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Clinical Med B > Lecture 4: Bacterial Infections Part 1 > Flashcards

Lecture 4: Bacterial Infections Part 1 Flashcards

1
Q

What are the 3 main G+ Cocci that cause infection?

A

Staphylcoccus
Streptococcus
Enterococcus

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2
Q

What is the most pathogenic staphylococcus?

A

S. aureus

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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.

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4
Q

What species of Staph are Coagulase negative?

A

S. epidermis
S. saprophyticus
S. lugdunesis

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5
Q

Where is staph usually found?

A

On the skin and anterior nares of healthy individuals.

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6
Q

What is the most common way staph infects someone?

A

Direct tissue invasion:
SSTI
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis

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7
Q

What is the indirect way staph infects someone/causes disease?

A

Exotoxin production:
Staph food poisoning
Toxic shock syndrome
Scalded skin syndrome

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8
Q

What is the common clinical presentation of a staph infection?

A

Erythema + purulent drainage of an abscess.
MRSA will look more severe.

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9
Q

What kind of infections typically attract staph?

A

Open wound
Open burn

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10
Q

What is the first step in treating a staph infection on skin?

A

Draining the abscess.

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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.

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12
Q

If the patient is at low risk for MRSA, what tx would I give?

A

Keflex
Dicloxacillin

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13
Q

If the patient is at high risk for MRSA, what tx would I give?

A

Clindamycin
Doxy/Mino
Bactrim

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14
Q

What is safe to give in kids if they are at high risk for MRSA?

A

Bactrim

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15
Q

If the patient is being admitted for MRSA, what tx would I give?

A

Vanco IV

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16
Q

What percentage of osteomyelitis cases are caused by S. aureus?

A

60%!!!

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17
Q

How is osteomyelitis confirmed?

A

XRAY

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18
Q

What is the most confirmatory scan for osteomyelitis?

A

Bone Scan

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19
Q

What is the first step once osteomyelitis is confirmed?

A

Culturing the bacteria!!

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20
Q

What is the initial tx for osteomyelitis?

A

Empiric ABX:
Vanco + 3/4th gen cephalosporin (ex: ceftriaxone)

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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.

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22
Q

What are the primary ways Toxic Shock Syndrome occurs?

A

Tampon use
Nasopharynx packing
Diret inoculation via wound or abscess.

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23
Q

What causes toxic shock syndrome specifically?

A

A focal concentration of toxin-producing S. aureus.

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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.

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25
Q

Why does toxic shock syndrome need to be treated asap?

A

Hepatic damage
Thrombocytopenia
Confusion

Leading to…

Renal impairment
Syncope
SHOCK

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26
Q

What is desquamation often indicative of?

A

Strep or staph infection

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27
Q

How is toxic shock syndrome treated?

A

IP admission with supportive measures.
Debridement and decontamination of local sites.
Empiric ABX.

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28
Q

What is the empiric ABX treatment for toxic shock syndrome?

A

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.

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29
Q

What demographic is most susceptible to Scalded Skin Syndrome?

A

Infants & young children.

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30
Q

What causes scalded skin syndrome and how is it transmitted?

A

S. aureus toxins

Transmitted via birth canal or adult hands.

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31
Q

How does scalded skin syndrome present?

A

Widespread bullae with sloughing.
Desquamation.

Can lead to electrolyte abnormalities and sepsis.

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32
Q

How is scalded skin syndrome confirmed?

A

Clinical diagnosis.

Culture of bullae fluid
OR
Skin biopsy and culture confirmation.

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33
Q

What is the tx protocol for scalded skin syndrome?

A

Supportive care (treating it like actual burns)

ABX:
MSSA will be nafcillin or oxacillin.
MRSA will be Vanco IV.

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34
Q

What is staph food poisoning and what is the common clinical scenario in which it occurs?

A

Contamination of food by S. aureus carriers.
Improperly cooked food or room temp food can allow it to reproduce and produce toxins.

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35
Q

How does staph food poisoning present?

A

N/V/D, abd cramps 2-8 hours post digestion.

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36
Q

How do you treat staph food poisoning?

A

Self-limiting, resolves in 12 hours.

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37
Q

Where are coagulase negative staph infections from most commonly?

A

Hospital acquired.

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38
Q

Where do coagulase negative staph infections typically reside?

A

Postoperative incisions
Prosthetic devices
Indwelling catheters

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39
Q

What is the concern with coagulase negative staph infections?

A

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.

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40
Q

What are the most common causes of pharyngitis?

A

Strep throat
Peritonsillar abscess
Scarlet fever

All of which are caused by GABHS

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41
Q

What are 3 common skin infections?

A

Impetigo
Erysipelas
Cellulitis

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42
Q

What systemic complications can occur from GABHS?

A

Rheumatic fever
Acute glomerulonephritis (2 weeks post infection)

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43
Q

What demographic is most susceptible to GABHS pharyngitis?

A

5-15 y/o.

<2 y/o are extremely rare due to lack of direct inoculation.

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44
Q

What is the most common cause of viral pharyngitis?

A

Adenovirus.

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45
Q

How does pharyngitis present?

A

Tonsillar hypertrophy with erythema and/or exudate
Beefy red uvula
Palatal petechiae
Tender anterior cervical lymphadenopathy

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46
Q

What is the most common clinical presentation of strep throat?

A

Beefy red uvula
Palatal petechiae

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47
Q

How is a diagnosis of strep throat made?

A

Clinical presentation.

THEN

Rapid strep.
Positive = treat
Negative = negative unless you are highly suspicious, then you can do a throat culture.

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48
Q

What is the treatment protocol for strep throat?

A

Benzathine PCN G IM
OR
Penicillin VK
OR
Amoxicillin.

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49
Q

What is the treatment protocol for strep if allergic to PCN?

A

Keflex

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50
Q

How does scarlet fever present?

A

Sandpaper rash, which blanches and fades with a fine desquamation.

Flushed face with circumoral pallor.
Strawberry tongue

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51
Q

What causes scarlet fever?

A

Exotoxin producing GABHS

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52
Q

How does impetigo present?

A

Focal, vesicular, pustular lesions with HONEY-CRUSTED appearance and STUCK ON appearance.

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53
Q

What are the most common causes of impetigo?

A

GABHS
S. aureus

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54
Q

What is the treatment for protocol for normal impetigo?

A

Topical mupirocin/bactroban if localized.

Systemic:
Keflex
Dicloxacillin
Omnicef/cefdinir can be used instead of keflex for less frequent dosing.

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55
Q

What is the treatment protocol for suspected MRSA impetigo?

A

TMP-SMZ (bactrim)
Doxy
Clinda

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56
Q

What sport commonly has impetigo as a result?

A

Wrestling.

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57
Q

What is erysipelas and its susceptible demographic?

A

Adult only.

Superficial and painful cellulitis with dermal facial involvement.

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58
Q

What can cause erysipelas?

A

GABHS
S. aureus

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59
Q

How is uncomplicated erysipelas treated OP?

A

Penicillin VK
Amoxicillin

Dicloxacillin
Keflex
Clinda/erythro

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60
Q

How is complicated erysipelas treated IP?

A

Vanco if MRSA suspected.

cefazolin/Ancef
Ceftriaxone/Rocephin
Clinda

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61
Q

How is cellulitis treated?

A

Empiric coverage of GABHS and S. aureus.

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62
Q

What demographic is most susceptible to necrotizing fasciitis?

A

IV drug users

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63
Q

What organisms can cause necrotizing fasciitis?

A

GABHS
Clostridium perfringens

This prompts a culture since tx is different.

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64
Q

What can toxic shock syndrome be caused by?

A

S. aureus
GABHS

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65
Q

Which strep is a Group B?

A

Strep agalactiae

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66
Q

What demographic is most susceptible to S agalactiae?

A

Newborns born vaginally.

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67
Q

How is Group B strep treated and screened for?

A

Prenatal screening, as it can cause neonatal sepsis.

Tx is intrapartum prophylaxis:
PCN G or ampicillin Q4h until delivery.
Ancef
Clinda/vanco

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68
Q

What is another term for alpha-hemolytic?

A

Incomplete hemolytic

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69
Q

What are the two types of alpha-hemolytic strep?

A

S. pneumo
S. viridans

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70
Q

What diseases is S. pneumo known for causing?

A

OM
Sinusitis
CAP (most common cause of CAP)
Meningitis
Endocarditis

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71
Q

When is S. pneumo most prevalent?

A

Winter and early spring.

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72
Q

What are the 3 MC of OM?

A

S. pneumo (#1)
M. cat
H flu

Oh My SMH

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73
Q

What demographic is most susceptible to OM?

A

2-14 y/o

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74
Q

How does OM present?

A

Otalgia (pulling at ear)
Hearing loss
Poor balance/coordination
Fever
N/V
Diarrhea

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75
Q

What are the main risk factors for OM?

A

Smoker in household
Family Hx (Horizontal eustachian tubes)
Bottle feeding (laying flat)

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76
Q

What are some significant PE findings for OM?

A

Erythematous, bulging TM
Absence/displacement of light reflex (aka cone of light)
Poor mobility
Otorrhea w/ TM rupture

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77
Q

How is OM diagnosed?

A

Clinically.

Can use tympanogram if available.

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78
Q

What is the tx protocol for OM?

A

Analgesics/antipyretics

ABX:
Amoxicillin.

If not improved after 2 weeks:
Omnicef or augmentin. Will cover atypical H. flu

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79
Q

What is a tympanogram used for?

A

TM movement since valsalva is hard for kids to do.

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80
Q

Why are ABX used in OM if it can self-resolve in 70% of cases?

A

Shortens recovery time
Reduces complications

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81
Q

What is the most common cause of acute sinusitis?

A

Adenovirus.

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82
Q

What are the common bacterial causes of acute sinusitis?

A

S. aureus
S. pneumo
M. cat
H. flu

AKA OM causes + S. aureus

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83
Q

What are the risk factors for acute sinusitis?

A

Allergic rhinitis
Structural abnormalities
Nasal polyps

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84
Q

How does acute sinusitis typically present?

A

Symptoms:
Purulent rhinorrhea/PND
Sinus pressure/HA
Nasal pressure

Signs:
Erythematous/swollen turbinates and mucosa
Maxillary/front sinus pressure
Purulent rhinorrhea

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85
Q

How is acute sinusitis diagnosed?

A

Clinically.

CT is PRN.

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86
Q

What is more indicative of severity, the snot color or length of rhinorrhea?

A

Length.
Green snot is caused by dead eosinophils and WBCs. not always indicative of severity.

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87
Q

What is the tx protocol for acute sinusitis?

A

Augmentin.
Requires tx for 14-21 days since it is a cavity.

Doxy is alternative.

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88
Q

What is the most common cause of CAP?

A

S. pneumo (2/3 of all isolates)

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89
Q

What are the S/S of pneumococcal pneumonia?

A

High fever, chills
Early onset rigors
Rust colored sputum!!
SOB
Pleuritic CP!!!

Bronchial breath sounds vs crackles in affected lobe.

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90
Q

How is pneumococcal pneumonia diagnosed?

A

CXR.
Sputum in IP with comorbidities, otherwise not needed for healthy OP.

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91
Q

What is the tx protocol for standard OP pneumococcal pneumonia?

A

PSI or curb 65 score
Empiric ABX:
Amoxicillin
Doxy
Zithromax in areas with <25% resistance.

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92
Q

What is the tx protocol for COPD/comorbidity or recent abx tx for OP pneumococcal pneumonia?

A

Levofloxacin

OR

Combination of…
Augmentin OR cephalosporin + zmax or doxy

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93
Q

What qualifies as a comorbidity?

A

COPD/DM/Lung disease/Heavy smoker

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94
Q

What is the tx protocol for IP pneumococcal pneumonia?

A

Levofloxacin

OR

Zmax + beta-lactam like amoxicillin or ceftriaxone.

It is essentially the same as complicated OP pneumococcal pneumonia.

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95
Q

What is CURB 65?

A

5 question pneumonia scale.

Confusion
BUN > 19
RR >= 30
SBP < 90 or DBP <=60
Age >= 65

2 = IP admission.
4-5 = ICU admission.

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96
Q

What is PSI?

A

Much more extensive index for calculating pneumonia severity.
REQUIRES ABG and CXR.

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97
Q

Which gender is more susceptible to pneumonia?

A

Males are slightly more at risk.

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98
Q

How is pneumococcal pneumonia prevented?

A

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.

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99
Q

How is meningitis cause approximated? List the common causative organisms.

A

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-

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100
Q

How is the causative organism in meningitis often confirmed?

A

CSF via LP. They all look pretty different under the microscope.

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101
Q

What are the two main enterococci organisms?

A

E. faecalis
E. faecium

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102
Q

Where are the enterococci from?

A

Normal intestinal flora.

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103
Q

What do enterococci commonly cause?

A

UTI
Bacteremia
Endocarditis
Intra-abdominal infections
Wound infections

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104
Q

What is the tx protocol for enterococci?

A

Endocarditis:
Amp and gent

SSTI/UTI:
Mild or complicated is amp or vanco

Resistant:
VRE is treated with linezolid or dapto

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105
Q

What are the three G+ rods?

A

Bacillus
Listeria
Corynebacterium

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106
Q

What are the two types of bacilli?

A

B. anthracis
B. cereus

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107
Q

What is B. anthracis?

A

An encapsulated, toxin/spore producing bacteria.

It is the cause of anthrax poisoning and is a CDC cat A.

108
Q

What are the three types of anthrax poisoning?

A

Cutaneous (MC)
Ingestion
Inhalation (most fatal)

109
Q

How does cutaneous anthrax poisoning present?

A

PAINLESS black eschar.
Regional adenopathy
Fever, malaise, HA

All of this should present within 2 weeks of infection.

110
Q

How does ingested anthrax occur?

A

Inadequately cooked meat that is infected.

111
Q

How does GI anthrax poisoning present?

A

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
Q

How does inhaled anthrax poisoning present?

A

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
Q

How is anthrax poisoning diagnosed?

A

Culture/biopsy
Gram stain
Nasal swab for inhalation suspicion
CXR if pulmonary symptoms
LP if systemic

114
Q

What is the prophylactic tx for anthrax?

A

CIPRO ASAP

115
Q

What is the tx protocol for anthrax poisoning?

A

Cipro:
Cutaneous, 7-10 days.
Inhalation, 60 days

Alternative is doxy.

TX MUST BE CONFIRMED BY C&S.

116
Q

What are the two types of illness B. cereus can cause?

A

Diarrheal
Emetic: aka vomiting

117
Q

Where does B. cereus commonly come from?

A

Food left out at room temp for too long.

118
Q

What is the tx protocol for B. cereus?

A

Supportive care, aka resting and fluids.

It is self-limiting.

119
Q

What is the onset of B. cereus?

A

1-10 hours of exposure.

120
Q

What causes listeriosis?

A

Listeria monocytogenes (G+ Rod)

121
Q

What demographic is most susceptible to listeriosis?

A

Neonates
Elderly
Immunocompromised

122
Q

When is somoene at the greatest risk for listeriosis and what are the consequences?

A

Pregnancy.

It can cause sponatenous abortion or neonatal meningitis.

123
Q

How is listeriosis transmitted?

A

Ingestion of contaminated foods:
Dairy
Raw veggies
Meat

124
Q

How does listeriosis commonly present?

A

Bacteremia with high fever and multi-organ involvement
Meningitis
Dermatitis
Oculoglandular symptoms:
Retinitis
Lymph node enlargement.

125
Q

How is listeriosis diagnosed?

A

Blood cultures
CSF

126
Q

How is listeriosis treated?

A

IP is amp and gent
OP is amoxcillin (generally continuation of IP tx)

127
Q

What is the primary disease causing corynebacterium?

A

Corynebactrium diphtheriae

128
Q

What are the two types of diphtheria?

A

Pharyngeal diphtheria: gray membrane covers tonsils and pharynx.

Nasal infection: mainly just discharge.

129
Q

How does pharyngeal diphtheria commonly present?

A

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
Q

How is diphtheria diagnosed?

A

Clinically.
Confirmed via culture.

131
Q

How is corynebacterium diphtheria treated?

A

Diphtheria equine antitoxin from the CDC.

ABX:
PCN or erythro

Contact:
Erythro

132
Q

How is diphtheria prevented?

A

Immunization. Tdap and DTap.

Note:
Susceptible people exposed should get a booster + PCN/erythro.

133
Q

What are the 3 G- cocci?

A

Acinetobacter
Moraxella
Neisseria

134
Q

How do acinetobacter infections occur?

A

Opportunistic, commonly nosocomial and critically ill/immunocomped.

135
Q

What is unique about acinetobacter reservoirs?

A

It can stay on a dry surface for an entire month. (AKA medical equipment)

136
Q

What are the most common infection sites for acinetobacter?

A

Respiratory is MC.
Esp. tracheostomy sites

Suppurative infection that can lead to bacteremia.

137
Q

What infections does M. cat cause?

A

Acute OM
Acute and chronic sinusitis
COPD exacerbations

138
Q

What is the treatment for acute OM?

A

Amoxicillin.

Augmentin or omnicef if persistent.

139
Q

What is the tx for acute/chronic sinusitis?

A

Augmentin, second is doxy.

140
Q

What are the two types of neisseria bacteria?

A

N. meningitiditis
N. Gonorrhoeae

141
Q

What are the characteristics of meningococcal meningitis?

A

Human reservoirs (40% of adults are carriers)

Close contact required (aka college dorms)

Outbreaks most common in spring and winter.

Immunization available.

142
Q

How does meningococcal meningitis present?

A

Fever, HA, stiff neck
N/V, photophobia, lethargy
AMS
Maculopapular rash, petechiae
Positive kernig’s and brudzinski
High mortality if progresses to meningococcemia.

143
Q

How is meningococcal meningitis diagnosed?

A

Gram stain
LP with CSF analysis
Blood culture

144
Q

What is the tx protocol for meningococcal meningitis?

A

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
Q

What is given for meningococcal meningitis prophylaxis?

A

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
Q

How does meningococcal vaccination work?

A

Meningococcal vaccine ACWY strains.
+
Meningococcal vaccine B strain

Vaccinate at 11-12.
Booster at 16.

147
Q

What diseases can N. gonorrheae cause?

A

Cervicitis, Urethritis
PID
Prostatitis
Disseminated disease
Skin rashes
Septic arthritis
Conjuctivitis (esp in newborns)

148
Q

How does a gonorrheal disease present?

A

Yellow-green purulent discharge
Erythematous cervix

Note:
Can be asymptomatic as well.

149
Q

What bacteria can cause a yellow-green discharge?

A

H flu
Gonorrheae
Adenovirus

150
Q

If there is excess discharge from an eye, what should I do?

A

Culture it.

151
Q

How is gonorrhea diagnosed?

A

Gram stain + culture

152
Q

What is the tx protocol for gonorrhea?

A

Rocephin (single dose)

153
Q

What is the most common type of pseudomonas?

A

P. aeruginosa
G- rod

154
Q

What does P. aeruginosa cause?

A

Opportunistic infections.

In healthy, it only causes OE, UTIs, and dermatitis.

In immunocomped pts, it can cause UTIs, pneumonia, bacteremia, and sepsis.

155
Q

What counts as immunocomped relative to P. aeruginosa?

A

Burn pts
Cystic fibrosis pts
Ventilator acquired pneumonia.

156
Q

What color is the discharge of P. aeruginosa?

157
Q

What is pseudomonas the #1 causative organism in?

A

OE
Corneal ulcers in contact lens wearers due to bacterial keratinitis.
ICU-related pneumonia
Osteochondritis due to tennis shoe puncture.

158
Q

What is pseudomonas the #2 causative organism in?

A

G- organism in nosocomial pneumonia

159
Q

What is pseudomonas the #3 causative organism in?

A

Hospital-acquired UTIs

160
Q

What is a common infection/manifestation of pseudomonas that is water-related?

A

Hot tub folliculitis.

161
Q

What is the first common symptom of a pseudomonas infection?

162
Q

What is the tx protocol for OP pseudomonas?

A

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
Q

What is the tx protocol for IP pseudomonas?

A

Pip/tazo
Ceftazidime
Cefepime
Meropenem
Zithromax

Note:
All IV. Need hosp admission if positive for pseudomonas on culture?

164
Q

What are the 4 G- rods that cause respiratory tract illnesses?

A

B. pertussis
H. flu
Legionella
Klebsiella

165
Q

What disease does B. pertussis cause?

A

Whooping cough

166
Q

What is the most susceptible demographic to B. pertussis?

A

Unvaccinated children.

167
Q

What are the 3 clinical stages of pertussis?

A

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
Q

How is whooping cough diagnosed?

A

Clinical presentation + NP culture.

169
Q

What is the tx protocol for pertussis?

A

Supportive care.

ABX:
Zithromax, alt is bactrim if allergy.

If started early in catarrhal, it can stop the disease progression.

170
Q

How is pertussis prevented?

A

Children: DTap
Booster: Tdap

Note:
ap standards for acellular pertussis

171
Q

What diseases can H flu cause?

A

Sinusitis
OM
Bronchitis
Epiglottitis (MC)
Pneumonia
Cellulitis
Meningitis
Endocarditis

172
Q

What is H flu often implicated in?

A

COPD exacerbations resulting in purulent bronchitis.

173
Q

What is the tx protocol for H flu?

A

Depends on site, but it is generally augmentin or omnicef.

174
Q

What is the causative organism for legionnaire’s?

A

Legionella pneumophilia. Also a common cause of CAP.

175
Q

What demographic is most susceptible to legionnaire’s?

A

Immunocomped
Smokers
Chronic lung disease (Esp those on CPAP)

176
Q

What transmission causes outbreaks of legionnaire’s?

A

Aerosolization by water. Commonly if it is in a water tower or AC unit.

177
Q

How does legionnaire’s present?

A

Scant sputum production
Pleuritic CP
High fever
Toxic appearance

178
Q

How is legionnaire’s diagnosed?

A

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
Q

What is the tx protocol for Legionnaire’s?

A

Macrolide (azithromycin, clarithomycin)
Fluoroquinolone (Levofloxacin)

10-14 days/ 21 days for immunocomped

180
Q

What demographics are most susceptible to klebsiella infections?

A

Alcoholics (esp. those who aspirate)
Diabetics
HIV

181
Q

How does a klebsiella pneumonieae infection commonly present?

A

Severe pneumonia symptoms like SOB and pleuritic CP.
Red currant/jelly-like sputum
Can progress to a lung abscess.

182
Q

How is klebsiella diagnosed?

A

CXR
Sputum culture

183
Q

What is the tx protocol for klebsiella?

A

C&S REQUIRED

Empiric abx:
Respiratory fluoroquinolones (levo and moxi and gemi)
Carbapenem

184
Q

What G- rods cause GI illnesses?

A

E. coli
Campylobacter
Salmonella
Shigella
Vibrio

185
Q

What is the general tx protocol for a diarrheal illness?

A

Cipro
Secondary is zithromax

186
Q

How does E. coli diarrhea/traveler’s diarrhea commonly present?

A

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
Q

What is the main concern in traveler’s diarrhea?

A

Dehydration

188
Q

What are the OTC/non-abx tx for traveler’s diarrhea?

A

Peptobismol
Antimotility/anti-diarrheals

189
Q

What is the ABX tx for traveler’s diarrhea?

A

3-5 days of cipro if severe symptoms or 3+ stools/8h

190
Q

What is the concern with antimotility agents?

A

Bowel obstruction.
Should stop after 48 hrs if s/s worsen.

191
Q

Who cannot take peptobismol?

A

Children
Preggo
ASA allergy

192
Q

Who should not take antimotility agents?

A

Infants
Fever or bloody diarrhea (could delay clearance of bacteria)

193
Q

What campylobacter bacteria is the most common causative organism?

194
Q

What is the presentation of campylobacteriosis?

A

Inflammatory, sometimes bloody diarrhea.
Dysentery syndrome w/ cramps, fever, pain

195
Q

What is the tx protocol for a C. jejuni infection?

A

Cipro
Zithromax

196
Q

How does shigellosis/shigella infection present?

A

Abrupt onset of bloody and mucus-filled diarrhea.
Lower abd cramping, pain, and tenesmus.

Systemic:
fever
chills
malaise
HA
anorexia

197
Q

What will be indicative of an inflammatory diarrhea from a stool sample?

A

WBC in the stool

198
Q

What is the tx protocol for shigellosis?

A

Cipro
TMP-SMZ

199
Q

What is the common mode of transmission for a cholera infection?

A

Ingestion of contaminated food or water.

200
Q

What is the MC of a cholera infection?

A

Vibrio cholerae

201
Q

How does a cholera infection present?

A

Acute, voluminous diarrhea with grayness, turbidity, and NO ODOR.
Often described as rice water stool.

202
Q

How is cholera diagnosed?

A

Stool culture

203
Q

What is the tx protocol for cholera?

A

Doxy/tetra
TMP-SMZ
Zithromax
Cipro

Rehydration

204
Q

What are the other 3 vibrios that cause disease?

A

Vibrio parahaemolyticus from coastal US + Japan
V. mimicus
V. hollisae

205
Q

How do non-cholera vibrio infections present?

A

Enteric illness:
Water diarrhea, tenesmus, abd cramping

Cellulitis

206
Q

What is the tx protocol for non-cholera vibrio infection?

A

Doxy or cipro

207
Q

How is a non-cholera vibrio infection diagnosed?

A

Stool culture

208
Q

What are the two infections caused by salmonella?

A

Enteric fever/typhoid caused by S. enterica.

Acute enterocolitis caused by typhimurium or enteriditis

209
Q

What is the incubation period for a salmonella infection?

A

5-14 days.

210
Q

What is the first stage of typhoid fever and how does it present?

A

Prodromal stage:
malaise
HA
cough
sore throat
N/V
abd pain

Will worsen after 7-10 days.

211
Q

What are the common sources of S. enterica?

A

Raw eggs (cookie batter, cake batter)
Raw chicken

212
Q

What are the key PE findings for typhoid fever?

A

Blood pea soup diarrhea
Rose spot

213
Q

How is typhoid fever diagnosed?

A

Positive blood, stool, and urine cultures.

214
Q

What is the tx protocol for typhoid fever?

A

Cipro/Levo
Rocephin
Zithromax

215
Q

What is the tx protocol for typhoid carriers?

A

Cipro 4 weeks

216
Q

How is acute enterocolitis transmitted?

A

Ingestion of infected food:
Eggs, poultry, meat, RAW MILK
DIRECT CONTACT WITH REPTILES AND TURTLES

217
Q

How does acute enterocolitis present?

A

Nausea, crampy abd pain.
Potentially bloody/mucus diarrhea (inflammatory)
Fever

Sx 12-48 hrs post contact.

218
Q

How is enterocolitis diagnosed?

A

Stool culture

219
Q

What is the tx protocol for enterocolitis?

A

Uncomplicated = do not treat, does not shorten recovery.

Complicated = Cipro, rocephin, Zithromax, TMP-SMZ

220
Q

What G- rods can cause UTIs?

A

E. coli
Enterobacter
Serratia
Proteus
Klebsiella

221
Q

What is MCC of a UTI?

222
Q

What is the next stage if a UTI is left untreated?

A

Pyelonephritis

223
Q

Where are most UTIs mainly localized?

A

Bladder and urethra, aka lower urinary tract.

224
Q

What is the tx protocol for uncomplicated cystitis?

A

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
Q

What is the tx protocol for pyelo?

A

Cipro
Levaquin
Rocephin + bactrim/augmentin/omnicef (1 of 3)

226
Q

What causes the bubonic plague and where is it endemic?

A

Yersinia pestis

Endemic to CA, AZ, NV, NM

227
Q

How is the bubonic plague transmitted?

A

Rodents that have been bitten by infected fleas.

228
Q

What are the 3 types of the bubonic plague?

A

Pneumonic
Septicemia
Bubonic

229
Q

How does the bubonic plague present?

A

Profound illness.
Axillary/inguinal lymphadenitis (Bubo)
Blood-tinged sputum
Purpuric spots on skin

230
Q

What is the tx protocol for bubonic plague?

A

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
Q

What is the MCC of tularemia and how is it transmitted?

A

Francisella tularensis

Transmitted via rabbits, rodents, ticks. Aerosolized.

Note:
I just remember it as the rabbit disease

232
Q

How does tularemia present?

A

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
Q

How is tularemia diagnosed?

A

Serologic tests:

lymph node aspiration
Blood culture
Ulcer culture

234
Q

What is the tx protocol for tularemia?

A

Identical to bubonic plague

1 of the 4:
Strepto
Gent
Doxy
Fluoroquinolones

235
Q

What is the minimum temp for a fever?

A

38C
100.4 F

236
Q

Which temperature method requires adjustment?

A

Axillary. Add 1 deg F.

237
Q

What are the 3 criteria for a fever to be considered of unknown origin?

A

A fever > 38.3C or 101.9F on several occasions orally.
Failure to diagnose despite 1 week IP investigation.
>3 weeks duration

238
Q

What are the 4 kinds of FUO?

A

Classic FUO
Hospital-acquired FUO
Immunocomped/neutropenic FUO
HIV-related FUO

239
Q

What are the 4 differential diagnoses for a FUO category wise?

A
  1. Noninfectious (MC)
  2. Infectious
  3. Malignancy/neoplastic
  4. Misc
240
Q

What are common non-infectious causes of a FUO?

A

CT diseases
Vasculitis
Granulomatous disorders

Giant cell arteritis, SLE, RA

241
Q

What are the common infectious causes of a FUO?

A

TB
Cat-scratch
EBV

242
Q

What are some miscellaneous causes of a FUO?

A

Cirrhosis, Crohn’s, PE

243
Q

What key finding will help guide the workup for an FUO?

A

Shaking/chills is more suggestive of an infectious etiology. (very common in s. pneumo)

244
Q

What do you need to do everyday if you’re trying to deduce the etiology of a FUO?

A

Full PE and daily while in the hospital.

245
Q

What are lab tests you can order to help workup a FUO?

A

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
Q

What is the tx protocol for a FUO?

A

MUST FIND ETIOLOGY.
NO EMPIRIC.

Consider an ID consult.

247
Q

What is SIRS?

A

Systemic inflammatory response syndrome.

It is a lead-up to sepsis, but is not sepsis itself.

248
Q

What is SIRS criteria?

A

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
Q

What are some causes that can meet SIRS criteria?

A

Ischemia
Inflammation
Trauma
Infection
Combination of other factors

250
Q

What is the definition of sepsis?

A

Sepsis is the presence of SIRS + documented/presumed infection

251
Q

What is the definition of bacteremia?

A

Presence of bacteria in blood.

NOT technically fatal.

252
Q

What is the MCC of bacteremia/septicemia?

A

Respiratory infections in those => 65 in winter.

G+ is most common, followed by G- and fungal.

253
Q

Describe the basic 4 step pathway of sepsis.

A
  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
Q

What are the risk factors for sepsis?

A

ICU admission
Bacteremia (95% of blood cultures associated w/ sepsis)
DM and Cancer
CAP
>= 65 yo
Previous hospitalization
Immunosuppression/comp
Genetic disposition

255
Q

How does sepsis commonly present?

A

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
Q

How is early sepsis diagnosed?

A

qSOFA score, >= 2.

257
Q

What is qSOFA criteria?

A

RR >= 22/min
Altered mentation
SBP <= 100 mm Hg

258
Q

When do I do a full SOFA score?

A

If my qSOFA >= 2.

259
Q

What are some common CBC findings for septic pts?

A

Leukocytosis/Leukopenia (>12000, <4000)
Normal WBC but >10 immature forms
Thrombocytopenia

260
Q

What are some common BMP findings for septic pts?

A

Hyperglycemia w/o diabetes. (>140)
Crp > 2 SD above normal
Acute oliguria

261
Q

What are some specific lab findings for septic pts?

A

Hyperbilirubinemia >4 mg
Elevated aPTT or INR
Adrenal insufficiency dt hyponatremia or hyperkalemia
Hyperlactatemia > 2mmol
PCT > 2SD above normal.

262
Q

What causes PCT elevations?

A

Pro-inflammatory state.
Rises more due to bacterial infections.

263
Q

What is the tx protocol for sepsis?

A

ABX therapy within 1 hr of suspected Dx.
Vasopressors
Multiple empiric ABX
Central lines
IV Fluids
Organ perfusion methods

264
Q

What pathogens are the most fatal in sepsis?

A

Anaerobes that cause ischemic bowel.

265
Q

What is more fatal, nosocomial pathogens or community-acquired?

A

Nosocomial

266
Q

What infection has the lowest mortality in sepsis?

Clinical Med B (22 decks)

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