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Bacterial Infection Flashcards

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1
Q

Etiologic agent whooping cough

A

Bordetella pertusis gram + bacilli

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2
Q

Mot of pertusis

A

Close contact respiratotmry secretions

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3
Q

Incubation period pertussis

A

6-20days

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4
Q

Characteristic of whooping cough

A

100 days cough

Successive cough with inspiratory whoop

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5
Q

3 stages whooping cough

A

Catarrhal 1-3weeks
Paroxysmal 2-4week
Convalescent 100 days

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6
Q

What is catarrhal stage of pertussis

A 
Most contagious stage
Nonspecific manifestation
Mild uri
Low grade fever
Important to diagnose early to shorten disease course
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7
Q

Paroxysmal phase pertussis

A

Obvious sign and symptoms
Successive cough ending with high pitched inspiratory whoop
Clinical pertussis
Machine gun burst of cough

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8
Q

Convalescent stage pertussis

A

Reduce frequency and severity of cough last 100 days

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9
Q

Diagnosis of patient with pertussis.

A

Cbc: highleucocyte count 15,000-100,000 with absolute lymphocytosis(leukemoid reaction)
Xray: perihilar infiltrate, atelectasis or emphysema

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10
Q

Total duration of pertussis

A

Up to 12 weeks

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11
Q

Complication and hospitalization of pertussis

A

Occur most commonly in the young under 6 months

Pneumonia, apnea, otitis, conjunctival hemorrhage,epistaxis, seizure, acute encephalopathy, hernia, pneumothorax

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12
Q

Differential diagnosis pertussis

A

Atypical pneumonia, chlamydia, mycoplasma, adenovirus
Tracheobronchial Tb
Foreign body
Bronchiolitis

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13
Q

Confirmation of diagnosis

A

Isolation of the organism from bordet gengou culture of nasopharyngeal mucus
Best yield during 3 weeks of illness
Pcr, fluorescent antibody, serology

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14
Q

Treatment of pertussis

A

Most effective during first 2weeks of illness
DOC: erythromycin 40-50mg/kg/day x 14 days
Other drugs: azithromycin, clarithromycin
All household contacts should be given chemoprophylaxis regardless the age and immunization status
Supportive:paracetamol, iv fluids
Vaccination

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15
Q

Drug of choice for whooping cough

A

Erythromycin

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16
Q

Etiologic agent syphilis

A

Treponema pallidum-spirochette

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17
Q

Mot of syphilis

A

Direct contact with the lesion
Perinatal intrauterine infection
Blood transfusion

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18
Q

Adult syphilis vs congenital syphilis

A

Adult syphilis

  • sexually transmitted
  • prevalent in adolescent

Congenital syphilis

  • vertical transmission from pregnant mother
  • transmission can occur at any stage
  • usually infected fetus die in the utero or shortly after birth
  • surviving babies have severe congenital and developmental anomalies
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19
Q

3stages of syphilis

A

Primary (site of penetration)

  • painless indurated ulcer
  • chancre usually found in the genitalia
  • after few weeks ulcer heals then goes secondary

Secondary(dissemination)

  • condyloma lata(wart like lesion on the anal verge)
  • skin lesion, fever rash

Tertiary(deep organ involvement)

  • gumma(granulomatous lesion)
  • neurosyphilis(tabes dorsalis) most prominent
  • cardiosyphilis
  • not due to the bacteria but by the tissue damage brought about by the bacteria
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20
Q

Early onset of congenital syphilis

A
  • first 2years of life
  • hepatomegaly, snuffles, lymphadenopathy, mucocutaneous lesions, pneumonia, osteochondritis rash, pseudoparalysis, hemolytic anemia, thrombocytopenia

-can be mistaken with neonatal sepsis, maternal history is important

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21
Q

Late onset of congenital syphilis

A

2 yrs old and above
Bone malformation( frontal bossing, saddle nose, saber shin-bowing of tibia)
Neurosyphilis
Mulberry molars
Rhagades(fissure which appears at the mucocutaneous junction)
Hutchinson triad( keratitis, hutchinson teeth, 8th nerve deafness

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22
Q

Diagnosis of syphilis

A

Darkfield microscopy
Serology-mainstay
- non treponemal= VDRL, RPR ( screening monitor response to therapy- quantitative test to measure ab titer)
-treponemal= FTA TPHA (confirmatory)

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23
Q

Treatment of syphilis

A

DOC: penicillin G
Newborn: aqueous crystallography ne pen G or procaine pen G
Children: benzathine pen G
Alternative: erythromycin/ tetracycline

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24
Q

Etiologic agent of salmonellosis

A 
Salmonella typhi(typhoidal human source)
S. Enteritidis, s. Cholerasuis(non typhoidal animal zoonitic source)
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25
MOT of salmonellosis
Fecal oral contaminated food and water Bacteria goes to the terminal ileum submucosal lymph node, monocytic infiltration of peyers patches Non typhoidal: contaminated milk, dairy products water, pastries Typhoidal: humans
26
Clinical features of s. Typhi typhoidal
Mild to severe prolonged presentation Congenital infection/fetal typhoid: high fever low BW Typhoid fever: high grade intermittent fever(stepladder) on and off for 2 weeks Diarrhea(pea soup) or constipation Abdominal distention Rose spots appears on the 7th and 2nd week of illness on the trunk Bradycardia, hepatomegaly, meningeal sign, typhoidal psychosis
27
Complication of typhoid fever
Occur on 2nd and 3rd week of illness-intestinal hemorrhage/ perforation- most dreaded complication Peritonitis,jaundice, splenic rupture, pneumonia , encephalitis, nephritis, meningitis psychosis Salmonella gastro enteritis= most common presentation of salmonellosis -intestinal hemorrhage secondary to typhitis/ typhoid ileitis
28
Most common presentation salmonellosis
Salmonella gastroenteritis
29
Most dreaded complication of typhoid fever
Intestinal hemorrhage or perforation
30
Diagnosis of salmonellosis
Fecalysis: pus cells , rbc in the stool Culture of blood (1-3wks), urine(first 2wks), stool (2nd -4wks), bone marrow aspirate(90%sensitive) last resort due to invasiveness Widal test- for non endemic areas Cbc: leukopenia, lymphocytosis-typhoid fever Leukocytosis-non typhoidal Serologic test: latex particle, elisa typhi dot( detects specific igm and igG
31
Mean incubation period of salmonellosis
24 hours
32
Treatment for typhoid fever
DOC: chloramphenicol 57-75mg/kg/day q6hx 14 days Others:amoxicillin ceftriaxone, cefotaxime NO ANTIBIOTICS FOR SALMONELLOSIS(self limiting)
33
Treatment for salmonella gastroenteritis
``` Fluids and electrolytes Supportive antibiotics given only if: 1. <3 mos 2. Immunodeficient 3. Undernourished and blood culture positive ```
34
Treatment for extra intestinal salmonellosis
Antibiotics prolonged for 4-6wks(bone infection), 4 wks (meningitis)
35
Treatment for chronic carrier of salmonellosis
High dose ampicillin
36
Prevention for salmonellosis and typhoid fever
1. Personal hygiene 2. Public health measures in food preparation and storage 3. Infection control 4. Vaccine- vi capsular polysaccharide vaccine one dose IM
37
Etiologic agent of shigellosis
Shigella dysenteriae
38
Mean incubation period of shigella
24hrs | Though as few as 10 organism can cause diarrhea (shiga toxin)
39
Triad of shigellosis in infant
Dysentery High grade fever Seizure
40
Clinical manifestation of shigellosis
``` Bloody diarrhea(dysentery) Fever Abdominal pain, crampy borborygmous Neurologic Hus(just like EHEC) ```
41
What is the most common cause of bloody dysentery
Shigella
42
Treatment for shigellosis
Supportive and 3-5days antibiotics( cefixime, ceftriaxone,ciprofloxacin)
43
Etiologic agent of cholera
Vibrio cholerae, vibrio parahemolyticus | Usually it is associated in history of eating shellfish that may lead to food poisoning
44
Toxin of cholera responsible for epidemic disease
Strain 01 and 0139 | Toxin is also called choleragen which causes severe secretory diarrhea
45
Most characteristic manifestation of cholera
Voluminous diarrhea( rice water)
46
Main problem in patient with cholera
Massive diarrhea that will lead to severe dehydration
47
Clinical manifestation of cholera
Emesis Low grade fever Shock due to fluid volume depletion
48
How to diagnose cholera
Stool rectal swab | Gold standard is culture of organism
49
Complication of cholera
Renal- renal and pre renal failure Cardiac-due to hypovolemic shock Coma-due to poor cerebral perfusion Volume depletion
50
Treatment of cholera
1. Correct hydration -very important to correct loss , antibiotics are only given for 3days so its not enough 2.antimicrobials- doxycyclinie, tetracycline, TMO-SMZ, erythromycin, Ciprofloxacin,cotrimoxazole
51
K1 capsular is associated with
NeonatL sepsis and meningitis
52
Diarrhea strains
EPEC EHEC ETEC EIEC
53
Escherichia coli is
Gram negative bacteria | Belongs to enterobactericiae
54
Travelers diarrhea strain
ETEC
55
Manifest with bloody stool strain
ETEC | EHEC
56
Manifest with watery stool strain e. Coli
EPEC | EAEC
57
Produces shiga like toxin
Enterohemorrhagic e. Coli 0157 H 7 Colitis with bloody diarrhea
58
Strain of infantile diarrhea
EPEC
59
MOT OF e. Coli
Fecal oral route
60
Most common cause of UTI
E coli due to poor perineal hygiene,ascending infection
61
Diagnosis of diarrhea
History of uncooked meat | Stool culture-gold standard
62
Treatment for diarrhea in patient with e.coli
1. Rehydration 2. ETEC-self limited 3. Antibiotics are contraindicated with EHEC due to increase progression to HUS 4. UTI- amoxicillin clavulanate, ampi sulbactam, cotrimoxazole 5. Sepsis meningitis , pneumonia-ceftriaxone, cefotaxime
63
Etiologic agent of tetanus
Clostridium tetany- anaerobic sporeformer neurotoxin
64
Sourceof clostridium tetani
Soil, dust human and animal(feces, unsterile suture,rusty instruments nails scissors or pins)
65
MOT of tetanus
Spores introduce into the area of injury or wound(direct inoculation)
66
Portal entry of tetanus
Dental carried, otitis media, penetrating wounds, illiciting drug injections, abscesses, ear piercing, fire cracker injuries Greater risk in deep punctured wounds, avulsion, crushing injuries
67
Incubation period of tetanus
2-14 days after the injury
68
Pathogenesis
Upon inoculation tetanospasmin bind with NMJ prevent neurotransmitter release-hypersympathetic state due to. Locked inhibitory neurons- nonstop tetanic spasm
69
Clinical forms of tetanus
Neonatal tetanus Generalized tetanus- most common Cephalic tetanus Localized tetanus
70
Neonatal tetanus
Usually 3-10day Difficulty in sucking, jaw stiffness Excessive cry hoarse to starngled Opisthotonous, apnea, paralysis,constipation, urinary retention spasm
71
Generalized tetanus
Stiffness of the voluntary muscle- trismus/lockjaw, risus sardonicus, dyasphagia, opisthotonus,board like rigidity, flexed arms extended legs laryngeal spasm, tachycardia, sweats -excitants provoke painful spasm and seizure -intact sensorium -dysuria Urinary retention Accumulation of secretion Hyperactive dtr
72
Cephalic tetanus
Involve bulbar musculature | Retracted eyelids,deviated gaze, trismus, risus, spastic paralysis of the tongue and pharungeal muscle(CN 3,4,7,9,10,11)
73
Localized tetanus
Painful spasm of muscle adjacent to wound site
74
Ddx of tetanus
``` Rabies Tetany Polio Bacterial meningitis Drug reaction or withdrawal syndrom ```
75
Diagnosis of tetanus
Based mainly on clnical lab testing, cant confirm or exclude the disease CBC: mild pmn leukocytosis Normal csf with mild opening pressure
76
Complication of tetanus
- aspiration pneumonia - atelectasis - laryngospasm - vertebral fracture - im hematoma - tongue lacerations
77
Treatment of tetanus
Tetanus immuniglobulin 500units IM for infants 3000-6000 units IM (children and adults) Antitetanus serum (ATS) caution for side effect—serum sickness Recommended antibiotics:pen G and metronidazole Alternatives: erythromycin and tetracycline(>8y/o) Wound debridement Admit to a quiet area with minimal stimuli Supportive management
78
Etiologic agent of staphylococcal infection
S. Aureus abscesses and toxin related | Colonizer of anterior nares
79
Patient came in with high grade intermittent fever stepladder for 2 weeks with diarrhea(pea soup), abdominal pain and rose spots
Typhoid Fever

Pediatrics (6 decks)

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