Infectious Disease KPs Flashcards
Spinal epidural abscesses often arise from? Risk factors?
infected vertebral discs or intervertebral body disc spaces;
Needles (injections, acupuncture, tattoos); HIV, DM, alcoholism
Temporal lobe encephalitis - likely infection? CSF will likely show?
HSV; lymphocytic pleocytosis
All patients suspected of having encephalitis should be given?
Empiric intravenous acyclovir
preferred diagnostic test for West Nile neuroinvasive disease?
Cerebrospinal fluid serology (IgM)
In community-associated methicillin-resistant Staphylococcus aureus infections, the primary treatment of a cutaneous abscess?
I&D (no abx)
Monomicrobial (type II) necrotizing fasciits - causal agents?
Streptococcus pyogenes»_space;> S. aureus, Vibrio vulnificus, or Streptococcus agalactiae
Treatment for all human bites?
Prophylactic amoxicillin-clavulanate
Hospitalize a patient with PNA?
CURB-65 -
confusion, blood urea nitrogen >20 mg/dL (7.14 mmol/L), respiratory rate ≥30/min, blood pressure (systolic <90 mm Hg, diastolic ≤60 mm Hg), and age 65 years or older
Do not treat community acquired PNA for more than?
5 days
Minimal findings to diagnose lyme disease?
what may be falsely negative in localized disease?
erythema migrans with a compatible epidemiologic history
serologic testing is not indicated and may be falsely negative in localized disease.
best way to confirm the diagnosis of disseminated Lyme disease?
two-step serologic testing strategy that uses an enzyme-linked immunosorbent assay as an initial screening test followed by a confirmatory Western blot
illness that is clinically indistinguishable from localized Lyme disease?
Southern tick-associated rash illness (STARI);
Treatment for Babesiosis?
atovaquone plus azithromycin (mild to moderate disease)
clindamycin plus quinine (for severe disease)
Exchange transfusion if 10% or greater parasitemia or organ failure
Treatment for RMSF in pregnancy?
chloramphenicol
A culture of midstream, clean-void urine should be reserved for patients with?
suspected pyelonephritis,
complicated urinary tract infection,
recurrent urinary tract infection, or
multiple antimicrobial allergies and in those in whom the presence of a resistant organism is suspected.
Fosfomycin has lower efficacy and is more expensive than? (these drugs can be used for)
nitrofurantoin or trimethoprim-sulfamethoxazole
UTI ppx in women with recurrent UTIs
Treatment choice and duration of uncomplicated prostatitis?
FQ for 4-6 weeks
Role of nucleic amplification testing for TB?
Faster diagnosis, not not recommended yet
BCG is contraindicated in
patients who are pregnant or immunosuppressed (live attenuated)
Mycobacterium kansasii infection mimics?
TB ( cough, fever, weight loss, and cavitary lung disease.)
Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae infections are seen in? Typical infection?
immunosuppressed patients; Skin/soft tissue infection after trauma or surgery or cosmetic procedures (tattoo, piercings)
Do not use an echinocandin to treat this candidal infection?
meningitis or endophthalmitis because of poor organ penetration.
Treatment of asymptomatic candiduria is indicated only in?
neutropenic patients and those undergoing urologic procedures.
most common presentation of mucormycosis?
apidly fatal rhinocerebral infection, with
1) headache
2) epistaxis
3) ocular findings (proptosis, periorbital edema, and decreased vision).
Assay for cryptococcus? Use when suspect?
latex agglutination assay; Meningitis
Maintenance therapy is indicated for patients with AIDS and cryptococcal meningitis until?
CD4 cell count ≥100/μL for ≥3 months) and have been receiving antifungal therapy for at least 1 year.
Pulmonary complications of histoplasmosis?
granulomatous mediastinitis, fibrosing mediastinitis, broncholithiasis, pulmonary nodules (histoplasmomas)
Primary coccidioidomycosis infection most frequently presents as?
community-acquired pneumonia occurring 1 to 3 weeks after exposure
therapy of choice for cutaneous and osteoarticular sporotrichosis
Itraconazole
Exserohilum rostratum? How does one get the infection? Treat with?
Mold, meningitis in patients who received epidural or paraspinal injections (contamined methylpred); Treat with voriconazole
Who gets annual Chlamydia screening?Gonorrhea?
MSM; Sexual active women under 24
High risk women; MSM
Pt with syphillis - who else gets tx?
Sexual partners exposed within the preceding 90 days of diagnosis should receive treatment regardless of serologic results.
presents with a genital papule or ulcer followed by tender unilateral inguinal lymphadenopathy.
Lymphogranuloma venereum
pathognomonic of chronic osteomyelitis infection in the bone?
draining sinus tract
Treatment difference between acute and chronic osteo?
chronic osteomyelitis can be treated with oral agents alone
Signs of osteo in a diabetic foot ulcer?
Ulcers present for 2 weeks or longer, ulcer size greater than 2 cm, grossly visible bone or the ability to probe to bone, and an erythrocyte sedimentation rate greater than 70
Common variable immunodeficiency is diagnosed by?
confirming low levels of total IgG and IgA or IgM, as well as by a poor antibody response to vaccines.
What does an abnormal CH50 mean? Who should be screened for CH50 activity?
Deficit in a complement pathway.
Patients with recurrent bloodstream infection with encapsulated bacteria or invasive meningococcal or gonococcal disease
Postexposure prophylaxis for anthrax?
Cipro or doxy
Symptoms of botulism?
classic triad of symmetric, descending flaccid paralysis with prominent bulbar signs, absence of fever, and normal mental status.
Preferred antibiotics for typhoid fever?
ceftriaxone, fluoroquinolones, and azithromycin.
brucellosis - key features?
fever, myalgia, arthralgia, fatigue, headache, and night sweats, often with depression
Problem of Abx for salmonella? When to treat?
may lead to prolonged asymptomatic shedding
Severe salmonellosis
Treatment of giardiasis?
metronidazole
Test of choice for amebiasis?
stool antigen»_space; O&P
Treatment for cyclospora? If intolerant?
Bactrim; Cipro
Diagnosis of acute HIV infection relies on detecting the virus by?
RNA polymerase chain reaction or p24 antigen testing.
Fourth-generation HIV testing?
HIV antibody enzyme immunoassay + a test for HIV p24 antigen;
a positive test result is followed by HIV-1/HIV-2 antibody differentiation immunoassay.
Before treatment for latent tuberculosis?
Before prophylaxis against Mycobacterium avium complex (MAC) infection begins?
active tuberculosis infection must be ruled out in patients with a positive tuberculin skin test result or a positive result on interferon-γ release assay;
active MAC infection must be ruled out in patients with a CD4 cell count less than 50/μL.
Main side effects of HIV and its meds?
But Interrupting HIV therapy is associated with increased infections and also?
hyperlipidemia, glucose intolerance, and diabetes mellitus
Increased cardiovascular events
If IRIS is severe, can add?
steroids
When should HIV resistance testing be done?
when antiretroviral therapy is initiated and when treatment failures occur
Preexposure reigmen?
Postexposure prophylaxis for HIV should include?
tenofovir-emtricitabine
3 drug regimen
EBV with compromised airway or hemolytic anemia - start this med?
steroids
New zoster vaccine?
Inactivated for everyone
typically indicated in cases of cytomegalovirus reactivation in immunocompromised patient?
Ganciclovir
Tedizolid v linezolid?
more potent, works against linezolid resistant organisms, and lower risk of thrombocytopenia
active against multidrug-resistant strains of Pseudomona?
Ceftolozane-tazobactam
Tigecycline effective against?
MRSA, VRE, and penicillin-resistant S. pneumoniae, CRE, mycoplasma
(not pseudomonas)
colistin - used for? Toxicity?
MDR GNRs (pseudomonas)
Nephrotoxic
