Infectious Disease 7

Question 1

Treatment of outpatient community acquired PNA?

Treatment of Inpatient community acquired PNA?

Answer 1

OUTpatient:
1) PO Macrolide (Azithromycin, Clarithromycin)
OR 2) PO Respiratory Fluoroquinolone (Levofloxacin>Moxifloxacin)

INpatient:
1) IV beta lactam (Ceftriaxone) AND IV Macrolid (Azithromycine)
OR 2) IV Respiratory Fluoroquinolone (Levofloxacin>Moxifloxacim)

Question 2

What is the classic presentation of Measles (Rubeola)?

What is TRX?

Answer 2

PRODROME : fever and 3 cs (cough, coryza, conjunctivitis)

Koplik spots

MACULOPAPULAR RASH spreads head to toe, sparing palmes and soles.

TRX = Supportive, VIT A if hospitalized.

Question 3

What organism classically causes Epiglottitis in children?

Epiglottitis can present with high fever, tripod positions, stridor, drooling and dysphagia…what is the TRX if you suspect Epiglottis?

Answer 3

HAEMOPHILUS INFLUENZA TYPE B

TRX = immediate intubation and abx.

Question 4

What is the treatment for Necrotizing fasciitis?

Answer 4

BROAD SPEC tripple ABX:

• Piperacillin/Tazobactam (Zosyn) (covered group A strep and anaerobes)
• Vancomycin (gram +ve coverage, MRSA)
• Clindamycin (added to inhibit toxin formation by strep/staph)

Then …. SURGICAL DEBRIDEMENT ASAP

Question 5

What is the most common organism causing Necrotizing Fasciitis?

Answer 5

Group A Strep (Strep pyogenes)

Question 6

What are the 4 indications to do IV ABX (instead or PO) in Pyelonephritis or Cystitis?

Answer 6

1. HD instability
2. Cant tolerate PO (emesis)
3. Failure to improve on PO
4. < 2 month old (bc increased risk of sepsis)

Question 7

What are the 6 wounds with HIGH RISK of infection?

Answer 7

1. Crush injury
2. Bites on hands or feet
3. Cat bite (excluding face)
4. Human bite (excluding face)
5. Any bite in immunocompromised
6. Wounds > 12 hrs old on body, > 24 hours old on face

TREATMENT:

Question 8

For high risk wounds:

1. Crush injury
2. Bites on hands or feet
3. Cat bite (excluding face)
4. Human bite (excluding face)
5. Any bite in immunocompromised
6. Wounds > 12 hrs old on body, > 24 hours old on face

WHAT IS THE TRX?

Answer 8

TREATMENT:

1. Leave wound OPEN to heal by secondary intention
2. PPX with AMOXICILLIN-CLAVULANIC ACID (for mammalian bites)
3. Consider Tetanus PPX
   - IF < 3 vaccine - IVIG and vaccinate
   - IF + 3 Vaccine - Give vaccine if > 5 years ago. NO IVIG.

Question 9

What causes LACTATION MASTITIS and what organism is classically associated?

How do you DX and TRX?

Answer 9

Difficulty with breast feeding can cause inadequate drainage of engorged breasts, stasis causes bacterial infection. Usually STAPH AUREUS.

DX= clinical. NO TESTS

TRX = Oral Dicloxacillin OR Oral Cephalexin

(continue to breast feed, safe for baby)

Question 10

Lactation mastitis can rarely progress to this complications.

How do you DX and treatment?

Answer 10

Abscess formation –> fluctuant mass

DX = US
TRX = US guided fine needle aspirate of abscess.

Question 11

1. In what patient population do you see Cryptococcal Meningitis?
2. Individuals present with symptoms of meningitis (HA, fever, nuchal rigidity, ext). What skin findings can you also see?
3. You classically diagnose Cryptococcal Meningitis with CSF analysis. What does it classically show?
4. TRX?

Answer 11

1. HIV, CD4 < 400
2. Papular lesion with central umbilicaiton/necrosis (like MC) –> skin findings mean systemic infection.
3. CSF =
   - Increased WBC (lymphocytic )
   - Increase Pressure
   - Increased Protein
   - Decreased Glucose

+ India ink shows yeast with Broad Based Bud.

4. TRX =
   INDUCTION –> 2 weeks –> IV Amphtericin B and Flucytosine
   CONSOLIDATION –>8 weeks –> oral high dose Flucytosine
   Maintenance–> 1 year –> low dose oral Flucytosine (prevent recurrence)

IF increased ICP (HA/N/Papilledema) –> serial LPs.

Question 12

What are the three recommended vaccines for Adults?

Answer 12

1. Yearly FLU
2. Tetanus booster q 10 years (substitute Tdap one time)
3. 13 valent pneumococcal vaccine @ 65 yo, followed by 23 valent (23PPSV) 6-12 months later.

Question 13

Normally you vaccinate Adults > 65 yo for Pneumococcal PNA (first with PCV 13, then 6 months later with PPSV 23).

In what 5 HIGH risk groups would you consider vaccinating < 65 yo with BOTH PCV 13 and PPSV 23?

In what 6 groups would you vaccinate with PPSV 23 ALONE < 65 yo.

Answer 13

BOTH PCV 13 and PPSV 23:

• HIV
• Cochlear implant
• CSF leak
• Sickle Cell
• CKD

PPSV 23 ALONE:

1. Liver disease
2. Lung disease
3. Heart disease
4. Smoker
5. Alcoholic
6. DM

Question 14

What are the 2 most common cause of VIRAL meningitis in Children?

What is the most common cause in Adults?

Answer 14

Children –>

1. Enterovirus
2. Arbovirus

Adults –> Herpes.

Question 15

Dengue FEVER presents with what 3 classic symptoms?

IN the most severe life threatening form of the illness (Dengue Hemorrhagic FEVER) what additional S/S do you see?

What physical exam technique can you use in aiding dx?

What is the treatment of Dengue Fever?

Answer 15

DENGUE FEVER:

1. FLU-like illness (fever/myalgia)
2. Arthralgia “bone break fever”
3. Rtetroorbital pain.

Hemorrhagic fever:

• Plt < 100,000 –> Spont bleeding
• Increased vascular permeability (effusions, ascites, ext)

Tourniquet test –> petechiae after 5 min of inflation.

TRX = supportive.