Infectious disease Flashcards
SIRS criteria
- Temperature >38 or <36
- Tachycardia
- Respiratory rate over 20 or PCO2 under 32
- WBC over 12 or under 4
Organs in dysfunction in sepsis
Hypotension, AMS, increased creatinine, LFTs
Therapy goals for sepsis?
Goal directed therapy
- CVP 10-12 mm Hg
- MAP >65 mmHg
- U output of 0.5 cc/kg/hr
- SvcO2 over 70
What are the therapy actions needed to correct sepsis?
- Blood cultures should be drawn prior to sepsis
- Eliminate source of sepsis
- 30cc/kg bolus fluid challenge
- If fail fluid challenge - need pressors
- Maintian oxygenation as needed
- Empiric abx while waiting for cultures
Want to treat anaerobes?
Depends on location of bugs
- Gut and vagina: metro
- Everywhere else: Clindamycin
Staph infection? MRSA? UTI?
- Staph: Nafcillin
- MRSA: Vanc
- UTI: Ampicillin or ciprofloxycin (Flagyl)
Generations of quinolone and coverages
- 1st gen - ciprofloxacin: gram negative (UTI) only
- 2nd gen - levo: gram negative coverage
- 3rd gen - moxi: gram negative and positive
Penicillin allergy alternatives
If rash: Cephalosporins
If anyphylaxis: DONT go cephalosporin
Pseudomonas coverage
Pip/tazo (zosyn), carbapenems, cefepime
Outpatient pneumonia treatment
Doxycycline, azithryomycin moxifloxacin
Inpatient pneumonia drugs
- 3rd gen cephalosporins + azithromycin for CAP
- Vanc + Zosyn (pip/tazo) for HAP
Neutropenic fever drugs
- 4th gen cephalosporin (cefepime)
- Carbapenems
UTI drugs
TMP-SMX, nitrofurantoin
Meningitis treatment
Vanc, ceftriaxone +/- steroids, +/- ampicillin
Cellulitis drugs
Cefazolin, bactrim, clindamycin, IV Vancomycin
CENTOR criteria
CENTOR
- Absent Cough
- Exudates
- Nodes
- Temp (fever)
- OR - young = +1 and old = -1
Strep bovis origin? What does it cause?
Bovis comes from the colon and can cause endocarditis
Staph aureus origin and what can it cause in the heart?
IVDA cause tricuspid valve vegetations from skin flora
Oral flora?
Strep everything
Dukes criteria
Criteria for infective endocarditis
- Major
- Sustained bacteremia by organism known to cause IE
- Endocardial evidence by Echo
- New valvular regurgitation
- Minor
- Predisposing risk factors
- Fever > 38
- Vascular Phenomena
- Immunologic phenomena
Which organisms cause acute endocarditis?
Staph, strep pneumo which infect normal native valves
What is the presentation of acute endocarditis? How is this diagnosed?
- New murmur in a patient who is sic with persistent bacteremia leading to valve destruction.
- Diagnose with a unch of cultures to watch for clearance and start antibiotics right away
What is the presentation of subacute endocarditis?
- Roth spots in the eyes
- Janeway lesions (painless hands)
- Splinter Hemorrhages (Nailbeds)
- Osler nodes (Painful distal digit pulp)
How is infective endocarditis diagnosed?
- Acute: Keep getting cultures until bacteremia clears but then get a TEE
- Subacute endocarditis: Get a culture when you notice lesions. Bacteremia? Get a TEE
How long is infective endocarditis treated?
6 weeks
How is infective endocarditis treated with antibiotics in a native valve?
Vanc
What is the antibiotic regimen for prosthetic valves?
- <60 days: Vanc, gent, cefepime
- 60-365: Vanc, gent
- Over 365: Vanc, gent, ceftriaxone
When does an endocarditis valve need to go to surgery?
- >15 mm without embolization
- >10 mm + embolization
- Abscess
- Valve destruction or CHF
- Fungus
What are the prophylaxis measures for a bad valve?
Congenital heart disease, prosthetic valve, history of endocarditis?
- Amoxiciillin
- Cefazolin
- Clindamycin
What are the prophylaxis measures for a dental procedure?
Amoxicicillin
Cefazolin
Clindamycin
Treatment for urethritis
- Ceftriaxone + Doxy or Azithromycin
What is the treatment for cystitis?
TMP-SMX or Nitrofurantoin or fosfomycin
What is the treatment for pyelo
IV cephalosporin if inpatient or PO fluoroquinolones outpatient
What is the treatment for a urinary tract abscess
Drain it and use IV cephalosporin inpatient or PO FQ outpatient
What do you do after treating someone who is pregnant with a UTI?
Confirmation of eradication by urine cultures
Treatment difference between complicated and uncomplicated urethritis
Uncomplicated? 3 days. Complicated? 7 days
What is the treamtent for cellulitis?
Group A strep and Staph aureus infection, so use first gen cephalosporin or antibiotics that cover MRSA like bactrim or clindamycin
What causes you to suspect meningitis? What do you do after?
- Check for fever and headache
- Blood cultures, Antibiotics and Lumbar puncture
What LP findings show bacterial meningitits? What do you do after you find this?
- Increased cell count with tons of neutrophils
- Decreased glucose
- Increased protein
- Tx: Ceftriaxone, vanc, steroids and ampicililn if immunocompromised
What will make you think encephalitis and not meningitis?
Fever, headache and confusion
What should be considered before doing an LP?
FAILS menmonic
- F: Focal neurological deficits
- A: AMS
- I: Immunocompromised
- L: Lesion
- S: Seizures
How is the definitive diagnosis of HSV made?
PCR
What should clue you in to an abscess vs cancer?
Brain biopsy is needed and will show organisms in an abscess requiring drainage or cancer requiring radiation and chemo
Presentation of syphilis and test to confirm?
- Presentation: Painless firm ulcer with lymphadenopathy
- Test:
- Primary: Dark field
- Secondary: RPR
- Tertiary: LP
Presentation and tests for Ducreyi?
Painful singular ulcer with lymphadenopathy. Gram stain and culture
What is the presentation and test for LGV?
Painless singular ulcer that requires no test
What is the presentation and test to confirm herpes?
Roofed painful vesicles with an erythematous base tested with HSV PCR
2+1 treatment for HIV
2NRT-I and 1 of the following…
- 1 NNRTI
- 1 PI/r
- 1 Integrase inhibitor
- 1 Fusion inhibitor
What drugs are in PrEP? PEP? What HIV drug do you use in pregnancy?
- PrEP: Emtricitabine and tenofovir
- PEP: EMtricitabine and tenofovir +/- Raltregravir
- Pregnancy: AZT at the time of delivery
Define AIDS
CD4 under 200 or the presence of an opportunistic infection
When do you have to prophylax for PCP pneumonia and what do you do?
1st bactrim then dapsone (if allergic to bactrim) then atovaquone (if G6PD deficient) at CD4 level 200
When do you prophylax for toxo and what do you do?
Bactrim and pyrimethamine at under 100
When do you prophylax for MAC?
Azithromycin at CD4 under 50
What are the RIPE side effects?
- R: Red Urine
- I: Neuropathy
- P: Hyperuricemia and gout
- E: Eye disturbance
What is the presentation of tuberculosis
Night sweats, fever, weight loss, hemoptysis and cough
What is the diagnostic process of tuberculosis?
- Asymptomatic screen performed on people who arent symptomatic but require proof of their absence of exposure
- If positive exposure then do chest xray
- If this is positive then the person is infected and need an AFB Smear
- If positive then active infection and ripe
- If negative then INH + B6 x 9 months
- If negative then INH + B6 x 9 months
- If this is positive then the person is infected and need an AFB Smear
What are the cutoffs for + PPD screening
- 5 mm (immunosuppressed)
- HIV, organ transplant, steroids, TB
- 10 mm “exposed”
- Incarcerated
- Healthcare provider
- Endemic areas
- 15 mm “not exposed”
