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IPT: ID > Block 3 - STDs, TB, UTI > Flashcards

Block 3 - STDs, TB, UTI Flashcards

(107 cards)

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1
Q

Patho of Tb?

A

Tubercle bacilli droplet is inhaled and smaller % enter bloodstream

Within 2-8wks, macrophages ingest them and they form a barrier shell (granuloma) aka latent Tb

If they cant keep it under control, bacilli multiplies

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2
Q

If latent Tb is present, what can it be detected by?

A

TST or IGRA

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3
Q

(T/F) Peeps with latent Tb are infectious

A

False, they dont spread to others

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4
Q

What are the classic CSF findings for Tb meningitis?

A

Hypoglycorrhachia (<45 glucose or ≤0.5 serum glucose of CSF)

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5
Q

What are the risks of developing Tb in someone with normal and weak immune systems?

A

Normal = about 10% will develop Tb in some point in their life

Weak = Untreated HIV individuals will have 7-10%/yr + children <5 have increased risk

Additional RF = diabetes and excessive alcohol use

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6
Q

M. tuberculosis is a (fast/slow) - growing organism that replicates in ____ hours and is visible in the culture at weeks ____

A

Slow growing organism - replicates in 20 hours and visible culture growth at 3-8 weeks

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7
Q

Immune response to Tb?

A

T lymphs are required

CD4 secrete interferon (IFN)-y to activate macrophages

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8
Q

Reactivation of Tb occurs when?

A

~10%; usually in the first 2 years (5%)

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9
Q

Duration of Tb Tx, regardless of AFB or CXR smear

How long is it?

A

2 months

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10
Q

Duration of Tb Tx, if both CXR and AFB smear are negative

How long is it?

A

Additional 4 months (6 months total)

or in some populations an additional 7 months (9 months total)

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11
Q

Duration of Tb Tx, if both CXR and AFB smear are positive

How long is it?

A

If the 2 month culture is negative, addition of 4 months (6 months total)

If 2 months = positive, check cavitation, if negative it’s also an additional 4 months (6 months total)

If that cavitation was present, then additional 7 months (9 months total)

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12
Q

On the Mantoux Tb test, what should you look for?

A

Raised, hard area or swelling

Redness alone isnt part of the rxn

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13
Q

What is the booster effect on the Tb skin test?

A

Pt shows up negative initially but has positive rxn if retested

Immunize them with BCG vaccine

They may have had tuberculosis in the past

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14
Q

≥5mm for TB skin test is positive in what groups?

A

HIV+

Recent contacts of infectious TB

w/ fibrotic changes consistent with prior TB

w/ organ transplant or other immunosuppressed pts

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15
Q

≥10mm for TB skin test is positive in what groups?

A

Recent arrivals in high-prevalence countries

IVDU

High-risk congregate settings (work, etc)

Mycobacteriology personnel

Increased risk for progressing to TB

Children <4yo

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16
Q

≥15mm for TB skin test is positive in what groups?

A

No risk factors for TB

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17
Q

What can cause false-positives in Tb skin tests?

A

NON tuberculous mycobacteria

BCG vaccine

Problems with TST admin

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18
Q

QuantiFERON-TB GOLD (QTF) is used to diagnose what?

A

Latent TB ONLY!

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19
Q

What does a positive TB skin test tell you?

A

That they are infected with TB bacteria. Not if its latent or active

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20
Q

Rifampin MOA?

A

Bactericidal, concentration dependent

Inhibits DNA-dependent RNA polymerase

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21
Q

How should rifampin be taken?

A

Empty stomach

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22
Q

Rifampin AE?

A

Liver damage, rash, orange-red urine

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23
Q

Rifampin DI?

A

Potent INDUCER of CYP450

If given with non nucleoside reverse transcriptase inhibitors (nevirapine or efavirenz) they need their doses increased

Bunch of other drug doses would need to be adjusted as well

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24
Q

Isoniazid MOA?

A

Bactericidal for dividing organisms and bacteriostatic for resting bacteria

Disrupts cell wall synthesis by inhibiting mycolic acid synthesis

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25
How should isoniazid be taken?
Empty stomach!!
26
Isoniazid AE
Liver damage Peripheral neuropathy (take w/ pyridoxine) Neurotoxicity Hematologic toxicity
27
Isoniazid DI?
Inhibits certain CYPs Also interacts with tyramine
28
Pyrazinamide MOA?
Unknown, but bactericidal at acidic pH
29
Pyrazinamide AE?
Liver issues, arthralgia, gout exacerbation and photosensitivity
30
Ethambutol MOA?
Bacteriostatic Interferes with mycolic acid incorporation into mycobacterium cell wall
31
Ethambutol AE?
Optic neuritis Decreased visual acuity or red-green discrimination
32
Ethambutol DI?
Dont give w/ antacids
33
Which Rx are risk factors for UTI?
SGLT2 inhibitors (-gliflozin)
34
Ascending + Descending routes of UTI, what causes them?
Ascending (most common) = urethra colonized by fecal flora Descending = hematogenous from distant infections
35
Which patient population is considered "complicated" UTI?
Pregnant Males Children Diabetics Any structural abnormalities
36
Clinical presentation in UTI?
Lower = local symptoms, systemic is rare Upper = local symptoms often not present, but there is systemic effects
37
In the urinalysis (macroscopic), what should you focus on?
Leukocyte esterase (detects presence of WBC) Nitrite test (only enterobacteriaceae + forms by bacteria that reduces nitrate to nitrite)
38
In the urinalysis (microscopic), what should you focus on?
≥10^5 CFU indicates UTI ≥10^2 is diagnostic in presence of Sx
39
In uncomplicated UTI, what are the causative organisms?
E. coli + S. saprophyticus (usually found in young sexually active females)
40
In complicated UTI, what are the causative organisms?
E. coli + Enterococcus spp
41
What bug causes pH of urine to increase?
Proteas (produces urease)
42
What are the common ESBL organisms for UTI?
E. coli + K. pneumoniae
43
Which bug doesnt reduce nitrate to nitrite?
Pseudomonas
44
What are the medications used for asymptomatic bacteriura?
≥10^5 Nitrofurantoin, Cephalexin, Augmentin Bactrim (avoid in 1st and 3rd trimester)
45
What are the Rx for acute uncomplicated cystitis?
Nitrofurantoin x 5 days Bactrim x 3 days (avoid if local resistance >20%) Fosfomycin x once
46
How do you treat mild/moderate pyelonephritis?
FQ are first line (cipro, levo), if resistance >10% use 1g Rocephin or amino Cipro x 7 days Levo x 5 days Could use Bactrim x 14 days
47
How do you treat severe pyelonephritis?
IV Abx for 10-14days ``` 3rd/4th Cephs Extend-spec B-lac FQs Aminos Carbapenems ```
48
Explain the cipro surrogate marker
Levo's susceptibility can be assumed based off of cipro's for Enterobacteriaceae only
49
Peeps with recurrent UTI have what minimum of infections /year?
3+; start long-term prophylaxis and urine cultures every 1-2 months
50
What is the prophylaxis Tx for recurrent UTI?
Bactrim 0.5-1 tablet daily Nitrofurantoin 50-100mg PO daily **post-coital therapy = Bactrim 1 tablet after activity
51
What are the parenteral Tx options for complicated UTI?
``` 3rd/4th Cephs Extend-spec B-lac FQs Aminos Carbapenems Aztreonam ```
52
What are the oral Tx options for complicated UTI?
``` Nitrofurantoin Bactrim FQs Augmentin Cefdinir or cefpodoxime Fosfomycin ```
53
Oral Abx for complicated UTI + AE?
Bactrim - rash, hyperkalemia, and increased SCr Nitro - brown urine FQ - QTc prolongation, hypo/hyperglycemia, BBW of tendonitis, other CNS stuff
54
How long do you Tx complicated UTI?
10-14 days
55
What is catheter-associated UTI?
S/Sx of UTI AND ≥10^3cfu in a single urine specimen (previous 48hrs0
56
How do you treat catheter-associated UTI?
Asymptomatic - remove catheter and no Abx needed Symptomatic - remove catheter and treat as complicated infection Other considerations: bacteriuria ≥48hrs, Abx may be needed
57
How long do you treat catheter-associated UTI?
Women <65 w/o upper UTI sx after catheter removal = 3 days Quick resolution of sx = 7 days unless its levo, then 5 days Persistent sx = 10-14 days
58
How does acute vs chronic prostatitis present?
Acute = systemic effects Chronic = lower back pain, suprapubic discomfort
59
How long do you treat prostatitis?
Acute = 4-6wks Chronic = 6-12wks
60
Prostatitis Tx?
Bactrim, FQs Zosyn, 3rd Gen cephs, doxy/mino
61
Treating latent TB with Isoniazid, what is the direction?
300mg daily for 9 months, give w/ HAART
62
Treating culture positive pulmonary TB, what is the regimen?
RIPE for 7 days/week for 8 weeks (initial phase) R+I only for 7 days/week for 18 weeks
63
Monitoring parameters of specimen for TB?
Acid-fast bacilli smear, sample q1-2wks until 3 consecutive smears are negative Do monthly sputum cultures until 2 consecutive cultures are negative
64
Who receives DOT (direct observation therapy) for Tb?
Tx failure, HIV, Drug-R isolate, Positive smear, substance abuse, psychiatric issues, non-adherence
65
What causes gonorrhea and chlamydia?
Gonorrhea = N. gonorrhoeae Chlamydia = Chlamydia trachomatis
66
What bug causes syphilis?
T. pallidum
67
What bug causes chancroid?
H. ducreyi
68
For frequent co-infections of urethritis or cervicitis, what bugs should the drug regimen cover?
Gonorrhea and chlamydia
69
Presentation of gonorrhea?
Often asymptomatic (esp in females Dysuria Green/white discharge
70
RF for STDs?
of partners (#1 greatest RF) Male on Male Prostitution Illicit Rx use
71
Colonizers and bugs in vagina/prostate?
Colonizer for vagina only: LAG (lactobacillus, anaerobes, G. vaginalis) Pathogens for vagina: TEC (T. vaginalis, enteric pathogens, C. albicans) Pathogens for prostate: PES (UT pathogens + P.aeruginosa, enterococcus spp., S. aureus)
72
How is gonorrhea treated?
Ceftriaxone 250mg IM AND azithromycin 1g PO x1
73
How does disseminated gonococcal infection presented?
Skin lesions (red/purple spots), asymmetric arthralgia or septic arthritis
74
How is disseminated gonococcal infection treated?
Ceftriaxone 1g IM/IV for at least 7 days AND azithromycin 1g PO x1
75
How is chlamydia presented?
Often asymptomatic
76
How is chlamydia treated?
Azithromycin 1g PO x 1 or Doxy 100mg PO BID x 7days
77
How is bacterial vaginosis diagnosed?
3 of the 4 are required: Thin, white discharge Vaginal skin cell + bacteria stuck to edges pH>4.5 Whiff test positive (fishy odor before or after 10% KOH is added)
78
How is bacterial vaginosis treated?
Flagyl 500mg PO BID x7days Flagyl 5g gel intravaginallydaily x5days Clinda 5g cream intravaginally at bedtime x7days
79
How is syphilis diagnosed?
SCREENED via nontreponemal test (detects anti-cardiolipin ABs or RPR test) CONFIRMED via treponemal test (detects anti-treponemal or fluorescent AB)
80
Primary syphilis info?
10-90 days after infection Single painless ulcer found where the bacteria entered body
81
Secondary syphilis info?
2-8wks after initial infection Painless skin rash, mucocutaneous lesions, systemic sx
82
Latent syphilis info?
Sx of primary or secondary syphilis Seroconversion in nontreponemal titers for >2weeks If it occurs within a year = early latent If >1yr or unknown = late latent
83
Tertiary syphilis info?
10-30 yrs after initial infection Muscle issues or paralysis Gradual blindness Dementia Gumma (soft inflammatory masses)
84
Neurosyphilis info?
Occur at any stage Neurological issues
85
Syphilis Tx?
Primary, secondary, early latent syphilis = BENZATHINE Peng G 2.4mil x1 Tertiary, late latent syphilis, or unknown = BENZATHINE Peng G 2.4mil weekly x 3 doses Neuro or ocular syphilis = Aq crystalline Pen for 10-14 days
86
What is a Jarisch-Herxheimer Rxn?
May occur in first few hrs after Pen. is given for syphilis. Treat w/ antipyretics, but dont stop Pen. regimen
87
Pen. allergy + syphilis Tx?
Primary/Sec syphilis = Doxy, tetra, ceftriaxone x ~14 days Latent = Doxy, tetra x28 days Tertiary = ID specialist If pregnant or neurosyphilis, do penicillin desensitization
88
Chancroid presentation?
Multiple painful genital ulcers w/ or w/o regional lymphadenopathy
89
How is Chancroid treated?
Azithromycin 1g PO x1 or Ceftriaxone 250mg IM x1 or Cipro 500mg PO BID x3days Follow up in 3-7days
90
How are HPV genital warts presented?
Often asymptomatic Soft growth on genitals Types 6 + 11 are the ones that cause genital warts
91
How are genital warts treated?
Specific antivirals are not recommended You can prevent them with HPV vaccine. Recommended at 11-12 yrs old, CDC says 9-26 is okay, now FDA says 27-45 is good too
92
Genital wart vaccine info?
Cervarix (bivalent) covers only 16 + 18 (cervical cancer only) Gardasil (covers 6,11,16,18) Gardasil-9 All given with 3 dose series over 6 months
93
Genital herpes info?
Type 1: usually oral, but can be genital Type 2: genital Chronic lifelong infection with painful lesions
94
Genital herpes treatment?
First episode: acyclovir 400mg PO TID x7-10days or Valacyclovir 1g PO BID x7-10days Then use suppressive therapy Pretty much the same above but daily + famciclovir 250 mg PO BID
95
Trichomoniasis presentation?
Occurs in males and females Most prevalent non-viral STD in US
96
Trichomoniasis treatment?
Flagyl 2g PO x1 or Tinidazole 2g PO x 1 Follow up in 3months in women
97
VVC presentation?
Painful intercourse, abnormal discharge, Not usually sexually transmitted, but has STD-like sx
98
Classification of VVC?
Recurrent OR severe OR Non-albicans candida OR has DM, immunocompromised or debilition = Complicated Uncomplicated would be milder versions above and would include "AND" for each item
99
How is uncomplicated VVC treated?
OTC = Tioconazole, Miconazole, Clotrimazole Rx = Fluconazole 150mg x1, butoconazole, terconazole
100
How is complicated VVC treated?
Topical therapy for 7-14 days or fluconazole 150 PO every 72hrs (2 doses)
101
What is the expedited partner therapy program?
Treat all partners of chlamydia or gonorrhea for the past 60 days (heterosexual)
102
Which PID pt can be treated in outpatient?
Temp <38, WBC<11k, minimal evidence of peritonitis, active bowel sounds, and is able to tolerate oral nourishments
103
Outpatient PID tx?
1. Ceftriaxone 250mg IM x1 + doxy 100mg PO BID 14 days 2. Cefoxitin 2g IM x1 + Probenecid 1g PO x1 + Doxy 100mg PO BID x 14 days 3. Flagyl 500mg PO BID x14 days can be added for more anaerobic coverage
104
Inpatient Beta lactam regimen for PID?
Cefotetan 2g q12h + doxy 100mg q12h Cefoxitin 2g q6h + doxy 100mg q12h Unasyn 3g q6 + doxy 100mg q12 **doesnt cover M. genitalium
105
Inpatient Beta lactam free regimen for PID?
Clinda 900mg q8h + gent 2mg/kg LD then 1.5mg/kg q8h **doesnt cover M. genitalium
106
When can pt be switched from IV to PO for PID?
After they are stable for 24-48 hrs
107
If tx failure exists for PID, whats next?
Check for M. genitalium, then start Moxi 400mg PO daily for 14 days

IPT: ID (11 decks)

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