Infectious Disease Flashcards
Diagnosis:
- Hyperthermia/fever
- Muscle rigidity
- Cognitive changes
- Shivering*
- Hyperreflexia*
- Myoclonus* (involuntary twitch or jerk)
- Ataxia*
Serotonin Syndrome
*Shivering, hyperreflexia, myoclonus and ataxia are especial to serotonin syndrome.
Diagnosis:
- Hyperthermia/fever
- Muscle rigidity
- Cognitive changes
- Autonomic instability (dizziness, orthostatic hypotension, etc.)
- Diaphoresis
- Sialorrhea (hypersalivation)
- Seizures
- Cardiac arrhythmias
- Rhabdomyolysis
Neuroleptic malignant syndrome
What types of drugs predisposed patients to the development of neuroleptic malignant syndrome?
Dopamine receptor antagonists
When should you suspect drug fever in a patient?
Suspect drug fever in patients who recently started treatment with a new drug (usually an antibiotic) and have fever without other signs of infection or inflammation.
When do you prescribe antibiotics to treat sinusitis?
- 3-4 days of severe symptoms (temp >/= 39.0, purulent discharge, facial pain)
- Worsening of symptoms that were initially improving after a URI
- Symptoms that do not improve after 10 days
What is the Centor criteria?
The four-point Center criteria is a reasonable way to triage patients with pharyngitis to either empiric treatment with antibiotics, symptomatic treatment only or testing with treatment if the test result is positive.
What are the four-point Centor criteria?
- Temperature >38.1 C
- Tonsillar exudates
- Tender cervical lymphadenopathy
- Absence of cough
Diagnosis:
- Otalgia
- Itching or fullness
- Pain intensified by jaw motion
Physical Examination:
- Internal tenderness when the tragus or pinna is pushed or pulled
- Diffuse ear canal edema
- Purulent debris
- Erythema
Acute otitis externa
Signs/Symptoms:
Acute otitis externa
- Otalgia
- Itching or fullness
- Pain intensified by jaw motion
Physical Examination Findings:
Acute otitis externa
- Internal tenderness when the tragus or pinna is pushed or pulled
- Diffuse ear canal edema
- Purulent debris
- Erythema
Treatment:
Otitis media with URI
Observation
Do not routinely prescribe antibiotic therapy for adults with otitis media.
When should you suspect Lemierre syndrome?
In patients with:
- Pharyngitis
- Persistent fever
- Neck pain
- Septic pulmonary emboli
What is Lemierre syndrome?
Septic thrombosis of the jugular vein
Treatment:
Pseudomonas Aeruginosa pneumonia
Beta-lactam + aminoglycoside
(i.e. piperacillin-tazobactam + amikacin)
Initial empiric therapy with two anti-pseudomonal agents should be initiated in patients with risk factors for Pseudomonas pneumonia.
What are the risk factors for Pseudomonas Aeruginosa?
- History of smoking
- Chronic lung disease
- Use of broad-spectrum antibiotics in the previous month
- Recent hospitalization
- Malnutrition
- Neutropenia
- Glucocorticoid use
What prognostic models can you use to determine which patients with community-acquired pneumonia are at risk for complications and require hospitalization?
- CURB-65
2. Pneumonia Severity Index
What are the CURB-65 criteria?
Confusion blood Urea nitrogen >19.6 Respiration rate >/= 30/min systolic Blood pressure<90mmHg or diastolic <60 mmHg Age>/=65
Admit for scores >2.
What CURB-65 score indicates the need for:
- Hospitalization
- Admission to ICU
- 2 or more
2. 3 or more
Treatment:
Outpatient community-acquired pneumonia
Azithromycin
Ensure patient does not have risk factors for Streptococcus pneumonia infection.
List the risk factors for drug–resistant Streptococus pneumoniae infection.
- Age >65 years old
- Beta-lactam therapy in they last 3 months
- Medial comorbidities
- Immunocompromising conditions and immunosuppressive therapy
- Alcoholism
- Exposure to a child in day care
Work-up:
Severe community acquired pneumonia
- Blood cultures
- Urine antigen assays for Legionella and Streptoccocus pneumonia
- Endotracheal aspirate for Gram stain and culture
Define severe community-acquired pneumonia (CAP).
CAP in a patient who requires admission to the ICU (CURB-65 score of 3 or more) or transfer to an ICU within 24 hours of admission.
How do you manage a patient hospitalized with bacteremic community-acquired pneumonia who has responded promptly to therapy?
Discharge home on oral medications once they are clinically stable.
Amoxicillin x7days is sufficient.
When is the interferon-gamma-releasing assay preferred over the tuberculin skin test?
- In patients who have received the Bacillus Calmette-Guerin (BCG) vaccine.
- Patients who do not return for follow-up reading of the tuberculin skin test.
