SSTI + bones + HIV + tb Flashcards
erypsiela
-layers and organism
- epidermis and dermis
- GAS
impetigo caused by which organism
staph aureus
cellulitis
- GAS
- epidermis, dermis, SC
if severe purulent infection , if mssa , tx with what ?
cefazolin
if moderate purulent infection, if mssa , tx with what ? if mrsa tx with what ?
cefalexin , tmp smx
mild non purulent SSTI tx ?
oral cephalexin
moderate non purulent SSTI tx ?
IV cefazolin
recurrent cellultitis trial - possible suggestions ? ( 2)
- daily oral pnc if have more > 3 cxellulitis in a year ( oral pnc daily) despite controlling other factors ( i.e. revasc , wound care, foot wear, compression, tinea)
- compression stocking = first lne prevention for chronic leg edema and recurrent cellulitis
toxic shock syndrome 2/2 to what ?
- 2/2 to strep group A»_space;
- rarely S aureus ( with nasal packing, tampons)
tx of toxic shock syndrome
beta lactam + clinda
diagnostic criteria for toxic shock syndrome
Diagnostic Criteria:
* Hypotension(sBP<90)AND
* IsolationofGASfromnormallysterile site
AND at least two of the following:
– Renalimpairment(Cr>177)
– Coagulopathy(plt<100orDIC)
– Liverfxabnormality(ALT/AST/Tbili2X Upper limit of normal)
– ARDS
– Generalizederythematousmacularrash that may desquamate
funky management tss
IVIG
hyperbaric o2
chemoprophylaxis tss ?
cephalexin 10 day
when to add metornidazole for OM treatment ?
non vertebral OM suspected in sacrum
tx duration for non vertebral osteomyelitis
6 weeks from last debridement if residual infection if non hematogenous |
4-6 weeks if hematogenous
or 48H post complete source control
the most impt sign to know if ulcer is infected ?
pain in chronic wound
arterial vs venous chronc wouds. which one is lateral, which one is medial
art : lateral
venous : medial
gold stand to dx OM ?
bone biopsy
what arer high LR signs of OM in db patient
- bone to probe
- bone exposure
- ulcer >2 cm
- high CRP
meds for pjp
other meds and when to avoid those meds
tmp smx 1 ds po daily
dapsone ( but avoid if sjs ten)
atovaquone ( to give if sjs ten)
at what levle of cd4 do we worry about pjp
<200
worry about toxoplasma what level of cd4
tx?
100
tmp smx
how long do you continue toxoplasma and mac tx ?
until cd3 count stabilizes for 3 months
mac
- cd4 levels and tx
-< 50 and tx= azithro/claritrhro
severe PJP implies what exactly
- Moderate – Severe PJP: PaO2 <% 70 or A-a gradient ≥35mmHg
tx for actual pjp
tmp smx +/- pred if severe
tx for actual toxoplasma
sulfadiazine + pyrimethamine
or even tmp smx
tx for actual mac
clarithromycin + ethambutol
azithromycin + ethambutol
cd4 count at which tb can happen ?
any levels
intrapartum vs HIV
- if VL > 1000 or levels are unknown near delviery , what are your recommendations
IV Zidovudine ( AZT) + c/s
if VL suppressed intrapartum, do we need to do a c/s
no
postpatum care regarding kid
- if suppressed 4 months within deliviery
- if not suppressed at birth
- AZT x 4 weeks
- 3 drug ART presumptively
PrEP HIV combo
- tdf + ftc
- taf + ftc
- cab
within how long to start PEP
72H
what do you give in PEP
TDF+ FTC + DOL
TDF + FTC + RAL
how long after in PEP do you check for HIV serology again
3 months to make sure no serovongersion
how long treat PEP ?
28 days
first line regimens for latent tb
rifampin 4M DIE
rifapentin + isoniazide weekly 3M
what’s you cocktail for active tb tx
ripe and drop e when get susceptibility
- RIP x 2 months and then c ontinue INH and rifam for 4 months
3 tb meds safe in pregnancy. what about the 4th
rifampin, isonizide , ethambutol
pza only added if extensivce disease, smear pulnmonary diseas,e disseminated tb , intolerance of other agents
do you tx latent tb in pregnancy . exceptions ? regimen?
no after delivery
unless high risk of tb regimens
use 4R regimen
latent tb + hiv regimens
- rifampentin+inonizide weekly x 3 M
- isoniazide + rifampin daily 3MN
when should you avoid initiation of art in art naive patients and wait how long and what to add
- why ?
tb meningitis, defer for 8 weeks
addd steroids for tb meningitis
- risk fo iris ( especially if low cd, high viral load, disseminated tb)
