11 - Staphylococcal/streptococcal Flashcards
(85 cards)
1
Q
Flesh eating bacteria may be?
A
Monomicrobial or polymicrobial
2
Q
Many people who are affected by flesh eating bacteria also have?
A
Co-morbidities
- DM,
- immunocompromised
- obesity
- PVD
- Advanced age
3
Q
The infection is often ___ but it doesnt have to be
A
Synergestic infection of 2 organisms
4
Q
Common organisms for necrotizing fasciitis?
A
Group A hemolytic strep Staph Vibro Aeromonas Bacteroides Clostridium Peptostreptoccus
5
Q
Necrotizing fasciitis can look like superficial cellulits but
A
They often are much deeper infections
6
Q
Pathognomonic for necrotizing fasciitis?
A
Pain out of proportion
7
Q
Common features of necrotizing fasciitis?
A
Pain out of proportion Failure to respond to abx Woody feel Systemic toxicity TTP beyond erythema Crepitus Bullous lesions Skin necrosis Ecchymosis
8
Q
Good meds to start pending lab results?
A
Pen G and Clindamycin
Doripenem
Vancomycin
9
Q
What is a key to reduced mortality?
A
Early and extensive debridement reduces mortality
10
Q
What newish treatments is really good for necrotizing fasciitis as an adjunct?
A
HBO - hyperbaric oxygenation
11
Q
X rays may show?
A
Gas bubbles (60%) - not required for diagnosis
12
Q
Preferred radiology?
A
MRI - soft tissues and edema
13
Q
What causes strep throat?
A
Streptococcus pyogenes
- group A Beta-hemolytic streptococcus
14
Q
MC age group for strep?
A
5-12 yrs old
15
Q
Peak season for strep throat?
A
Late fall - early spring
16
Q
Strep is not commonly seen?
A
In kids under 3
Adults (not so much in practice though)
17
Q
S/S strep throat?
A
Sore throat Tonsils - red + enlarged Exudate Dysphagia Odynophagia Constitutional symptoms
18
Q
Classic strep presentation?
A
Hurts to swallow
19
Q
Tx for strep?
A
Benzathine Penicillin
- IM
Or
Pen V x 10 days
Alt
Clindamycin
20
Q
Complications of unresolved strep?
A
Rheumatic fever Glomerulonephritis Periotonsillar abscess Otitis media Acute sinusitis Mastoiditis Meningitis Pneumonia
21
Q
Differential for strep?
A
Other streptococcus
Neisseria gonorrhoea
22
Q
Scarlet fever is?
A
Group A beta-hemolytic strep infection
23
Q
Group a beta hemolytic is a ___ toxin?
A
Erythrogenic toxin
24
Q
S/s of scarlet fever?
A
Fever Chills HA Vomiting Pharyngitis Tongue dorsum - white exudate Projecting edematous papillae
25
Scarlet fever also has?
Rash
- fine papular or punctate lesion
- begins on axillae, groin and neck
- forehead and cheeks appear flushed
- circumoral pallor
26
The scarlet fever rash feels?
Like coarse sandpaper
27
Tx for scarlet fever?
Pen V
| Erythromycin
28
What is scalded skin syndrome?
Similar to scarlet fever
| Endotoxin mediated response
29
Scalded skin syndrome is aka?
Ritter disease
30
Scalded skin rash?
Acute exfoliation
Sandpaper like
Bullae
Nikolskys sign
31
MC sites for ritter syndrome?
Oral or nasal cavities
Throat
Umbilicus
32
S/s of scalded skin syndrome?
```
Fever
TTP
Warmth to palpation
Diffuse erythematous rash
Nikolsky’s sign
Dehydration
```
33
What is nikolskys sign?
Gentle stroking of the skin
Separate at the epidermis
Basically you rub the skin gently with your finger and it peels off
34
Tx for scalded skin syndrome?
Supportive care - dehydration
Eradication of organism
IV nafcillin pending C and S results
35
Differential for scalded skin syndrome?
R/O toxic epidermal necrosis
36
What is toxic shock syndrome?
Toxin mediated multisystem disease
Secondary to trivial staphylococcal infection
37
Common bug for toxic shock syndrome?
Staphyloccus aureus
- rarely Group A Strep
38
TSS is seen with?
Tampon use
But can be any staphylococcal infection
39
S/s of TSS?
```
Influenza like syndrome
Fever (>102)
Confusion
Tissue infection
N/V
Diarrhea
Chills
Myalgia
```
40
Presenting complaints for TSS?
```
Pain
Vomiting
Nausea
Diarrhea
Influenza like symptoms
HA
Dypsnea
```
41
Physical for TSS?
```
Bullae
Scarlet fever - like rash
Petechiae or maculopapular rash
Desamanation
HOTN
Orthostatic syncope
```
42
Presentation of desquamation with TSS?
1-2 weeks after onset of illness
Involves palms and soles
43
Consider TSS with?
Sudden onset of fever
Rash
HOTN
Systemic evidence of toxicity
44
Diagnostic criteria for multi-system involvement with TSS?
3 + of
- GI
- muscular (CK >2x normal)
- mucous membrane
- renal (bun 2x normal)
- hepatic (bili 2x normal)
- hematological (platelets <100k)
- CNS - disorientation
With no other obvious cause
45
Tx for TSS?
Aggressive supportive therapy
Nafcillin (pending labs)
Pen G + clinda for strep
D/C tampon use
46
Sequela of TSS?
```
Prolonged/refractory Hypovolemic shock
ARDS
Bacteremia
Acute renal fx
Electrolyte and acid-base imbalance
Cardiac dysrhythmia
DIC w thrombocytopenia
Mortality (3%)
```
47
GBS aka
Streptococcus agalactia
48
GBS is a major cause of?
Major cause of sepsis/meningitis in neonates
Peripartum fever in women
49
Types of neonatal presentation (GBS)
Early onset
- 1st week (median - 20hrs)
Late onset
- 1 week - 3 months
50
Where do neonates get GBS from when its early onset?
From a colonized maternal tract
51
Risk factors for GBS?
Fever and prolonged labor
| Prematurity
52
S/s of early onset GBS>?
```
Respiratory distress
Lethargy
Hypotension
Pneumona
RDS
Fever
Lethargy
Irritability
Poor feeding
Seizures
```
53
Where do neonates get late onset GBS from?
At birth
Later from mom
Nursery personnel
54
Presentation for GBS?
Bacteremia w ukn source
Osteomyelitis
Facial cellulitis
Septic arthritis
55
Labs for GBS?
```
Cultures and susceptibilities
CBC
UA
CSF
Chemistries
```
56
Tx for GBS?
Pen G
57
Complications for GBS?
Moratlity 10-40%
50% if they have meningitis
```
Longterm neruo
Seizures
Profound MR
Mild language delay
Hearing loss
Blindness
```
58
Who gets adult GBS?
```
Pregnancy
Elderly
Sickly
- DM
- malignancy
- immunocompromised
```
59
Fatality rate for adult GBS?
40%
60
MC manifestation of adult GBS?
Peripartum fever
61
Considerations for adult GBS?
```
Peripartum fever
Urinary tract infections
Pneumonia
Endocarditis
Septic arthritis
Cellulitis and soft tissue infections
```
62
Less common GBS presentation?
Meningitis
Osteomyelitis
Intra-abdominal/pelvic abscess
63
Tx for GBS?
Pen G
64
Common presentation of MRSA?
Skin - cellulitis, abscess
Joint - septic arthritis, bursitis
Pneumonia
65
Where does MRSA commonly come from?
```
Institutions
Hospitals
Prisons
Sports
Military
```
66
MRSA accounts for?
60% of staff infections in
- alaska
- california
- georgia
- texas
67
Outpatient vs inpatient MRSA tx?
<5cm - outpatient
| - multiple or >5cm
68
Drugs for <5cm MRSA?
Trimethoprim sulfamethoxazole
Doxycycline
Clinda
69
Meds for MRSA >5cm or multiple?
Vancomycin
70
Physicians and MRSA?
Docs are commonly colonized with MRSA and can spread that shit
71
Tx for MRSA carriers?
Bactroban - nares and wounds
Chlorhexidine (hibiclins) baths
X 5 day course
72
What causes tetanus?
Clostridium tetani
73
Forms of clostridium tetani?
Spore (dormant)
- soil, dust, poo
Vegetative cell (active)
74
Active tetanus cell in the wound release 3 toxins which one matters?
Tetanospasmin is responsible for the disease
75
4 types (presentations) of tetanus S/S?
Generalized
Local tetanus
Cephalic tetanus
Neonatal tetanus
76
MC/most sever tetanus?
Generalized tetanus
Can affect all skeletal muscles
77
Cephalic tetanus affects?
Facial muscles
78
Neonatal tetans?
Basically generalized but in neontates
79
S/s of tetanus?
```
Trismus/lock jaw
Irritability
Muscle cramps
Dysphagia
Associated fx and dislocations
Respiratory (severe)
Seizures
Opisthotonos
Flexion and abductins of arms
Clenching of fists (on thorax)
Extension of lower extremities
```
80
Death is likely if (tetanus)
Respiratory muscles are involved
81
MC s/s of tetanus?
Trismus or lock jaw
82
Whats different about tetanus seizures?
The dont loose consciousness
They are painful
83
Labs and diagnostics for tetanus?
No good ones, its clinical
84
Tx for tetanus?
Seizures - diazepam
Disease
- tetanus immune globulins
- metronidazole
85
A bacteria walks into a bar. The bar tender says “we dont serve your kind here”
The bacteria says “but I work here, I’m staph”
