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YR5 Microbiology > Crash Course: Endocarditis, GI, UTI, SSI > Flashcards

Crash Course: Endocarditis, GI, UTI, SSI Flashcards

1
Q

Define infective endocarditis

A

Infection, typically bacterial, of the endocardium

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2
Q

How is infective endocarditis classified by onset?

A

Subacute: classic indolent presentation

Acute: rapid onset, present septic

Prosthetic: high-risk 1-2m following valve replacement

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3
Q

How is infective endocarditis classified by valve affected?

A

L more common than R

Prosthetic valves are higher risk

TRICUSPID (R) affected in IVDU

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4
Q

What are the 3 classical signs of infective endocarditis?

A

Pyrexia of unknown origin
Constitutional Sx
New regurgitant murmur

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5
Q

What embolic phenomena manifest in infective endocarditis?

A

JANEWAY lesions: painless

SPLINTER HAEMORRHAGES

Septic emboli to brain, spleen, kidney- splenomegaly, haematuria

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6
Q

What immune phenomena occur in infective endocarditis?

A

ROTH spots
OSLER nodes: PAINFUL
Glomerulonephritis

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7
Q

What is the most common organism causing infective endocarditis in the UK vs the developing world?

A

UK: Staphylococcus aureus

DW: Streptococcus viridans

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8
Q

Which organism causing infective endocarditis is associated with recent prosthetic valve surgery?

A

Staphylococcus epidermidis

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9
Q

Which organism causing infective endocarditis is associated with colon tumours? Thus what investigations should be performed?

A

Streptococcus bovis
If culture +ve for S Bovis do colonoscopy

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10
Q

Which organisms causing infective endocarditis are culture negative?

A

HACEK organisms

Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

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11
Q

Which organism causing infective endocarditis is associated with exotic birds?

A

Chlamydia psittaci

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12
Q

Which organism causing infective endocarditis is associated with farm animals?

A

Coxiella burnetti

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13
Q

Which organism causing infective endocarditis is associated with unpasteurised dairy?

A

Brucella spp.

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14
Q

What is the criteria used for diagnosing Infective endocarditis?

A

Duke criteria
2 Major
or
1 major + 3 minor
or
5 minor

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15
Q

What are the major criteria for diagnosing infective endocarditis?

A

BC’s +ve for infective endocarditis (at least 2 cultures, with typical organism)

Evidence of endocardial involvement on USS: new regurgitation + vegetation

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16
Q

What antibiotic regimen is used for infective endocarditis?

A

Initial ‘blind’: Amoxicillin + Gentamicin

S. aureus: Flucloxacillin + Vancomycin + Rifampicin

S. viridans: Benzylpenicillin

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17
Q

Give 4 indications for surgery in infective endocarditis

A

Continuing to worsen on Abx

Acute heart failure

Aortic root abscess: IE in aorta + developed abscess, suggested by PR prolongation

Prosthetic valve disease

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18
Q

What is non-infective endocarditis?

A

Endocardial vegetations without infection:

Mucin-producing adenocarcinomas (esp. Pancreatic adenocarcinomas)

SLE/ APLS = Libman-Sacks endocarditis

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19
Q

How can GI infection presentations be broadly split?

A

Infections limited to secretory GI Sx

Infections causing inflammation in the GI tract – dysentery

Infections causing systemic Sx

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20
Q

Give 4 causes of secretory GI disease. What is each associated with?

A

Bacillus cereus: Reheated RICE

Staphylococcus aureus: BBQ, short incubation as Sx caused by preformed toxin

Escherichia coli: Traveller’s diarrhoea

Vibrio cholera: Ricewater stool, comma- shaped bacterium

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21
Q

What is dysentery?

A

Bloody stool

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22
Q

Which organisms are associated with dysentery?

A

CHESS
Campylobacter jejuni: BBQs, longer incubation
Haemorrhagic E.coli
Entamoeba histolytica (Amoeba)
Salmonella enteritides: poultry, eggs
Shigella spp

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23
Q

Other than CHESS organisms, what can cause dysentery?

A

Yersinia enterocolitica
Non bloody or more often bloody diarrhoea

Often causes terminal ileitis + adenitis- can resemble appendicitis (RLQ pain)

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24
Q

Give 3 features of GI infection presentation due to Entamoeba histolytica

A

Dysentery
Chronic diarrhoea
Liver abscess

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25
Q

What is seen on histology in Entamoeba histolytica infection?

A

Flask shaped ulcers

Anchovy paste in abscess

26
Q

What is used to treat Entamoeba histolytica?

A

Metronidazole

27
Q

Give 2 features of GI infection presentation due to Giardia lamblia

A

Chronic diarrhoea
Malabsorption

28
Q

What is seen on histology in Giardia lamblia infection?

A

Pear shaped trophozoites

29
Q

What is used to treat Giardia lamblia?

A

Metronidazole

30
Q

Which 2 organisms are associated with diarrhoeal illness in patients with HIV?

A

Cryptosporidium
Microsporidium spp

31
Q

What causes Clostridium difficile?

A

Cephalosporins
Clindamycin
Ciprofloxacin

32
Q

What investigations can be used to diagnose C difficile?

A

Stool C. difficile toxin

Visualise pseudomembrane

33
Q

What is the treatment for first C. difficile infection? What is the treatment for first recurrence?

A

1st: Vancomycin PO

!st recurrence: Fidaxomicin PO

34
Q

What is the treatment for further recurrence of C. difficile infection?

A

Consider faecal microbiota transplant

35
Q

What is fulminant C difficile infection? What is the treatment for fulminant C. difficile infection?

A

In shock/ toxic megacolon

Vancomycin PO + IV metronidazole

36
Q

Describe the appearance of C difficile on histology

A

Wet cornflake
Pseudomembranous colitis

37
Q

In which scenarios is a UTI considered to be complicated?

A

Urinary tract abnormality
Pregnant
Immunocompromise
Instrumentation

38
Q

How is UTI classified on severity?

A

Lower UTI/ cystitis: only affects bladder, classic Sx only

Pyelonephritis: infection ascends to kidney, fever, rigors, flank pain, systemically unwell

Pyonephrosis: pyelonephritis with obstruction, not producing urine. Hydroureter + enlarged kidney on USS

39
Q

What is seen on urine dipstick in UTI?

A

Leukocytes ± nitrites ± haematuria

Nitrites specific for coliform UTIs

If -ve for nitrites, could still have a UTI, but probably not E coli

40
Q

What is diagnostic of UTI on MC+S?

A

> 10^4 colony-forming units/ml any organism

> 10^3 colony-forming units/ml E. coli or Staph. saprophyticus

41
Q

When is renal tract imaging performed in UTI?

A

if concern for complicated UTI

42
Q

What could contaminate MC+S in potential UTI?

A

Epithelial squamous cells
Mixed growth
Organisms that don’t make sense e.g. S aureus

43
Q

What are fried egg cells on MC+S? What are they indicative of?

A

Epithelial cells
Indicative of contamination

44
Q

Why should you avoid urine dipsticks for diagnosing UTI in >65s?

A

Less reliable

Majority have bacteruria without infection/ Sx

Abx not indicated, may cause harm e.g. C diff risk

45
Q

What is the most common cause of UTIs?

A

Escherichia coli

46
Q

Which patient group is Staphylococcus saprophyticus associated with?

A

Young healthy women

47
Q

What is Proteus mirabilis associated with on MC+S?

A

Struvite stones- affinity for calculi

48
Q

What is Klebsiella aerogenes associated with on MC+S?

A

Catheterisation-adheres to plastic

49
Q

Give 5 causes of sterile pyuria

A

TB

Sexually Transmitted Disease

Calculi

Catheterisation

Bladder neoplasm

50
Q

What is the treatment for lower UTI?

A

Nitrofurantoin, Trimethoprim, Cephalexin

Uncomplicated: 3d

Complicated or Male: 7d

51
Q

What is treatment for pyelonephritis?

A

Admit
IV Co-amoxiclav + Gentamicin

52
Q

What is treatment for asymptomatic bacteriuria?

A

Do not treat unless pregnant

53
Q

What must be checked before prescribing Trimethoprim for UTI?

A

Check if on Methotrexate (folate antagonist)
Do not give Trimethoprim if already on folate antagonist

54
Q

What antibiotics can be used to treat UTI in pregnancy?

A

1st + 2nd Trim: Nitrofurantoin, Amoxicillin, Cephalexin
3rd Trim: Amoxicillin, (Trimethoprim) or Cephalexin

55
Q

Why should Trimethoprim be avoided in the first trimester?

A

Teratogenic risk as it’s a folate antagonist

56
Q

Why should nitrofurantoin be avoided at term?

A

Risk of neonatal haemolysis.

57
Q

From most to least common give 4 causes of surgical site infection

A

Staphylococcus aureus
Escherichia coli
Streptococcus spp.
Pseudomonas

58
Q

From most to least common give 3 causes of Osteomyelitis

A

Staphylococcus aureus
Streptococcus spp.
Escherichia coli

59
Q

What organism is the most common cause of osteomyelitis and septic arthritis in sickle cell patients?

A

Salmonella

60
Q

From most to least common give 3 causes of Septic arthritis

A

Staphylococcus aureus
Streptococcus spp.
Escherichia coli

61
Q

From most to least common give 3 causes of prosthetic joint infection

A

Staphylococcus epidermidis (in first 2 months post-op)
Staphylococcus aureus
Streptococcus spp.
Escherichia coli

YR5 Microbiology (23 decks)

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