Lecture 4: Bacterial Infections Part 1 Flashcards
1
Q
What are the 3 main G+ Cocci that cause infection?
A
Staphylcoccus
Streptococcus
Enterococcus
2
Q
What is the most pathogenic staphylococcus?
A
S. aureus
3
Q
Is S. aureus coagulase positive or negative? What does that tell us?
A
Coagulase +
Produces an enzyme that has the ability to clot blood.
4
Q
What species of Staph are Coagulase negative?
A
S. epidermis
S. saprophyticus
S. lugdunesis
5
Q
Where is staph usually found?
A
On the skin and anterior nares of healthy individuals.
6
Q
What is the most common way staph infects someone?
A
Direct tissue invasion:
SSTI
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis
7
Q
What is the indirect way staph infects someone/causes disease?
A
Exotoxin production:
Staph food poisoning
Toxic shock syndrome
Scalded skin syndrome
8
Q
What is the common clinical presentation of a SSTI dt staph?
A
Erythema + purulent drainage of an abscess.
MRSA will look more severe.
9
Q
What kind of infections typically attract staph?
A
Open wound
Open burn
10
Q
What is the first step in treating a staph infection on skin?
A
Draining the abscess.
11
Q
What would prompt us to culture post abscess drainage and what kind of culture?
A
Blood cultures if there are also systemic signs of infection like a fever.
12
Q
If the patient is at low risk for MRSA in their skin infection, what tx would I give?
A
Keflex
Dicloxacillin
13
Q
If the patient is at high risk for MRSA, what tx would I give besides vanco?
A
Clindamycin
Doxy/Mino
Bactrim
14
Q
What is safe to give in kids if they are at high risk for MRSA?
A
Bactrim
15
Q
If the patient is being admitted for MRSA, what tx would I give?
A
Vanco IV
16
Q
What percentage of osteomyelitis cases are caused by S. aureus?
A
60%!!!
17
Q
How is osteomyelitis confirmed?
A
XRAY
18
Q
What is the most confirmatory scan for osteomyelitis?
A
Bone Scan
19
Q
What is the first step once osteomyelitis is confirmed?
A
Culturing the bacteria!!
20
Q
What is the initial tx for osteomyelitis?
A
Empiric ABX:
Vanco + 3/4th gen cephalosporin (ex: ceftriaxone)
21
Q
What are the specialized treatments for osteomyelitis?
A
Once a C&S is done, prolonged therapy for 4-6 weeks may be required:
MSSA: Nafcillin IV/oxacillin/cefazolin
MRSA: Vanco IV
Surgery may be required.
22
Q
What are the primary ways Toxic Shock Syndrome occurs?
A
Tampon use
Nasopharynx packing
Diret inoculation via wound or abscess.
23
Q
What causes toxic shock syndrome specifically?
A
A focal concentration of toxin-producing S. aureus.
24
Q
How does toxic shock syndrome typically present?
A
Sudden onset high fever
Hypotension
Myalgia
Diffuse erythematous rash, specifically on palms and soles of feet. Usually will desquamate as well.
25
Why does toxic shock syndrome need to be treated asap?
Hepatic damage
Thrombocytopenia
Confusion
Leading to...
Renal impairment
Syncope
SHOCK
26
What is desquamation often indicative of?
Strep or staph infection
27
How is toxic shock syndrome treated?
IP admission with supportive measures.
Debridement and decontamination of local sites.
Empiric ABX.
28
What is the empiric ABX treatment for toxic shock syndrome?
VANCO + CLINDA + 1 of the following:
Pip/tazo
Cefepime
Imipenem/Meropenem
Note:
The 1 of the following is to cover pseudomonas!
The Clinda is to add additional G-, anaerobic , and group A strep coverage.
The vanco is the primary MRSA coverage.
29
What demographic is most susceptible to Scalded Skin Syndrome?
Infants & young children.
30
What causes scalded skin syndrome and how is it transmitted?
S. aureus toxins
Transmitted via birth canal or adult hands.
31
How does scalded skin syndrome present?
Widespread bullae with sloughing.
Desquamation.
Can lead to electrolyte abnormalities and sepsis.
32
How is scalded skin syndrome confirmed?
Clinical diagnosis.
Culture of bullae fluid
OR
Skin biopsy and culture confirmation.
33
What is the tx protocol for scalded skin syndrome?
Supportive care (treating it like actual burns)
ABX:
MSSA will be nafcillin or oxacillin.
MRSA will be Vanco IV.
34
What is staph food poisoning and what is the common clinical scenario in which it occurs?
Contamination of food by S. aureus carriers.
Improperly cooked food or room temp food can allow it to reproduce and produce toxins.
35
How does staph food poisoning present?
N/V/D, abd cramps 2-8 hours post digestion.
36
How do you treat staph food poisoning?
Self-limiting, resolves in 12 hours.
37
Where are coagulase negative staph infections from most commonly?
Hospital acquired.
38
Where do coagulase negative staph infections typically reside?
Postoperative incisions
Prosthetic devices
Indwelling catheters
39
What is the concern with coagulase negative staph infections?
It is resistant to most beta-lactams, so it needs to be treated with Vanco IV.
If it infects a prosthetic, the device needs to be removed.
40
What are the most common causes of strep pharyngitis?
Strep throat
Peritonsillar abscess
Scarlet fever
All of which are caused by GABHS
41
What are 3 common skin infections caused by GABHS?
Impetigo
Erysipelas
Cellulitis
42
What systemic complications can occur from GABHS?
Rheumatic fever
Acute glomerulonephritis (2 weeks post infection)
43
What demographic is most susceptible to GABHS pharyngitis?
5-15 y/o.
<2 y/o are extremely rare due to lack of direct inoculation.
44
What is the most common cause of viral pharyngitis?
Adenovirus.
45
How does pharyngitis present?
Tonsillar hypertrophy with erythema and/or exudate
Beefy red uvula
Palatal petechiae
Tender anterior cervical lymphadenopathy
46
What is the most common clinical presentation of strep throat?
Beefy red uvula
Palatal petechiae
47
How is a diagnosis of strep throat made?
Clinical presentation.
THEN
Rapid strep.
Positive = treat
Negative = negative unless you are highly suspicious, then you can do a throat culture.
48
What is the treatment protocol for strep throat?
Benzathine PCN G IM
OR
Penicillin VK
OR
Amoxicillin.
49
What is the treatment protocol for strep pharyngitis if allergic to PCN?
Keflex
50
How does scarlet fever present?
Sandpaper rash, which blanches and fades with a fine desquamation.
Flushed face with circumoral pallor.
Strawberry tongue
Note:
Scarlet strawberries are sandy
51
What causes scarlet fever?
Exotoxin producing GABHS
52
How does impetigo present?
Focal, vesicular, pustular lesions with HONEY-CRUSTED appearance and STUCK ON appearance.
53
What are the most common causes of impetigo?
GABHS
S. aureus
54
What is the treatment protocol for normal impetigo?
Topical mupirocin/bactroban if localized.
Systemic:
Keflex
Dicloxacillin
Omnicef/cefdinir can be used instead of keflex for less frequent dosing.
Note:
Special, does not use PCNs
55
What is the treatment protocol for suspected MRSA impetigo?
TMP-SMZ (bactrim)
Doxy
Clinda
56
What sport commonly has impetigo as a result?
Wrestling.
57
What is erysipelas and its susceptible demographic?
Adult only.
Superficial and painful cellulitis with dermal lymphatic involvement.
58
What can cause erysipelas?
GABHS
S. aureus
59
How is uncomplicated erysipelas treated OP?
Penicillin VK
Amoxicillin
Dicloxacillin
Keflex
Clinda/erythro
60
How is complicated erysipelas treated IP?
Vanco if MRSA suspected.
cefazolin/Ancef
Ceftriaxone/Rocephin
Clinda
61
How is cellulitis treated?
Empiric coverage of GABHS and S. aureus.
62
What demographic is most susceptible to necrotizing fasciitis?
IV drug users
63
What organisms can cause necrotizing fasciitis?
GABHS
Clostridium perfringens
This prompts a culture since tx is different.
64
What can toxic shock syndrome be caused by?
S. aureus
GABHS
65
Which strep is a Group B?
Strep agalactiae
66
What demographic is most susceptible to S agalactiae?
Newborns born vaginally.
67
How is Group B strep treated and screened for?
Prenatal screening, as it can cause neonatal sepsis.
Tx is intrapartum prophylaxis:
PCN G or ampicillin Q4h until delivery.
Ancef
Clinda/vanco
68
What is another term for alpha-hemolytic?
Incomplete hemolytic
69
What are the two types of alpha-hemolytic strep?
S. pneumo
S. viridans
70
What diseases is S. pneumo known for causing?
OM
Sinusitis
CAP (most common cause of CAP)
Meningitis
Endocarditis
71
When is S. pneumo most prevalent?
Winter and early spring.
72
What are the 3 MC of OM?
S. pneumo (#1)
M. cat
H flu
Oh My SMH
73
What demographic is most susceptible to OM?
2-14 y/o
74
How does OM present?
Otalgia (pulling at ear)
Hearing loss
Poor balance/coordination
Fever
N/V
Diarrhea
75
What are the main risk factors for OM?
Smoker in household
Family Hx (Horizontal eustachian tubes)
Bottle feeding (laying flat)
76
What are some significant PE findings for OM?
Erythematous, bulging TM
Absence/displacement of light reflex (aka cone of light)
Poor mobility
Otorrhea w/ TM rupture
77
How is OM diagnosed?
Clinically.
Can use tympanogram if available.
78
What is the tx protocol for OM?
Analgesics/antipyretics
ABX:
Amoxicillin.
If not improved after 2 weeks:
Omnicef or augmentin. Will cover atypical H. flu
79
What is a tympanogram used for?
TM movement since valsalva is hard for kids to do.
80
Why are ABX used in OM if it can self-resolve in 70% of cases?
Shortens recovery time
Reduces complications
81
What is the most common cause of acute sinusitis?
Adenovirus.
82
What are the common bacterial causes of acute sinusitis?
S. aureus
S. pneumo
M. cat
H. flu
AKA OM causes + S. aureus
83
What are the risk factors for acute sinusitis?
Allergic rhinitis
Structural abnormalities
Nasal polyps
84
How does acute sinusitis typically present?
Symptoms:
Purulent rhinorrhea/PND
Sinus pressure/HA
Nasal pressure
Signs:
Erythematous/swollen turbinates and mucosa
Maxillary/front sinus pressure
Purulent rhinorrhea
85
How is acute sinusitis diagnosed?
Clinically.
CT is PRN.
86
What is more indicative of severity, the snot color or length of rhinorrhea?
Length.
Green snot is caused by dead eosinophils and WBCs. not always indicative of severity.
87
What is the tx protocol for acute sinusitis?
Augmentin.
Requires tx for 14-21 days since it is a cavity.
Doxy is alternative.
88
What is the most common cause of CAP?
S. pneumo (2/3 of all isolates)
89
What are the S/S of pneumococcal pneumonia?
High fever, chills
Early onset rigors
Rust colored sputum!!
SOB
Pleuritic CP!!!
Bronchial breath sounds vs crackles in affected lobe.
90
How is pneumococcal pneumonia diagnosed?
CXR.
Sputum in IP with comorbidities, otherwise not needed for healthy OP.
91
What is the tx protocol for standard OP pneumococcal pneumonia?
PSI or curb 65 score
Empiric ABX:
Amoxicillin
Doxy
Zithromax in areas with <25% resistance.
92
What is the tx protocol for COPD/comorbidity or recent abx tx for OP pneumococcal pneumonia?
Levofloxacin
OR
Combination of...
Augmentin OR cephalosporin + zmax or doxy
93
What qualifies as a comorbidity for pneumococcal pneumonia?
COPD/DM/Lung disease/Heavy smoker
94
What is the tx protocol for IP pneumococcal pneumonia?
Levofloxacin
OR
Zmax + beta-lactam like amoxicillin or ceftriaxone.
It is essentially the same as complicated OP pneumococcal pneumonia.
95
What is CURB 65?
5 question pneumonia scale.
Confusion
BUN > 19
RR >= 30
SBP < 90 or DBP <=60
Age >= 65
2 = IP admission.
4-5 = ICU admission.
96
What is PSI?
Much more extensive index for calculating pneumonia severity.
REQUIRES ABG and CXR.
97
Which gender is more susceptible to pneumonia?
Males are slightly more at risk.
98
How is pneumococcal pneumonia prevented?
Pneumovax for >65 OR immunocompromised/very sick people > 2y/o.
19-64 is asthma/smoking/SNF resident.
Prevnar is for kiddos with chronic conditions OR adults that never got prevnar 13.
99
How is meningitis cause approximated? List the common causative organisms.
By age.
<3 months: Group B strep.
<3 mo - 10 y/o: S. pneumo
10 y/o - 19 y/o: N. meningitditis
S. aureus = penetrating head trauma
H. flu (rare since we have Hib but more prevalent outside of US)
Adults:
S. pneumo
S. aureus
N. meningitiditis
Elderly
S. Pneumo
S. aureus
Listeria monocytogenes.
Note:
If immunocomp, consider pseudomonas, listeria, and G-
100
How is the causative organism in meningitis often confirmed?
CSF via LP. They all look pretty different under the microscope.
101
What are the two main enterococci organisms?
E. faecalis
E. faecium
102
Where are the enterococci from?
Normal intestinal flora.
103
What do enterococci commonly cause?
UTI
Bacteremia
Endocarditis
Intra-abdominal infections
Wound infections
104
What is the tx protocol for enterococci?
Endocarditis:
Amp and gent
SSTI/UTI:
Mild or complicated is amp or vanco
Resistant:
VRE is treated with linezolid or dapto
105
What are the three G+ rods?
Bacillus
Listeria
Corynebacterium
Look Come Back Rod Please
106
What are the two types of bacilli?
B. anthracis
B. cereus
107
What is B. anthracis?
An encapsulated, toxin/spore producing bacteria.
It is the cause of anthrax poisoning and is a CDC cat A.
108
What are the three types of anthrax poisoning?
Cutaneous (MC)
Ingestion
Inhalation (most fatal)
109
How does cutaneous anthrax poisoning present?
PAINLESS black eschar.
Regional adenopathy
Fever, malaise, HA
All of this should present within 2 weeks of infection.
110
How does ingested anthrax occur?
Inadequately cooked meat that is infected.
111
How does GI anthrax poisoning present?
Lesions and bleeding in GI tract, AKA...
GI bleeding
Bloody diarrhea
Oral mucosa ulcerations
Bowel obstruction/perf
Initial presentation:
Fever
N/V
Bloody diarrhea
112
How does inhaled anthrax poisoning present?
Insidious onset of flu-like symptoms.
Progresses to CP, severe respiratory distress, and acidemia.
Severe hypoxemia and shock will occur.
Can also progress further to mediastinitis, pleural effusion, septicemia, and meningitis.
113
How is anthrax poisoning diagnosed?
Culture/biopsy
Gram stain
Nasal swab for inhalation suspicion
CXR if pulmonary symptoms
LP if systemic
114
What is the prophylactic tx for anthrax?
CIPRO ASAP
115
What is the tx protocol for anthrax poisoning?
Cipro:
Cutaneous, 7-10 days.
Inhalation, 60 days
Alternative is doxy.
TX MUST BE CONFIRMED BY C&S.
116
What are the two types of illness B. cereus can cause?
Diarrheal
Emetic: aka vomiting
117
Where does B. cereus commonly come from?
Food left out at room temp for too long.
118
What is the tx protocol for B. cereus?
Supportive care, aka resting and fluids.
It is self-limiting.
119
What is the onset of B. cereus?
1-10 hours of exposure.
120
What causes listeriosis?
Listeria monocytogenes (G+ Rod)
121
What demographic is most susceptible to listeriosis?
Neonates
Elderly
Immunocompromised
122
When is someone at the greatest risk for listeriosis and what are the consequences?
Pregnancy.
It can cause spontaneous abortion or neonatal meningitis.
123
How is listeriosis transmitted?
Ingestion of contaminated foods:
Dairy
Raw veggies
Meat
124
How does listeriosis commonly present?
Bacteremia with high fever and multi-organ involvement
Meningitis
Dermatitis
Oculoglandular symptoms:
Retinitis
Lymph node enlargement.
125
How is listeriosis diagnosed?
Blood cultures
CSF
126
How is listeriosis treated?
IP is amp and gent
OP is amoxcillin (generally continuation of IP tx)
Listerine LAGs makes u go AAAA
127
What is the primary disease causing corynebacterium?
Corynebactrium diphtheriae
128
What are the two types of diphtheria?
Pharyngeal diphtheria: gray membrane covers tonsils and pharynx.
Nasal infection: mainly just discharge.
129
How does pharyngeal diphtheria commonly present?
Gray membrane covering tonsils and pharnyx.
Fever, mild sore throat, and malaise followed by toxemia and prostration (super lethargy)
Can spread to heart, CNS, and kidneys.
130
How is diphtheria diagnosed?
Clinically.
Confirmed via culture.
131
How is corynebacterium diphtheria treated?
Diphtheria equine antitoxin from the CDC.
ABX:
PCN or erythro
Contact:
Erythro
132
How is diphtheria prevented?
Immunization. Tdap and DTap.
Note:
Susceptible people exposed should get a booster + PCN/erythro.
133
What are the 3 G- cocci?
Acinetobacter
Moraxella
Neisseria
Note:
MAN Cocci
134
How do acinetobacter infections occur?
Opportunistic, commonly nosocomial and critically ill/immunocomped.
135
What is unique about acinetobacter reservoirs?
It can stay on a dry surface for an entire month. (AKA medical equipment)
136
What are the most common infection sites for acinetobacter?
Respiratory is MC.
Esp. tracheostomy sites
Suppurative infection that can lead to bacteremia.
137
What infections does M. cat cause?
Acute OM
Acute and chronic sinusitis
COPD exacerbations
138
What is the treatment for acute OM?
Amoxicillin.
Augmentin or omnicef if persistent.
139
What is the tx for acute/chronic sinusitis?
Augmentin, second is doxy.
140
What are the two types of neisseria bacteria?
N. meningitiditis
N. Gonorrhoeae
141
What are the characteristics of meningococcal meningitis?
Human reservoirs (40% of adults are carriers)
Close contact required (aka college dorms)
Outbreaks most common in spring and winter.
Immunization available.
142
How does meningococcal meningitis present?
Fever, HA, stiff neck
N/V, photophobia, lethargy
AMS
Maculopapular rash, petechiae
Positive kernig's and brudzinski
High mortality if progresses to meningococcemia.
143
How is meningococcal meningitis diagnosed?
Gram stain
LP with CSF analysis
Blood culture
144
What is the tx protocol for meningococcal meningitis?
PCN G - if C&S shows it is a susceptible strain.
Rocephin to cover all other organisms
ABX therapy must continue for at least 5 days of pt being afrebile.
Close contacts must be given prophylaxis.
Note:
Rocephin will cover atypicals, group B strep, S. pneumo, and H flu.
145
What is given for meningococcal meningitis prophylaxis?
Vaccine is primary
ABX includes:
Rifampin (all age. CI in preggo, jaundice, and drug interactions)
Cipro (non-pregnant adults only)
Rocephin (all age. preferred in preggos, but IM only)
Zithromax (used if high cipro resistance in area)
Link:
https://www.ncbi.nlm.nih.gov/books/NBK537338/
146
How does meningococcal vaccination work?
Meningococcal vaccine ACWY strains.
+
Meningococcal vaccine B strain
Vaccinate at 11-12.
Booster at 16.
147
What diseases can N. gonorrheae cause?
Cervicitis, Urethritis
PID
Prostatitis
Disseminated disease
Skin rashes
Septic arthritis
Conjuctivitis (esp in newborns)
148
How does a gonorrheal disease present?
Yellow-green purulent discharge
Erythematous cervix
Note:
Can be asymptomatic as well.
149
What bacteria can cause a yellow-green discharge?
H flu
Gonorrheae
Adenovirus
150
If there is excess discharge from an eye, what should I do?
Culture it.
151
How is gonorrhea diagnosed?
Gram stain + culture
152
What is the tx protocol for gonorrhea?
Rocephin (single dose)
153
What is the most common type of pseudomonas?
P. aeruginosa
G- rod
154
What does P. aeruginosa cause?
Opportunistic infections.
In healthy, it only causes OE, UTIs, and dermatitis.
In immunocomped pts, it can cause UTIs, pneumonia, bacteremia, and sepsis.
155
What counts as immunocomped relative to P. aeruginosa?
Burn pts
Cystic fibrosis pts
Ventilator acquired pneumonia.
156
What color is the discharge of P. aeruginosa?
Green.
157
What is pseudomonas the #1 causative organism in?
OE
Corneal ulcers in contact lens wearers due to bacterial keratinitis.
ICU-related pneumonia
Osteochondritis due to tennis shoe puncture.
158
What is pseudomonas the #2 causative organism in?
G- organism in nosocomial pneumonia
159
What is pseudomonas the #3 causative organism in?
Hospital-acquired UTIs
160
What is a common infection/manifestation of pseudomonas that is water-related?
Hot tub folliculitis.
161
What is the first common symptom of a pseudomonas infection?
Fever
162
What is the tx protocol for OP pseudomonas?
Cipro (oral)
Levofloxacin (oral)
Tobramycin (inhaled but its for 9 months and is post IP admission)
Note:
This is CId in children, but if you have CF, no other option.
163
What is the tx protocol for IP pseudomonas?
Pip/tazo
Ceftazidime
Cefepime
Meropenem
Zithromax
Note:
All IV. Need hosp admission if positive for pseudomonas on culture?
164
What are the 4 G- rods that cause respiratory tract illnesses?
B. pertussis
H. flu
Legionella
Klebsiella
BLK Flu
165
What disease does B. pertussis cause?
Whooping cough
166
What is the most susceptible demographic to B. pertussis?
Unvaccinated children.
167
What are the 3 clinical stages of pertussis?
Catarrhal: similar to allergies or simple cold, insidious onset.
Paroxysmal: Forceful, worsening coughing fits. Whoop occurs when gasping for air.
Convalescent: Diminishing symptoms, lingering cough
Note: The coughing fits can cause children to aspirate and die.
168
How is whooping cough diagnosed?
Clinical presentation + NP culture.
169
What is the tx protocol for pertussis?
Supportive care.
ABX:
Zithromax, alt is bactrim if allergy.
If started early in catarrhal, it can stop the disease progression.
170
How is pertussis prevented?
Children: DTap
Booster: Tdap
Note:
ap standards for acellular pertussis
171
What diseases can H flu cause?
Sinusitis
OM
Bronchitis
Epiglottitis (MC)
Pneumonia
Cellulitis
Meningitis
Endocarditis
172
What is H flu often implicated in?
COPD exacerbations resulting in purulent bronchitis.
173
What is the tx protocol for H flu?
Depends on site, but it is generally augmentin or omnicef.
174
What is the causative organism for legionnaire's?
Legionella pneumophilia. Also a common cause of CAP.
175
What demographic is most susceptible to legionnaire's?
Immunocomped
Smokers
Chronic lung disease (Esp those on CPAP)
176
What transmission causes outbreaks of legionnaire's?
Aerosolization by water. Commonly if it is in a water tower or AC unit.
177
How does legionnaire's present?
Scant sputum production
Pleuritic CP
High fever
Toxic appearance
178
How is legionnaire's diagnosed?
CXR with focal patchy infiltrates or consolidation
Antigen detection:
PCR of lower respiratory tract secretions
Urine antigen
Respiratory tract fluid culture
NOTE:
SPUTUM GRAM STAIN WILL TYPICALLY SHOW NO ORGANISMS
179
What is the tx protocol for Legionnaire's?
Macrolide (azithromycin, clarithomycin)
Fluoroquinolone (Levofloxacin)
10-14 days/ 21 days for immunocomped
180
What demographics are most susceptible to klebsiella infections?
Alcoholics (esp. those who aspirate)
Diabetics
HIV
181
How does a klebsiella pneumonieae infection commonly present?
Severe pneumonia symptoms like SOB and pleuritic CP.
Red currant/jelly-like sputum
Can progress to a lung abscess.
182
How is klebsiella diagnosed?
CXR
Sputum culture
183
What is the tx protocol for klebsiella?
C&S REQUIRED
Empiric abx:
Respiratory fluoroquinolones (levo and moxi and gemi)
Carbapenem
184
What G- rods cause GI illnesses?
E. coli
Campylobacter
Salmonella
Shigella
Vibrio
185
What is the general tx protocol for a diarrheal illness?
Cipro
Secondary is zithromax
186
How does E. coli diarrhea/traveler's diarrhea commonly present?
Abrupt during or post trip to developing country.
Increased frequency, volume, and weight of stools.
Commonly 4-5 water stools a day.
Tenesmus
Abd cramps, all the usual N/V, bloating, fever
187
What is the main concern in traveler's diarrhea?
Dehydration
188
What are the OTC/non-abx tx for traveler's diarrhea?
Peptobismol
Antimotility/anti-diarrheals
189
What is the ABX tx for traveler's diarrhea?
3-5 days of cipro if severe symptoms or 3+ stools/8h
190
What is the concern with antimotility agents?
Bowel obstruction.
Should stop after 48 hrs if s/s worsen.
191
Who cannot take peptobismol?
Children
Preggo
ASA allergy
192
Who should not take antimotility agents?
Infants
Fever or bloody diarrhea (could delay clearance of bacteria)
193
What campylobacter bacteria is the most common causative organism?
C. jejuni
194
What is the presentation of campylobacteriosis?
Inflammatory, sometimes bloody diarrhea.
Dysentery syndrome w/ cramps, fever, pain
195
What is the tx protocol for a C. jejuni infection?
Cipro
Zithromax
196
How does shigellosis/shigella infection present?
Abrupt onset of bloody and mucus-filled diarrhea.
Lower abd cramping, pain, and tenesmus.
Systemic:
fever
chills
malaise
HA
anorexia
197
What will be indicative of an inflammatory diarrhea from a stool sample?
WBC in the stool
198
What is the tx protocol for shigellosis?
Cipro
TMP-SMZ
199
What is the common mode of transmission for a cholera infection?
Ingestion of contaminated food or water.
200
What is the MC of a cholera infection?
Vibrio cholerae
201
How does a cholera infection present?
Acute, voluminous diarrhea with grayness, turbidity, and NO ODOR.
Often described as rice water stool.
202
How is cholera diagnosed?
Stool culture
203
What is the tx protocol for cholera?
Doxy/tetra
TMP-SMZ
Zithromax
Cipro
Rehydration
204
What are the other 3 vibrios that cause disease?
Vibrio parahaemolyticus from coastal US + Japan
V. mimicus
V. hollisae
205
How do non-cholera vibrio infections present?
Enteric illness:
Water diarrhea, tenesmus, abd cramping
Cellulitis
206
What is the tx protocol for non-cholera vibrio infection?
Doxy or cipro
207
How is a non-cholera vibrio infection diagnosed?
Stool culture
208
What are the two infections caused by salmonella?
Enteric fever/typhoid caused by S. enterica.
Acute enterocolitis caused by typhimurium or enteriditis
209
What is the incubation period for a salmonella infection?
5-14 days.
210
What is the first stage of typhoid fever and how does it present?
Prodromal stage:
malaise
HA
cough
sore throat
N/V
abd pain
Will worsen after 7-10 days.
211
What are the common sources of S. enterica?
Raw eggs (cookie batter, cake batter)
Raw chicken
212
What are the key PE findings for typhoid fever?
Blood pea soup diarrhea
Rose spot
213
How is typhoid fever diagnosed?
Positive blood, stool, and urine cultures.
214
What is the tx protocol for typhoid fever?
Cipro/Levo
Rocephin
Zithromax
215
What is the tx protocol for typhoid carriers?
Cipro 4 weeks
216
How is acute enterocolitis transmitted?
Ingestion of infected food:
Eggs, poultry, meat, RAW MILK
DIRECT CONTACT WITH REPTILES AND TURTLES
217
How does acute enterocolitis present?
Nausea, crampy abd pain.
Potentially bloody/mucus diarrhea (inflammatory)
Fever
Sx 12-48 hrs post contact.
218
How is enterocolitis diagnosed?
Stool culture
219
What is the tx protocol for enterocolitis?
Uncomplicated = do not treat, does not shorten recovery.
Complicated = Cipro, rocephin, Zithromax, TMP-SMZ
220
What G- rods can cause UTIs?
E. coli
Enterobacter
Serratia
Proteus
Klebsiella
221
What is MCC of a UTI?
E. coli
222
What is the next stage if a UTI is left untreated?
Pyelonephritis
223
Where are most UTIs mainly localized?
Bladder and urethra, aka lower urinary tract.
224
What is the tx protocol for uncomplicated cystitis?
TMP-SMZ (CI in 1st trimester)
Macrobid (Increased risk of jaundice in last trimester)
Fosfomycin
Keflex/Omnicef (OK in children + bactrim and last trimester)
Cipro (reserved for pyelo)
225
What is the tx protocol for pyelo?
Cipro
Levaquin
Rocephin + bactrim/augmentin/omnicef (1 of 3)
226
What causes the bubonic plague and where is it endemic?
Yersinia pestis
Endemic to CA, AZ, NV, NM
227
How is the bubonic plague transmitted?
Rodents that have been bitten by infected fleas.
228
What are the 3 types of the bubonic plague?
Pneumonic
Septicemia
Bubonic
229
How does the bubonic plague present?
Profound illness.
Axillary/inguinal lymphadenitis (Bubo)
Blood-tinged sputum
Purpuric spots on skin
230
What is the tx protocol for bubonic plague?
Strepto 10 days OR
Gent 10 days OR
Doxy 10 days OR
Cipro, levo, moxi
STRICT RESPIRATORY ISO
Contacts must be given cipro & doxy for 7 days.
231
What is the MCC of tularemia and how is it transmitted?
Francisella tularensis
Transmitted via rabbits, rodents, ticks. Aerosolized.
Note:
I just remember it as the rabbit disease
232
How does tularemia present?
Fever, HA, nausea, prostration.
Regional lymphadenopathy
Papule progressing to ulcer at site of inoculation.
ESCHAR is possible, like anthrax but more localized and different histories.
233
How is tularemia diagnosed?
Serologic tests:
lymph node aspiration
Blood culture
Ulcer culture
234
What is the tx protocol for tularemia?
Identical to bubonic plague
1 of the 4:
Strepto
Gent
Doxy
Fluoroquinolones
235
What is the minimum temp for a fever?
38C
100.4 F
236
Which temperature method requires adjustment?
Axillary. Add 1 deg F.
237
What are the 3 criteria for a fever to be considered of unknown origin?
A fever > 38.3C or 101.9F on several occasions orally.
Failure to diagnose despite 1 week IP investigation.
>3 weeks duration
238
What are the 4 kinds of FUO?
Classic FUO
Hospital-acquired FUO
Immunocomped/neutropenic FUO
HIV-related FUO
239
What are the 4 differential diagnoses for a FUO category wise?
1. Noninfectious (MC)
2. Infectious
3. Malignancy/neoplastic
4. Misc
240
What are common non-infectious causes of a FUO?
CT diseases
Vasculitis
Granulomatous disorders
Giant cell arteritis, SLE, RA
241
What are the common infectious causes of a FUO?
TB
Cat-scratch
EBV
242
What are some miscellaneous causes of a FUO?
Cirrhosis, Crohn's, PE
243
What key finding will help guide the workup for an FUO?
Shaking/chills is more suggestive of an infectious etiology. (very common in s. pneumo)
244
What do you need to do everyday if you're trying to deduce the etiology of a FUO?
Full PE and daily while in the hospital.
245
What are lab tests you can order to help workup a FUO?
CBC w/ diff
Peripheral blood smear
CMP + Hep ABC panel
ESR/sed rate
UA and Cx
Blood cultures (3 sets minimum drawn a few hrs apart)
HIV serology
TB serology
CXR
246
What is the tx protocol for a FUO?
MUST FIND ETIOLOGY.
NO EMPIRIC.
Consider an ID consult.
247
What is SIRS?
Systemic inflammatory response syndrome.
It is a lead-up to sepsis, but is not sepsis itself.
248
What is SIRS criteria?
At least 2 or more of the following:
Fever > 38C/100.4F or < 36C/96.8F
HR > 90 BPM
RR > 20 or PaCO2 < 32mm Hg
Abnormal WBC:
>12000
<4000
>10% bands
249
What are some causes that can meet SIRS criteria?
Ischemia
Inflammation
Trauma
Infection
Combination of other factors
250
What is the definition of sepsis?
Sepsis is the presence of SIRS + documented/presumed infection
251
What is the definition of bacteremia?
Presence of bacteria in blood.
NOT technically fatal.
252
What is the MCC of bacteremia/septicemia?
Respiratory infections in those => 65 in winter.
G+ is most common, followed by G- and fungal.
253
Describe the basic 4 step pathway of sepsis.
1. Infection (most commonly lungs)
2. Bacteria enter bloodstream
3. Bacteria cause blood vessels to leak bacteria everywhere
4. Organ dysfunction everywhere, leading to death.
254
What are the risk factors for sepsis?
ICU admission
Bacteremia (95% of blood cultures associated w/ sepsis)
DM and Cancer
CAP
>= 65 yo
Previous hospitalization
Immunosuppression/comp
Genetic disposition
255
How does sepsis commonly present?
S/S coinciding with infectious source.
Systemic S/S:
Hypotension
Elevated temp
Tachycardia
Tachypnea
End organ perfusion (warm flushed skin, dec cap refill, cyanosis, mottling)
AMS
Absent bowel sounds
256
How is early sepsis diagnosed?
qSOFA score, >= 2.
257
What is qSOFA criteria?
RR >= 22/min
Altered mentation
SBP <= 100 mm Hg
258
When do I do a full SOFA score?
If my qSOFA >= 2.
259
What are some common CBC findings for septic pts?
Leukocytosis/Leukopenia (>12000, <4000)
Normal WBC but >10 immature forms
Thrombocytopenia
260
What are some common BMP findings for septic pts?
Hyperglycemia w/o diabetes. (>140)
Crp > 2 SD above normal
Acute oliguria
261
What are some specific lab findings for septic pts?
Hyperbilirubinemia >4 mg
Elevated aPTT or INR
Adrenal insufficiency dt hyponatremia or hyperkalemia
Hyperlactatemia > 2mmol
PCT > 2SD above normal.
262
What causes PCT elevations?
Pro-inflammatory state.
Rises more due to bacterial infections.
263
What is the tx protocol for sepsis?
ABX therapy within 1 hr of suspected Dx.
Vasopressors
Multiple empiric ABX
Central lines
IV Fluids
Organ perfusion methods
264
What pathogens are the most fatal in sepsis?
Anaerobes that cause ischemic bowel.
265
What is more fatal, nosocomial pathogens or community-acquired?
Nosocomial
266
What infection has the lowest mortality in sepsis?
UTIs
