Infectious Disease Flashcards by ANC V.

IE: Factors associated with increased risk of embolization

S. aureus IE, mobile vegetations >10 mm in diameter, and infection involving the mitral valve anterior leaflet

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Definite IE requires:

2 major criteria or
1 major 3 minor or
5 minor

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Possible IE definition:

1 major + 1 minor or
3 minor

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Definition of “evidence of endocardial involvement” in Duke criteria

Positive echocardiogram:
- Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation, or
- Abscess, or
- New partial dehiscence of prosthetic valve,

New valvular regurgitation (increase or change in preexisting murmur not sufficient)

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Negative TEE but IE still likely, next dx step:

Repeat TEE in 7-10 daysC

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Imaging comparable to TEE in detection of vegetations and possibly superior in defining paravalvulaar infection

Cardiac CT angiogram (CTA)

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Drug of choice for streptococci endocarditis

Penicillin + Gentamicin regimen (duration depends on sensitivity)

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Preferred duration of treatment for PVE

6 weeks

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Used in streptococci IE for patients with immediate (urticarial) severe penicillin allergy

Vancomycin

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Dose of gentamicin for Streptococcal IE

Gentamicin 3mg/kg daily IV or IM as a single dose or divided into equal doses

Duration:
2 weeks if penicillin susceptible and relatively penicillin-resistant
6 weeks if moderately penicillin-resistant strep

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Preferred cell wall-active agent for use in combination with gentamicin for Enterococci IE

Ampicillin or penicillin

Regimen:
Penicillin G (4–5 mU IV q4h) plus gentamicin (1 mg/ kg IV q8h), both for 4–6 weeks

Ampicillin (2 g IV q4h) plus gentamicind (1 mg/kg IV q8h), both for 4–6 weeks

If penicillin allergic or isolates are resistant to penicillin/ampicillin: may use Vancomycin

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Alternative regimen for E. faecalis (not E. faecium) if strains possess high level gentamicin resistance

Ampicillin-Ceftriaxone

Ampicillin (2 g IV q4h) plus ceftriaxone (2 g IV q12h), both for 6 weeks

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Multidrug regimen for MRSA PVE

VAN + Genta (2 weeks only) + Rif

Vancomycin (15 mg/kg IV q12h for 6–8 weeks)
plus
Gentamicin (1 mg/kg IM or IV q8h for 2 weeks)
plus
Rifampin (300 mg PO q8h for 6–8 weeks)

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Multidrug regimen for MSSA PVE

Naf/oxa/flucloxa + Genta 2 weeks only) + Rif

Nafcillin, oxacillin, or flucloxacillin (2 g IV q4h for 6–8 weeks)
plus
Gentamicin (1 mg/kg IM or IV q8h for 2 weeks)
plus
Rifampin (300 mg PO q8h for 6–8 weeks)

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Regimen for MRSA NVE

Vancomycin (15 mg/kg IV q8–12h) or daptomycin (8–10 mg/kg daily) for 6 weeks

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Drug of choice for febrile patients in whom prolonged neutropenia (>7 days) is anticipated

(1) ceftazidime or cefepime
(2) piperacillin/tazobactam
(3) imipenem/cilastatin or meropenem

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When to initiate and stop G-CSF / GM-CSF

Start 24-72h after chemotherapy
Continue until ANC is 10,000 /uL
Do not use concurrently with chemo or radiation therapy

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Fever of unknown origin work up (required)

TB: tuberculin skin test (TST) or interferon γ release assay (IGRA)

Inflammation: ESR, CRP, LDH, Ferritin

Hema: CBC: platelet count; leukocyte count and differential; hemoglobin, protein electrophoresis

Immunologic: antinuclear antibodies, and rheumatoid factor

GI: Alkaline phosphatase, ALT, AST

Renal: Electrolytes, creatinine, total protein, urinalysis, creatine kinase

Cultures: Blood cultures (n = 3)
Urine culture

Imaging: chest x-ray, Abdominal ultrasonography

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Most common among the neoplasms that present with FUO

Malignant lymphoma

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Next work up in FUO after obligatory investigations, manipulation with thermometer and drug fever excluded, and still with misleading or absent PDCs

Cryogobulin and fundoscopy

> FDG-PET/CT or gallium scan/labeled leukocyte scintigraphy
If normal, repeat history and PE and PDC driven invasive testing
If still no diagnosis, late state work up is chest CT and abdominal CT, temporal artery biopsy >55y

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Tx if still with no dx for FUO after chest and abdominal CT and temporal artery biopsy

Stable: follow up and consider NSAID tx
Deterioration: further tests and consider therapeutic trial with Anakinra

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Condition that may increase the risk of an adverse event or that may compromise the ability of the vaccine to evoke immunity

Precaution

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Condition that increases the risk of a serious adverse reaction to vaccination

Contraindication

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Permanent contraindications to vaccination

Severe allergic reaction to a vaccine component or following a prior dose

Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination

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Gold standard for a diagnosis of HIV infection

positive EIA with a positive HIV RNA assay

In cases with strong clinical evidence of leptospirosis, a SINGLE antibody titer (MAT) __ is required for diagnosis

1:200-1:800

Treatment for severe leptospirosis (4)

Penicillin (1.5 million units IV or IM q6h) or Ceftriaxone (2 g/d IV) or Cefotaxime (1 g IV q6h) or Doxycycline (loading dose of 200 mg IV, then 100 mg IV q12h)

Chemoprophylaxis for Leptospirosis

Doxycycline (200 mg PO once a week) or Azithromycin (250 mg PO once or twice a week) * Doxy contraindicated if pregnant

Tx for mild leptospirosis (3)

Doxycycline (100 mg PO bid) or Amoxicillin (500 mg PO tid) or Ampicillin (500 mg PO tid)

First line treatment for uncomplicated P. falciparum malaria in malaria endemic areas

Artemisin-based combination therapy (ACT)

Prophylaxis in areas with chloroquine- or mefloquine- resistant P. falciparum

Atovaquone-proguanil (Malarone) Doxycycline

Only drug advised for pregnant women traveling to areas with drug-resistant malaria

Mefloquine

Timing of antimalarial drugs

Start 2 days to 2 weeks before departure Continue for 4 weeks after the traveler has left the endemic area If atovaquone-proguanil was given- can d/c after 1 week

Added to regimen tovprevent relapse incap. vivax or P. ovale infection

Primaquine

Rabies spreads ____ along peripheral nerves toward the spinal cord or brainstem via retrograde fast axonal transport (rate, up to ~250 mm/d), with delays at intervals of ~12 h at each synapse

CENTRIPETALLY

Eosinophilic cytoplasmic inclusions in brain neurons that are composed of rabies virus proteins and viral RNA

Negri bodies

Rabies PRE exposure prophylaxis schedule

Day 0, 7, 21 OR 28

Rabies Post exposure prophylaxis schedule

Day 0, 3, 7, 14, 28

Rabies category of "minor or superficial scratches or abrasions without bleeding, including those induced to bleed"

Ctagory 2 But all cat 2 on head and neck are considered cat 3

Management of Cat 2 rabies

Wash with soap and water No RIG indicated Complete vaccination until Day 28 if -animal is laboratory proven to be rabid -animal is killed without lab testing -animal has signs and sx of rabies -animal is not available to be observed for 14 days

Site of administration of RIG

Entire dose of RIG (20IU/kg) should be infiltrated at the site of the bite T/N: rabies vaccine and RIG should never be administered at the same site or with the same syringe

Preferred antibiotic therapy for tetanus

Metronidazole 400mg rectally or 500mg IV q6h for 7 days

Treatment of tetanus

Antitoxib should be given early (HUMAN tetanus Ig or equine antitoxin)

Tetanus toxoid in pregnancy... how many doses

All pregnant women should received at least TWO doses tetanus toxoid containing vaccine with interval of at least 4 weeks between doses and second dose at least 2 weeks before birth 3rd dose should be given 6 months after the 2nd dose 4th and 5th doses should be given with interval of at least 1 year or in subsequent pregnancies (to complete 5 doses) to ensure lifelong protection

Most common site of infectious arthritis in IV drug users

spine, sacroiliac joints, sternoclacivular joints

Antibiotics added in case of IV drug users for coverage of PAE infectious arthritis

Cefepime 2g q8h-12h or Ceftazidime 2g q8h

Primary treatment for gas gangrene

Clindamycin + Pen G Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4–6h) alternative: Clinda+cefoxitin 2 grams IV q6h

Primary treatment for necrotizing fasciitis (Group A strep)

Clindamycin + Pen G Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4–6h) alternative:Clinda+1st or 2nd gen ceph

Primary treatment for necrotizing fasciitis (mixed aerobes and anaerobes)

Ampicillin + Clindamycin + Ciprofloxacin Ampicillin (2 g IV q4h) plus clindamycin (600–900 mg IV q6–8h) plus ciprofloxacin (400 mg IV q6–8h) alternative: VAN + Metro + Ciprofloxacin

Usual cause of traumatic gangrene (from penetrating injuries)

Clostridium species C. perfringens, C. septicum, C. histolyticum

Lucio's phenomenon

Leprosy reaction, observed in diffuse leprosy of Lucio and Latapi and may be a variant of erythema nodosum Marked vasculitis and thrombosis of the superficial and deep vessels result in hemorrhage and infarction of the skin

3 cardinal signs for diagnosis of leprosy (need 2 of 3 for dx)

Hypopigmented or erythematous skin lesions with definite loss or impairment of sensation Involvement of the peripheral nerves as demonstrated by definite thickening with sensory impairment Positive result for AFB in slit-skin smears / biopsy sample / positive result in a biopsy PCR v

Treatment for T1R leprosy reaction

Glucocorticoids Prednisolone 1mg/kg body weight once a day (max 60-80mg) tapered slowly

Treatment for multibacillary leprosy (adult)

Dapsone 100mg daily Rifampin 600mg monthly Clofazimine 50mg daily, 300mg monthly *supervised 4-weekly dose of rifampin and clofazimine for 12 months (6 months for paucibacillary)

Syndrome of fever, myalgia, general malaise, fatigue, headache, nonproductive cough, abdominal symptoms in a patient who contracted schistosomiasis

Katayama fever / Katayama syndrome

Preemptive treatment for px at risk for invasive NTS infection considered for:

neonates (probably up to 3 months of age); persons >50 years of age with known or suspected atherosclerosis; and patients with immunosuppression, cardiac valvular or endovascular abnormalities, or significant joint disease

UTI: Definition of significant pyuria

>10 WBC/HPF

UTI: Definition of positive gram stain of unspun urine

>2microorganism/oif

Asymptomatic bacteriuria cut off

Women: 2 consecutive voided urine with same bacterial strain >100,000 cfu/mL Men: clean-catch voided urine with same bacterial strain >100,000 cfu/mL If catheterized: 100cfu/mL

Definition of recurrent UTI

3 or more AUC in a year or 2 or more in 6 months *documented by urine culture Relapse if it occurs 1-2 weeks after stopping tx Reinfection if >2 weeks

Cut off value for significant bacteriuria in complicated UTI

100,000 cfu/mL

Treatment duration in complicated UTI

at least 7-14 days Repeat urine culture 1-2 weeks after completion of antibiotics

Cut off value for bacteriuria in CA-UTI

10^3 aka 1,000 cfu/mL in a single catheter urine specimen or in a midstream voided urine specimen