Infectious Disease Flashcards
How is adenovirus treated?
Cidofovir with pre/post hydration and probenecid
Can have renal toxicity and Fanconi-type syndrome (proteinuria, glucosuria, bicarbonate wasting)
Recall the table of antivirals
Which tick borne disease does not get treated with doxy?
Babesiosis- atovaquone + azith, consider exchange transfusion
What are features that help differentiate Staph and Strep TSS?
Staph- primarily young women, tampons/nasal packing, rare pain, erythroderma and tissue necrosis are rare, 2-6% mortality
Strep- 20-50yo, equal gender, trauma/NSAIDs/postpartum, severe pain and erythroderma and bacteremia are common, mortality 33-81%
Recall some bioterrorism buzzwords
What are the pulmonary findings in Nocardiosis?
nodules, infiltrates, GGOs, pleural effusions
Tx with bactrim
Remember weakly acid fast branching
Recall some parasitic buzzwords
First three treated with albendazole, last is praziquantel
What adjunct is used for prosthetic valve MSSA/MRSA endocarditis?
Gentamicin for 2 weeks in addition to standard targeted therapy
What are the features of DRESS/DIHS?
2-6 weeks post drug exposure
Fever and LAD, rash, facial edema
Eosinophilia and 1 other organ involvement
Tx with stopping drug, steroids, IVIG is controversial
When is vanco indicated for empiric neutropenic fever treatment?
Sepsis/shock
Indwelling line/port
STI
PNA
How long do you treat bacteremia associated with acute cholagnitis?
7-10 days, can narrow the antibiotic coverage based on culture data including anaerobic coverage
Which immunosuppressants can cause PRES?
tacrolimus, cyclosporine, sirolimus, cisplatin, interferon
What are the indications for getting a head CT prior to an LP?
Immunocompromised, history CNS disease, new onset seizures within 1 week, papilledema, focal deficit, abnormal level of consciousness
How do WNV and Guillain Barre syndromes differ?
WNV- asymmetric weakness, proximal>distal, no sensory symptoms, encephalopathy, pleiocytosis in CSF
What are the features of a submandibular infection (Ludwig’s)?
drooling, dysphagia, trismus is absent, muffled voice, woody induration, no adenopathy
Cover GNRs and beta lactamase oral anaerobes
What are the features of para-pharyngeal infections (Lemierre’s)?
Septic thrombophlebitis of JV, bacteremia, metastatic infection, often Fusobacterium
Cover GNR and beta lactamase anaerobes for 4-6 weeks, no anticoagulation
What is the abdominal perfusion pressure?
MAP-IAP
Maintaining an APP >60 correlated with survival in IAH and Abdominal compartment syndrome
What is the utility in S pneumoniae urinary antigen?
POC, easy to obtain. Doesn’t identify subtype
Sensitivity better in bacteremia patients, but specificity is high to allow for early narrowing of abx
Which bacteremia can be treated for only one week?
Gram negative bacteremia is noninferior to 2 weeks
What skin manifestations accompany Pseudomonas bacteremia?
Ecythma gangrenosum (hemorrhagic pustules)
What are the features of brucellosis?
Contaminated meat or dairy, endemic to Middle East, central Asia, sub-Saharan Africa, and central/south America
Undulating fevers, productive cough, myalgias, arthralgias, leukopenia, transaminitis, abnormal chest imaging. Need tissue biopsy
Tx doxy and aminoglycoside
What is time dependent killing vs concentration dependent killing?
Time-dependent: cumulative percentage of time over 24hr that free antibiotic exceeds the MIC (beta lactams)
Concentration-dependent: peak concentration in a dosing interval divided by MIC (aminoglycosides, dapto)
Concentration dependent with time dependent: area under the curve over 24hr period divided by the MIC (vanc, fluoroquinolones, tigecycline, linezolid)
What are the surgical indications for IE?
Valve dysfunction, heart block, annular/aortic abscess, persistent and uncontrolled infection, highly resistant or fungal organisms, recurrent emboli or enlarging vegetations, large (>10mm) vegetations
What defines severe pneumonia?
MV with PEEP 5 or higher
HFNC with p/f <300 with FiO2 50% or more
p/f <300 with NRB
Which meds have good synergy for NDM-1 producing K pneumoniae?
ceftazidime-avibactam plus aztreonam
What are the risk factors for multi-drug resistant VAP?
RRT prior to VAP onset, prior abx within 90days, septic shock at the time of VAP, ARDS preceding VAP, 5+ days hospitalization prior to VAP
What can reduce VAP in patients with acute brain injuries who are comatose and have undergone intubation?
1 dose ceftriaxone within 12h of admission
What are the features of leptospirosis?
Acute bacteremic phase followed by immune-mediated recrudescence
Tropical exposure
conjunctival suffusion, edema, erythema without purulence. Meningeal symptoms, jaundice, DAH, myocarditis, arrhythmias, AKI
What are some unique features of strongyloides?
Migrating rash, polymicrobial bacteremia
