Infectious Disease Flashcards
What does meningitis affect?
Arachnoid, subarachnoid space
CSF
Most Common Bacterial Culprits in Meningitis
Strep pneumo
N. meningitidis
H. influenza
Most Common Viral Culprits for Meningitis
Enteroviruses HSV HIV West Nile VZV Mumps
Most Common Fungal Culprit for Meningitis
Cryptococcus
NonInfectious Etiology of Meningitis
Tumor Trauma Brain abscess Subdural empyema Pharmacologic reaction
Community Acquired Culprits of Meningitis
Strep pneumo
N. menigitidis
H. influenza
Listeria monocytogenes
Healthcare Acquired Culprits of Meningitis
Staph
Aerobic gram negative bacilli
Classic Triad of Meningitis
Fever
Nuchal rigidity
Change in mental status
Other Symptoms of Meningitis
Intense headache Photophobia Lethargy N/V Joint pain Seizures Non-blanching petechial rash (N. meningitidis)
Red Flags for Diagnosing CNS Infections in the Elderly
Behavioral changes Personality changes Seizures Lack of other source of infection Headache Nuchal rigidity Exposure to infected persons Low threshold to do LP
Indications for Head CT Prior to LP
Immunocompromised Hx of seizure 1 week prior Abnormal level of consciousness Hx of CNS disease Papilledema Focal neurologic deficit Possible focal infection
Meningitis Work Up
Blood cultures
CBC
Chem 7
CSF: cell count, gram stain, culture, glucose, protein
Treatment of Meningitis
Rocephin as soon as LP complete
Admit to hospital
Normal CSF Values
Pressure: 70-180 Appearance: clear, colorless Protein: 15-45 mg/100mL Glucose: 50-80 mg/100mL Cell count: 0-5 WBCs, no RBCs Chloride: 110-125 mEq/L
Bacterial Meningitis in Pediatric Population
2 months-2 years
Clues of Meningitis in Infants
Irritability
Poor feeding
Paradoxical irritability
Most Common Etiologic Agents of Meningitis in Pediatrics
Strep pneumo
N. meningitidis
HIB (rare)
Neonates: gram negative and Group B strep
Primary prevention of Meningitis
S. penumoniae vaccine
HIB vaccine
Meningococcal vaccine
Define Encephalitis
Inflammation of the brain
Etiologic Agents for Encephalitis
HSV-1 HSV-2 West Nile CMV Mumps EBV
Difference Between Encephalitis and Meningitis
Encephalitis has: Altered brain function Personality changes Paralysis Hallucinations Altered smell Problems with speech
Symptoms of Encephalitis in Adults
Flu like symptoms Severe HA Fever Altered consciousness Confusion Agitation Personality changes Seizures Loss of sensation Paralysis Muscle weakness Hallucination Double vision Perception of foul smells Speech/hearing problems LOC
Symptoms of Encephalitis in Children
Bulging fontanels N/V Body stiffness Inconsolable crying Paradoxical irritability Poor feeding
Work Up of Encephalitis
Head CT and/or MRI
CBC
CMP
LP
Treatment of Encephalitis
Acyclovir q8h
Most Common Site of Septic Arthritis
Knee
Signs and Symptoms of Septic Arthritis
Acute or subacute onset of pain Erythema Swelling Limited joint motion \+/- systemic symptoms
What should you send joint fluid for?
Crystals Glucose Cell count Culture + sensitivity R/O gonorrhea
Treatment of Septic Arthritis
High dose IV antibiotics
Signs and Symptoms of Bacteremia
Fever +/- chills Rigors Disorientation Hypotension Respiratory failure Sepsis Septic shock Skin lesions
Treatment for Gram Positive Sepsis +/- Shock
Empiric: vancomycin
MSSA: PCN, nafcillin, oxacillin, vancomycin
MRSA: vancomycin, daptomycin
Treatment for Gram Negative Severe Sepsis +/- Shock
Gentamicin or tobramycin or amikacin
PLUS cefepime
+/- vancomycin
What needs to be ruled out and what test needs to be run for it in gram positive bacteremia?
TEE
Infective endocarditis
Signs and Symptoms of Sepsis/Septicemia
Infection General symptoms Inflammatory symptoms Hemodynamic symptoms Poor urine output Elevated creatinine Elevated INR, PTT Low platelets Ileus Elevated bilirubin Elevated lactate Decreased capillary refill Arterial hypoxemia
General Symptoms with Infection for Sepsis
Temp: 38.3+ or less than 36 HR: 90+ RR: 20+ AMS Significant edema Hyperglycemia without DM: 140+
Inflammatory Symptoms with Infection for Sepsis
WBC: 12K+ or less than 4K, left shift
Elevated CRP
Elevated procalcitonin
Hemodynamic Symptoms with Infection for Sepsis
Hypotension
Wide pulse pressure
Treatment of Sepsis
Supportive
Treat most likely source of infection
3 Superficial Soft Tissue Infections that are Emergencies
Infection around the face and hand
Cellulitis in the presence of DM or PVD
Local infection with the presence of leukemia or HIV
Define Cellulitis
Acute spreading infection of the skin to and through the dermis
Drug of Choice for Cellulitis
Bactrim
Clindamycin
Most Common Culprit of Impetigo
Strep
Describe Impetigo
Small vesicles which rupture and form “honey-colored” crusts
Treatment of Impetigo
Bactroban
Define Endocarditis
Infection of the endothelial surface of the heart, most often the valves
Patients at High Risk for Endocarditis
Previous valve damage
Valve replacement
History of IVDU
Poor dental health
Symptoms of Subacute Endocarditis
Anorexia
Night sweats
Weight loss
Presentation of Acute Endocarditis
Cardiac failure
Stroke
Cold extremity
Cutaneous Lesions with Endocarditis
Conjunctival and palatal petechiae
Subungual hemorrhages
Oslers nodes
Janeway lesions
Describe Oslers Nodes
Painful and erythematous nodules
Located on pulp of fingers and toes
Describe Janeway Lesions
Erythematous, blanching macules
Nonpainful
Located on palms and soles
Diagnostics for Endocarditis
TTE/TEE
Normocytic, normochromic anemia
Elevated ESR
Obtain blood cultures
What does toxic shock syndrome result from?
Absorption of toxin from localized staph aureus colonization or infection
Signs and Symptoms of Toxic Shock Syndrome (TSS)
Fever: mild to 102.2+ Myalgias Vomiting Diarrhea Pharyngitis SBP less than 80 mmHg Multiple organ failure Diffuse, blanching, macular erythema Pan-mucosal inflammation
Labs that Represent Multiple Organ System Involvement
Leukocytosis and thrombocytopenia Elevated BUN and creatinine Elevated LFTs and Bili Sterile pyuria Elevated CPK Decrease serum albumin and total protein Blood cultures NEGATIVE Cultures of source
Treatment of TSS
Supportive care
Prevent additional toxin production
Culprit of Rocky Mountain Spotted Fever
Rickettsia rickettsi
Symptoms of Rocky Mountain Spotted Fever
Fever Chills Malaise Myalgias Severe frontal headache
Rocky Mountain Spotted Fever: Days 2-5
Pink, macular rash on palms of hands, soles of feet, hands, feet, wrists, and ankles
24-48 hours: petechial, purpuric, gangrenous
Rash spreads centripetally
Diffuse edema
Why diffuse edema in rocky mountain spotted fever?
Capillary leakage
Hypotension
Spenomegaly
Delirium
Treatment for Rocky Mountain Spotted Fever
Tetracycline (TCN)
Doxycycline
Chloramphenicol (children)
Spirochete that Causes Lyme Disease
Borrelia burgdorferi
Stage I of Lyme Disease
Erythema migrans
Fever/chills
Malaise
Regional adenopathy
Stage II of Lyme Disease
Days to weeks after infection
Multisystem involvement
Fatigue and lethargy
Stage III of Lyme Disease
Lingers for months
Arthritis
Neuropathy
Acrodermatitis chronica atrophicans
Treatment of Lyme Disease
Empirically while awaiting labs
Tetracycline x 30+ days
When do malaria symptoms occur?
12-35 days after exposure
Uncomplicated Malaria Case Symptoms
Fever Malaise Myalgias Arthralgias Headache Anemia Elevated WBC Low platelets
Complicated Malaria Case Symptoms
Fever Anemia Splenomegaly Altered consciousness Seizures ARDS Circulatory collapse Metabolic acidosis Renal failure Liver failure Coagulopathy DIC Intravascular hemolysis Hypoglycemia
PE Findings in Malaria
Pallor Petechiae Jaundice Hepatomegaly Splenomegaly Splenic rupture
Treatment of Malaria
Consult CDC for treatment for region exposed
Describe Clostridium Botulinum
Gram positive
Rod-shaped
Spore forming obligate anaerobic bacteria
5 Forms of Botulism
Foodborne Infant Wound Adult enteric Inhalation
Presentation of Botulism
Bilateral cranial neuropathies Symmetric descending weakness Absence of fever Responsive Normal/slow HR Normal BP No sensory deficits except blurred vision
Botulism Testing in Infants
Evaluate stool for spores and toxin
Botulism Testing in Foodborne Botulism
Serum analysis for toxin
Botulism Testing for Wound Botulism
Culture positive
Negative serum assay
Anaerobic culture
Botulism Testing for Adult Enteric Botulism
Evaluate stool for spores and toxin
Treatment of Botulism
Admit to hospital
Monitor for respiratory failure
Antitoxin (1+ years)
Antibiotics (Wound)
Antibiotics for Treatment of Botulism
PCN G
Metronidazole
Transmission of Smallpox
Droplet
Contact
Airborne
When does smallpox spread most rapidly?
Cool, dry winter
Clinical Features of Smallpox
Non-specific prodrome
Rash prominent on face and extremities
Rash scabs over in 1-2 weeks
Synchronous onset
Diagnosis of Smallpox
Appearance of rash
Culture of lesions: by immunized person, alert lab
Control of Smallpox
Decontaminate
Prophylaxia
Vaccine
Contact/airborne isolation
Treatment of Smallpox
Supportive
Isolate
Immunize contacts
Cidofovir
Bacteria that Causes Anthrax
Bacillus anthracis
3 Clinical Forms of Anthrax
Cutaneous
Inhalation
Gastrointestinal
Clinical Course of Anthrax
Papule -> vesicular -> eschar
Edema, redness and/or necrosis
Diagnostic Testing for Cutaneous Anthrax
Gram stain, PCR, culture of vesicular fluid, exudate, or eschar Blood culture (systemic symptoms) Biopsy
Clinical Presentation of Inhalation Anthrax
Myalgia Fatigue Fever \+/- respiratory symptoms Hypoxia Dyspnea Rad evidence of mediastinal widening Meningitis
Clinical Presentation of Gastrointestinal Anthrax
Abdominal distress Bloody vomiting or diarrhea Fever Signs of septicemia Oropharyngeal ulcerations Cervical adenopathy
Treatment of Anthrax
Ciprofloxacin
Doxycycline
