Infectious Diseases Flashcards
MSSA
IV
Oral
Iv: oxacillin/naffillin or cetazolin (1 st gen cephalosporin
Oral: dicloxacillin or cephalexin (1st gen)
Mrsa
severe infection
Minor infection
Severe infection : vancomycin, linelozid, daptomycin, ceftaroline, tigecycline, telavancin
Minor: TMP/Smx, clindamycn Or doxy
Linezolid s/e
Thrombocytopenia
Daptomycin s/e
Myopathy
Rising CPK
PCN allergy
Rash
Anaphylaxis
Severe infection
Minor infection
Rash; safe to use ceph
Anaphylaxis: macrolides ))(azithro, clarityromyxin) Or clindamycin
Severe: vanc, linezolid, daptomycin, televancin
Minor; macrolides like azithro, clarithro
Or clarithro,TMP/smx
Streptococcus meds
PCN
Amoxicillin
Ampicillin
Blue box
If the organism is sensitive, pxacillin and nafcillin are superior to vanc
Exceptions
Ertapanem is the only carbapanem that does not cover pseudomonas
Piperacillin and Ticarcillin also covèr streptococcus And anaerobes
Levofloxacin, gemifloxafin and moxifloxacin are excellent! Pneumococcal drugs
Aminoglycosides work Synergistically with other agents to treat Staphylococcus and enterococcus
Carbapanems are Excellent! anti anaerobic meds. They cover streptococcus and mssa
Tigecycline covers Mrsa and is broadly active against gram neg bacilli. Tigecycline is weaker than other Mrsa drugs
GI anaerobes (bacteroides)
Metronidazole is the Best! Med for abdominal anaerobes but carcapanems, pipercacillon, And ticarcillin are equal in efficacy compared to metronidazole
Climdamycin! Is the Best drug for anaerobic streptococcus
Meds with no anaerobic coverage: Aminoglycosides, Aztreonam, fluoroquinolones oxac/nafcillin and all cephalosporins except cefoxitin and cefotetAn
VAnco: red man syndrome
What to do
Slow the rAte or infusion
Antiviral agents
Acyclovir valcyclovir And famciclovir (herpes simplex , varicella) Are All equal in efficacy
CMV
Fiscarnet
CMV retinitis
Valganciclovir
Valganciclovir And gAnciclovir s/e
Neutropenia And bone marrow suppression
Foscarnet s/e
Renal toxicity
Chronic hep c oral agents
Simeprevir
Sofosbuvir
Ledipasvir
Boceprevir
Hep c treatment in combination with interferon
Ribavirin
Ribavirin s/e
Anemia
Chronic hep b meds
Lamivudine Interferon Adefovir Tenofovir Entecavir Telbigudine
Itracanozole
Rarely the best initial therapy
Voriconazole
Best against Aspergillus
Voriconazole s/e
Some visual disturbance
Echinocandins like caspofungin
Micafungin
Anidulafungin
Excellent! Neutropenic fever patients
Fact about Echinocandins
They have no .s/e because they effect the 1,3 glucan synthesis step in fungi cell walls
Amphoterecin indications
Cryptococcus
Mucormycosis
Aspergillus
Voriconazole
Neutropenic fever pts
Echinocandins
Amphotericin s/e
Renal toxicity (switch to liposomal amphotericin Met acidosis Hypokalemia fever shakes and chills
Osteomyelitis what comorbodities?
Diabetes
Peripheral arterial disease
Or both with an ulcer or soft tissue infection
OSteomyelitis
Best initial
Best second
Most accurate
Plain x Ray
MRI
Bone biopsy and culture
Earliest finding on x Ray on osteomyelitis
Periosteal elevation
Osteomyelitis ccs
Move clock forward to get x Ray results unless they are negative
Osteomyelitis follows response to therapy
ESR
Greater sensitivity; mri or bone scan?
They are Equal!
MRI is way more specific though
Osteomyelitis treatment
Staphylococcus: most common
IV oxacillin or nafcillin
MRSA: vancomycin, linezolid, ceftaroline or Daptomycin
Osteomyelitis blue box
To treat osteomyelitis appropriately, a Bx or culture needs to be performed
Otitis externa
Swimmers eAr
Ofloxacin Ciprofloxacin Polymyxin/neomycin \+ Topical hydrocortisone to decrease swelling \+ Acetic avid and water solution
Malignant otitis externa
Best initial test
Most accurate test
CT or mri
Biopsy
Otitis media
Best initial therapy m
Most accurate test
Amoxicillin 7-10 days
Tympanocentesis: rarely necessary
Otitis media
Ccs tip
Move clock forward 3 days and if the infection is not improving ( switch to Amoxicillin- clavulanare Cefdnor Cefibuten Cefuroxime Cefprozil Cedpodoxime
Otitis media
Ccs tip
Move clock forward 3 days and if the infection is not improving ( switch to Amoxicillin- clavulanare (augmentin) Cefdnor Cefibuten Cefuroxime Cefprozil Cedpodoxime
Sinusitis
Best initial test
Most accurate
X Ray
Sinus aspirate for culture
Pharyngitis symptoms
Sore throat or pain
Exudate
Adenopathy
No cough/hoarseness
Pharyngitis
Best initial test
Most accurate test
Rapid strep test
Culture
Influenza
Dx testing
Viral rapid antigen detection
Influenza vaccination
COPD, CHF, dialysis patients, steroid use, health care workers and everyone >50
Important *** inhaled live attenuated vaccines for -<50
Egg allergy is no longer an absolute CI
Impetigo Tx
Mupirocin
RetApulin
Impetigo Tx Severe disease
Oral dicloxacillin
Cephalexin
Impetigo Tx Ca-MSSA
TMP/SmX
Linezolid is def effective
Clinda is sometime useful
Erysipelas
Best initial Tx
Confirmed
Oral dicloxacillin
Cephalexin
Penicillin VK
Skin goes to kidney
Throat goes to kidneys and heart
Erysipelas—> glomerulonephritis
Pharyngitis—> glomerulonephritis and rheumatic fever
Scalp antifungals
Terinafine- oncreased LFT
Itracanozole
Griseofulvin- less efficacy than the other two meds
Urethritis
Discharge without dysuria
Cystitis
Dysuria but no discharge
Disseminated gonorrhea
Polyarticular disease
Petechial rash
Tenosynovitis
Nucleic acid amplification test
Single best test for goborrhea and chlamydia
PID
Measure of severity
Leukocytosis
PID
Best initial test
Most accurate test
Pregnancy test then cervical cx then NAAT
Laporoscopy- rarely needed
PID tc
OP
IP
PCN allergic
OP: IM Ceftriaxone and oral doxy
IP : iV cefoxitin and doxy
PCN allergic: Clindamycin and gentamicin
Antibiotics safe in pregnancy
PCNs Cephalosporins Aztreonam Erythromycin Azithro
Epididymo-orchitis
Extremely painful and tender testicle with a normal position in the scrotum
Epididymo-orchitis Tx
>35
< 35
Fluoroquinolone
Ceftriaxone and doxycycline
Chancroid
Haemophilus ducreyi
Best initial test is gram stain and cx
Tx: single I’m shot Ceftriaxone and single oral dose of azithro
Lymphogranulosum venerum
Chlamydia trachomatos
Tx: aspirate the bubo. Treat with doxycycline or azithro
Herpes simplex virus type 2
Multiple vesicles/—> acyclovir valcyclovir Or famcyclovir for 7-10 days
Acyclovir is safe in pregnancy—> use if active lesions at 36 weeks
Acyclovir resistant herpes—> foscarnet
Mostt accurate test: viral cx
Primary Syphilis most accurate test
DArkfield microscopy
Secondary syphilis
Rash
Mucous patch
Alopecia wrests
Condyloma Lata
Initial dx test: RPR and FTA
Tx: single im shot of pcn
If PCN allergic give doxycycline
Tertiary syphilis
.dx: rpr And fta from a lumbar puncture
Tx: IV PCN
Desensitize if PCN allergic
Desensitize for …
Neurosyphyllis
Pregnant women
Grajuloma inguinale
Rare beefy red gebital lesion that ulcerates
Dx: biopsy or touch prep
Donovan bodies
Klebsiella granilomatis
Tx: doxy, TMP/smx, Or azithro
Warts
Diagnosed by how they look. Caused by hpv
Ttx: meghanical removal
Imiquimod is an immunodtimulsnt that leads to sloughing off of the wart
Uncomplicated cystitis tx
Complicated cystitis tx
Fosfomycin or nitrofurantoin x3 dsys
TMP/smx Or cipro x7 days
IP
Op pyelonephritis
Cipro
Ceftriaxone Ertapanem Ampicillin Quinolone Gentamicin
Leukocyte esterase
Derived from granulocytic WBC and indirect evidence of the presence of bacteriuria
Perinephric abscess tx
Quinolone and staph coverage lik oxacillin, nafcillin Or vancomycin
Prostatitis
Best initial test
Most accurate test
Tx
UA
Urine wbc after prostate massage
Cipro Or TMP/smx x2 weeks for acute
x6 weeks for chronic
Endocarditis
Fever + murmur= possible endocarditis—> do blood cultures!!
2 positive blood cultures + positive echo= endocarditis
Endocarditis tx
Vancomycin + gentamicin for 4-6 weeks
The Only! Cardiac defects that need prophylaxis
Prosthetic valves
Previous endocarditis
Unrepaired cyanotic heart disease
Transplant recipients
The Only procedures that need Px
Dental procedures that cause bleeding—> amoxicillin
PCN allergic—> clindamycin
Respiratory tract Sx
Infected skin Sx
The following procedures that do NOT need Ppx
Dental fillings
All ob/gyn procedures
All flexible scopes
Urinary procedures including cûystoscopy
These cardiac defects do NOT need Ppx
Aortic or mitral stenosis Or regurgitation Atrial or ventricular septal defects HOCM MVP Pacem Implantable defibrillator
HIV Tx
Trople HAART
Tenofovir + emtrocitabine + integrase inhibitor
Tenofovir + emtricitabine + efavirenz
Tenofovir + emtricitabine + atazanavir ( or darunavir) add small amount of ritonavir
NRTIs s/e
Lactic acidosis
Zidovudine s/e
Anemia
Didanosine s/e
Pancreatitis and periphèral neuropathy
Stavudine s/e
Pancreatitis and periphèral neuropathy
AbAcavir s/.e
Rash
Tenofovir s/e
Renal toxicity
Protease inhibitors s/e
Gyperglycemia
Hyperlipideia
Indinavir s/e
Kidney stone
NNRTIs s/e
Drowsiness ( efavirenz)
CCR-5
It acts as the attachment point for gp-120 to enter the cd4 cell
Maraviroc is the drug that blocks this
Needle stick injury
HAART for one month
Tenofovir plus emtricitibane plus integrase ( raltegravir) or protease inhibitor
Pregnancy and hiv
2 nrti (zidovudine and lamivudibe) with protease inhibitor
All hiv+ women at any cd4 or viral load need Tx
Start first trimester and continue
PCP Ppx
TMP/smx
If there is a rash, switch to atovoquane or dapsone
MAI
Azithro PO once a week
PCP treatment not prophylaxis
TMP/smx
If rash—> iV pentamadine Or clindamycin with primaquine
Atovoquane—> mild pcp
Steroids if po2< 70 or A_l-a gradient >35
Toxoplasmosis
Pyrethamine and sulfadiazine for /2 weeks
Lesions smaller?—> it’s toxo
Lesions unchanged—> brain biopsy—> lymphoma
Ganciclovir
Low wbc
Foscarnet
High creatinine
CMV Tx
Ganxiclovir
Foscarnet
Maintenance therapy with oral vangicoclovir unless cd4 goes up with HAART
Cryptococcus
Best initial test: India ink
Most accurate test: crypto antigen 95% sens and spec
Dx: amphotericin with 5- Fc
followed by fluconozaleg
PML
~<50 cd4 cells with focal neurological abnormalities
Best initial test : CT or mri
Most accurate test: pcr of csf for JC virus
MAI
Weight loss
Fever
Fatigue
**anemia
Hepatic involvement
Inc ALK phos
Inc ggp
Normal bilirubin
Bone marrow is more sensitive
Liver biopsy is most sensitive
Blood culture is least sensitive
Tx: clarithro and ethambutol
Ppx with azithro
Rifqbutin is sometimes arded
Leptospirosis
Spirochete
Animal exposure + jaundice + renal= leptospirosis
Severe disease leads to ams
Tx Ceftriaxone or PCN
Tularemia
Rabbits
Ulcer at the site of contact
Enlarged lymph nodes
Conjunctivitis
Dx with serology
Tx gentamicin or streptomycin
Cystercicosis
T.solium
The ct will show thin walled cysts** that are calcified **
Ingested infected pork
Tx albendazole
Lyme disease
Joint involvement is most common—> doxycycline, amoxicillin Or cefuroxime
Cardiac AV conduction or block —> Ceftriaxone
Neurological is Bell’s palsy or 7th cn palsy’s —> Ceftriaxone
Babesiosis
Infects rbc, so affect spleen—-> hemolytic anemia! So Dx is with a peripheral smear or pct
Tx is with azithro and atovaquone
ErlichiA/Anaplasma
No rash
Elevated lft
Thrombocytopenia
Leukopenia
Dx peripheral smear shows morulae
Or pcr
Tx doxycycline
Malaria Tx and Ppx
Mefloquine
Atovoquone/Proguanil
Same drugs for Ppx
Mefloquine s/e :
Neuripsychatrucs/e
Sinus bradycardia
QT prolongation
Nocardia
Respiratory
But it may disseminate to brain and skin
Best initial test is CXR
Most accurate test is culture
*weakly acid fast which shows branching gram positive filaments
Tx TMP/smx
Actinomycetes
- normal immune system
Hx of facial or dental trauma
Dx with gram stain and confirm with anaerobic culture
Tx PCN
Histoplasmosis
Bad
Lung disease but does disseminate into bone marrow —> pancytopenia!
It’s associated with bat dropping in wet areas* Ohio and Mississippi River valleys
Palate and oral ulcers
Splenomegaly
Pancytopenia
Best initial test histoplasmosis urine antigen
Most accurate test biopsy with culture
Acute pulmonary disease is transient and needs no therapy
Disseminate disease/—> amphotericin
Cocfidiomycosis
Acute respiratory disease
Joint pain
Eeythema nodosum
It’s found n very dry areas like anrizona
Tx itracanozole
Blastomycosis
Broad budding yeast= Bone lesions= Blastomycosis
Tx amphotericin or itracanozole
Toxo
Dx
Instead of treat and wait to see if it decreases in size, obtain toxoplasmosis serology ( IgG and IgM)
