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Infectious disease Flashcards

1
Q

Pneumonia (etiologies)

A
  • NN: Grp B strep, E coli, Listeria
  • 6wks-18yo: virus, strep pneumo, mycopl, chlam pneumo
  • 18-40yo: mycopl, strep pneumo, virus, chlam pneumo
  • 40-65yo: strep pneumo, haem influ, mycopl, virus
  • Elderly: strep pneumo, haem influ, virus, staph aureus
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2
Q

Pneumonia (PE)

A

Classic: sudden, fever, prod cough, dyspn, pleuritic chest pain
Atypical: gradual, dry cough, headac, myalgia, sore throat

↓ or bronch sounds, rales, wheez, dull to perc, tact fremit
Minim/atyp PE: elder, COPD, DM, immcompr

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3
Q

Pneumonia (dg, complications)

A

Dg: ≥2 symp of acure resp inf + new infilt on CXR/CT
If hospit ptt or refrac outptt: sputum Cx, nasoph aspir, bld Cx, ABG

Complic: pleur effus, empyema, abscess, necrot pneumonia, bacteremia

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4
Q

Pneumonia (ttt)

A

ttt: outptt w/ oral empiric AB if uncomplic
If obstr ds, add pseudo/staph/anaerob coverage

Hopit criteria: CURB-65 (2-3 inptt ttt; >4 admiss)
Confus; Uremia (BUN>19); RR (>30/min); BP (S<90 or D<60); >65yo

Pneumo vacc: all children; >65yo; splenic dysfct, asplen; immcompro; w/chronic ds

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5
Q

Tuberculosis (RF, PE)

A

Latent (asympt) → active (sympt)
Inf lungs/CNS/GU/bone/GI

RF for reactiv: immsuppr; alcoh; lung ds; DM; adv age
Cough, hemoptysis, dyspn, ↓weight, fatigue, night sw, fever, … for >3wks
HIV: atyp sympt and ↑R of extrapulm TB

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6
Q

Tuberculosis (dg)

A

Active: sputum Cx (bld/tissu if extrapulm) #1
Sputum AFS
CXR (cavit in upp lobe); calcif ≥1 LN (Ghon complex)
HIV or 1*TB: low lobe infilt +/- cavit
Miliary: multip fine nod in 2 lungs (hemato/lymph dissem)

Latent: ⊕PPD or QuantiFERON-TB (→ always CXR)
Immcompr w/ latent may be ⊖

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7
Q

Tuberculosis (ttt)

A

Lat+activ: report to local/state health departm
Resp isolat if activ TB

Activ: RIPE x2mo then INH+rifamp x4mo
VitB6 w/ INH
Latent: INH x9mo

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8
Q

Acute pharyngitis (etiologies, PE)

A

Viral (90%): rhino, corona, adeno, EBV, CMV, infl, coxsa, …
Bact: Grp A strep, N gonorr, Coryne diphth, M pneumo

Typical strep: fever, sore thr, eryth, tonsil exudate, LN
Atyp strep: coryza, hoarsn, rhinorr, cough, conjunc, stomatitis, GI sympt

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9
Q

Acute pharyngitis (Dg, ttt, complications)

A

Dg: clinic; GAS Ag; throat Cx
ttt: penicillin x10d if GAS suspect (or cephalo, amoxi, azithro)
Complic:
-Nonsupp: acute rh fever (early AB prevent); PSGN (not prev)
-Supp: lymphadenitis, mastoiditis, sinusitis, …
-Peritonsillar abscess: odynoph, trismus, hot potato voice, uvula deviat, … Intraoral US/CT; ttt AB + surg drain

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10
Q

Sinusitis (etiologies, PE)

A

-Acute: <1mo; virus, S pneumo, H infl, M catarr
Bact rare ass w/ purul disch, tendern, hyposmia, sympt >10d
-Chronic: >3mo; by obstr of sinus drain, low-grade anaerob inf

Fever, facial pain/tendern, headac, congest, discharg

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11
Q

Sinusitis (dg, complications, ttt)

A

Dg: clinic; Cx or radio if chronic/refract
Complic: meningitis, osteomyelitis, cavernous sinus thrombosis, abscess

ttt: acute+viral (self-lim; decong, antihist, saline lavage)
Acute+bact: amoxi/clav x10d (or clarith, azith, TMP-SMX, fluoroq, C2G)
Chronic: AB x3-6wks; intranasal CS, decong, antihist; +/- surg

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12
Q

Coccidioidomycosis (PE)

A

SW USA; pulm fung inf +/- extrapulm
Acut/subacut; incub 1-4wks

Fever, cough, dyspn, night sweats, arthralgias
Dissem (HIV/pgnt/black/filip): meningitis, bone les*, soft T abscess

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13
Q

Coccidioidomycosis (dg, ttt)

A

Dg: serology; PCR of resp; BAL/sput Cx (spherules)
CXR; bronchosc; FN biopsy

ttt: acute (PO flucon/itracon if mild; IV amphoB if sev/dissem)
Chronic: no ttt if asympt; if progr/sympt surgery + azole x8-12mo

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14
Q

Influenza (types, PE)

A

↑contag orthomyxoV; types A/B/C
Ag drift: small gradual chang in surf prot; point mutat
Ag shift: acute major chang in infA; genet reassortment

US: Nov to March; yearly vacc (inact) for all ≥6mo old
Abrupt fever, myalgia, chill, cough, coryza, weak; atyp in elderly (confusion)

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15
Q

Influenza (dg, ttt, complications)

A

Dg: clinic; Ag (nasoph swab); DFA/PCR/Cx
Leukopenia

ttt: analges, cough meds
Oseltam/Zanamiv in 2d of onset (↓inf by 1-3d)
Complic: sev viral pneumonia; 2* bact pneumonia; sinusitis/bronchitis; COPD/asthma exacerb

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16
Q

Meningitis (RF, PE)

A

Acute bact: life-threat emergency
Viral = aseptic, more common, less morbid

RF: ear inf, sinusitis, immdefic, neurosurg, crowded living, sick contact
PE: triad fever, headac, neck stiff
Mal, photoph, alter ment stat, N/V, seiz, Kernig/Brudzinski

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17
Q

Meningitis (etiologies by age)

A
  • 0-6mo: GBS, E.coli/GNRs, Listeria
  • 6mo-6yo: S.pneumo, N.mening, H.influ type b, enteroV
  • 6-60yo: N.mening (#1 teen), S.pneumo, enteroV, HSV
  • > 60yo: S.pneumo, GNRs, Listeria, N.mening
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18
Q

Meningitis (dg)

A

Dg: LP (CSF Gram+Cx); gluc/prot/WBC+diff/RBC/opening pressure; !!! if no papilledema or focal neuro deficit
Viral PCR; crypto Ag if HIV
CT or MRI: if alt ment stat, papilled, focal neuro def → exclude mass or ↑ICP
Bld Cx, CBC

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19
Q

Meningitis (management, complications)

A

AB rapidly + empirically before LP
! AB started before CT
Some viral: support + follow-up
Close contact if N.mening: rifampine or ciprofloxacine

Complic: sensorineur ↓hearing; mental impair; seiz; cereb edema; ↑ICP; empyema; abscess; hydroceph +/- inf; focal neuro def; coma; death

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20
Q

Meningitis (ttt)

A

Dexameth in S pneumo: 15min before AB; ↓morta, ↓short-term neuro complic
If immcompr, elder, NN: add ampicillin (Listeria)

  • <1mo: ampicill + cefotax or gentam
  • 1mo-adult: vancom IV + ceftriax or cefotax
  • > 60yo/alcoh/chron ds: ampicill + vancom + cefotax or ceftriax
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21
Q

Encephalitis (PE, #dg)

A

Esp HSV and arboviruses
Rare: CMV, toxopl, West Nile V, VZV, Borrelia, …
Esp child and elder

Alter consc, headac, fever, seiz
Letharg, confus*, coma, focal neuro def
#dg: abscess, malign, toxic/metab encephalop, hematoma, hge
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22
Q

Encephalitis (dg, ttt)

A

CSF: ↑lymphoc, ↑prot, ↓glu in TB/fung/bact/amebic
LP: cells, glu, prot, Cx, Gram, AFS, India ink, PCR, serology
CT or MRI: HSV in temporal lobe

ttt: HSV immediate IV acyclovir (! ↑morbi)
CMV: IV ganciclovir +/- foscarnet
Doxycycline if susp RMSF/ehrlich
Lyme: ceftriaxone

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23
Q

Brain abscess (etiologies)

A

Esp strepto, staph, anaerob; polymicrob
Immsuppr: toxopl, candida, asperg, zygomyc
Epidemio: neurocysticercosis

Direct spread: sinusitis, otitis med, mastoiditis, dental inf
Direct inoculation: head trauma, neurosurg
Hemato spread: middle cereb art distribution w/ multiple absc at gray-white junction

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24
Q

Brain abscess (PE, dg, #dg)

A

dg: if no fever, susp 1* or meta brain tumor

Early: fever, headac (dull/constt/refract), inattent, confus, seizures → ↑ICP (CN III+VI def) → signs of focal neuro def

Dg: CT (ring enhanc); MRI (if early or post fossa)
No LP (!!! herniation); ↑ESR/↑CRP
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25
Brain abscess (ttt)
Broad IV AB + surg drain (dg +/- ttt); IV mannitol (↓ICP) If <2cm, just medical ttt C3G + metronid +/- vancom IV for 6-8wks and follow w/ serial CT/MRI If severe, dexameth (↓cereb edema) Prophyl anticonvulsant
26
HIV (PE)
- CD4+ count: degree of immsuppr; guides ttt/prophyl; determ complic + pg - Viral load: predict rate of progr; indicat* ttt; resp to ART Acute inf: dys-wks aft expo; asympt or flu-like Later: night swt, ↓weight, thrush, recurr inf, opport inf
27
HIV (dg)
- ELISA: detect Ab (up to 6mo to ⊕) - Western blot: to confirm - Rapid HIV tests - Baseline: RNA PCR (vir load), CD4+ count, PPD or IGRA, Pap smear, VDRL/RPR, serol CMV, viral hepat, toxo, VZV
28
Common AIDS-defining illnesses
``` Esoph candidiasis CMV retinitis Kaposi sarcoma (HHV-8) CNS lymphoma; toxoplasmosis; PML P jirovecii or recurrent bacterial pneumonia HIV encephalopathy Disseminated mycobacterial or fungal infection Invasive cervical cancer ```
29
HIV (ttt)
-ART: all ptts, regardless of sympt or CD4+ count; lifelong 2 NRTIs + 1 NNRTI or protease inhib or integrase inhib - HIV genotype before ttt and when resistance -Monthly monitor CD4+ and viral load until suppression (<50 copies) then every 3-6months -Prophyl ag opportun inf -Prophylaxis when expo to HIV: ≥2 ART asap x4wks; dep on severity of source inf
30
HIV (prophylaxis against opportunistic infections)
- CD4 >200: MMR and varicella vaccines - <200: P.jirov; TMP-SMX - <50-100: MAC; azithro/wk - <100: toxo; TMP-SMX - PPD>5mm or ↑R: INH x9mo (+B6) or rifampin x4mo - Multiple recurr: candida (esoph: flucon; oral: flucon or nystatin); HSV (acyclo/valacyclo/famcyclo daily) - All ptts: S pneumo (pneumovax /5y); influenza (vaccine/y)
31
Oropharyngeal candidiasis / Thrush
RF: xerostomia, AB use, denture, immsuppr Soft white scrapab plaq, erythem base, odynoph #dg: oral hairy leukopl Dg: clinic; KOH or Gram (budd yeast +/- pseudohyph) ttt: thrush (nystatin susp, clotrimaz PO, flucon PO) Esoph (PO azole)
32
Cryptococcal meningitis
RF: AIDS, expo to pigeon dropp Headac, fever, ↑ICP, impair ment, !!No mening signs #dg: toxo, lymphoma, TB mening, AIDS dementia, PML, HSV enceph, other fung Dg: LP, crypto Ag (CSF or bld), CSF india ink, fung Cx ttt: IV amphotB + flucytosine x2wks then flucon x8wks Lifelong flucon until asympt + CD4>100 for >1y
33
Histoplasmosis (RF, PE, #dg)
RF: HIV/AIDS, spelunk, expo bat excr; Ohio/Mississipi RV 1* expo: asympt or flulike to pulm+/-extrapulm manif Dissem: fev, ↓weight, HSMG, LNpathy, cough, pancytop #dg: atyp bact pneumonia, blastom, coccidio, TB, sarcoid, pneumoconiosis, lymphoma
34
Histoplasmosis (dg, ttt)
Dg: CXR; urine+serum polysaccharide Ag; Cx (bld, sputume, CSF); biopsy or BAL w/ special stain; monitor response to ttt/relapse ttt: mild pulm ds (itracon); chronic cavit (itracon >1y); severe acute pulm or dissem (liposomal amphotB x2wks then itracon ≥1y)
35
Pneumocystis jirovecii pneumonia
RF: impaired cell imm; AIDS Dyspn on exert*, fev, nonprod cough, tachypn, impair O2, ↓weight, fatig; +/- dissem #dg: TB, histop, coccidio Dg: cytology (sputum/BAL) w/silver stain; ABG (PaO2); CXR ttt: high-dose TMP-SMX x21d; prednisone if mod-sev hypox
36
CMV (RF, PE)
70% of adults in US; most asympt By sex, vertical, breast milk, resp dropl, bld transfu RF for reactiv: 100d s/p transpl; HIV/AIDS (CD4<100 or viral >10K) Mono-like; retinitis (detach); GI+hepatobil (pain/bleed/ cholangiopathy); pneumonitis (↑morta); CNS (polyradic/ myelitis/subacte enceph)
37
CMV (dg, ttt)
Dg: Cx, tissu histopath, serum PCR ttt: ganciclovir, valganciclovir, foscarnet
38
Mycobacterium avium complex (PE, prevention)
1* inf: pulm; in apparent healthy nonsmoker 2* inf: pulm; in ptt w/ preexist pulm ds (COPD/TB/CF) Dissem: AIDS w/ CD4<50; in ptt Not on HAART or proph for MAC; fever/weak/↓weight Prevent: azithro/wk for CD4<50 or AIDS-def opport inf
39
Mycobacterium avium complex (dg, ttt)
Dg: mycobact bld Cx (⊕ in 2-3wks) Anem, hypoalb, ↑ALP, ↑LDH Biopsy (BM/liv/intest): foamy macroph w/ A-F bacilli ttt: clarithrom (#1); ethambutol+/-rifabutin (#2) >12mo and until CD4>100 for >6mo
40
Toxoplasmosis (RF, PE, dg)
RF: raw/underck meat; cat litter 1* inf: asympt Reactiv: immcompr (brain/lung/eye > others) Dg: serology, PCR; histo or tissu Cx If CNS involv, CT (multiple iso/hypodense ring-enhanc) or MRI (basal gg)
41
Toxoplasmosis (ttt, prophylaxis)
High-dose PO pyrimethamine + sulfadiazine and leucovorin x4-8wks Then low-dose until resolut* (clinic+radio) Prophyl if CD4<100 w/ ⊕IgG: TMP-SMX or pyrimethamine+dapsone
42
Chlamydia (RF, #dg, complications)
``` #1 STD in US RF: unprotect sex; new or multiple partners LGV serovars: lymphogranuloma venereum ``` ``` #dg: gonorr, endometriosis, orchitis, vaginitis, UTI Complic: chron inf/pelv pain; Reiter sd (ureth, arthr, conjunct); Fitz-H-C sd; ectopic pgncy; epididymitis ```
43
Chlamydia (PE)
Asympt in men; penile disch or testic tenderness Urethritis, mucopur cervicitis, PID; cervical/adnexal tenderness in women Other: arthritis, neonat conjunctivitis, pneumonia LGV: 1* painless papul/ulcer; 2* painful swell ing LN; 3* anogenital sd
44
Chlamydia (dg, ttt)
Dg: Cx (#1); urine NAAT (rapid); Gram of discharge (PMNs but no bact bcz intracell) ttt: doxycycline x7d or azithrom once (azithr or amoxi in pgnt); ttt partner; ! ttt gonor LGV ttt x21d
45
Gonorrhea (PE, #dg, complications)
W: green/yellow disch; pelv/adnex pain; swoll Bartolin M: purul urethr disch; dysuria; eryth of meatus ``` #dg: chlam, endometriosis, pharyngitis, vaginitis, UTI, salpingitis, tubo-ovar abscess Complic: persist inf/pain; infertil; abscess+rupture; dissem (migrat polyarth, tenosynov, pustul skin) ```
46
Gonorrhea (dg, ttt)
Dg: Gram+Cx (#1); NAAT (genit tissu, urine) Dissem: monoartic septic arthritis; rash; tenosynovitis ttt: ceftriax IM and azithrom PO Condoms (prophyl); ttt partner Dissem: IV ceftriax ≥24h
47
Syphilis (3 phases)
1* (10-90d): painless ulcer (chancre) 2* (4-8wks): low-gr fever, headac, mal, LNpathy, symm maculopap rash palm/sole (nonprur); condyloma lata -Early: <1st y; asympt; ⊕ serology -Late: >1y; asympt; ⊕or⊖ serology; 1/3 prog to 3* 3* (1-20y): gummas, neurosyph (tabes dorsalis, meningitis, Argyll Robertson pupil), cardiovasc (aortitis, Ao root aneurysm, Ao regurg)
48
Syphilis (dg, ttt)
Dg: VDRL (false⊕ w/ virus, drugs, IVDA, RF, RA, SLE, leprosy) Neurosyph: in AIDS w/ neuro sympt + ⊕RPR test ttt: 1*/2* (benzathine penicillin IM once); tetracyc/doxyc x14d if peni all Latent (benzathine peni) Neurosy: peni IV x10-14d ! Jarisch-Herxheimer: flulike after ttt (endotox release)
49
Urinary tract infections (etiologies, RF)
E coli; serrat; enterobact; klebs pneumo; staph saproph; pseudom; proteus mirab RF: catheter, instrum, anatom abNl, previous UTI/pyeloneph, DM, recent AB, immsuppr, pgncy
50
Urinary tract infections (PE, #dg)
Dysuria, urgency, fqcy, suprapub pain, hematur Child: bedwett, poor feed, ... Elder: delirium, acute confus* #dg: vaginitis, STDs, urethritis, prostatitis
51
Urinary tract infections (dg)
Dg: clinic; UA (↑leukoc esterase, ↑nitrites); microsc (pyuria >5WBCs, bacteriuria 10^6); Cx (>10^5) If asympt just ttt child/anatom abNl/pgnt W/instrument/surg/renal transpl
52
Urinary tract infections (ttt)
- Uncompl: outptt, PO TMP-SMX x3d, fluoroq x3d, nitrofur x5d - Compl (obstr/men/renal transp/cath/instrum): same AB x7-14d - Pgnt W: nitrofur, cephalosp, amoxic x3-7d (No fluoroq, TMP-SMX, tetracyc) even asympt - Urosepsis: hospit + IV AB (broad cover to include resist GNRs/enterococ) - Prophyl for W w/ recurr uncompl UTIs
53
Pyelonephritis (etiologies, RF, PE, dg)
Same etiologies + RF as cystitis Same signs + symptoms as cystitis w/ flank pain, fev/chill, N/V Dg: UA (w/ WBC casts); Cx; CBC (↑WBCs); if no resp to ttt in 48-72h do US/CT (obstr/abscess/complic)
54
Pyelonephritis (ttt)
Mild: outptt; fluoroq x7-14d; ↑fluids+monitor Severe/complic/pgnt/susp bacteremia: hospit; IV AB (fluoroq, C3G, C4G, Beta-lactam+B-lactamase inh, carbap)
55
Sepsis (etiologies)
SIRS (≥2): temp (<36;>38); RR (>20; PaCO2<32); HR (>90); WBCs (<4K; >12K; >10% band) Sepsis: SIRS + docum inf Severe sepsis: w/ end-org dysfct from poor perf Sepsis shock: w/ hypoTN + org dysfct from vasodil Gram⊕shock: 2/2 fluid loss by exotoxins Gram⊖shock: 2/2 vasodilation by endotoxins
56
Sepsis (PE, dg, ttt)
Abrupt fever/chill; alt ment stat; tachycard; tachypn +/- end org dysfct; hypoTN Sep shock: warm extr Dg: clinic; ↑/↓WBCs; ↓plts; ↓tissu perf; abNl coag !!! Cx of all approp sites; CXR/CT ttt: ICU; aggr IV fluids; emp AB; vasopress; underl cause; !!! maintain BP + org perfusion
57
Malaria (PE, complications)
P.falciparum highest morbi/morta Chemoproph + mosq repellent befor travel endemic Hx of travel (even after mo/ys) + periodic chill/fever (>41) + diaphoresis (4-6h) SMG ≥4d after Asympt betw/ attacks; attacks every 2-3d Complic: cerebral malar; sev hemolyt An; renal; pulm edem; lactic acidosis; ...
58
Malaria (dg, ttt)
Dg: species; Giemsa/Wright thin/thick bld films; normoch normocyt An w/ reticulocyt ttt: uncompl inf (chloroquine PO) P. vivax/ovale: chloroquine + primaquine Severe: IV quinidine then PO Prophyl to chlor-resist sp: atovaquone-proguanil and mefloquine
59
Infectious mononucleosis (PE, #dg)
Acute EBV; body fluids Fev + pharyngitis; fatig; LNpathy (post cerv); SMG; bilat upper eyelid edema; sympt after 2-5wks #dg: strep phar; CMV; toxo; HIV; HHV-6
60
Infectious mononucleosis (dg, ttt)
Dg: Monospot; EBV-specif Ab. If both ⊖ then CMV Mild ↓plts; ↑lymphoc (atypic T lymphoc) ttt: support; CS if airway comprom (tonsill enlarg) ! Ampicillin gives prolong/prurit maculopap rash
61
Infectious mononucleosis (complications)
- CNS inf: asept meningitis; encephalitis; CN palsy; ... - Splenic rupt: esp men, abdo pain then left should - Upper airway obstr: ttt w/ steroids - Bacterial superinf: 2* strep phar - Fulminant hepatic necrosis: esp men, #1 death cause - Autoimmune hemolytic anemia: rare, Coombs⊕, ttt w/ CS if severe
62
Fever of unknown origin (PE, etiologies, dg, ttt)
>38.3 for ≥3wks w/o dg after 3 outpt or 3 hospit + headac, myalg, malaise Causes: esp inf + cancer; then autoimm ds Dg: Hx (fam/social/sex/occup/diet/expo/travel); CBC w/ diff; ESR; serum prot electroph; Cx from everyw/; PPD; specif tests (ANA, ...); CXR/CT TAP; colono; ... ttt: Stop unnecessary meds
63
Fever of unknown origin (#dg)
- Inf: TB, endocarditis (HACEK), abscess, osteomyelitis, cath inf; if HIV then MAC/histopl/CMV - Neopl: lymphoma, leuk, hep or renal cell carcin - Autoimm: Still, SLE, cryoglob, PAN, connect tiss ds, granulomatous ds - Miscell: PE/DVT, IBD, alcoh hepatitis, drug, FMF, factitious - Idiop (10-15%)
64
Neutropenic fever
1 episode ≥38.3 or ≥38 for ≥1h + neutrop (ANC<500) Esp cancer ptt w/ chemot (esp 7-10d s/p chemot) Dg: detailed PE but No DRE (bleed); CBC w/ diff; creat; BUN; transam; Cx from everyw/; test V/B/F; CXR; CT ttt: empir IV AB w/ antipseudom (cefepime or pip-tazo) If fever persist >72h, start antifungal
65
Ehrlichiosis
``` Lone star tick Endemic to S-central + SE of US Headac, fev, chill, alt ment stat, myalg Leukopenia, thrombocytopenia, ↑liv enz ttt: doxycycline ```
66
Lyme disease (PE)
Spirochete Borrelia burgdorferi; Ixodes tick Esp summer; endemic to NE of US Rash + fev, mal, fatig, headac, myalg/arthralg 1* (local): erythema migrans 2* (early dissem): migrat polyarthrop, neuro (Bell palsy), meningitis, myocarditis, conduc abNl (3* block) 3* (late): arthritis, subacute encephalitis
67
Lyme disease (dg, ttt)
Dg: early (clinic, Hx); dissem/late (clinic, Hx, serolog) Serol tests just when: endemic + expo RF + sympt (dissem/late). If ⊕/UNK, ELISA IgM/IgG the Western blot ttt: early (doxycy)(amoxic if <8y or pgnt); advanc (ceftriax) Prophyl: avoid ticks in endem; 1dose doxycy if 4 criteria met. If not, observe and ttt when erythema migrans
68
Rocky mountain spotted fever
Rickettsia rickettsii; Dermacentor tick Invade endoth of capill → small Vx vasculitis Headac, fev, mal, rash (macular on wrists+ankles then petech/purpura spread centrally) Dg: clinic + confirm w/ biopsy + indir ImmFluor ttt: doxycyc or chloramph (if pgnt); fatal if unttt Prevent tick bite
69
Infectious conjunctivitis (common causes)
-Staph/Strep/Haemo/Pseudo/Morax: purul disch; Gram/Cx if sev; AB drop/ointm -N.gonorr: Emergency! (!blind); Gram; IM/IV ceftriax -C.trachom A-C: neonat; mucopurul; Giemsa/Cx; Azithro/tetrac/erythro x3-4wks (NN) Trachoma: recurr keratitis; !!prevent; 1dose PO -AdenoV: watery disch; LNpathy; contagi (epidem); topical CS w/ follow-up
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Orbital cellulitis
Strep, staph, H.influ; mucor/rhizopus (immcompro/DM) Acute fev, proptosis, ↓extraoc mvt, pain, ↓vis acuity Hx of ocul trauma/surg; sinusitis Dg: clinic; bld/tissu Cx; CT (!abscess) ttt: admit, IV AB, Opht/ENT consult; +/- surg Immcompro/DM: amphoB + surg debri Complic: endophthalmitis, blind; caver sinus thromb
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Otitis externa
Pseudom, enterobacteriaceae; excess moisture Pain (+ w/ mvt tragus/pinna), prurit, purul disch, edema, erythema Dg: clinic; Cx if sev/refr; CT if ptt toxic ttt: clean + AB drop (oflox/ciprof) + steroid drop Immdef/DM/Sev: !necrotizing OE: IV AB (fluoroq/C3G/C4G + aminogly)
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Infective endocarditis (RF, etiologies)
``` Esp valves (esp MV) RF: rheum, congen, valvul ds, prosthetic V, IVDA, immsupp ``` - S aureus: >80% of acute IE; IVDA; prosthetic V - Viridans strep: #1 left subacute IE; dental proc; native V - Coag⊖ staph (epiderm): #1 IE in prosthetic V - Strep bovis: GI malign - Candida/Asperg: long-term IV cath; malign; AIDS; org transpl; IVDA
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Infective endocarditis (Cx ⊖)
``` H: Haemo parainflu A: Actinobacillus C: Cardiobacterium E: Eikenella K: Kingella Coxiella/Brucella/Bartonella ```
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Infective endocarditis (PE)
``` Fev/FUO, ↓weight, fatig Murmur (MV>AV; in IVDA TV>MV>AV) Osler nodes: small tender, finger/toe Janeway les*: small periph hge Splinter hge: subungual petech Roth spots: retinal hge Focal neuro def (embolic stroke); other emboli ```
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Infective endocarditis (dg)
Serial bld Cx from diff sites Duke criteria (2Maj; 1Maj+3min; 5min) -Major: ≥2⊕ bld Cx w/ typic org OR persist bacteremia w/ any org OR 1⊕bld Cx coxiella -Major: ⊕ TEE OR new murmur -minor: predisp RF -minor: fever ≥38.3 -minor: vascular phen (septic emboli/infarct; mycotic aneurysm; Janeway les*) -minor: immuno phen (glomeruloneph; Osler; Roth) -minor: microb evidence #major
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Infective endocarditis (ttt)
Early empir IV AB (vanco + genta) Change AB once ⊕Cx ! Acute V replac sometimes Pre-proced prophyl: amoxicillin (clinda/azithr/clarith) ONLY if ptt w/ signif card defect (prosth V, unrepaired congen, prior Hx IE, transpl heart) AND high-risk proced (dental+gingival, mucos perfor (mouth/respir), GI/GU surg w/ recurr GI/GU inf)
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Anthrax (RF, PE)
Animal wool/hair/hides/bone meal prod; biol weapon No person-to-person Cutaneous (#1): 1-7d after skin expo; prurit papul → ulcer → black eschar; LNpathy Inhalation (#1 morta): fev, dyspn, hypox, cough, hgic mediastinitis GI: undercook contam meat; dysph, N/V, bld diarr, abdo pain
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Anthrax (dg, ttt)
Dg: 1⊕Cx or 2 nonCx (PCR/immhistochem/ELISA) CXR (wide mediast; pleur eff) ttt: ciproflox or doxyxy + 1-2 AB Inh or cut face/neck: ≥14d Cut (other): 7-10d Postexpo prophyl: ciproflox x60d
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Osteomyelitis (etiologies)
Bone or BM; direct spread (80%; adult); hemato (20%; child/metaphyse; IVDA/vertebral) - No RF: S aureus - IVDA: S aureus, pseudo - SCD: salmonella - Hip repl: S epiderm - Chronic: S aureus, pseudo, enterobacteriaceae - DM: polymicr, pseudo, S aureus, strep, anaerob
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Osteomyelitis (PE, dg)
Local bone pain, tendern, warmth, swell, limit motion Fev/chill, purul disch Dg: ↑WBCs/ESR/CRP; bld Cx; Xray (first ⊖ then 10-14d periost elevat*) MRI (#1); bone aspirat* w/ Gram/Cx (defin)
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Osteomyelitis (ttt, complications)
ttt: surg debrid then IV AB x4-6wks Clindam + Ciproflox or ampic/sulbactam or oxacill/nafcill (MSSA); vanco (MRSA); ceftriax or ciproflox (G⊖) Complic: chron osteomy; sepsis; septic arthritis Marjolin ulcer = chron osteom w/ draining tract leading to SCC

English 2 (16 decks)

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