Infectious Disease 2 Flashcards
Most common manifestation in primary (spontaneous) bacterial peritonitis
Fever
Diagnostic criterion for peritoneal fluid in PBP
> 250 PMNu/L
Common etiologic agents in PBP
Typically single organism
(E. coli, and occasional other gram positive bacteria - streptococci, enterococci, somestimes pneumococci)
vs secondary peritonitis- mixed flora and anarobes is the rule
Continuous ambulatory peritoneal dialysis (CAPD) peritonitis etiologic agent
Usually single organism
Most common - Staphylococcus sp
Most common cause of liver abscess
Associated disease of the biliary tractin
Single most reliable lab finding in liver abscess
Elevated alk phos
Treatment of candidal liver abscess
Initial administration of amphotericin B (3-5mg/kg IV daily) or an echinocandin with subsequent fluconazole therapy
Most common associated infection in splenic abscess
Bacterial endocarditis
Most common bacterial isolates in splenic abscess
Streptococcal species then S. aureus
vs liver: enteric gram negative bacilli and enterococci (anaerobes generally not involved unless w previous surgery or pelvic source)
Antibiotic therapy for epididymitis caused by N. gonorrhoeae or C. trachomatis
Ceftriaxone 500mg singel dose IM followed by doxycycline 100mg by mouth twice daily for 10 days
Diagnosis of MPC
Detection of cardinal signs at the cervix:
yellow mucopurulent discharge from the cervical os
Endocervical bleeding upon gentle swabbing
Edematous cervical ectopy
Increases risk of IRIS
Earlier ART is started
Lower baseline CD4 count
*ART should not be initiated during the first 8 weeks of TB treatment in patients with TB meningitis
Lung lobes commonly affected in primary pulmonary TB
Middle and lower lung zones
Lung lobes commonly affected in postprimary TB
apical and posterior segments of the upper lobes
superior segments of the lower lobe
Rasmussen’s aneurysm
inflammatory pseudo-aneurysmal dilatation of a branch of a pulmonary artery (PA) adjacent to a tubercular cavity
Rupture may cause hemoptysis
Most common lymph node affected in lymph node TB
posterior cervical and supraclavicular sites
Establishment of diagnosis in lymph nodes is via
FNAB or surgical excision biopsy
Characteristic of urine suggestive of GU TB
culture-negative pyuria in acidic urine
*culture of 3 morning specimens yields a definitive diagnosis
Most common spine level affected in adults with skeletal TB
Lower thoracic and upper lumbar
vs children: upper thoracic
CSF profile if tuberculous meningitis
high leukocyte count (up to 1000/μL)
usually with a predominance of lymphocytes but sometimes with a predominance of neutrophils in the early stage
protein content of 1–8 g/L (100–800 mg/dL)
and a low glucose concentration
Used in severe paradoxical reactions (IRIS)
Glucocorticoids
Chemoprophylaxis for meningococcal meningitis
Rifampicin 600mg every 12 hours for 2 days (not recommended in pregnant women)
Azithromycin 500mg single dose
Ceftrriaxone 250mg IM single dose
Drug of choice for pneumococcal meningitis if MIC > 1ug/mL
Vancomycin
*Rifampicin added for synergistic effect
Duration: 2 weeks
(vs uncomplicated meningococcal 7 days)
Indications for EMERGENT (same day) surgery in IE (4)
- Valve dysfunction with pulmonary edema or cardiogenic shock
- Acute aortic regurgitation plus preclosure of mitral valve
- Sinus of Valsalva abscess ruptured into right heart
- Rupture into pericardial sac
Type 1 Leprosy reaction
“reversal reaction”
Delayed hypersensitivity reaction associated with sudden alteration of CMI status
Usually observed in borderline portion of the spectrum
(+) Acute swelling and redness of skin leasions
(+) neuritis –> nerves may be painful and tender –> nerve damage and disfigurement
Type 2 Leprosy reaction
aka Erythema nodosum Leprosum (type 3 hypersensitivity rxn)
(+) Evanescent, pink-to-red maculopapular, papular, nodular, or plaque lesions suddenly appear and are usually accompanied by constitutional symptoms like malaise and fever
Clinical dx of leprosy (3)
2 ouf of 3 required:
Hypopigmented or erythematous skin lesion(s) with definite loss or impairment of sensation
Involvement of the peripheral nerves, as demonstrated by definite thickening with sensory impairment
A positive result for AFB in slit-skin smears, establishment of the presence of AFB in a skin smear or biopsy sample, or a positive result in a biopsy PCR.
Earliest abnormality seen in CBC in Dengue
Decrease in total WBC
Dengue serotypes associated with severe disease accompanying secondary dengue infections
DEN 2 and DEN 3
Individuals suffering from Dengue are protected from clinical illness with a different serotype within _____ months of the primary infection but with no long-term cross-protective immunity
2-3 months
*Primary infection is thought to induce lifelong protective immunity to the infecting serotype
Higher case fatality rate in which Dengue serotype
When DEN 2 is followed by DEN 1
Homecare advise for Dengue on fluid intake
Adequate fluid intake (>5 glasses for average-sized adult or accordingly in children)
- Milk, fruit juice (caution with diabetes patient) and isotonic electrolyte solution (ORS) and barley/rice water
- Plain water alone may cause electrolyte imbal-ance
-Reduce osmolarity of ORS containing sodium 45 to 60 mmol/liter.
🚫- Sports drinks should NOT be given due to its high osmolarity which may cause more danger to the patient.
Fluids in Dengue fever with SHOCK
Give 10mL/kg plain isotonic crystalloid
> over 1 hour in compensated shock
> over 15m in hypotensive shock
(Get baseline CBC first)
If no improvement in Hct, give 2nd bolus fluid 10ml/kg (compensated) and 10-20ml/kg (hypotensive)
-Should not exceed 3L/day to avoid fluid overload
-Monitor Hct every 6 h if feasible (or as necessary
-If with overt/occult bleeding - fresh whole blood 20m/kg or pRBC 10ml/kg
Discharge criteria for Dengue
ALL must be present
- No fever for 48 hours
- Improvement in clinical status (general well-being,
appetite, hemodynamic status, urine output, no res-
piratory distress) - Increasing trend of platelet count
- Stable hematocrit without intravenous fluids
Infectious diarrhea MILD signs of dehydration:
Dry mouth, decreased axillary sweat, decreased urine output, and slight weight loss
VS MODERATE: orthostatic fall in blood pressure, skin tenting, and sunken eye
Severe: lethargy, obtundation, feeble pulse, hypotension, and frank shockn
Diagnostic criteria for C diff
- diarrhea (≥3 unformed stools per 24 h for ≥2 days) with no other recognized cause plus
- detection of toxin A or B in the stool, detection of toxin-producing C. difficile in the stool by nucleic acid amplification testing (NAAT; e.g., polymerase chain reaction [PCR]) or by culture, or visualization of pseudomembranes in the colon
Primary treatment (DOC) for GAS necrotizing fasciitis
Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4h)
*T/N: Same if gas gangrene
Alternative: Clindamycin (600–900 mg IV q6–8h) plus a cephalosporin (first- or second-generation)
Primary treatment (DOC) for mixed arobes and anaerobes necrotizing fasciitis
Ampicillin (2 g IV q4h) plus clindamycin (600–900 mg IV q6–8h) plus ciprofloxacin (400 mg IV q6–8h)
Appropriate empiric antibiotic tx for mixed aerobic-anaerobic infections
(1) clindamycin (600–900 mg IV every 8 h) or metronidazole (500 mg every 6 h)
plus
(2) ampicillin or ampicillin-sulbactam (1.5–3 g IV every 6 h)
plus
(3) gentamicin (1–1.5 mg/kg every 8 h)
