bacinfxns Flashcards by Emilio Pahina

incubation period of diphtheria (via resp droplets)

2-6 days

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3 biotypes of diphtheria

mitis; gravis; intermedius

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offending agent in pseudomembranous pharyngitis

Corynebacterium diptheriae

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bullneck appearance and leather-like adherent membrane and extension beyond the faucial area

diptheria

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difference bet diphtheria and strep throat

diphtheria: relative lack of fever and nonexudative throat

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Dx of diphtheria

culture from nose and throat(negative results does not rule it out)

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rationale for giving antimicrobials in diphtheria

to halt toxin production; treat localized infection and prevent transmission to contacts

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Tx for diphtheria

Pen G IM/IV 100k-150k U/kg/day q6 fo 14 days; Erythromycin 40-50/mkd orally or IV for 14 days eradicates nasopharyngeal carriage

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how to determine treatment of diphtheria

2 successive negative cultures taken 24 hrs apart after completion of therapy; antimicrobial prophylaxis given for 7-10days and diphtheria toxoid for asymptomatic carriers

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most infectious stage of whooping cough

catarrhal stage

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incubation period of whooping cough

7-10 days

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characteristic of cough in pertussis

explosive outburst in series of 5-10 rapid coughs in one expiration and ending in a high pitched whoop(forceful inspiratory gasp) often associated with suffusion of face and popping out of eyes and vomiting

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presumptive diagnosis of pertussis

symptoms + very high WBC count(leukemoid rxn) with absolute lymphocytosis

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Dx of pertussis

(+) growth of culture in Bordet-Gengou agar from a swab taken from the posterior nasopharynx for 15-30s

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complications of pertussis

Hemorrhage; Seizures; Otitis media;Atelectasis;apnea;activation of latent TB;Pneumonia

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Tx of pertussis

Erythromycin 40-50mkd PO q6 x 14days; Erythromycin for 14 days given promptly to all household contacts and other close contacts

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Diffuse adrenal hemorrhage; DIC; coma; death

Waterhouse-Friedrichsen syndrome

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important features of meningococcemia

abrupt onset of fever chills headache vomiting; rapid worsening of symptoms within hours; initially morbiliform rash becoming petechiae then purpuric within hours

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DOC for meningococcemia

Pen G 250k-450k U/kg/day IV in 4-6 divided doses at least 5-7days

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who are considered exposed in meningococcemia

household; school or day care contacts during the 7 days before exposure

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Prophylactic tx for those exposed to meningococcemia

Rifampicin 10mkd q12 x4doses; or Ceftriaxone 125mg single dose IM for less than 12yo; >18yo:Ciprofloxacin 500mg PO single dose

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most common mode of transmission of enteric fever

ingestion of food or water contaminated with S. typhi from human feces

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when is enteric fever infectious

throughout the duration of fecal excretion

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incubation period of enteric fever

7-14days

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what dse entity do you find rose spots

enteric fever

rare complications of enteric fever

toxic myocarditis; delirium; increased ICP; pyelonephritis; meningitis; endocarditis

when does the stool and urine cultures become positive in enteric fever

after the 1st week of illness

mainstay of diagnosis in enteric fever

blood culture

Tx for uncomplicated and fully sensitive enteric fever

Chlorampenicol 50-75mkd x14-21days OR Amoxicillin 75-100mkd for 14days

Tx for severe typhoid fever

Fully sensitive: Ampicillin at 100mkd x14days; MDR: Fluoroquinolone 15mkd x10-14days; Quinolone resistant: Ceftriaxone 60-75 mkd x10-14days

who are considered chronic carriers of S. typhi

those who secrete S. typhi for more than 3mos

at what age is Shigellosis most common

2-3years old

basic virulence trait of shigella

ability to invade intestinal epithelial cell (it crosses the colonic epithelium through the M cells overlying the Peyer patches)

What species of Shigella produce Shiga toxin; a potent protein-synthesis inhibiting exotoxin that causes HUS

Shigella dysenteriae

Presumptive diagnosis of shigellosis

fecal leukocyte and blood; leukocytosis

definitive diagnosis of shigellosis

culture of stool and rectal swab (MacConkey agar; xylose-lysine deoxycholate; SS agar)

Empirical tx of shigellosis

Cefixime 8mkd PO q12 x5days; OR Ceftriaxone 50mkd IV or IM OD x5days; OR Azithromycin 12mkd PO 1st day then followed by 6mkd for the next 4days; AND Zinc 20mg/day x14days improves immune response to Shigella

group of E. coli that causes infantile explosive diarrhea with dehydration; few or no structural changes in the mucuso

ETEC

group of E.coli that causes colonic lesions like dysentery

EIEC

group of E.coli that causes nonbloody diarrhea with mucus

EPEC

group of E.coli that causes significant dehydration

EAEC

group of E.coli that produces shiga-toxin

EHEC

Tx for culture confirmed ETEC

TMP-SMX

slightly curved; gm(-) aerobic bacillus that has serotypes 01 and 0139

Vibrio cholerae

predominant strain of cholera

O1 El Tor

laboratory finding in cholera

hemoconcentration; hypokalemia; hyponatremia ; hypchloremia; metabolic acidosis

confirmatory test for cholera

Cary-Blair transport medium plated onto TCBS (thousulfate-citrate-bile-sucrose media)

rapid test for cholera

darkfiel microscopy (wetmount of liquid stool examined for DARTING organism)

complications of cholera

dehydration that may lead to acute tubular necrosis; hypoglycemia; hypokalemia; pulmonary edema

DOC for cholera

for 9yo:Tetracycline:50mkd PO qid x3days

neurotoxin produced by C. tetani

tetanospasmin

alternative to Ig Tet

Human IVIG

tx for tetanus for best survival rates

NM blockers (Vecuronium and Pancuronium)

clean painless papule (chancre) that appears 2-6wks after inoculation and heals spontaneously within 4-6hr

primary syphilis

nonpruritic maculopapular rash on the palms and soles (may be pustular) manifests when if primary syphilis is not treated

2-10 wks (secondary syphilis)

neurologic; cardiovascular GUMMAtous lesion (granulomas of the skin and MSS)

tertiary syphilis (latent)

refusal to move the involved extremity in early congenital syphilis

pseudoparalysis of Parrot

barrel-shaped upper central incisors in late congenital syphilis

Hutchinson teeth

painless knee joint swelling with sterile synovial fluid in late congenital syphilis

Clutton joint

linear scars on mouth anus and genitals in late congenital syphilis

rhagades

Dx of congenital syphilis

darkfield microscopy; immunofluorescence; nontreponemal tests (VDRL RPR); Treponemal test(TPI FTA-ABS MHA-TP)

Diagnostic test for syphilis to determine disease activity

nontreponemal tests (VDRL and RPR)

Diagnostic test fro syphilis that measure antibody specific for T. pallidum

treponemal tests (TPI FTA-ABS MHA-TP)

Tx for congenital syphilis

Aqeous Pen G 100k-150k Ukd IV for 10-14 days

Tx for primary secondary and early latent syphilis

Benzathine Pen G 50k U/kg IM single dose

acute systemic febrile rxn with exacerbation lesions occurs in 15-20% of all px with acquired or congenital syphilis who are treated with penicillin

Jarisch-Herxheimer rxm

technique to visualize Leptospira

darkfield microscopy or silver staining impregnation staining

manifestions of anicteric leptospirosis

conjunctival suffusion with photophobia and orbital pain; truncal maculopapular rash; fever; chills; headache; malaise; nausea; vomiting; severe muscle pain and tenderness on the LE

other term for Icteric Leptospirosis

Weil's syndrome

hemorrhage and cardiovascular collapse; RUQ pain; hepatomegaly; increased liver enzymes; hyperbilirubinemia; azotemia-oliguria-anuria

most useful screening test for Leptospirosis

microscopic slide-agglutination test using killed antigens

Tx of Leptospirosis

Parenteral Pen G 6-8 M U/m2/day in 6 divided doses for 1wk; OR Tetracycline