Infectious Disorders Flashcards
Acute vs chronic bronchitis
acute: < 3 wks, viral (only bact if no improvement)
chronic: > 3 mos, smokers/COPD
acute bronchitis tx
supportive: antipyretics, short-act bronchodilator (SABA), antitussive (dextromethorphan = best evidence, peds > 2)
acute bronchitis tx
like COPD exacerbation. If change in sputum color/amount from baseline, resp fxn decline, or increased DOE: abx (augmentin, cephs, macrolides)
Post-tussive emesis = suspicion for ? in peds
pertussis - give azithromycin & isolate x 5 days
acute bronchiolitis epi/ppx
- 1st episode of wheezing in peds < 1-2 yrs w/ NO other eti (PNA, atopy)
- mostly < 2 mos old
- ppx w/ synagis if high risk during 1st RSV season
acute bronchiolitis agents
RSV (MC) rhinovirus flu, paraflu adenovirus human metapneumovirus
acute bronchiolitis s/s, wu, mgmt
- URI, conjuctivitis/OM, wheezing/tachypnea/retractions/crackles
- dx = clinical, CXR (hyperinflation, interstitial pneumonitis, infiltrates), ELISA for RSV is available
- supportive (humidifier, O2 PRN if sev, bronchodils/steroids)
Acute epiglottitis agents
- H. flu
- strep pneumo/pyogenes
- staph aureus
- trauma
acute epiglottitis s/s, ddx
- abrupt onset of high F, sore throat, stridor, dysphagia, drooling, trismus, tripoding/sniffing
- croup, peritonsillar abscess, FB, diptheria
acute epiglottitis wu/mgmt
- lateral XR (“thumb sign”)
- trans to ED, abx, stabilize airway!
croup agents/ddx
- parainfluenza (MC), RSV, human metapneumovirus
- epiglottitis, neoplasm, bact tracheitis, pharyngeal abscess, FB
croup s/s, wu, mgmt
- 18 mos old, stridor, hoarseness, barking cough, low F, rales, rhonchi, wheezing, worse at night
- CXR (“steeple sign”)
- supportive (cool humidifier), ED for inhaled epi if sev or stridor at rest, steroids)
flu s/s, ppx
- abrup onset, F > 101.5, myalgias, HA, malaise, painful/dry cough, sore throat, rhinitis (cols = slow/insidious)
- ppx: vacc at 6 mos (live if 2-49 & healthy)
flu wu/tx
- nasopharyngeal swab (for epi purposes)
- supportive, ipratropium inhlr for secretions, +/- steroids, antivirals (for A/B only w/ hosp/sev/progressive dz, < 2/>65, institution/HC workers W/IN 48 HRS OF SX ONSET)
- 2ndary staph aureus PNA may follow
pertussis ppx
Dtap for peds
Tdap for adults
pertussis s/s
- initial: cold-like, rhinorrhea, lacrimation, dry cough w/ episodes of sev cough, low F, pot-tussive emesis
- paroxysmal stage: cough more sev, persist up to 10 wks, +/- whoop
- convalescent stage: cough dec & disappears over 2-3 wks, may recur w/ subsequent URIs
pertussis wu/mgmt/prog
- nasopharyngeal swab cx/PCR for Bordetella
- macrolides = DOC, septra = alt
- may be infectous x several wks if untx’d
RSV facts/mgmt
- highly contagious
- trans via aerosols/fomites (objects)
- MC cz of fatal acute resp inf in infant/young peds
- very serious if preemie, chronic lung dz, heart defects, asthma, immunocomp’d, old
- supportive, +/- hospital w/ fluid/resp support, albuterol trial, steroids if older peds
TB s/s, wu
- latent/primary: asx
- active: cough, F, wt loss, night sweats, hemoptysis, fatigue, dec appetite, CP
- if high suspicion, send to ED (w/ mask)
- CXR (active): infiltrates in mid/lower, hilar adenopathy, CAVITATION (caseating granuloma), empyema
- PPD, AFB smear (Acid- Fast Bacilli)
active TB tx
- initial x 2 mos: isoniazid, rifampin, pyrazinamide, ethambutol
- continue x 4-7 mos: isoniazid, rifampin
latent TB tx
- isoniazid x 9 mos OR rifampin x 4 mos
TB monitoring
- sputum smears & cx during tx
- vision checks & color vision testing w/ ethambutol
- CMP, CBC, bili (for tox/adr)
TB drug ADRs
- isoniazid:
- rifampin:
- pyrazinamide:
- ethambutol:
PNA vacc
- 23 (pneumovax): 1 yr s/p PCV at 65 y.o. (q 5 yrs? if immunocomp’d/at risk)
- 13 (PCV): at 2, 4, 6, 12-15 mos; at 65 y.o. if no prev dose
PNA CXR findings (lag behind PE!)
- Lobar: s pneumo, H flu, legionella (check urine)
- patchy infils (bronchopna): s aureus, atyps, viral
- fine dense granular infils (intersitial pna): influenza, CMV, PCP
- abscess: anaerobes
- nodular: fungal
PNA outpt mgmt
- macrolide
- if comorbid: cover s pneumo, enterics, m cat w/ levo or macrolide + B lactam (ceftriaxone)
how to determine in vs out pt mgmt
PORT
CURB-65: confusion, urea (BUN), RR, BP, 65+ y.o.
when pt goes to ED for PNA
RR > 30, HR > 125, SBP < 90, comorbidities
PNA prog
F clears x 2-4 days tx
CXR clears x 30 d (6 mos if old)
HAP
- 48 hr s/p admission or recently hosp’d pt
add’l wu if ICU, EtOH, or pleural eff pt
blood & sputum cx, legionella & pneumococcal antigen
Non-HCAP mgmt
- Non-ICU: B-lactam (rocephin, ertapenem, amp-sulbactam) + macrolide (atyps) or monotx w/ FQ
- ICU: add vanc if MRSA, anti-psudomonal for COPD/freq steroid/abx users w/ B-lactam + FQ
- clinical improvement w/in 72 hrs
- fu CXR for pts > 50 y.o. at 7-12 wks
Empiric HAP/HCAP/VAP mgmt
- cover MRSA w/ vanc or linezolid
- cover pseudomonas & gram negs w/ Zosyn, cefepime, ceftazidine, aztreonam (only for sev PCN allergy b/c not as effective)
- add’l coverage for gram negs & atyps w/ cipro, levo, gentamicin, tobramycin, or carbapenem
