
37
Antibiotic therapy for Gonorrhoeae
IM ceftriaxone + azithromycin or doxycycline
38
Gonorrhoeae Pearls
- major cause of cervicitis, pelvic inflammatory disease (PID), ectopic pregnancy, and infertility
39
Chlamydia Pearls
- Treatment: azithromycin or doxycycline - Leading cause of PID
40
Syphilis antibiotic treatment
Benzathine penicillin G
41
Systemic inflammatory response syndrome (SIRS) criteria
The presence of >2 of the following four criteria (one must be abnormal temperature or leukocyte count) - hyperthermia or hypothermia - tachycardia or bradycardia - tachypnea - leukocytosis or leukopenia
42
Sepsis Pearls
- Although not specific for bacterial infections, leukocytosis with a left shifted differential classically suggests a bacterial infectious etiology - Leukocytosis with a lymphocyte predominance is indicative of a viral infectious etiology
43
Clinical Presentation of Epstein-Barr Virus
- Fever, pharyngitis, malaise, lymphadenopathy, splenomegaly - Tonsillopharyngitis, cervical or peritonsillar abscess, meningitis, encephalitis, and may be associated with malignancy
44
HSV Pearls
- In HSV encephalitis, CSF analysis shows a lymphocytic pleocytosis, elevated protein level, and increased number of erythrocytes with an RBC count >1,000 - MRI demonstrates temporal lobe enhancement - EEG may show paroxysmal lateral epileptiform discharges (PLEDs)
45
Clinical Presentation of Parvovirus B19
- Erythema infectiosum (fifth disease): intensely erythematous exanthem on cheeks with circumoral pallor ("slap cheek rash"), diffuse maculopapular rash that fades to a lacy erythematous rash, fever, headache, myalgias, malaise
46
Diagnostic Evaluation
- PCR, DNA hybridization, serologic antibody testing - CBC with diff, **reticulocyte count (will be decreased)
47
Lemierre Syndrome Pathophysiology
- Commonly caused by gram-negative anaerobic bacteria Fusobacterium necrophorum - Hematogenous spread of bacteria after passing through the oral mucosa either by direct tissue contact or via the tonsillar vessels - Results in septic thromboemboli in internal jugular vein - Microemboli circulate throughout the body developing abscesses and infarctations - Lungs are the primary site for septic emboli to lodge, followed by large joints such as hips, knees, and elbows
48
Lemierre Syndrome Treatment
- B-lactams, clindamycin, third-gen cephalosporins, vancomycin, metronidazole, and linezolid - Secure airway via intubation depending on degree of edema and risk of airway occlusion - Anticoagulation: controversial, initial treatment with heparin then to warfarin or enoxaparin for outpatient therapy - Surgical intervention: I&D or thrombectomy
49
Pathogen causing Toxic Shock Syndrome
Staph. aureus and Strep. pyogenes (GAS)
50
Clinical criteria for TSS
- Fever > 102 - Rash: diffuse macular erythroderma - Desquamation: 1-2 weeks following onset of rash - Hypotension: systolic BP <90mmHg for adults or less than 5th%ile for patients <16 years - Multisystem involvement (3 or more organ systems)
51
Significance of Blood cultures in TSS
- Blood cultures are positive for Staph. aureus in 10% of cases - Blood cultures are positive for GAS in >70% of cases
52
TSS Management
- Third gen cephalosporin and vancomycin for empiric therapy - Clindamycin should be added if suspicion for TSS is high - Consider IVIG
53
Management of Lyme Disease
- Doxycycline, amoxicillin, or cefuroxime
54
Lyme Disease Pearl
Diagnosis is best made clinically in early stages of Lyme disease based on the presence of erythema migrans
55
Clinical Presentation of Rocky Mountain spotted fever
- Fever, headache, myalgias, abdominal pain, emesis, conjunctival injection, macular erythematous rash on wrists, ankles, palms, and soles which may spread to trunk
56
Tick-borne illness caused by bacterium Rickettsia rickettsii
Rocky Mountain Spotted Fever
57
Tick-borne illness caused by Borrelia burgdorferi
Lyme disease
58
Tick-borne illness caused by Francisella tularensis
Tularemia
59
Treatment for Tularemia
Streptomycin, gentamicin, or doxycycline
60
Treatment for Rocky Mountain Spotted Fever
Doxycycline
61
Clinical Presentation of Malaria
- **Paroxysmal fever - Chills, headache, malaise, cough
62
Diagnostic Evaluation of Dengue
- Leukopenia with thrombocytopenia and elevated hematocrit should raise suspicion - Avoid agents likely to contribute to coagulopathy such as aspirin and NSAIDs
63
Spastic muscle disorder caused by neurotoxin produced by Clostridium tetani found in contaminated wounds
Tetanus
64
Management of Tetanus
- Human tetanus immune globulin (TIG) 3,000-6,000 units IM - Antimicrobials: metronidazole or IV penicillin G - Vaccination
65
Criteria to meet UTI in urine specimen
- negative result: <10,000 bacteria/ml of urine - positive result: >100,000 bacteria/ml of urine; or >50,000 bacteria/ml urine in catheter specimen
66
Neutrophils in CSF indicate what?
bacterial meningitis/cerebral abscess
67
Mononuclear lymphocytes in CSF indicate what?
viral meningitis or encephalitis
68
Contraindications to obtained CSF
- increased ICP (can induce herniation) - patients who are receiving anticoagulation; risk of epidural hematoma - patients with infection near the lumbar puncture site
69
Inflammatory marker that shows earlier and has a more intense rise (detectable 6-10hrs after inflammatory response)
C-reactive protein
70
Normal range for CRP
<1.0mg/dL or <10mg/L
71
Normal range for ESR
Male: up to 15mm/hr Female: up to 20mm/hr Child: up to 10mm/hr Newborn: up to 0-2mm/hr
72
CSF evaluation: high WBC >1,000 low glucose high protein
bacterial meningitis

Pediatric ACNP (4 decks)

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