infectious diseases Flashcards
most common clinical presentations of invasive group A strep (IGAS)
toxic shock, nec fasc, myositis, bacteremia, pneumonia
risk factors for IGAS in children
pharyngitis, varicella, soft tissue trauma, NSAID use
who is at risk for secondary spread of IGAS?
household contacts, nosocomial
Which conditions classify as “severe” IGAS
Strep TSS, soft tissue necrosis (NF, myositis, gangrene), meningitis, pneumonia (with isolation of GAS from a sterile site such as pleural fluid), any other life threatening condition or infection resulting in death
What qualifies IGAS as being “invasive”
isolation of GAS from normally sterile site, with or without clinical evidence of severe invasive disease
what are the criteria for strep TSS
HYPOTENSION (<5th% for age in children) AND >= 2 of the following signs:
-renal impairment (creatinine 2x ULN for age or 2x patient’s baseline)
-coagulopathy (platelets <=100 or DIC)
-LFT abnormalities
-ARDS
-Generalized erythematous macular rash that may later desquamate
Which presentations classify as “non-severe” IGAS?
bacteremia, cellulitis, wound infections, soft tissue abscesses, lymphadenitis, septic arthritis, osteomyelitis, without evidence of strep TSS or soft tissue necrosis
what is the empiric treatment for suspected TSS?
staph and strep TSS clinically indistinguishable therefore cover for both with beta-lactamase stable beta lactam (ie. cloxacillin) in combo with clindamycin. Can also add Vanco if concerns for MRSA
what is empiric antibiotic choice for nec fasc?
pip-tazo or a carbapenen with Clindamycin
what is treatment of choice for confirmed GAS infection?
Penicillin with clindamycin (clindamycin added because its good and inhibiting toxins)
other than antibiotics, what is another treatment for strep TSS?
IVIG—help get rid of the toxins
which med should you use cautiously in ppl with IGAS?
NSAIDs
Who is considered a close contact of someone with IGAS who would be offered chemoprophylaxis?
household contacts, ppl who have shared a bed with or had sex with index case, direct contact with mucous membranes or oral or nasal secretions, direct contact with open skin lesion of index case, injection drug users who have shared a needle, home daycares
which antibiotics are options for chemoprophylaxis for IGAS?
1st gen cephalosporin ex. cephalexin x 10 days
alternatively 2nd or 3rd gen cephalosporin
penicillin is less effective in eradicating GAS colonization than cephalosporins
