MICRO: Actinomyces, C difficile, UTI Flashcards
What is second line for PCP?
Clindamycin and primaquine with IV methylpred
What stain is used for PCP?
Methanamine silver
aka Grocott-Gomori
When is the viraemic peak in HIV?
4 weeks
Which bacterial infections are common if neutrophil defects exist?
Staph
Pseudomonas
What infection is most common with complement defects?
Neisseria
What are alcoholic patients at risk of?
Actinomyces and other slow growing organisms
Encapsulated organisms
What types of infection doe Actinomyces cause?
Lung or brain abscesses which are difficult to treat
What are the micro features of actinomyces?
Gram +ve rod that branches (often confused with fungi, Nocardia looks the same)
What is a characteristic feature of actinomyces on histopathology?
Basophilic granules or sulfur granules
What stain is used for actinomyces?
Grocott
List the features of severe C diff according to Imperial guidelines.
Temperature over 38.5 HR >90 WCC >15 Cr rising No response to abx in 72hrs Severe colitis features
What is the management of mild C diff?
Metronidazole 400mg TDS
What is the management of severe C diff?
Vancomycin ~200mg +/- metronidazole
What is the management of C diff with colonic dilatation?
Metronidazole IV (!) and vancomycin PO
What is the management of C diff with ileus?
Intracolonic vancomycin
What are the 3 Cs associated with C diff?
Clindamycin
Cephalosporin
Ciprofloxacin
What non-Abx drugs can cause C diff?
PPIs (higher pH so more spores survive)
Name 2 places where C diff toxins act to cause pseudomembranous colitis.
epithelial junctions –> neutrophils infiltrate
tight junctions –> fluid loss
Is CRP high in C diff?
No, commonly low with high WCC
What % of UTI are caused by several bacteria?
5%
What virulence factor does staph saprophyticus have to cause UTI?
P-fimbrae - adherence to epithelium
Other than E coli/SS, what are other causes of UTI?
Proteus m
Klebsiella aerogenes
Enterococcus faecalis
Staph epidermidis
What UTI is staph epidermidis associated with?
Prosthesis e.g. catheter
What UTI is proteus associated with?
Kidney stones