Infectious Diseases Flashcards
His patient who comes in with PCP pneumonia + PO2 35. What should be started along with TMP-SMX to reduce morbidity and mortality?
PREDNISONE
Treatment of PCP pneumonia in AIDs patient
TMP-SMX
-if TMPS-SMX causes rash: IV pentamidine
PCP is usually common in patients with HIV who have CD4 <200.
Empiric treatment for nosocomial infections not associated with ICU or ventilators include:
Levofloxacin Ceftriaxone Ciprofloxacin Ampicillin/sulbactam Piperacillin/tazobactam Ertapenem
Empiric treatment for acinetobacter baumannii
Imipenem
MCC of pneumonia in patients 6wks-18 years
RSV
Mycoplasma
Chlamydia pneumoniae
Streptococcus pneumoniae
MCC of pneumonia in patients 18-40 years
Mycoplasma
C. Pneumoniae
S. Pneumoniae
MCC of pneumonia in patients 40-65 years of age
S. Pneumoniae H.influenza Anaerobes Viruses Mycoplasma
MCC of pneumonia in elderly
S. Pneumoniae Viruses Anaerobes H. Influenza Gram positive rods
3 MC Atypical pneumonia
Mycoplasma
Legionella
Chlamydia
Diagnostic test for legionella pneumonia
Urine legionella antigen test
Diagnostic test for chlamydia pneumoniae
Serologic testing, PCR
Diagnostic test for mycoplasma
Serum cold agglutinins
Serum mycoplasma antigen
MCC of pneumonia in a patient with COPD
S. Pneumoniae
H. Influenza
MCC of pneumonia in a patient with recent viral infrction
S. pneumonia
Staph. Aureus
Treat outpatient pneumonia with:
Macrolides (azythromycin, clsrithromycine) or doxycycline
Patients with comorbidities or recent antibiotic use:
-Fluoroquinolones (levofloxacin, moxifloxacin)
Treat inpatient pneumonia with:
Ceftriaxone + azythromycin
Or
Fluoroquinolones alone
Treat HAP with:
- Anti pseudomonas cephalosporins
- cefepime or ceftazidime - Anti pseudomonas penicillins
- Piperacillin/ tazobactam - Cabapenems
Treat ventilator associated pneumonia with:
1 imipenem/meropenem, Piperacillin/tazobactam or cefepime/ceftazidime Plus 2. Gentamicin or Quinolones Plus 4. Vancomycin or Linezolid
What should be done for patients who have negative AFS but high suspicion of TB
Bronchoscope with Bronchoalveolar lavage
Side effect of Ethambutol
Optic neuritis
Complications of pharyngitis
Rheumatic fever
Glomerulonephritis
Paritonsillsr abscess
How does peritonsillar abscess present
Odynophagia Trismus(lockjaw) Muffled voice Unilateral tonsillitis enlargement Uvula and soft pallate deviated AWAY from the affected side
Most common organisms for sinusitis and otitis media
S.pneumonia
H.influenza
M. Catarrhalis
Best initial and most accurate test for sinusitis
Best initial: x-Ray
Most accurate: sinus aspirated for culture
Culture is more accurate than CT and MRI
Best initial and most accurate therapy for otitis media and sinusitis
Best initial: amoxicillin
Most accurate: OM- tympanic entasis and aspirate of tympanic membrane for culture
Close contact of patients with meningococcal meningitis should receive ppx with:
Rifampin/ ciprofloxacin/ Ceftriaxone
What medication should be given along with antibiotics for S. Pneumonia meningitis
Dexamethasone
Empiric treatment for meningitis caused by S. Pneumonia and N. meningitis:
IV Vancomycin + Ceftriaxone/Cefotaxime
Empiric therapy for meningitis caused by Listeria:
Ampicillin
Most common organisms causing meningitis is 6wk-6months infants:
GBS
E. Coli
Listeria
Empiric treatment for meningitis in 6wks-6months
Ampicillin + Cefotaxime or gentamicin
Most common causes of meningitis in 6months-6 years:
S.pneumonia
N. Meningitidis
H.influenza
Enterovirus
Most common cause of meningitis in 6years-60years:
N. Meningitidis
S. Pneumonia
Enterovirus
HSV
Most common cause of meningitis >60years:
S. Pneumonia
Gram negative rods
Listeria
N. Meningitidis
Infections at increased risk with CD4 >200 in an HIV + patient:
Varicella Herpes simplex TB oral/vaginal candida Bacterial pneumonia Kaposi Sarcoma
Infection associated with CD4 <200 and PPX + Tx
PCP PPX: TMP-SMX - if rash: Atovaquone or dapsone (Do not use dapsone for G6PD def.) Tx: TMP-SMX - if rash: IV pentamidine
Infections associated with CD4 <100 and treatment
Toxoplasmosis
Tx: Pyrimethamine and sulfadiazine for 2 weeks
Infections associated with CD4 <50 and PPX + treatment
MAC: PPX: azithromycin Tx:Clarithromycin and ethambutal
CMV: Tx: Gancyclovir or Foscarnet
-Valacyclovir for life long therapy
Cryptococcus: Tx: Amphotericin followed by Fluconazole
most common cause of death in patients with HIV:
TB
empiric treatment for infective endocarditis
vancomycin + gentamicin
when in surgery needed in infective endocarditis
Valve rupture prothetic valve Abscess Fungal endocarditis Embolic events while on antibiotics
What cardiac defects require PPX for endocarditis
Prothetic Valve
Unrepaired congenital heart defect
previous endocarditis
Heart transplant patients with valve disease
Procedures that need PPX treatment
Dental procedures that cause bleeding : use amoxicillin or clindamycin
Respiratory tract surgery
Surgery of infected skin
Adverse effects of amphotericin B
Renal toxicity
Hypopkalemia
Metabolic acidosis
Flu like symptoms
Infectious mononuclesis: diagnosis
clinical: presents like strep along with splenomegaly
CBC: elevated WBC with ATYPICAL LYMPHOCYTES
Heterophil antibody (monospot test)
-if negative but suspicion is high–> EBV specific antibody test
infectious mononucleosis: treatment
Supportive (acetaminophen)
self-limited infection
empiric therapy for aspiration pneumonia
clindamycin
