Infectious Disease Flashcards
Definition of septic shock
Sepsis, plus dangerously low BP and abnormalities in cellular metabolism
Signs and symptoms of septic shock
Hypotension SBP <90mmHg
Signs of SIRS:
Signs of shock: hypoT, oliguria, lactic acidosis
Diagnostic workup of septic shock
+ Mangement:
essentially clinical dx
w/u: confirmed by blood cultures, often can’t find source of infection
Mangement: ABCs, O2, fluids, vasopressors (dopamine, NE, phenylephrine)
Acute menigococcemia onset timing?
Onset within hours to days
Neisseria meningitidis
Meningitis s/s?
fever, HA, n/v, photophobia, neck stiffness, AMS, purpuric rash, increased intracranial pressure.
Kernig: pain with knee flexion
Brudzinski’s: neck flexion causes involuntary flexion of hip/knee
Toxic shock syndrome
Eti:
S/s
S. aureus (also MRSA), group A strep
RFs: retained foreign bodies, tampons, skin and soft tissue infections etc.
S/s: Diffuse macular erythroderma, desquamation, hypotension, multiorgan involvement, fever.
Disseminated gonococcemia
Eti:
S/s
Dx
Neisseria gonorrhoeae
Eti: sexually transmitted.
S/s: Petechial or pusturlar acral skin lesions with erythematous base, asymmetric arthralgias, fever, general malaise
Dx: blood cultures
Nongonococcal acute bacterial (septic) arthritis Path: Eti: S/s: Dx:
Path: bacteria invade the joint space and release endotoxins and trigger cytokine release of neutrophil infiltation, leads to destruction of the joint
Eti: Staph a. , strep, gram - bact.
- Nongonococcal SA until proven otherwise!
S/s: Joint pain, fever, hx of joint swelling
Dx: Requires joint aspiration (gram stain and culture, crystal analysis
Gonococcal arthritis
Eti;
S/s
Eti: MC cause of septic arthritis in young sexually active people
S/s: Joint infection usually prodrome, often progress in additive pattern (knees, wrists, hands, ankles..)
- Fever, chills, rash
Dx: Cultures of mucous membranes
Viral arthritis
Path
S/s
Parvovirus B19, rubella, Hep B
s/s: symmetrical polyarticular arthritis
Lyme disease
Pathogen
S/s
borrelia burgdorferi
S/s: monoarticular or asymmetric joint involvement (usually large joints)
Dx: Serology IgM and IgG
Tx: Doxy 100mg BID 10-14 dyas
Osteomyelitis Eti S/s Dx Tx
- Contiguous (more common) open fracture, wound, etc
- Hematogenous, long bones in kids, spine in adults
- MC path: Staph A. 60%
S/s: fever, malaise, hot and painful joint
Dx: xray but MRI is better, ESR elevated, blood cultures
Tx: vanco + piptazo
Gas gangrene Eti S/s Dx Tx Abx empiric and definitive
ETi: clostridia (gram + rods)
S/s: Localized swelling with serosanguinous exudate soon after onset of pain
- Skin turns bronze, then blue/black with blebs and hemorrhagic bullae
- Crepitus
- Pain out of proportion
Dx: rapidly developing hemolytic anemia with elevated LDH, gram stain of exudate “box car” large gram + bacteria
Tx: Surgical debridment +
Empiric: Pip/tazo (zosyn)
Directed: PCN G and clinda
Indications to aspirate a potentially infected joint?
- febrile pt. with an acute flare of established arthritis to rule out superimposed septic arthritis
- unexplained inflammatory fluid
- monitor septic arthritis
Contraindications to doing joint aspiration
- needle aspiration through cellulitis or impetigo (absolute)
- coagulopathy or bactermia (relative)
