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Infectious diseases > Sepsis,meningitis and UTI > Flashcards

Sepsis,meningitis and UTI Flashcards

1
Q

What is the criteria for qSOFA?

A

Resp rate > 22/min

Altered mental status (GCS ≤ 14)

Systolic BP < 100mmHg

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2
Q

What are some points to be aware and some signs of when a patient presents with sepsis?

A

Tachypnoea is often an early sign of sepsis

Elderly patients often present with non-specific findings (like confusion, drowsiness or simply “off legs”)

Neutropenic or immunocompromised pts may have normal observations despite being life-threateningly unwell.

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3
Q

What is septic shock? What are the diagnostic levels?

A

Sepsis with PERSISTENT hypotension.
Diagnosis : Low MAP (<65mmHg) DESPITE fluid resuscitation and raised serum lactate (>2mmol/L)

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4
Q

What do vasopressors do if a patient has septic shock?

A

As septic shock is characterised by hypotension (and hence hypoperfusion), giving vasopressors like noradrenaline would cause vasoconstriction and increase systemic vascular resistance increasing tissue perfusion.

Fluid resuscitation does not work in patients who have septic shock. It is not enough.Vasopressors are required.

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5
Q

What are some of the risk factors of sepsis?

A
  • Older age > 65 (or very young)
  • Immunocompromised patients e.g. steroid use
  • Recent surgery/procedures
  • Indwelling catheters or central lines
  • Diabetes mellitus
  • Haemodialysis
  • Drugs/alcohol use
  • Pregnancy
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6
Q

What investigations should be done if a patient has suspected sepsis?

A

FBC for the WC count and neutrophils
U&Es (kidney function and AKI)
LFTs (liver function and possible source of infection)
CRP (to assess inflammation)
Blood glucose (hyper/hypoglycaemia)
Clotting (to assess for disseminated intravascular coagulopathy)
Blood cultures (to assess for bacteraemia)
ABGs (for lactate,pH and glucose)

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7
Q

What are the ABG reference ranges?

A

pH: 7.35 – 7.45
PaCO2: 4.7 – 6.0 kPa || 35.2 – 45 mmHg
PaO2: 11 – 13 kPa || 82.5 – 97.5 mmHg
HCO3–: 22 – 26 mEq/L
Base excess (BE): -2 to +2 mmol/L

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8
Q

What is SEPSIS 6?

A

3 tests and 3 treatments for patients with sepsis.
3 tests: Take serum lactate,blood culture and urine output
3 treatments: O2 sats 94-98% (88-92% in COPD pts), empirical IV broad-spectrum antibiotics and IV fluids (to restore circulation)

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9
Q

If patients have a qSOFA score ≥ …..

A

greater than 2, then they are at a heightened risk of mortality.

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10
Q

When is someone termed as having neutropenic sepsis?

A

When the patient is on chemotherapy medications that may cause neutropenia and have a temperature above 38˚c, until proven otherwise

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11
Q

What is the treatment for neutropenic sepsis?

A

Involves broad spectrum antibiotics (piperacillin with tazobactam (tazocin))

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12
Q

What medications can cause neutropenia?

A
  • Chemotherapy(for cancer)
  • Clozapine(for schizophrenia)
  • Hydroxychloroquine(for rheumatoid arthritis)
  • Methotrexate(for rheumatoid arthritis)
  • Sulfasalazine(for rheumatoid arthritis)
  • Carbimazole(for hyperthyroidism)
  • Quinine(for malaria)
  • Infliximab(a monoclonal antibody used for various autoimmune conditions)
  • Rituximab(a monoclonal antibody used for various autoimmune conditions and cancers)
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13
Q

What are some causes of bacterial meningitis?

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae
  • Group B streptococcus (GBS —→ Particularly in neonates as GBS may colonise in the vagina)
  • Listeria monocytogenes
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14
Q

What are some viral causes of meningitis?

A

Enteroviruses (e.g., coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

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15
Q

Meningococcal septicaemia can cause which presentation?

A

Non-blanching rash

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16
Q

What are some typical presentations of meningtis?

A

Fever
Neck stiffness
Seizure
Vomiting
Headache
Photophobia
Altered consciousness

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17
Q

What are some non-specific signs a baby may have if they have suspected meningitis?

A

Hypotonia,poor feeding, lethargy,hypothermia and a bulging fontanelle

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18
Q

What do the NICE guidelines recommend if a baby has sepsis?

A

A lumbar puncture if they are;
-Under 1 month presenting with a fever
or
-1 to 3 months and are unwell or have a low/high WBC count

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19
Q

What are the 2 tests to test for meningitis?

A

Kernig’s test involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges. Where there is meningitis, it will produce spinal pain or resistance to movement.

Brudzinski’s test involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed, flexing their chin to their chest. A positive test, indicating meningitis, is when this causes the patient to flex their hips and knees involuntarily.

20
Q

What do you give patients in a primary care setting when you suspect meningitis while waiting for hospital transfer?

A

Give benzylpenicillin (IM or IV)

21
Q

What dose of benzylpenicillin do you give to under 1 children?

A

300mg

22
Q

What dose of benzylpenicillin do you give to children from 1-9 years?

A

600mg

23
Q

What dose of benzylpenicillin do you give to children over the age of 10?

A

1200mg

24
Q

What are the key complications of meningitis?

A

HEARING LOSS
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Focal neurological deficits like limb weakness and spasticity

25
Q

How do you diagnose patients who may have meningitis?

A

Lumbar puncture (results are different if it is bacterial or viral)
Blood culture
Meningococcal PCR (to detect meningococcal DNA

26
Q

What do you give patients while awaiting the results of a lumbar puncture?

A

Pt should be commenced on broad-spectrum antibiotics with CNS penetration,give;
Ceftriaxone –> if pt is above 3 months (bacterial)
Cefotaxime +amoxicillin (under 3 months)
Aciclovir (if viral)
Given IV

This is the particularly the case if pts are at high risk

27
Q

What antibiotic do you give to patients who may have penicillin resistant pneumococcal infection in meningitis?

A

Vancomycin

28
Q

What do you give to pts to reduced hearing loss and neurological complications as a result of meningitis?

A

Steroids (e.g. dexamethasone)

29
Q

What is pyelonephritis?

A

Inflammation of the kidney caused by bacterial infection (which affects the kidney tissue/parenchyma and renal pelvis)

30
Q

What is a UTI?

A

Infection of the bladder casuing cystitis

31
Q

How can someone develop a UTI? Transmission?

A

The primary source is via bacteria (usually E.Coli).
Can be found in faces,sexual activity can spread the bacteria,incontinence, poor hygiene and urinary catheters are contributing factors.

32
Q

Name symptoms of UTI?

A

Dysuria (pain and stinging when peeing)
Suprapubic pain/discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy/foul-smelling urnie
Confusion (more common in older patients)

33
Q

What are symptoms of pyelonephritis and how can they differ from UTI?

A

Pyelonephritis has teh same symptoms as a UTI in addition to a triad of symptoms:
1.Fever
2.Loin/back pain
3.Nausea/vomiting

34
Q

If a patient has nitrites or leukocytes plus red blood cells in their urine test, do you treat that patient as having a UTI?

A

Yes

35
Q

If a patient has only leukocytes upon mid-stream urine testing, are they treated as having a UTI?

A

No (unless there is enough clinical evidence)

36
Q

Is a patient treated as having a UTI if they have nitrites plus leukocytes or ONLY nitrites in their urine sample?

A

Yes

37
Q

When do you need to send an MSU for analysis for suspicion of UTI?

A

If the pt is:
-Pregnant
-has recurrent UTIs
-Has atypical symptoms
-If the symptoms do not improve with antibiotics

38
Q

What is the most common cause of UTI?

A

E.Coli (Escherichia Coli)

39
Q

What are the first line treatments for UTI?

A

NICE guidelines recommend trimethoprim or nitrofurantoin (for 3 days)

40
Q

What are other causes of UTI (apart from E.coli)?

A
  • Klebsiella pneumoniae (gram-negative, anaerobic, rod-shaped bacteria)
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Candida albicans(fungal)
41
Q

What are some alternatives to using nutrofurantoin/trimethoprim for treating a UTI?

A

Pivmecillinam
Amoxicillin
Cefalexin

42
Q

If a patient has impaired renal function (eGFR<45), which antibiotic should you avoid when treating a UTI?

A

Nitrofurantoin

43
Q

Why would trimethoprim be avoided in use of patients with a UTI?

A

It is often associated with high rates of bacterial resistance

44
Q

What patients should be on an antibiotic for treating a UTI for 7 days?

A

-Men
-pregnant women
-Catheter related UTIs

45
Q

What are the first line antibiotics in the case of treating pyelonephritis? Duration of antibiotics course?

A

7-10 days
Cefalexin
Co-amoxiclav (if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)

46
Q

What medication should NOT be given in the first trimester for UTI treatment?

A

Trimethoprim

47
Q

Which medications should be AVOIDED in the third trimester for treatment of UTI in pregnant women?

A

Nitrofurantoin

Infectious diseases (6 decks)

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