Infectious Diseases (5-10%) Complete Flashcards
CNS Infections: Meningitis vs Encephalitis
Meningitis
Predominantly starts with ______, ______, and ______ and can get ______ later into the course.
Encephalitis
Predominantly starts with _____ and _____ and can get _____, _____
CNS Infections: Meningitis vs Encephalitis
Meningitis
It predominantly starts with headache, neck stiffness, and fever and can get altered LOC later into the course.
Encephalitis
Predominantly starts with altered LOC/mental status and fever and can get seizures, focal neurological
changes associated.
Meningitis:
Most sensitive sign?
Jolt accentuation – high sensitivity (97% in one study)
Meningitis:
Most specific sign?
Kernig’s and Brudzinski’s signs – high specificity, poor sensitivity
Basal skull meningitis:
– _________, _______ signs
– Organisms: Think _____, _____, _____, _____, _____
Basal skull meningitis:
– + CN palsies, long-tract signs
– Think TB (LEPTOMENINGEAL ENHANCEMENT), Listeria, Cryptococcus, Syphilis, Lyme in correct host
Suspicion for Bacterial Meningitis:
When to do CT head?
Individual CSF predictors for bacterial meningitis each with > 99% certainty:
- Glucose _____________
- CSF: blood glucose _____________
- Protein _____________
- WBC _____________
- PMNs _____________
Individual CSF predictors for bacterial meningitis each with > 99% certainty:
- Glucose < 1.9 mmol/L
- CSF: blood glucose < 0.23
- Protein > 2.2 g/L
- WBC > 2000 cells/mL
- PMNs > 1180 cells/mL
Meningitis:
Age 18-50:
Common bacterial pathogens?
Antimicrobial Rx - Empiric?
Age > 50 or immunocompromised:
Common bacterial pathogens?
Antimicrobial Rx - Empiric?
Meningitis: Antibiotic, and treatment duration
- S. pneumoniae?
- N.meningitidis
H. Flu - L.monocytogenes
Steroids in Meningitis
Only helpful in __________
Dose?
Do not start if _____________
Only helpful in S. pneumoniae (50% reduction in mortality/morbidity)
Dose? Dexamethasone 10 mg IV q6h for 4 days PRIOR TO or WITH the first dose of antibiotics
Do not start if antibiotics have already been given to the patient
Neisseria meningitis – CHEMOprophylaxis
Who?
____________
____________
____________
____________
____________
____________
When?
____________
What to give?
____________
OR ____________
OR ____________
Who?
– Household contacts
– Persons sharing sleeping arrangements
– Persons who have direct nose/mouth contamination w oral/nasal secretions (Kissing)
– Children and staff in childcare or nursery
– HCWs who have had intensive unprotected contact (without wearing a mask) (eg. intubating, resuscitating, closely examining the oropharynx)
– Airline passengers sitting immediately on either side of the case (but not across the aisle) when total time on aircraft > 8 hours
When?
– Within 10 days usually
What to give?
– Ciprofloxacin 500mg PO X 1 dose (increasing resistance concern)
– OR ceftriaxone 250mg IM X 1 dose
– OR rifampin 600mg PO BID X 2d
N. meningitis – IMMUNOprophylaxis
Who?
____________
____________
____________
____________
What to give?
____________
Who?
– Household contacts of a case of invasive
meningococcal disease (IMD)
– Persons sharing sleeping arrangements with a case of IMD
– Persons who have direct nose/mouth contamination
with oral/nasal secretions of a case with IMD
– Children and staff in contact with a case of IMD in
childcare or nursery school facilities
What to give?
– Meningococcal vaccine (Men-C-ACYW or 4CMenB can be considered)
- If more than one year since the last meningococcal vaccine, then vaccinate again
IE Workup:
Diagnostic workup
– at least ___ sets of blood cultures prior to _______
– Initial ____ for everyone
Diagnostic workup
– at least 2 sets of blood cultures prior to antibiotics (3 in 2015 IE statement)
– Initial TTE for everyone
TEE
Class I indications?
- TTE nondiagnostic or
- IE complications suspected or
- intracardiac leads
(TEE widely used these are just the Class I – eg consider if staphylococcal, enterococcal, fungal infections)
IE – Diagnosis
IE – Antibiotic Treatment:
- MSSA native valve
- MSSA Prosthetic valve
- MRSA native valve
- MRSA prosthetic valve
- CNST native
- CNST prosthetic
- Streptococcus viridans
Duration of treatment?
In patients with _____-sided IE caused by Streptococcus, E. faecalis, S. aureus, or CNST deemed stable by the multi-D team on IV antibiotics
– ____ before the switch to oral therapy
– Follow-up ____ can be performed 1-3 days before the completion of the abx course
In patients with left-sided IE caused by Streptococcus, E. faecalis, S. aureus, or CNST deemed stable by the multi-D team on IV antibiotics
– TEE before the switch to oral therapy
– Follow-up TEE can be performed 1-3 days before the completion of the abx course
Infective Endocarditis:
CLASS I Surgical Indications
IE – Class II Surgical Indications
IE - Prophylaxis;
Patient population
______________________ (Not indicated for ______)
______________________
______________________
______________________
Procedures
______________________
______________________
______________________
NOT FOR __/___/___ procedures
Regimen?
______________________
CAP - Pathogens:
Most common?
Severe disease?
Post-influenza pneumonia?
CAP – Outpatient Treatment
- Healthy outpatients without comorbidities or risk factors
________________________
________________________
________________________ - Outpatients with comorbidities
________________________
________________________
CAP – Inpatient Treatment
- Inpatients, non-severe, without risk factors for MRSA or PsA: _________________
- Inpatients, severe CAP, without risk factors for MRSA or PsA: _________________
- Aspiration Pneumonia
- What about Legionella?
CAP:
- Duration of treatment? _______________
- Steroids? _______________
- Influenza?
– __________ if hospitalized regardless of the duration of symptoms
HAP/VAP:
Empirical Treatment? ___________________
Duration of treatment? ___________________
Diarrhea: Diagnosis
• Stool cultures:
for __________, __________, __________, __________, __________ in patient with diarrhea AND:
– __________
– __________
– __________
– __________
– __________ or __________
– (__________ in large volume rice water stools)
• Stool cultures:
for Salmonella, Shigella, Campylobacter, Yersinia, STEC in patient with diarrhea AND:
– Fever
– Bloody or mucoid stools
– Severe abdominal pain
– Sepsis
– Immunocompromise or outbreak exposure
– (V. Cholerae in large volume rice water stools)
Diarrhea: Diagnosis
C. difficile testing in patients with:
– __________
– Work in __________/__________ or __________
– __________ syndrome
– __________ flare
C. difficile testing in patients with:
– Recent antibiotics
– Work in healthcare/LTC or prison
– Compatible syndrome
– IBD flare
Diarrhea: Diagnosis
Blood cultures in patients with:
– __________
– __________
– Suspicion of __________
Blood cultures in patients with:
– Immunocompromise
– Sepsis
– Suspicion of enteric fever
Diarrhea: Diagnosis
Stool for Ova and Parasites in patients with:
– Diarrhea __________ days
– __________
– __________
– *Increased yield if ordered __________
– Repeat up to __________ to increase yield if high suspicion
Stool for Ova and Parasites in patients with:
– Diarrhea ≥ 14 days
– Immunocompromise e.g. HIV
– Travel
– Increased yield if ordered daily x 3 days
– Repeat up to 3x to increase yield if high suspicion
Diarrhea - Treatment
• Empiric therapy in adults with bloody diarrhea not recommended UNLESS:
1. _________________
2. _________________
3. _________________
Empiric therapy in adults with bloody diarrhea not recommended UNLESS:
1. Sick immunocompetent patients with bacillary dysentery (frequent scant bloody stools, abdominal pain, tenesmus, fevers), suggestive of Shigella
2. Recent travel with high fever (≥ 38.5) and/or sepsis
3. Sick immunocompromised patients
Diarrhea - Treatment:
Empiric antibiotic choice: __________ or __________
Empiric antibiotic choice: ciprofloxacin or azithromycin
Diarrhea - Treatment:
First choice:
- Campylobacter: _____________________
- S. enterica typhi or paratyphi: _____________________
- Shigella: _____________________
- Vibrio cholerae: _____________________
- Yersina enterocolitica: _____________________
- Non-typhoidal S. enterica, STEC (inc. O157): _________
C. difficile Infection (CDI) Diagnosis
Testing:
– Stool ____________ test - combinations
• ____________
• ____________
– ____________ on colonoscopy
Testing:
– Stool toxin test - combinations
• EIA for GDH, toxin
• NAAT PCR for toxin
– Pseudomembranes on colonoscopy
C. difficile Infection (CDI) Diagnosis
Criteria for severe C. difficile:
– WBC _______ OR serum Cr ____ x premorbid level
Criteria for severe C. difficile:
– WBC > 15 OR serum Cr 1.5 x premorbid level
– Other risk factors: Age > 65, immunosuppression, T > 38, Albumin < 30
C. difficile Infection (CDI) Diagnosis:
Fulminant C. difficile:
– ________, ________, ________, ________, toxic megacolon (colon dilation >__________)
Fulminant C. difficile:
– Sepsis, Shock, Ileus, perforation, toxic megacolon (colon dilation >6cm)
C. difficile Infection
First Episode Treatment:
1.1st episode (non-fulminant)
_______________________
_______________________
- 1st episode (Fulminant)
_______________________
C. difficile Infection Recurrence Treatment:
- First relapse (Within _______ months of previous infection)
_______________________
_______________________
_______________________ - ≥2nd relapse
_______________________
_______________________
_______________________
UTI – Empiric Treatment
First-line treatments and duration:
1. Acute Simple Cystitis
________________________
________________________
________________________
- Complicated UTI OR Pyelonephritis (Oral)
________________________
________________________ - Complicated UTI OR Pyelonephritis (IV)
________________________
________________________
Syphilis treatment:
- PRIMARY, SECONDARY, EARLY LATENT: __________
- LATE LATENT or UNKNOWN DURATION, TERTIARY
SYPHILIS: __________ - NEUROSYPHILIS: __________
PRIMARY, SECONDARY, EARLY LATENT:
Benzathine penicillin G 2.4 mU IM x 1
LATE LATENT or UNKNOWN DURATION, TERTIARY
SYPHILIS: Benzathine penicillin G 2.4 mU IM weekly x3
NEUROSYPHILIS: Aqueous penicillin 4mU q4 hours IV x 14 days
Syphilis Test Interpretation
Purulent (Furuncle/Carbuncle/Abscess)
– __________ and __________ should be performed
Empiric treatment:
1. Moderate infection?
- Severe infection?
Purulent (Furuncle/Carbuncle/Abscess)
– I&D and C&S should be performed
Managing SSTIs: Non-Purulent
Non-Purulent (Impetigo/Erysipelas/Cellulitis) – Think _____________
Antibiotic treatment:
1. Mild severity
- Moderate severity
Duration of antibiotics:
Generally, ____ days, extend up to ___ days if no improvement at completion (not if simply persistent _________)
Non-Purulent (Impetigo/Erysipelas/Cellulitis) – Think Strep!
Necrotizing Fasciitis (NF):
Presentation? ___________________________________________
First step? ___________________________________________
Empiric antibiotics treatment? __________________________
– Consider ________ if shock or pre-operative
Types? _________________________________________________
_________________________________________________
Toxic Shock Syndrome (TSS):
Organism: _________, sometimes __________ – tampons, nasal packing
Diagnostic Criteria?
Management?
• __________ and __________ precautions*
• Antibiotics: __________ PLUS __________
• Chemoprophylaxis – __________ x __________days (__________ if PCN allergy)*
Organism: Group A Strep, sometimes S. aureus – tampons, nasal packing
Prosthetic joint infection?
Empiric treatment? ______________, add _______ for staphylococcal
When to remove the prosthesis?
Duration of treatment?
HIV – Initiation of ARV
ARV recommended for ________ with HIV, regardless of _______ to __________________ associated with HIV infection
ARV regimen should include ________ PLUS
______ OR
______ OR
______
First-line therapy?
ARV recommended for all individuals with HIV, regardless of CD4 count to reduce morbidity and mortality associated with HIV infection
ARV regimen should include TWO NRTIs PLUS
INSTI (Integrase Strand Transfer Inhibitor) OR
NNRTI OR
PI
TST Result and Situation in which reaction is considered positive
0-4mm: __________________
5mm:_____________________
> or equal to 10mm: ___________
0-4mm: Generally considered negative
Active TB and HIV
Malaria – Management:
Treatment of complicated Malaria?
Treatment to choose for uncomplicated P. falciparum Malaria?
Treatment to choose for uncomplicated
NON-P. falciparum Malaria?
If P. vivax or P. ovale, add _______ (check ___________ first) to treat the hypnozoite stage
Malaria – Management:
Treatment of complicated Malaria?
IV artesunate X 48h then PO
• Atovaquone-proguanil OR
• Doxycycline OR
• Clindamycin
Treatment to choose for uncomplicated P. falciparum Malaria?
CR (most common) Atovaquone-proguanil
Treatment to choose for uncomplicated
NON-P. falciparum Malaria?
CS (most common) Chloroquine
If P. vivax or P. ovale, add primaquine (check G6PD level first) to treat hypnozoite stage
Monkeypox Vaccination:
Indication for pre-exposure vaccination?
Indication for post-exposure vaccination?
Lyme Disease - Dx
Lyme Disease – Rx
Immunomodulating Therapy Work-up
Workup before starting prolonged steroids?
Prevention Strategies:
VAP
CLABSI (Central Line-associated Bloodstream Infection)
CAUTI
Precautions
Precautions (2)
Tetanus prophylaxis in wound management
• Rabies post-exposure prophylaxis
