Micro - PUO + endocarditis Flashcards
Definition fo PUO
> 38.3C for 3 weeks despite 1 week of Ix
8 causes of a “classical PUO”
- Endocarditis
- ABSCESSES
- TB
- Returning traveller: malaria
- HIV
- CTD/vasculitis
- Malignancy
- Complicated UTI
4 diseases which present with fever in a returning traveller within 7-10 days of return
Malaria
Dengue
Diarrhoeal disease
Typhoid
Which cause of fever in a returning traveller will present at 3 weeks from return?
Brucellosis
Name 4 commonest causes of fever in a returning traveller, which may present with a rash?
Malaria
Dengue
Rickettsia
Typhoid
Cause of ‘spotted fever’
Tx of spotted fever?
Rickettsia
Tx with DOXYCYCLINE
E.g.s of healthcare associated PUO?
Lines (biofilms) Catheter -->UTI Bedsores Ventilation assoc pneumonia Post-surgical (wound infection)
C Diff colitis
what kinda organisms tend to cause hospital acquired pneumonia?
Gram - species, as these colonise the skin more in hospital
Immune-deficient PUO: which patients tend to be affected by this?
BMT patients
Infective causes of immune-deficient PUO
CMV (post transplant)
TB
Risk factors for neutropenic fever?
Aspergillus spp infection
- Lines
- Chemo/BMT
- IRIS syndrome
which particular infection do we majorly worry about in neutropenic fever?
Aspergillus spp
In HIV patients, what lab investigation is particularly important to know which infections they are susceptible to?
CD4 count
in a patient with CD4 count of <200, which 3 infections are they particularly susceptible to?
- Cryptococcus
- PCP
- Disseminated mycobacterium avium complex
characteristic features of PCP?
Desaturating on exercise
- CXR is deceivingly ok
PUO in pt who has returned from Malaysia. What infection do we need to consider?
Histoplasmosis
Useful lab tests in a patient with PUO?
Blood cultures x3 Returning traveller: blood film HIV TEST!!!!!! Rapid Ag test FBC, CRP, LFTs
If eosinophils are high.. think of…?
worms:
- schistosomiasis
- Filaria
- Strongloides
Gram - coccobacillus + unpasteurised milk ingestion
Brucellosis
Immediate mx of neutropenic fever
Empirical antibiotics + BCs
A dimorphic fungus from Malaysia
histoplasmosis
fever + murmur + splenomegaly…?
infective endocarditis!
Oslers nodes vs Janeway lesions
Oslers nodes: small and painful nodules
Janeway lesions: painless macules
Renal complications of infective endocarditis
- Glomerulonephritis
- Abscess
- Infarction
Top 3 pathogens in infective endocarditis
Strep viridans
Staph Aureus
Staph epidermis
In patients with a prosthetic valve, what is the most common pathogen causing IE?
Staph epidermis (coagulase negative staph)
What are the “major criteria” for diagnosing IE?
1) 2x BCs with +ve microorg that is typical of IE
2) Echo findings: new regurgitation/abscess/oscillating mass on valve
“minor criteria” for diagnosing IE? (name 4, don’t bother with the +ve BC and echo findings which don’t satisfy the major criteria)
1) fever
2) Oslers nodes/janeway lesions
3) Predisposing <3 prob/IVDU
4) vascular ting: major arterial emboli/pulmonary infarcts
Tx of MSSA endocarditis?
Fluclox for 4-6 weeks
Tx of MRSA endocarditis
Vanc + gent
Tx of strep viridian’s endocarditis
Benzylpenicillin + gentamicin
Tx of enterococcal endocarditis
Ampicillin + gentamicin
