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Flashcards in Bacterial Infections Part 2 Deck (101):
1

Tetanus

Sources

Soil
Dust
Human and animal feces

2

Tetanus

MOT

Spores introduced into an area of injury or wound

3

Tetanus

Other cause

Neonate cut umbilical cord
Contamination of wound
Dental carries
Otitis media

4

Tetanus

Greatest risk

In deep punctures wound

5

Tetanus

IP

2-14 days after injury

6

Tetanus

Leading to nonstop titanic spasm

Tetanospamin-bind NMJ prevent neurotransmitter release- hypersympathetic state due to blocked inhibitory neurons

7

Neonatal tetanus

Usually how many days after the delivery

3-10 days

8

Most common tetanus

Generalized tatanus

9

Generalized tetanus

Symptoms

Trismus or lockjaw
Risus sardonicus
Dysphagia
Opisthotonos
Board like rigid abdomen

10

Generalized tetanus

Excitants provoke

Painful spasms

11

Generalized tetanus

He is aware of what is happening but cannot control it

Sensorium is intact

12

Generalized tetanus

Other symptoms

Dysuria
Urinary retention
Accumulation of secretions
Intact sensorium
Hyperactive DTR

13

Involve bukbar musculature, retracted eyelids, deviated gaze, Trismus, risus,ms plastic paralysis of tongue and pharyngeal muscles

Cephalic tetanus

14

Cephalic tetanus cranial nerves affected

3
4
7
9
10

15

Cephalic tetanus

Notice grimace, it is called

Sardonic smile and there is clenching of teeth

16

Painful spasm of muscles adjacent wound site

Localized tetanus

Kung saan ang sugat doon lang may spasm

17

Tetanus differentials

Rabies
Tetany
Polio
Bacterial meningitis
Drug reaction or withdrawal syndrome

18

Tetanus

Diagnosi

CBC mild PMN leucocytosis,
CSF normal with mild elevation opening pressure

19

Tetanus complication

Aspiration pneumonia
Atelectasis
Laryngospasm
Vertebral fractures
IM hematoma
Tongue lacerations

20

Tetanus

Treatment

3 important things to remember

1. Neutralize toxin from diffusing,
2. Eliminate bacteria
3. Support the patient

21

Tetanus

Treatment

For infants

Tetanus immune globulin 500 units

22

Tetanus

Treatment

For children and adults

3000-6000 units IM tetanus immune globulin

23

Tetanus

Treatment

Alternative

Antitetanus serum (ATS) caution serum sickness

24

Active immunization against tetanus should be started with other

DTP for children

25

Tetanus

Treatment


Antibiotic

Prevent multiplication of C. Tetani and stop exotoxin release

Pen G and metronidazole

26

Tetanus

Treatment

Alternative antibiotic

Erythromycin
Tetracycline >8years old

27

Tetanus

Treatment

Supportive

Airway- tracheostomy, ventilator,
Seizures- use diazepam or midazolam, muscle relaxant, nutrition NGT

28

Tetanus

Treatment

Good nursing care

Admit to a quiet area with minimal stimuli, pulmonary toilet

29

Tetanus

An

Inexcusable disease

30

Tetanus

Treatment

Prevention and control

Tetanus prophylaxis post injury

31

Staphylococcal infection

Organism

S. Aureus (most common)

32

Staphylococcal infection
Colonizer of anterior nares

S. Aureus

33

Staphylococcal infection

Coagulase negative staph

S. Aureus

34

Staphylococcal infection

Dismissed as contaminants but can cause bacteremia in NICU, immunocompromised and in catheters and shunts

S. Epidermidis

Normal skin flora
Opportunistic infection (artificial medical devices)

35

Staphylococcal infection

UTI in young sexually active adults

S. Saprophyticus

36

Staphylococcal infection

Reservoir

Humans

37

Staphylococcal infection

MOt

Hands,
Nasal discharge
Infection may follow colonization

38

Staphylococcal infection

IP

Variable, usually within a week

39

Staphylococcal infection

Hallmark

Abscess

40

Staphylococcal infection

Hallmark for staph aureus

Pus

Hematogenous means ( not by direct contact)

41

Staphylococcal infection
Direct bacterial infection

Skin

Folliculitis (maliit na pigsa)
Furuncles
Curbuncles (malaking pigsa)
Impetigo
Abscess and surgical wound infection

42

Staphylococcal infection
Direct bacterial infection

Most common cause of

Osteomyelitis and septic arthritis in children (acquired Hematogenously)

Example - bullous impetigo
Erythema- bullae- rupture

43

Staphylococcal infection
Direct bacterial infection

Non bullous impetigo

Streph

44

Staphylococcal infection
Direct bacterial infection

Rapid, progressive necrotizing, empyema, pneumatocoeles of abseceses, pyopneumothorax

Staph pneumonia

45

Staphylococcal infection
Direct bacterial infection

Bullae inside the lungs

Pneumatocoeles

46

Staphylococcal infection
Direct bacterial infection

Staph pneumonia

Septicemia
Meningitis following bacteremia or iatrogenic brain abseceses
Eneterocolitis,
Endocarditis,
Renal abscess
Myositis

47

Staphylococcal infection
Direct bacterial infection

Diagnosis

Gram stained smear, culture of exudates

Grape like clusters

48

Staphylococcal infection
Direct bacterial infection

Diagnosis

CONS

Pathogen or contaminats

49

Staphylococcal infection
Direct bacterial infection

Diagnosis

CBC

Moderate leucocytosis with polumorphonucleosis

50

Staphylococcal infection
Direct bacterial infection

Diagnosis

Total WBC

51

Staphylococcal infection
Direct bacterial infection

Treatment

DOC

Oxacillin 100-200 m/k/d

52

Staphylococcal infection
Direct bacterial infection

Treatment

Other drugs

Cloxacillin or nafcillin 4-6 division dose

53

Staphylococcal infection
Direct bacterial infection

Treatment

MRSA

Vancomycin

54

Staphylococcal infection
Direct bacterial infection

Treatment

For skin soft tissue, oral or brief parenteral antibiotic

Cloxacillin, cephalexin, amoxyclav

55

Staphylococcal infection
Direct bacterial infection

Treatment

Intranasal for carriers eto yung bacitracin

Mupirocin topical

56

Staphylococcal infection
Toxin mediated disease

Food poisoning - performed enterotoxins

57

Staphylococcal infection
Toxin mediated disease

IP

2-6 hours no antibiotic needed

58

Staphylococcal infection
Toxin mediated disease

Macular erythoderma with desquamation

Toxic shock syndrome toxin 1 (TSST1)

Negative ang culture dahil toxin

59

Staphylococcal infection
Toxin mediated disease

TSST1 DDx

Kawasaki disease
Scarlet fever
Measle
Leptospirosis
Strep TSS

60

Staphylococcal infection
Toxin mediated disease

Treatment for TSST1

Oxacillin
Cloxacillin

61

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Negative results in blood, throat, CSF cultures
Negative for RMSF, leptospirosis, measles

62

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)
2

Epidermolytic toxin or exfollatin

63

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Focus infection

Impetigo
Conjunctivitis
Gastroenteritis
Pharyngitis

64

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Manifestations

Large peeling epidermidis +nikolsky sign

65

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Abortive type

Eruption no blister

66

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Complications

Cellulitis
Pneumonia
Septicemia

67

Staphylococcal infection
Toxin mediated disease

Scalded skin syndrome (RItters disease)

Diagnosis and treatment

Based on clinical grounds, skin biopsy, frozen exam
Anti staph antibiotic

68

Streptococcal infection
Group A strep pyogenes

MOT

Droplet or direct contact

69

Streptococcal infection
Group A strep pyogenes

Age

Any, but most frequently (6-12)

70

Streptococcal infection
Group A strep pyogenes

Most common illness produced by GAS is

Acute tonsilitis
Pharyngitis

71

Streptococcal pharyngitis

Most important cause of bacterial sore throat

72

Streptococcal pharyngitis

Infants under 6 months of age

Febrile nasopharyngitis
Wala pang tonsils

73

Streptococcal pharyngitis

Children above 3

Acute exudative tonsillopharyngitis

Meron ng tonsils

74

Streptococcal pharyngitis

Determine if bacteria or virus

No cough, cold URTI, bacteria

75

Streptococcal pharyngitis

Bacteria

Enlarged beefy red tonsils with patchy exudate, palatial petechiae

76

Streptococcal pharyngitis

Diagnosis

CBc

Moderate leucocytosis with polumorphonucleosis

77

Streptococcal pharyngitis

Dx

Rapid Dx test kits

ELISA base

78

Streptococcal pharyngitis

Dx

Immunologic response to strep antigen-

Rise in titer 2-4 weeks apart ASO TITER >166 Todd units

79

Streptococcal pharyngitis

Rise in titer 2-4 weeks apart ASO TITER >166 Todd units

Body is producing antibody against streptolysin O

80

Streptococcal pharyngitis

Differential Dx

Diphtheria
Herpangiana
Infectious mononucleosis (EBV)

81

Streptococcal pharyngitis

Complications

Cervical adenitis
Peritonsillar (Quinsy)

Rheumatic fever- not because of bacteria but immunity agaist it

82

Streptococcal pharyngitis

If you have recurrent sore throat you can develop

Rheumatic fever

If recurrent pyoderma you can have AGN

83

Streptococcal pharyngitis

Treatment

DOC

Benzathine Pen G Im
Phenoxymethylpenicillin oral

84

Streptococcal pharyngitis

Treatment

If allergy in penicillin

Erythromycin
Clarithromycin
Azithromycin

85

Streptococcal skin infection

MOT

Scratching, insect bites, wounds, dirty fingers

86

Streptococcal skin infection

Most common in

6 years old
Summer

87

Streptococcal skin infection

Manifestations

Impetigo or pyoderma-bullous , honey colored crust

88

Streptococcal skin infection

Non bullous

Pyoderma

89

Streptococcal skin infection

Warm tender, erythema and edema

Cellulitis

90

Streptococcal skin infection

St Elmo's fire

Erysipelas

91

Streptococcal skin infection

Gangre
Flesh eating

Necrotizing fascitis

92

Impetigo contagiosa

Cigarette burn appearance
Honey crusted

Associated with acute glomerulo nephritis

93

Sharply defined, slightly elevated border, swollen, red tender
Deeper layers,
Para syang apoy na kumakalat sa ilalim ng balak

Erysipelas

94

Associated with strep pyogenes
Produce necrotic ulcer

E. Ecthyma

95

Edematous with lymphangitis and fever
Skin and subcu

Cellulitis due to group A streptococcus

96

Cellulitis due to group A streptococcus

Dx

Gram stain exudates from lesions
Culture of pus

97

Cellulitis due to group A streptococcus

Complications

Non suppurative sequelae
Acute hemorrhagic glomerulo nephritis

98

Cellulitis due to group A streptococcus

Treatment

Pen G
Pen V

99

Swollen tongue
Magenta tongue
Acute exudative tonsillopharyngitis
GAd strains with eryhtrogenic exotoxin

Scarlet fever

100

Super antigen exotoxin
Associated with soft tissue like cellulitis, abscess, necrotizing fascitis, may also be associated with invasive infections

Toxic shock syndrome 2

101

Tetanus

Organism

C. tetani, anaerobic, spore former neurotoxin