MEGAQUIZ Flashcards
common “colonizers”
-skin- staph, strep, corynebacterium, candida
-mouth- strep (aerobes and anaerobes), candida
-colon- bacteroides, enterobacter, enterococcus, candida
-vagina- lactobacillus, costridium, enterobacter
tuberculosis
-aerobic, nonmotile, acid-fast bacillus
-incubation- 2-12 weeks
-mycobacterium tuberculosis
-M. tuberculosis complex - M. bovis
-primary progressive TB
-latent -> reactivation TB or progressive secondary TB
-extrapulmonary TB -> children and immunocompromised (pleura, meninges, lymphatic system, genitourinary (GU), bones)
-gold standard- sputum for acid-fast bacilli (AFB) staining using Ziehl-Neelsen (ZN) stain -> PCR
macule vs papule
-macule is flat
-vesicle has pus/liquid
-papule has texture
tuberculosis treatment
-latent- isoniazid w/ or w/o pyridoxine for 9 months
-daily rifampin for 4 months- alternative
-active and/or extrapulmonary TB- isoniazid, rifampin, ethambutol, streptomycin, pyrazinamide
-hard to treat- bacterias slow reproductive rate
lyme disease
-incubation- 3-30 days
-early localized- EM, flu
-early disseminated- multiple ME
-late disseminated- neurological, heart
-EM bx culture in Barbour Stoenner Kelly medium -> IgM and IgG serologica antibody testing
-24-36 hour- increased transmission
-single dose doxycycline within 72 hours
syphilis
-presents differently
-10-90 days
-gram neg spirochete
-can be congenital
-condyloma latum- mucous membranes -> resolve 3-6 weeks without treatment -> enters latency
-secondary- 4-10 weeks
-chancres, macules, and papules
syphilis testing
-darkfield microscopy or direct fluorescent antibody testing on fluid or smears from lesions
-serological tests:
-nontreponemal (screening)
-treponemal specific (confirmatory)
-RPR, VDRL, TRUST
-+ results followed up with confirmatory treponemal-specific testing -> T. pallidum enzyme immunoassay (TP-EIA) or fluorescent treponemal antibody absorption (FTA-ABS)
syphilis treatment
-benzathine penicillin G x 1 for primary, secondary, or latent infections less than 1 years duration
-latent > 1 year or indeterminate age and tertiary infections other than neurosyphilis -> benzathine penicillin G weekly x 3
-neurosyphilis -> continuous IV for 10-14 days
RMSF
-rickettsia rickettsii
-transovarial transmission- tick to eggs
-incubation- 2-14 days
-gram negative obligate intracellular bacteria
-6-10 hours transmission
-macular
-labs- hyponatremia, thrombocytopenia, high LFTs, increased bilirubin, and increased BUN
-western blot- detection of rickettsial nucleic acids by PCR in blood/skin biopsy
-fever w/o rash- Eldery and African American
-More severe- males, alcoholic, AA, pts with G6PD, immunocompromised
-severe case- necrosis, gangrene, acute respiratory distress syndrome, pulmonary edema, nausea/vomiting, abdominal pain, diarrhea, confusion, acute renal failure, meningoencephalitis, ataxia, blindness
chlamydia
-incubation- 1-3 weeks
-gold standard- nucleic acid amplification testing (NAAT)
-rapid version -> 90 mins
-uncomplicated- single dose of azithromycin OR doxycyclin 100 mg orally twice a day for 7 days
pelvic inflammatory disease
-treated w/ ceftriaxone and doxycycline +/- metronidazole, IV
-systemic symptoms - fever, chills, nausea, vomiting
-cervical motion tenderness, adnexal tenderness, peritonitis
-tubo-ovarian abscess
-infertility
-increased risk for ectopic
-Fitz-Hugh-Curtis syndrome*- perihepatic adhesions late symptom
gonorrhea
-incubation- 1-14 days
-purulent urethral discharge in men
-extragenital infection- rectum, pharynx, conjunctiva
-disseminated gonococcal infection (DGI) -> triad of polyarthritis, tenosynovitis, dermatitis OR septic arthritis (knees)
-DG meningitis and endocarditis -> rare
gonorrhea treatment
-uncomplicated- ceftriazone IM and oral azithromycin
-azithromycin may reduce gonococcal resistance to cephalosporins
-IM ceftriaxone and 10 days of doxycycline -treat epididymo-orchitis, prostatitis, and proctitis
-conjunctivitis- ceftriaxone IM and azithromycin
leprosy
-Hansen disease
-Myobacterium leprae
-incubation- 9 months- 20 years
-slow growing gram positive intracellular bacteria
-macular w/ raised granular margin
-anhidrosis
-muscle weakness
-auto-amputation
-skin bx and PCR to confirm
-dapsone was used until resistance emerged
-MULTIDRUG therapy is required now for 6-12 months longer
-2 protocols:
-paucibacillary- dapsone + rifampicin for 6 months
-multibacillary- dapsone, rifampicin, + clofazimine for 12 months
cholera
-incubation- 1-5 day
-vibrio cholerae
-afebrile, painless
-renal failure, acidosis, circulatory collapse, death
-sudden onset
-nonmalodorous- does not smell
-vomiting in beginning bc less gastric motility
-cholera gravis -> severe, fatal dehydration if untreated
-doxycyclin may reduce length/severity -> does not cure
shigella
-tenesmus
-small frequent stools
-initially water and becomes mucoid and blood
-complications: hemolytic uremic syndrome (HUS), seizures in children, and reactive arthritis
-stool culture- PCR
-azithromycin or ciprofloxacin
salmonella
-nontyphoidal salmonella
-tenesmus
-bloody diarrhea more common in children
-Complications: bacteremia, meningitis, septic arthritis, osteomyelitis (sickle cell pts are at increased risk), postinfectious IBS, reactive arthritis
-stool culture
-fluoroquinolones (ciprofloxacin or levofloxacin), macrolides (azithromycin), or cephalosporins (ceftriaxone or cefotazmine)
diphtheria
-can be asymptomatic carrier
-progressive symptoms
-gray psudomembrane
-tonsillopharyngeal diphtheria- lymphadenopathy, odynophagia (painful swallowing)
-laryngeal diphtheria- barking, bull, hoarse
-spreads hematogenously -> damage to cardiac, renal, and/or nervous system
-nasopharyngeal and oropharyngeal- cultures on Loffler or Tindale media -> chinese characters -> PCR and ELISA
-horse serum, erythromycin or penicillin
tetanus
-3-21 day incubation (10)
-generalized- trismus, risus sardonicus, descending muscle spasms, opisthotonus, laryngospasm
-localized
-neonatal- contamination of umbilical stump
-cephalic- 1-2 day incubation, unilateral facial paralysis
-tetanus immune globulin, wound care, benzodiazepines, intubation
boltulism
-no fever
-6 hour-10 day incubation
-wound infection- no GI, fever secondary to wound infection
-bilateral facial paralysis
-descending weakness
-bradycardia
-EMG, stool, serum, vomitus, food specimen
-wound must be by serum
-intubation
->1 year- horse serum
-<1 year- human derived immune globulin
campylobacter jejuni
-GI of animals
-fever and pseudo appendicitis prodromes
-tenesmus
-Guillain-Barre syndrome and reactive arthritis
-becomes bloody
-stool culture- PCR
-azithromycin 3 days or erythromycin 5 days 4x daily
group A streptococcus
-peaks late winter and early spring
-bacterial pharyngitis
-complications- poststreptococcal glomerulonephritis, and peritonsillar abscess
-RADT- rapid antigen detection test and throat culture
-oral petechiae, lymphadenopathy
-fever, anorexia, malaise, sore throat, headache, abdominal pain, nausea, and vomiting
-scarlatiniform rash
-no cough
-modified centor criteria
-penicillin, amoxicillin, cephalosporin
-erythromycin, clindamycin, or macrolides for penicillin allergy
infective endocarditis
-caused by staphylococci, streptococci, HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenell a, Kingella)
-short incubation
-risk factors- IV drug abuse, poor dentition, valvular heart disease, congenital heart disease, prosthetic heart valves, indwelling lines, pacemakers, past hx of infective endocarditis, and chronic hemodialysis
-fever, murmur, myalgia, arthralgia, splinter hemorrhages, septic emboli, petechiae, splenomegaly, cough, weight loss, and/or glomuleronephritis
-Janeway lesions, Osler nodes, and Roth spots
infective endocarditis treatment and diagnosis
-blood cultures from 3 different sites, if neg repeat before empiric treatment
-echocardiagram
-C-reactive protein, ESR and rheumatoid factor labs
-empiric treatment
-vancomycin and ceftriaxone or gentamycin
sepsis
-systemic inflammatory response syndrome (SIRS)
-body temp > 38 or <36
-tachycardia and tachypnea
-WBC- > 12,00 or < 4,000
-rigors
-confusion
-hypoxia
-hepatic/renal failure
severe sepsis
-organ dysfunction- renal failure, respiratory failure, delirium
-hypoperfusion- lactic acidosis
-hypotension- absolute systolic BP below 90 or 40 below the pt baseline
risk factors: gram positive vs negative vs anaerobic
-positive- normal/immunosuppressed host, asplenia
-negative- immunosuppression (chronic corticosteroid use, chemo, transplant, neutropenia, hemodialysis, diabetes), indwelling catheters
-anaerobic- uncommon, traumatic injuries (necrotizing skin, soft tissue infection)
sepsis causes/prevention
-bacteremia- IV, pulmonary infection, intraabdominal infection, endovascular infection, UTI
-intra-abdominal- peritonitis, cholecystitis, diverticulitis/abscess, pancreatic abscess, septic abortion, or Clostridium difficile colitis
-endovascular- endocarditis, vascular graft infection
-skin and soft tissue- necrotizing fasciitis, soft tissue abscess, surgery infection
-find source within 6 hours -> remove indwelling devices, drain infections
sepsis diagnosis
-CBC w/ diff- leukocytosis, elevated neutrophil (left shift) non-sensitive to infectious vs noninfectious sepsis
-thrombocytosis- elevated
-BMP- serum creatinine may affect antimicrobial dose
-liver enzyme and coagulation test (PT/PTT/INR)- biliary tract infection -> elevated alkaline phosphatase and total bilirubin; coagulation is non-specific -> elevation -> disseminated intravascular coagulation
-serum lactate- >4 -> tissue hypoperfusion -> need for fluid resuscitation
-urine microscopy/culture- >10 WBC -> cystitis, pyelonephritis, or renal abscess
-blood culture- 2 sets -> 1 percutaneous site and 1 vascular access site that has been there for > 48 hrs
-sputum gram stain culture
-wound or abscess culture- needle aspiration contents or deep cultures (not superficial)
-stool study- clostridium difficile colitis
-ESR, C-reactive protein, procalcitonin (PCT)- nonspecific
-PCT- .5-2 - sepsis possible
-PCT- 2-10- sepsis
-PCT- <.5 no sepsis
radiological study: sepsis
-abdominal/chest- pneumonia, abdomen -> may indicate free air (bowel perforation with peritonitis) or presence of gas within an abscess cavity
-abdomen/chest CT- pneumonia and intra-abdominal abscess -> 2 MOST COMMON CAUSES
-echo- transthoracic (TTE) or transesophageal (TEET) review of DULE criteria and eval endocarditis
-U/S- biliary tract or pelvis
sepsis treatment
-fluids
-CVP- 8-12
-MAP- >65
-central venous oxygenation > 70%
-norepinephrine and dopamine for cardiovascular support
-corticosteroid- hypotension (if fluids dont help)
-Hmg < 7- transfuse packed RBCs
-bleeding or < 5,000 platelets- tranfuse
-glucose > 150- insulin therapy
-1. Ceftazidime OR cefepime OR doripenem IV (gram - treatment)
AND
-2. Daptomycin OR linezolid OR vancomycin (gram + treatment)
-for 7-10 days
methicillin-resistant staphylococcus aureus (MRSA)
-SSTIs -> abscesses, furuncles, and carbuncles
-severe CA-MRSA- less frequent -> osteomyelitis, sepsis, septic thrombophlebitis, necrotizing fasciitis, necrotizing pneumonia with abscesses
-HA-MRSA can still cause SSTIs in community but LESS frequent
-wound culture- purulent
-u/s to identify abscess
-drainage, narrow spectrum antimicrobials
-elevate wound
-treat underling condition- tinea pedis
MRSA risk factors
-pts not hospitalized (<1yr) or had a medical procedure (dialysis, surgery, catheters)
-antibiotic use in past month, particularly cephalosporin and fluoroquinolone
-abscess
-reported spider bite
-intravenous (IV) drug use
-HIV infection
-hemodialysis catheter
-hx of MRSA infection
-close contract with similar infection
-children
-resident in long term care facility
HPV
-incubation- 2 weeks - 8 months
-dsDNA
-HPV 6 + 11- condyloma acuminata
-HPV 16 + 18- cervical cancer
-HPV 16- oropharyngeal, anal, vulvovaginal, penile cancers
-HPV 6,18,11- most common
-trichloroacetic acid (TCA), bichloroacetic acid (BCA), cryotherapy w/ liquid nitrogen, surgical removal, curettage, or electrocautery
-podophyllotoxin or imiquimod
-HPV 9-valent vaccine- best coverage
-risk- cigarette smoking, oral contraceptive use > 5 years, STI coinfections
