Infectious Disease Flashcards
Patients who are undergoing cardiothoracic or orthopedic surgery should be screened for what?
Nasal carriage of S. aureus. If positive, decolonize
First line therapy for coccidiomycosis?
Fluconazole, may need for life if diagnosing with meningitis
Consider amphotericin B if not responding to azoles
May present as acute/chronic pulmonary infection, cutaneous infection, meningitis or MSK infection
Empiric therapy for severe CAP (requiring ICU admission)
1) Strep pneumo, h flu and gram-negative bacilli covera with a beta lactam (ampicillin-sulbactam, cefotaxime, ceftriaxone, ceftaroline) PLUS
2) Legionella coverage (macrolide or quinolone)
Studies for FUO (defined as fever for 3+ weeks, undiagnosed after two ambulatory visits)
CBC with diff, CMP, blood culture set x3, ESR, TB eval, HIV testing, consider imaging with CT of C/A/P
How to diagnose suspected invasive aspergillus infection
Serum galactomannan, if negative consider BAL/Bronchosocopy
Consider invasive aspergillus in patients with:
1) prolonged neutropenia
2) SCT/Solid organ transplant
3) Fever, cough, chest pain and hemoptysis with pulmonary infiltrates/wedge-shaped densities on imaging
Leptospiral meningitis diagnostic criteria
1) Biphasic illness (weeks after exposure)
2) Uveitis
3) rash
4) Conjunctival suffusion (key finding)
5) Sepsis
6) LAD
7) AKI
8) HSM
Rapidly growing, nontuberculous mycobacterial findings
Chronic, nonhealing wounds anywhere the bacteria has been introduced that do not respond to typical therapy for skin/soft tissue infection
1) Mycobacterium fortuitum (pedicures, freshwater footbath)
2) Mycobacterium abscessus
3) Mycobacterium chelonae
PID vs cervicitis therapy
PID: IM ceftriaxone and doxy
Cervicitis: IM ceftriaxone and azithromycin
PEP regimen for HIV exposure
Tenofovir, emtricitabine, and dolutegravir (or raltegravir) for 4 weeks
Test for HIV at time of exposure, 4-6 weeks later, and 3 months after exposure
Patients with selective IgA deficiency are susceptible to what infection?
Giardia lambila (suspect with chronic abdominal cramping, bloating and diarrhea (usually nonbloody))
Most common cause of viral meningitis? Seasonality?
Enteroviruses - Mary to November
If winter time, consider HSV2, especially if recurrent benign lymphocytic meningitis (aka Mollaret meningitis).
No need for acyclovir with HSV-2 meningitis, outcomes are usually favorable. Contrast with HSV-1 encephalitis, which requires prompt treatment
Most common cause of viral meningitis? Seasonality?
Enteroviruses - Mary to November
If winter time, consider HSV2, especially if recurrent benign lymphocytic meningitis (aka Mollaret meningitis).
No need for acyclovir with HSV-2 meningitis, outcomes are usually favorable
Features of Brucellosis
Animal reservoir (sheep/goats)
- Mediterranean/Middle East
- Sx: Fever, HA, myalgias, arthralgias, depression
- Signs: HSM, LAD, Granulomas on reticuloendothelial tissues
- May present as relapsing/chronic
- Diagnosis: Serum agglutination (>1:160), Rose Bengal slide
- Treatment: Doxycycline, rifampin, streptomycin (or gentamicin) for several weeks. Substitute ceftriaxone for streptomycin in neurobrucellosis
CSF findings in sporadic Creutzfeldt-Jakob disease (CJD)
Positive for total Tau or 14-3-3 protein
Consider with progressive cognitive decline and vision loss
CSF findings in sproadic Creutzfeldt-Jakob disease (CJD)
Positive for total Tau or 14-3-3 protein
Consider with progressive cognitive decline and vision loss
Babesiosis
- Intraerythrocytic protozoan infection
- Black-legged deer tick, seen in areas of Lyme
- Sx: fever, fatigue, myalgia, jaundice, HSM
- Findings: Hemolytic anemia (Not seen in HME/anaplasmosis), thrombocytopenia, AKI, ARDS, elevated liver enzymes
- Maltese cross, get peripheral smear
- Severe illness more likely in asplenia
Treatment: atovaquone and azithromycin
- if severe: Clinda + quinine +/- exchange transfusion (parasitemia >10%)
Treatment for cyclospora parasitic infection
TMP-SMX DS x7-10d
Endemic in Peru, Guatemala, Haiti and Nepal
Modified acid-fast staining will demonstrate oocysts
Treatment for cyclospora parasitic infection
TMP-SMX
What screening test should be performed while taking Ethambutol?
Vision screening
Can cause optic neuritis affecting acuity and color vision
Hepatitis A travel vaccination recommendations
Ideally 2-4 weeks before departure as a single dose
Can give a single dose any time before travel
A booster can be given between 6 and 18 months after the initial vaccination, provides up to 10 years of protection
Hepatitis A travel vaccination recommendations
Ideally 2-4 weeks before departure as a single dose
Can give a single dose any time before travel
ESBL MDR UTI - first line treatment
Carbapenem class
Sensitivities may indicate susceptibility to agents such as Pip-tazo, but the susceptibility breakpoint used does not often convey clinical success
Monitoring parameters for daptomycin
Kidney function and CK level
What should be added for treatment of osteomyelitis with residual hardware?
Rifampin
Preventative therapies for OI after HSCT
1) TMP-SMX for toxo/PJP
2) Antifungal therapy with posaconazole or voriconazole for the first several months after HSCT
3) Test and treat for CMV or empiric valgancyclovir/ganciclovir, however monitoring preferred d/t side effects of antiviral therapy (neutropenia)
Treatment for severe candidemia
Echinocandin
Fluconazole is good for prevention, not treatment of severe candidemia
Blood cultures with yeast are never a contaminant! Risk factors: - neutropenia - malignancy and chemotherapy - organ transplant - intravascular catheters - broad spectrum Abx - HD
Treatment for severe candidemia
Echinocandin
Blood cultures with yeast are never a contaminant,
Risk factors:
- neutropenia
- malignancy and chemotherapy
- organ transplant
- intravascular catheters
- broad spectrum Abx
- HD
Treatment for histoplasmosis
1) Itraconazole (6-12 weeks)
2) For severe/disseminated infection: Liposomal amphotericin B
Treatment for various bioterrorism agents (Anthrax, Smallpox, Plague, Tularemia)
Anthrax: ciprofloxacin, levofloxacin, moxifloxacin PLUS two additional agents
Smallpox: Supportive care +/- tecovirimat
Plague: Streptomycin/gentamicin
Botulism: Antitoxin, supportive care
Tularemia: Streptomycin/gentamicin or doxy/cipro if severe disease
Banana-shaped gametocytes are indicative of what?
Plasmodium falciparum spp
High degree of parasitemia (along with Plasmodium knowlesi)
CMV treatment in HSCT patients
Ganciclovir
Consider if >1 month since HSCT with non-specific symptoms (pneumonitis, esophagitis, colitis, hepatitis)
Treatment duration for VAP
7 days
Treatment for aeromonas hydrophila
Eval for nec fasc, provide GN coverage –> ciprofloxacin and doxycycline
Preferred treatment for candida esophagitis
Oral fluconazole
Consider EGD if not responding to therapy
Antibiotic duration for prevention of acute rheumatic fever if:
1) uncomplicated
2) with carditis, no valvular disease
3) with carditis and valvular disease
Treatment is penicillin G benzathine every 3-4 weeks
1) for 5 years or until age 21
2) for 10 years or until age 21
3) for 10 years or until age 40
*Note these treatments are for whatever duration is longer
Treatment for candidal esophagitis and thrush with known HIV
Trial oral fluconazole x14-21 days
If not responding in 72 hours, schedule EGD for further evaluation (HSV, CMV)
First line treatment for onychomycosis
Oral terbinafine (minimum 6 weeks)
Second line is itraconazole BID once weekly per month for two months (pulse therapy)
Clinical presentations for
1) Blastomycosis
2) Histoplasmosis
3) Coccidiomycosis
1) Cutaneous plaques/ulcerations, bone lesions with sinus tracts, GU involvement, CNS (rare)
2) Hilar lymphadenopathy, HSM, Pancytopenia, Adrenal Insufficiency
3) Skin lesions, lymph node involvement, meningitis, osteoarticular involvement
What causes a chronic, non-tender indurated facial mass in patient with diabetes/dental caries/malnutrition?
Treatment?
Cervicofacial actinomycosis
Mandible most commonly involved
Treat with penicillin
