Module 6: Managing Common Infections Flashcards
1
Q
Immune Senescence Risk Factors
A
- Dysregulation of immune responses
- Decrease in adaptive T cell responses
- Decrease in naive t cells
- Decrease in cytokine production
- Decrease in cellular surface receptors
- Supporessed t-cell responses
2
Q
Protein-Energy Malnutrition PEM
A
- PEM is linked to CAP, nosocomial infection, and longer hospitalizations
- Specific nutrient deficiencies related to poor immune function & Infection
- B12 deficiency — inadequate pneumococcal vaccination response
- Vit D deficiency — incnreased risk of TB and C. Diff infection
3
Q
Social/Environmental Risk Factors
A
- Lower Socio-economic status — Associated w/ increased rates of CAP & invnasive pneumococcal infections
- Long term Care
- Residents frail, have multiple comorbidities and living in close proximity
- Can lead to severe outbreaks & high mortality rates
- Antibiotic resistance r/t high antibiotic use & poor infection control measures
4
Q
Common Presentation of infection in Older Adults
A
- No fever or low-grade fever
- Malaise
- Sepsis w/out leukocytosis and fever
- Falls
- Anorexia
- New onset of confusion
- Acute mental status change
- Acute decline in functional status
5
Q
COVID-19
-Illness Course
A
- 85% mild illness
- 14% severe disease requiring hospitalization (5% require ICU care)
- Predictors of severe illness
- Advanced age
- BMI >30
- Co-morbidities
- Low 02 saturations
- Lab findings — Lymphopenia, neutrophilia, hypoalbuminemia, leukocytosis, increased CRP, Increased D-Dimer, increased Transaminases, Increased lactate
6
Q
COVID-19
-Clinical Management
A
- Monoclonal antibodies
- Oral antiviral medications (5 day course)
- Paxlovid — Many drug interactions **
- Molnupiravir
7
Q
Herpes Zoster
A
- Re-activation of the varicella-zoster virus
- Localized — Rash in 1-2 adjacent dermatomes
- Disseminated — rash affects 3+ dermatomes
- Complications — Post-herpetic neuralgia 13%, blindness, bacterial superinfection of lesions
—Older adults can have confusion with infection
8
Q
Herpes Zoster — Treatment & Vacccination
A
- Isolation
- 7-10 day course of antiviral medicaiton
- PHN can be treated with gabapentin, pregabalin — Use caution d/t risk of confusion/falls in older adults —
Vaccination
- Shingriz recommended over zostavax
- 2 doses — 2nd dose given 2-6 months after first dose
- Previous zostavax vaccination — shingrix recomended
- Previous zoster infection — Shingrix recommended
SHINGRIX is vaccination of choice ** — 2nd vaccine can cause sx’s — rest after vaccination
RENALLY dose acyclovir**
-Once rash has developed a crust — NO LONGER infectious
9
Q
Herpes Zoster
-Clinical information
A
- Wash hands, cover rash with dressing, do not scratch
- Zoster rash is NOT infectious once it is crusted over
- Stay away from those with decreased immunity like children
10
Q
Sepsis/Bacteria
A
- Most likely occurs from GI or GU source and most likely gram negative rod
- High risk population — long term care
- Antibiotic coverage similar to that of young adult
- Broad coverage
- High suspicion of resistant microbe — Cover MRSA, resistant gram negative rods, enterococci - IV fluids but monitor fluid status
11
Q
Sepsis Workup
A
- Physical exam
- Source of infection, lines prosthetic devices, hemodynamic stability - Labs/diagnostics
- CBC w/ diff, BMP, UA w/ culture and sensitivity, Blood cultures x2 and chest xray
12
Q
C. Diff
A
- Bacterial spores spread via fecal-oral route and thrive on toilets, hospital equipment, and door handles
- Spores may survive for months
- Outpatient incidences are rising
- Risk factors — ANTIBIOTIC EXPOSURE, PPI use, advanced age, duration of hospitalization
13
Q
High risk antibiotics for C. Diff
A
- High risk
- Clindamycin, penicillin, quinolones, 2nd and 3rd generation cephalosporins - Medium risk
- Macrolides
- Tetracyclines
- Aminoglycosides - Rare risk
- Flagyl and vancomycin
14
Q
C. Diff Workup
A
- Stool sample and Nucleic acid amplification test (NAAT)
- Diagnosis requires — Stool test for cdiff toxins or C diff toxin gene **TEST
- CBC w/ diff and a CMP
- Up to 50% of patients have + C. Diff PCR for up to 6 weeks after completion of therapy TEST
15
Q
C. DIff Tx and Management
A
- Contact Isolation — Private Room and dedicated equipment
- Use soap and water for handwashing
- Fluid replacement — Oral or IV
- Low residue diet
- D/C offending antibiotic if indicated
- NO ANTIDIRRHEALS
- VANCOMYCIN is now 1st line treatment
- Alternative first line agnet — Dificid - fidaxomicin
16
Q
C. Diff Recurrence
A
- Treat similar as original episode if uncomplicated
- may require pulse-dose or tapered vancomycin
- Fecal microbiota transplants indicated after 3rd recurrence** Poop transplant
17
Q
C. Diff Prevention
A
- Clean equipment w/ bleach
- Concomitant probiotic use while on antibiotics?
- Taper and D/C PPI if indicated
18
Q
Influenza
-Info
A
- Influenza is an RNA virus and has A, B and C subtypes that impact humans
- Influenza D primarily affects cattle and isn’t known to infect humans
19
Q
Influenza A
-Info
A
- Divided into subtypes based on 2 proteins on the surface of the virus
- Hemagglutinin (H) 18 subtypes
- Neuraminidase (N) 11 subtypes - This is further broken down into strains
- Current subtypes of influenza A found in people — H1N1 and H3N2 — These are both included in the vaccination
20
Q
Influenza B
-Info
A
- Not divided into subyptes
- Broken down to lineages and strains - Current influenza B viruses — one of the following lineages:
-B/Yamagata
-B/Victoria
—Both of these are included in vaccination every year
21
Q
Influenza C
A
- Milder respiratory sx’s
- Not thought to cause epidemics
- Seasonal flu vaccine does NOT cover influenza C
22
Q
First Flu Vaccine?
A
- First flu vaccine was given in the US in 1938.
23
Q
Flu Vaccination for Senior Citizens
A
- FLUAD
- approved over age 65 yrs
- egg based
- + adjuvant (MF59) - FLUZONE High Dose
- Approved over age 65 yrs
- egg based
- Has 4x amount of antigen
NO RCTs comparing FLUAD to FLUZONE High Dose
24
Q
Influenza
-Am I contagious?
A
- Typical incubation period is 1-4 days (Average 2 days)
- Adults shed influenza virus from the day before sx’s begin through 5-10 days after illness onset
- Virus shed declines rapidly by 3-5 days onset
- Severely immunocompromised can shed virus for weeks or months **
25
Q
Influenza Rapid Flu Test
A
- Advantages
- Easy and quick results <15 minutes - Disadvantages
- False negative results common
- Not all tests distinguish between A & B
- None of the tests differentiate between specific strains (H1N1 vs H3N2) - If rapid is (-) but flu-like sx’s — Treat w/ antiviral medication
- If flu is documented in your community, do not have to perform a rapid flu test — clinical presentation of flu is sufficient for diagnosis
26
Q
Pharm management antiviral meds
A
- Neuraminidase inhibitors
- Tamiflu — Oral — renal dosing
- Relenza — Inhaled — Contraindicated in asthma or COPD - Endonuclease inhibitors
- baloxavir (Xofluza) — One time dose
27
Q
Oseltamivir (Tamiflu)
-Info
A
- Effective against influenza A or B
- Start w/in 48 hr window after sx’s begin
- Oral (pill or liquid) 75mg BID x 5 days
- Prophylaxis 75 mg Qd x 7-14 days
A/E’s — N/V, reports of transient neuropsychiatric events (self injury or delirium), especially in children/adolescents
28
Q
Baloxavir (Xofluza)
A
- Endonuclease Inhibitor
- 12 years old and up
- Uncomplicated influenza
- Patients w/ High risk of developing influenza-related complications - Start w/in 48 hrs of sx’s onset
- Single dose 40-80 mg — Dose dependent
A/E — Nausea *
29
Q
Pneumonia Stats
A
- 8th leading cause of death in US older adults
- Cumulative 2 year risk for nursing home resident to develop PNA is 30%
- Baseline incidence in those 75+
- Community dwelling elsders = 12/1000
- NH residents = 33/1000 - PNA mortality in older adults 3-5x greater than young adults
30
Q
PNA
-Mortality
A
- Co-morbidities — STRONGEST predictor)
- Age >65
- Debility
- CRI (Creatinine >1.5)
- Leukocytosis, leukopneia, and/or anemia
- Multi-lobar PNA on radiograph
31
Q
CAP
-Atypical PNA
A
- Mycoplasma Pneumonia Hallmark sign is a NAGGING COUGH**
- More common in persons 20-40 yrs
- Incubation 2 weeks
- requires close contact w/ infected person
32
Q
35 minutes
A
35 minutes
