Infectious Dz Flashcards
RF for MRSA
hospitalization
indwelling catheter
recent abx
reside in LTC
close contact sports
close living quarters (eg prison)
MSM
IVDU
day care attendance
gram + cocci with mecA gene?
MRSA
botulism organism
clostridium botulinum
presenting symptoms of botulism and mechanism behind it
-often starts with GI symptoms.
descending (ie starting with cranial nerves flaccid paralysis with mydriasis, ptosis, eventual resp paralysis, endo toxin block release of Ach at NMJ
3 broad categories of botulism
infant (72%) , food-borne (25%), wound (rare)
test and tx of botulism
test: toxin in blood, stool or food or bacteria grown from wound
tx: supportive + immunoglobulin
tetanus organism
clostridium tetani
presenting symptom of tetanus
spastic paralysis and tetany
due to blockage of inhibitory neurotransmitters.
4 types of tetanus
local, generalized, neonatal, caphalic
(say a few things about each), pg 481 FA
ddx for tetansu
strychine poisoning –> found in pesticides, homeopathic meds etc. tx is benzos
presenting symptoms of generalized tetanus
trismus
sardonic smile
opisthotonus
resp failure
tx of symptomatic tetanus
tetanus IG (TIG), 3000 U IM and Td vax at seperate site, dont debride wounds until TIG given
can consider flagyl, but limited evidence
what is a high risk wound for tetanus
> 6h old, contaminated (dirt, saliva, feces), puncture, crush, avulsion, fb, burns, frostbite
tetanus wound proh: high risk wound
-if 3 or more vax – > update vax >5 years from last dose
-if unknown or 2 or less –? give TIG (250 U IM) and give Tdap
tetanus wound proph: low risk wounds
-if 3 or more vax – > update vax >10 years from last dose
-if unknown or 2 or less –update with Tdap
define sepsis
is a condition of life-threatening organ dysfunction (such as hypotension, altered mentation, oliguria, & others) due to
a dysregulated host response to infxn (confirmed or suspected)
define septic shock
Septic shock is characterized by refractory hypotension & vasopressor requirement (40 mL/kg of crystalloids) to maintain an MAP ≥65 mmHg
& having a serum lactate level >2 mmol/L
1st and secoond pressor in sepsis with doses
nor epi : start 0.1 up to max of 0.4 mcg/kg/min
vasopressin: 0.03 U/min
map and urine goals in sepsis
65 and >=0.5 ml/kg/hr
qSOFAt is it, how to use it?
2 or more of:
RR ≥22
Systolic BP ≤100
Any altered mental status (or Glasgow Coma Scale [GCS] ≤13 if established)
For pt with a diagnosed or suspected infxn, the dx of sepsis should be established by the presence of organ dysfunction as
reflected by a ≥2 points increase from their baseline score in their qSOFA score if they are outside of the ICU (or in the absence of lab data enabling the use of the more detailed
SOFA score)
preffered fluid in sepsis and minimum resucitation in forst 4-6 hours
RL and 30 mL/kg
surviving sepsis 3 and 6 hour bundles
To be completed within 3 hr of presentation:
1. Measure lactate level
2. Obtain blood cx before abx administration
3. Administer broad-spectrum abx (administer within 1 hr)
4. Administer 30 mL/kg crystalloid (minimum) for hypotension or for lactate >4 mmol/L … USE PRESSORS IF MAP <65 DURING FLUID RESUSCITATION
To be completed within 6 hr of presentation:
1. Apply vasopressors if unresponsive to appropriate fluid resuscitation (goal MAP ≥65 mmHg)
2. If hypotension is sustained after initial fluid resuscitation
a. Measure & follow CVP trend
b. Measure & follow ScvO2
3. 3. If lactate is elevated, remeasure & aim for normalizing lactate
uncomplicated vs disseminated gonorrhea
uncomplicated = GU or oropharyngeal infection with no bactermia or ascending infection
2 locations for disseminated GC
septic arthritis
tenosynovitis/dermatitis/polyarthalgia syndrome
Tx of uncomplicated and disseminated GC
uncomp: Ctx 250 IM X1 or cefixime 800 po X1
comp: CTX 1 g IV
+ in both cases treat for chalmydia!!! azithro 1g X1
stages of syphillis
-primary: painless chancre on genitals
-secondary: maculopapular rash (palms and soles); condylomata lata (wart like genital lesions)
-latent: asymptomatic
-tertiary–. gummotous MM lesions
-neurosyphillis:
tests for syphillis
VDRL or RPR are screening tests, but have false +,
confirm with florescent treponema antibody test (stays positive for life)
Jarisch-Herxheimier reaction
fever that lasts 12 hours, self-limited, occurs with tx of spirochete infection, worse in HIV pt
tx of syphillis
primary/secondary: PCN 2.4 million unit IM X1
tertiary/latent: same but longer course, weekly X3 doses
neurosyph: IV PCN
%age of ppl with monoantibodies vs %age of ppl with clinical infection
> 90%, about 10%
most pediatric infections are asymptomatic
s/s of mono/EBV infection
sore throat, fever, myalgias
pharyngitis, cervical adenopathy and hepatosplenomegaly.
how long to avoid contact sports in mono
4 weeks
dosing of rabies prophylaxis: RIG and vaccine
vaccine: 4 doses IM on day 0, 3, 7, 14 and on day 28 if immunocomp
RIG 20 U/kg, infiltrate as much as possible at site of bite. rest is given IM at site distant from vaccine
bat exposure with no known bite?
prophylaxis is recommended
Rabies post exposure prophylaxis
Rose Gardner’s disease?
sporotrichosis, fungal infection, occurs 3 weeks after inoculation of wound in soil/on plants. presents with suppurative nodules on skin that progress proximally along lymphatic channels
can progress to systemic disease (rarely), tx is antifungal
most common helminth infection, symptoms and treatment
pinworms, perianal itching, can dx with scoth tape, tx is mebendazole
loeffler syndrome
pneumonitis and pulm symptoms (eg cough and wheeze) from worm migration to lungs
timeframe to think about infections in transplant patients
first month, 1-6 months, > 6 months
types of infections in first month for transplant pt (3)
- donor related (rare due to pre-screen)
-recipient re-activation (pseudomonas, TB, aspergillus)
-regular hospital acquired/peri-op infections
types of infections months 1-6 for transplant pt (2)
-reactivation of previously latent infection (especially CMV, EBV, VZV)
-opportunistic infections
how does CMV present in transplant pt
pneumonitis, GI symptoms, renal injury, skin manifestations or CNS infection
infections in transplant pts after 6 months
lowest risk period, they are at slightly increased risk for typical community acquired infections, esp pma. CMV also always a consideration
diseases in needlestick injury
HIV, HepB, HepC and bacterial infections
BW for needlestick: source person
if they consent: HepB surface Ag, HepC antibody and HIV
BW for needlestick: person who got poked
HepB surface ANTIBODY, anti HCV Ag and HIV
Hep C needlestick protocol
no vaccine or prophylaxis.
check HCV RNA at 3 weeks and 3/12 post exposure, if + refer.
risk of transmission 2% if infected pt from needlestick
HepB needlestick protocol
all depends on vax status of person who got poked, if 3 imms and anti-HepB > 10, then do nothing, if < 10 depends on their prev vax history and risk of the particular exposure, vaccine and HBIG are options.
HIV needlestick protocol
risk of infection 0.1% from needlestick
if low risk exposure: test for HIV at 3/52, 6/52 and 6 months
if high risk exposure: start PEP and f/u public health (often 5 day starter pack). PEP shoudl be started within 72 hrs, ideally within 2 hrs.
malarian transmission and organisms
plasmodium (a protzoa) is transmitted by mosquito bites.
clinical manisfestations of malaria
generally causes hemolytic anemia, symptoms are nonspecific, usually fever/malaise, sometimes jaundice. often fevers come in waves as RBC lyse in cycles
diagnosis of malaria
thick and thin blood smears looking for parasites X3 q 24 hrs to r/o
if +, send for speciation
malaria endemic areas
central america, carribean, south america, south asia, africa
treatment of malaria?
depends on species, area and sensitivies. choloroquine is classic tx but there is some resistance issues
ebola, signs/symptoms, when to consider and mgmt
fever/HA/GI/rash/eays brusing
recent travel to africa (esp West and central)
tx is supportive and isolation (spread via bodily fluids)
Dengue, virus, signs/symptoms, when to consider and mgmt
-flavivirus
-fever, n/v, bone pain.
(can cause hemmorhagic fever too)
-spread by moquitos anywhere tropical (including florida)
-tx is supportive (fluids, pain mgmt)
leptospirosis: organism, signs/symptoms, when to consider and mgmt
causes by leptospirosis interrogans (obligate anaerobe, gram neg spirochete)
causes biphasic dz: firts febrile illness, then Wil syndome (multi organ failure: icterus, renal failure, ARDS).
suspect when exposure ot contaminated freshwater (percutaneous or mucus membranes) in tropical areas.
tx is doxy and amox
chagas disease: organism/distribution, symptoms, dx and treatment
parasite T cruzi passed on by bugs in tropical areas including Southern US,
can cause myocarditis/heart failure, symptoms of fever and malaise. dx is blood smear and tx Nifurtimox
test for acute HIV?
send HIV viral load, HIV ab test will be neg for 3-12 weeks
RF for HIV (4)
MSM
IVDU
unprotected intercourse
blood transfusion before 1985
what CD4 count does AIDS happen, when can you start to get symtpoms/
AIDS <200,
early symptomatic <500
3 AIDS defining pulm infections
histoplasmosis
coccidiomycosis
pneumocystis pneumonia (PCP)
histoplasmosis
coccidiomycosis
pneumocystis pneumonia (PCP)
systems HIV can present with/involve
pulm, CNS, GI, dermatologic, opthalmologic
do you need CT before LP in HIV
YES
multidermatomal VZV (shingles) is suspicious for?
HIV
Disease in HIV based on CD4
dx of AIDS
cd4 <200 or HIV with AIDS defining illness (lots of them)
Hairy leukoplakia vs thrush
Thrush comes off easier. Leukoplakia is more lateral on tongue
Can cd4 count improve with anti retrovirals? Can aids be reversed?
Yes and yes
Rabies organism
Lyssavirus
indication and dose for lyme prophylaxis
ixodes bite, attached >36hrs, doxy 200 mg single dose
stages of lyme
early localized: erythema migrains, flulike symptoms
early disseminated: arthitis, disseminated erythema migrans, neuro sx, AVB
late disseminated: neuropathy, encephalopathy, chronic arthritis
RMSF organism
ricketsia rickettsii
RMSF spread
tick bites, mostly in appalachia
RMSF triad
tick expsoure, fever, rash (can be petechial/pupuric, starts distally (palms and soles) and moves centrally)
treatment for RMSF
treat empirically with doxycycline (25% mortality if not treated)
other tick spread illnesses (4)
babesiosis, ehrlichiosis, q fever, colorado tick fever
Diphtheria:say a bit about it
