Infectious Diseases Flashcards
Most common CAP vs Nosocomial pneumonia
CAP=Strep. Pneumo
Nosocomial=E. coli, Pseudo, and S. Aureus
Atypical pneumonia common bugs and signs
Mycoplasma pneumonia, Chlamydia pneumonia, Coxiela, legionella, influenza
Dry cough, headache, sore throat
Normal pulse with high fever
Legionella common demographics
Organ transplant recipeients, renal failure, patients with chronic lung disease, and smokers
Nursing home residents common infection
Psuedomonas predilection for upper lobes
CD4 count less than 500 infections
Tb, recurrent pneumonias, vaginal candidiasis, and herpes zoster
CD4 count less than 200 infections and prophylaxis
pneumocystis jirovecii, cryptococcis (treat with IV amphotericin B plus flucytosine and chronic suppression with fluconazole, frequent lumbar punctures), histoplasmosis, or cryptospordiosis
Prophylaxis with TMP-SMX for pneumocystis one double strength tablet daily
P02 less than 70 and A-a gradient more than 35 have poor prognosis and should be given prednisone before TMP-SMX
CD4 count less than 50 infections
Mycobacterium aviium intracellulare complex, disseminated histoplasmosis, CMV retinitis, colitis, adrenalitis, and esophagitis (IV ganciclovir, foooscarnet or cidofovir), CNS lymphoma (diagnose with stereotactic brain biopsy or with CSF for epstein barr virus)
MAC with CD4 count less than 50 treatment
Clarithromycin, ethambutol, and rifabutin for weeks
MAC prophylaxis-clarithromycin 500 mg twice daily
Azithromycin 1200 mg weekly
Don’t need concomitant HAART therapy with prophylaxis once CD4 counts recover
CD4 count less than 100
Prophylaxis with daily dosing of TMP-SMX
toxoplasmosis (sulfadiazine and pyrimethamine)
CURB 65 guidelines
Confusion Uremia >20 BUN RR >30 BP less than 90/60 >65 More than 2= inpatient More than 4=ICU
Outpatient younger than 60 with pneumonia bugs and treatment
S. pneumo, Mycoplasma, Chlamydia or legionella
Treatment: Macrolides (azithromycin or clarythromycin)
or doxycycline
For 5 days
Older than 60 or with comorbidiites outpatient pneumonia treatment
Fluroquinolone (levofloxacin, moxifloxacin)
Second or third cephalosporin
For 5 days
Co morbidities to consider for pneumonia
Heart disease, sickle cell, pulmonary disease, diabetes, alcoholic cirrhosis
Inpatient CAP treatment
Macrolides + cephalosporin
Or fluorquinolone
ICU CAP treatment
Cephalosprin + macrolide (IV)
Cephalsoprin + flluoroquinolone
Hospital acquired pneumonia (in hospital for >72 hours)
ceftazidime or cefepime
Imipenem
piperccillin/tazobactam
Ventilator associated pneumonia diagnosis and treatment
Diagnosis: new inflitrate on CXR, purlent secretion from endotracheal tube
Bronchoalveolar lavage
Treatment: 3 drugs
- ceftazdimine/cefipime OR pipercillin/tazobactam OR carbapenem (Pseudo)
- Aminoglycoside or fluoroquinolone (Pseudo)
- Vanco or linezolid (gram +)
Lung abscess treatment
Postural drainage
Antibiotics:
Gram positive: ampicillin or amoxicillin/clavulanic acid, ampicillin/sulbactam, or Vanco
Anaerobes: clinda or metro
Gram negative: fluoroquinolone or ceftazidime
Continue until cavity is gone or until CXR have improved considerably
Results of PPD test results and treatment
Used for latent TB not active TB (active TB order a sputum culture)
Positive if >15 mm in patients with no risk factors
High risk (high prevelance areas, immigrants, health care workers, nursing home residents, close contact with TB, alcoholics, diabetics)=10 mm positive
HIV, steroid users, organ transplant, close contact with active TB, radiographic evidence of primary TB=5 mm is positive
Never have had a PPD test before do another test in 1-2 weeks
If positive use chest X ray to rule out active disease-if excluded use 9 months of isoniazid (even if have had BCG vaccine)
Treatment of TB
2 months of RIPE (or streptomycin) and then 4 months of INH and rifampin
Ages and treatment of suspected meningitis
less than 4 weeks: aminoglycoside
Infants (less than 3 mos): cefotzxime +ampicillin +vanco
3 mos to 50 years: ceftriaxone or cefotaxime + vanco
greater than 50: ceftriaxone or cefotaxime+vanco+ampicilin
Impaired cellular immunity: ceftazidime +ampicilin +vanco
Aseptic is supportive