Infectious disease Flashcards
Criteria for in patient, IV tx for pneumona
> 65, comorbidities (ETOH, COPD, DM, malnutr), immunospr, malignancy, unstable vitals, AMS, multilobular
Empiric coverage: outpatient CAP
macrolide (eg azithromycin) or doxycycline
Empiric coverage: CAP requiring hosp
flouroquinolone or antipneumococcal b-lactam (eg piperacillin, ceftazidime) + macrolide (eg azithromycin)
Empiric coverage: CAP requiring ICU
antipneumococcal b-lactam (eg piperacillin, ceftazidime) + azithromycin or flouroquinolone
Empiric coverage: pneunomonia, critically ill, not responding to abx
vancomycin or linezolid, broad gram neg coverage
Empiric coverage: HAP
Extended-spectrum cephalosporin or carbapenem with antispeudomonal activity
Add aminoglycoside or flouroquinolone while sensitivity pending
Tb findings for normal host, immunocompr
Normal host: cavitary infiltrate upper lobe
Immunocompr, primary tb: lower lobe infiltrates, can be without cavitation
Miliary tb: multiple fine nodular densities
Tx: active and latent Tb
Active: 4x therapy (INH, pyriazinamide, rifampin, ethambutol) x2mo, INH+ rifampin x4mo
Latent: INHx9mo or rifampinx4mo
Common side effects:
- Rifampin
- Ethambutol
- INH
- Rifampin: turns fluids orange, P450 inducer
- Ethambutol: optic neuritis
- INH: peripheral neuropathy, hepatitis
Therapy for GAS
penicillin x10d
cephalosoprin, amoxicillin, azithromycin= alternatives
Lemierre’s syndrome: defn, causative organsm
Thrombophlebitis of jugular vein after pharyngitis
fusobacterium (oral anaerobe)
odynophagia, trismus, muffled voice, asymmetric uvula: dx and tx
peritonsallar abscess, US or CT + Cx
Abx + surgical drainage
HIV+, filipin, Af Am, pregnant from SW US who present with respiratory infxn: dx and tx
Coccidiomycoisis
Tx: PO fluconazole or itraconozaole
IV amphotericin B for severe
progressive symptomatic disease: surgery+ long term azole (8-12mo)
Meningococcal meningitis: Ppx and tx
Ppx: rifampin
Tx: ceftriaxone
Important adjunctive treatment for meningitis
Dexamethasone: (esp S. pneumo, H flu), give 15-20min before abx
Cerebral edema: dx tests and tx
loss oculocephalic reflex
CT/MRI
tx: IV mannitol
subdural empyema: presentation and tx
intractable seizures
Tx: surgical evacuation
CSF findings: bacterial vs viral menigitis
Bacterial: incr WBC (>1000 PMNs), decr glc, incr prot (>45) and opening pressures (>20)
Viral: Incr WBCs (mono/lymph), prot and opening pressure may be incr or normal
CSF finding: MS
incr gamma globulin
RBCs in CSF without a hx of trauma
HSV encephalitis
India ink stain (CSF)
cryptococcus
Giemsa stain (CSF)
trypnaosomes
Empiric treatment: meningitis
ampicillin + cefotaxime or gentamicin
Empiric treatment: Meningitis >1mo-adult
vancomycin + cetriaxone or cefotaxime
Empiric treatment: meningitis >60/ETOH
ampicillin + vancomycin + cefotaxime or cetriaxone
cranial nerve defects assoc with incr ICP, nature of headache
CN III, VI
headache, fever, local neuro deficit: dx and tx
typical of brain abscess (consider brain met if no fever)
Surgical drainage if >2cm
3rd gen cephalosporin (ceftazidime, ceftriaxone) + metronidazole +/- vancomycin (6-8wks)
Dexa/ IV mannitol
When start HAART, what use?
symptomatic pt, CD4
pseudohyphae + budding yeast, germ tupes at 37 deg: dx and tx
candida
PO azole
45 deg branching septate hyphae with rare fruiting bodies: dx and tx
aspergillus
5-10mm wide capsular halo with narrow-based unequal budding: dx and tx
cryptococcus
IV amphotericin B + flucytosine for 2 wks, fluconazoel x 8wks (for meningitis)
Irregular broad nonseptate hyphae with wide-angle branching: dx and tx
mucor
fever, weight loss, HSM, LAD, cough, palatal ulcers, ohio or spelunking: dx and tx
histoplasmosis
urine and serum polysaccharide antigen
Mild: itraconazle (cavitary lesion- >1yr)
severe/ dissem: amphtericin B x 14 d then itraconazole
“pizza pie” retinopathy with retinal detachment
floaters and visual field changes
CMV retinitis
tx: ganciclovir or foscarnet
Polyradiculopathy, transverse myelitis, subacute encephailtis in immunocompr
CNS involv CMV
fever, weakness, weight loss in immunocomp, anemia, incr alk phos and LDH: dx, tx (ppx and tx)
MAC
Bx: foamy macrophages with acid-fast bacilli
Tx: clarithromycin or ehtambutol +/- refabutin
ppx: azithromycin (CD4
Isodense or hypodense ring-enhancing mass lesions with predilection for basal ganglia: dx and tx
toxo
tx: pyrimethamine + sulfadiazine or leucovorin x 4-8wks
TMP -SMX ppx (CD4
anal pruritis with discharge, rectal strictures, rectovaginal fistula, elephantitis: dx
anogenital syndrome, tertiary lynphogranuloma venerium (chlamydia)
tx: doxy or azithromycin once; prolonged tx 21d
monoarticular septic arthrit, rash (hemorrhagic, panful pustules with erythematous bases), tenosynovitis: dx and tx
gonorrhea (disseminated
IV cetriaxone for at least 24h
hypotension with warm skin and extremities: dx and tx
septic shock
IVF, empiric abx, vasopressors
periodic fevers/ chills (>105.8), dipahoresis, splenomegally: dx, workup, tx (+ ppx)
Malaria (P falciparum- highest morbidity, vivax, ovale, malariae)
Giemsa or Wright-stained thick and thin blood films
cholroquine= standard tx
primaquien for p vivax or p ovale (to eradicate liver hynpozoites)
Severe infxn IV quinidine
Mefloquine for chemoprophylaxis
headache, fever, malaise, macular rash that starts and wrists/ankles and spreads ceantrally: dx and tx
rocky mountain spotted fever (reikettsia rickettsii) via american dog tick
tx: doxy or chloramphenical (for pregnant)
conjunctivitis, gram stain shows gram neg intracell diplococci: dx and tx
N. gnorrhea, IM ceftriaxione, PO cipro or oxfloxacin emergently
Recurrent epithelial keratitis in children, + giemsa stain: dx and tx
C. tracomatis
Axithromycin, tetracycline or erythromiycin for 3-4 wks
