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.
How do you interpret the Mantoux tuberculin skin test (TST)?
Criteria for positivity are based on the patients risk factors for infection with Mycobacterium tuberculosis.
Induration 5mm or greater is positive in (HIV–positive persons; recent contacts of persons with active tuberculosis; fibrotic changes on chest radiograph consistent with previous tuberculosis infection; patients with organ transplants or immunosuppressive conditions)
Induration 10mm or great is positive in (<5years since arrival from a high-prevalence country; injection drug users; residents or employees of high risk conjugate settings; people with clinical conditions that put them at high risk for active disease; children younger than 4 or exposed to adults in high-risk categories)
Induration 15mm or greater is positive in all other persons.
What testing is required before the administration of a biologic agent for immunosuppression?
Testing for tuberculosis with a tuberculin skin test or the interferon-gamma-releasing assay.
Treatment:
Adult with previously untreated tuberculosis
2-month initial phase treatment with:
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol
7-month treatment with isoniazid and rifampin if susceptible TB.
Treatment:
Susceptible TB
- Isoniazid
2. Rifampin
Treatment:
Latent tuberculosis infection in a patient high risk for active tuberculosis
Isoniazid for 9 months
Treatment may reduce the risk of active disease by up to 90%.
Treatment:
Antibiotic prophylaxis to prevent infective endocarditis in a patient with a heart murmur and native valve abnormality
None
Antibiotic prophylaxis is only recommended for patients with underlying conditions associated with the highest risk or adverse outcomes.
Treatment:
methicillin-resistant Staphylococcus aureus native valve infective endocarditis
IV vancomycin or daptomycin
What are the indications for infective endocarditis prophylaxis for patients before certain dental or surgical procedures.
Prophylaxis is needed in patients with:
- Prosthetic cardiac valves
- Hx of infective endocarditis
- Unrepaired cyanotic congenital heart disease
- Congenital heart disease repair with prosthetic materials or device within the last 6 months
- Palliative shunts and conduits
- Cardiac valvulopathy in cardiac transplant recipients
