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First AId 2CK > Infectious DIsease > Flashcards

Infectious DIsease Flashcards

1
Q

Infective Endocarditis

A
  • infection of the endocardium

- commonly affects heart valves, esp mitral valve

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2
Q

Risk factors for infective endocarditis

A
  • Rheumatic, Congenital or Valvular Disease
  • Prosthetic heart valves
  • IV drug use
  • Immunosuppression
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3
Q

Most common causative agent in infective endocarditis

A

S. aureus

- responsible for > 80% of acute bacterial endocarditis in pts with hx of IV drug use

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4
Q

Main causative agents in infective endocarditis

A
  • S. aureus
  • Viridans streptoccocci
  • Coagualse negative Staphylococcus
  • Streptococcus bovus
  • Candida and Aspergillus
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5
Q

Viridans strep in infectious endocarditis

A
  • most common pathogen for left-sided subacute bacterial endocarditis and following dental procedurs in native valves
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6
Q

Coagulase negative streptococcus in infectious endocarditis

A
  • most common infecting organism in prosthetic valves
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7
Q

Streptococus bovis endocarditis

A

S. bovis endocarditis associated with co-existing GI malignancy

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8
Q

Candida and Aspergillus endocarditis

A

account for most cases of fungal endocarditis

- predisposing factors are: long-term IV catheters, malignancy, AIDS, organ transplant, and IV drug use

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9
Q

Pt presents w/ fever and new / change inmurmur. Likely diagnosis?

A

Endocarditis

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10
Q

Complications of endocarditis

A 
JR = NO FAME
Janeway lesions (flat and painless)
Roth spots in eyes
Nail-bed (splinter) hemorrhage
Osler's nodes (raised and painful)
Fever
Anemia
Murmur
Emboli to lung or brain
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11
Q

Endocarditis: Hx adnd PE

A
  • Constitutional sx (fever/FUO, weight loss, fatigue)
  • exam reveals heart murmur (MV > AV) in non-IV drug users; right sided murmur in IV drug users (tricuspid > MV > AV)
  • immune phenomena (e.g. splinter hemorrhages, Roth spots)
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12
Q

Diagnosis of Endocarditis

A
  • Duke’s criteria
    • 2 major, 1 major + 3 minor, 5 minor
  • CBC with leukocytosis and left shift; incr ESR and CRP
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13
Q

Best initial test for endocarditi

A
  • Blood cultures
  • ## TTE
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14
Q

Duke’s Major Criteria for Endocarditis

A
  1. At least 2 separate positive blood cx for a typical organism, persistent bacteremia w/ any organism or a single culture of Coxiella
  2. Evidence of endocardial involvement (via TTE/TEE) or new murmur
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15
Q

Duke’s Minor Criteria

A
  1. predisposing factors
  2. Fever > 38.3
  3. Vascular phenomena: septic emboli, septic infarcts, mycotic aneurysm, Janeway lesions
  4. Immune phenomena: GN, Osler’s nodes, Roth’s spts,
  5. Microbiological evidence that doesn’t meet major criteria
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16
Q

Tx of infective endocarditis

A

Best empiric treatment is vancomycin and gentamycin

- narrow abx course wherever appropriate

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17
Q

Tx of Viridans Strep endocarditis

A
  • Ceftriaxone for 4 weeks
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18
Q

Tx of S. aureus (MSSA)

A

Oxacilln, nafcillin, or cefazolin

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19
Q

Tx of fungal endocarditis (candida or aspergillus)

A

Amphotericin and valve replacement

20
Q

Tx of staph epidermidis or resistant Staph endocarditis

A

Vancomycin

21
Q

Tx of Enterococi endocarditis

A

Ampicillin and gentamicin

22
Q

Indications for surgery in patient with endocarditis

A
  1. CHF or ruptured valve or chordae tendinae
  2. Prosthetic valves
  3. Fungal endocarditis
  4. Abscess
  5. AV block
  6. Recurrent emboli while on abx
23
Q

Causative organisms in culture negative endocarditis

A

HACEK (Haemophlus parainfluenzae, Actinobacillus, Cardiobacterum, Eikenella, Kingella)
Coxiella burnetti
Brucella
Bartonella

24
Q

Most common causes of culture negative endocarditis

A

Coxiella

Bartonella

25
Q

Tx of HACEK group endocarditis

A

Ceftriaxone

26
Q

Prophylaxis indications of endocarditis

A
  1. Significant cardiac defect (e.g prostetic
27
Q

HIV

A

retrovirus that targets and destroys CD4 T cells

- infection characterized by high rate of viral replication that leads to progressive decline in CD4 count

28
Q

CD4 count

A
  • indicates degree of immunosuppression

- guides therapy and prophylaxis and helps determine prognosis

29
Q

Viral load

A

may predict the rate of disease progression

- provides predictions for treatment and gauges response to ARTs

30
Q

HIV: Hx and PE

A
  • acute HIV, pts are often asymptomatic but patients may also present with mononucleosis-like or flu-like symptoms (e.g. fever, lymphadenitis, maculopapular rash)
  • HIV may present later as night sweats, weight loss, thrush, recurrent infxns or opportunic infxns
31
Q

Diagnosis of HIV

A

ELISA test (detects serum antibodies) then Western blot as confirmatory tests

32
Q

Baseline eval for HIV should incle:

A 
HIV RNA PCR (viral load)
CD4 count
PPD skin tests
Pap smear
Mental status exam
VDRL/RPR 
serologies for CMV
33
Q

Treatment for HIV

A

Initiate ART:

  1. symptomatic patients (those with AIDS defining illness no matter CD4 count)
  2. Patients with CD4 count < 350
  3. Pregnant patients
  4. Those with HIV specific conditions (e.g. HIV associated nephropathy, neurocognitive deficits)
34
Q

Initial regimen for HIV

A

2 nucleoside reverse transcriptase inhibitors (NRTIs) plus 1 nonnucleoside reverse transcriptase inhibitor

– most import is select multiple meds (usually 3) to achieve durable treatment response and limit resistance

35
Q

Goal of HIV therapy

A

Limit viral suppression < 50 copies
- after therapy is started CD4 count should be monitored monthly until suppression is achieved and every 3-6 months afterward

36
Q

HIV + with CD4 300 - 500

A 
Baceterial infections
TB
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposi's sarcoma
37
Q

HIV + with 75 - 175

A 
Pneumocytosis
Toxoplasmosis
Cryptococcus
Coccidiomycosis
Cryptosporidoios
38
Q

HIV < 50

A

Disseminated MAC infection
Histoplasmosis
CMV retinitis
CNS lymphoma

39
Q

Pregnant HIV + patient is not on ARVs at time of delivery, she should be treated with what meds?

A

Intrapaerum zidovudine

- infants should recieve AZT for 6 weeks after birth

40
Q

Which is only live vaccine that should be given to HIV patients?

A

MMR

41
Q

P jiroveci pneumonia (PCP pneumonia)

A
  • prophylaxis indicated at CD4 < 200
    prior PCP infection
  • unexplained fever x 2 weeks
  • HIV related candidiasis
42
Q

PCP prophylaxis

A
  • single strength TMP-SMX (Bactrim fo

* * discontinue PCP prophylaziz when CD4 > 200 for 3 months

43
Q

Mycobacterium avium complex (MAC)

A

prophylaxis indicated when CD4 count < 50-100

  • treated with weekly azithromycin
  • discontinue prophylaxis when CD4 count is > 100 for > 6 months
44
Q

Toxoplasma gondii (HIV +)

A

prophylaxis indicated < 100 with positive IgG serologies

- prophylaxis with double strength Bactrim

45
Q

M tuberculosis (HIV +)

A

prophylaxis indicated PPD > 5mm
- treated with isonizaid x 9 months (+ pyridoxine) or rifampin (4 months)
- include pyridoxine with INH-containing regiments
`

46
Q

Candida prophylaxis (HIV +)

A

prophylaxis indicated at multiple recurrences
esophagitis prophylaxis: fluconazole
oral: nystatin swish and swallow

First AId 2CK (22 decks)

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