Management of Common Infections Flashcards
Why is combination therapy used?
- synergy
- to prevent resistance
- mixed infection and 1 agent doesn’t cover all bases
Define pyrexia of an unknown origin?
fever where the cause remains unknown despite
- history & examination,
- 3 sets of blood cultures & urinalysis
- routine invesigations,
- CXR
- further tests directed by localising symptoms/signs
What are the main 3 causes of pyrexia of unknown origin?
- infections
- malignancies
- CT diseases (vasculitis, RA)
What are the infective causes of PUO?
TB Endocarditis Abscess Teeth Back - osteomyelitis Sinuses Typhoid Infected prosthesis
What are the rheumatological causes of PUO?
Periodic fever syndrome
Vasculitis
Adult onset Still’s
What are the cancerous causes of PUO?
Lymphoma
Renal cell carcinoma
Hepatocellular Carcinoma
What medications can cause PUO?
Antibiotics Anticonvulsants NSAIDs Antihypertensives Antihistamines Alcoholic hepatitis Recreational
What useful second line tests should you do for PUO?
- ESR
- CRP
- RhF
- Blood film
- serology
- imaging CT
- ECG
- biopsy, bone marrow aspiration
What is the prognosis of PUO?
- generally good outcome as get better with steroids/antibiotics
- low mortality
- symptoms gradually subside despite not knowing what is going on
Urinary Tract Infections
UTI
Pyleonephiritis
Prostaitis
PID
Skin and soft tissue infection
Cellulitis
Necrotising fasciitis
Bites
Resp tract Infections
Pneumonia
Empyema
TB
COPD
CNS Infections
Meningitis
Encephalitis
Cerebral abscess
Abdo Infections
Gastroenteritis
CHolangitis
Hepatitis
Bone and joint Infections
Septic arthritis
Osteomyeltiis
Diabetic Foot
Cardiovasc Infections
Endocarditis
Device related infection
UTIs
- common
- can be asymptomatic to renal abscess/urosepsis
- by organisms which normally reside in GI tract
- more common in woman as shorter urthera so bacteria less distance to travel
- dysuria, bladder tenderness, flank pain, fever, circulatory failure, organ failure
- dipstick, MSU culture, renal US/CT, abdominal CT
What is asymptomatic bacteria in UTI?
- no symptoms
- bacteria present
- not need treating excep immunosuppressed, abnormal anatomy of urinary tract, children, pregnancy
- pregnancy can develop pyelonephritis
What is proteus?
UTI associated with renal calculi
- breaks down urea to ammonia to alkaline urine to stones
- MSU growing proteins present
Things to look out for with UTI
- S. aureus in urine
- endocarditis
- renal abscess in urine
- check renal function before advising nitrofurantoin as won’t get into urine if eGFR <60
- pyelonephritis = prolonged fever
Skin and soft tissue infection guidelines
- common
- can be life threatening
- depends on what skin/soft tissue structures involved
- pus present?
- beware around eye, face, fingers, neck, groin/genitals
- if pain disproportionate to degree of damage = deeper infection?
Define cellulitis?
- inflammation of cells
- infection of dermis and subcutaneous tissues
- indistinct edge
Define erysipelas
- red skin
- infection of dermis only
- clear demarcated edge
Deifne impetigo
erythematous patches
associated with serous discharge and golden crust
Causes of hot red leg
Cellulitis DCT COntact dermatitis Gout Drug reaction Insect bite Exacerbation of lymphoedema
What is important about cellulitis?
Does not exist bilaterally!!
RTI guidelines
- over diagnosed
- COPD exacerbations don’t always need ABs as often viral
- sepsis message need urgent ABs
- range anatomically (upper, lower)
- often exacerbations of pre-existing resp conditions
- pathogen range (bac, viral, fungal)
Difference between typical and atypical pneumonias
Typical is S pneumonia or H. influenza grown but atypical no organism cultured as non-culturable (legionella, clhamydiphilia, mycoplasma)
- atypical milder, WBC less elevated, hyponatremia?, extra pulmonary manifestations
What is the CURB 65 score?
Clinical Judgement Assessment of severity of resp infections - confusion, urea, resp rate, BP, age - low, moderate, high severity - low = single AB - mod = amoxicillin and macrolide - high = beta lactam and macrolide
Define meningitis and presentation
- meninges inflammation
- headache, neck stiffness and photophobia
Define encephalitis and presentatin
- brain parenchyma inflamm
- associated with cerebral function = seziures, weakness, behaviour change
Difference between viral meningitis and encephalitis
Men does not need treatment but enceph does
- more viral enceph over bacterial
CNS Infection guidelines
- sample CSF
- anti-infectives start then cessate
Infective endocarditis guide
- positive vs negative culture
- native vs. prosthetic
- indolent vs. acute
- reason for specific organisim may be important as indicates other disease in body
- why that valve? something else wrong with it?
- surgery? depends
