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7005PHM Pharmthera II > Common Infectious Disease Presentations > Flashcards

Common Infectious Disease Presentations Flashcards

1
Q

What are some predisposing factors to skin/soft tissue injuries?

A

Tinea infection of feet
Fissured dermatitis
Lymphoedema, lymphatic malformation
Hx of DVT, vascular surgery, radiotherapy

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2
Q

What kinds of bacteria commonly cause Boils?

A

Staphylococcus aureus

Sometimes combined with streptococcus pyogenes

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3
Q

What can be used for boils/carbuncles treatment?

A

Susceptible to penicillin, want to go narrow

1) Flucloxacillin

or amoxicillin

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4
Q

What causes impetigo? (school sores)

A

Commonly caused by staph aureus, less commonly strep pyogenes (common in remote indigenous population)

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5
Q

How is impetigo treated?

A

Gram +ve bact

Non-endemic (S. aureus) = Treat with flucloxacillin or dicloxacillin, Cefalexin (preferred in kids)

Endemic = benzylpenicillin

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6
Q

What bacteria causes erysipelas and how is it treated?

A

diffuse spreading area of skin erythema (redness) , butterfly shape when on face. Lesions raised above levels of surrounding skin, clear line between infected and uninfected tissue

Almost always caused by Strep pyogenes –> benzylpenicillin or phenoxymethylpenicillin

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7
Q

What bacteria causes cellulitis and how is it treated?

A

Deeper than erysipelas, typically subcutaneous (children = peri-orb, adult = lower legs)

Spontaneous rapidly spreading cellulitis = S. pyogenes or streptococci (b, c, or g) –> phenoxymethylpenicillin or benzylpenicillin

Penetrating trauma/ulcerations = S. aureus –> diclox/flucloxacillin

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8
Q

What bacteria causes diabetic foot and how is it treated?

A

Diabetic foot infection, always serious

Acute infection, not recently received antimicrobials = staph aureus and streptococci —> diclox/flucloxacillin

Chronic diabetic foot = polymicrobial, involving G+ and G-ve aerobic and anaerobic bact –> empirical amoxicillin + cavulanate

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9
Q

Are human/animal bites and clenched fist injuries treated with antibiotics?

A

Necessary if high risk of infection is present:
- wounds with delayed presentation >8hrs
- puncture wounds that cannot be debrided
- wounds on hands, feet, face
- wounds involving deeper tissue (bones, joints, tendons)
- wounds in immunocompromised patients

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10
Q

Is antibiotic therapy used for skin/soft tissue wounds?

A

Antibiotics = reserved for sig injuries (muscular, skeletal, soft-tissue trauma, crush injuries, penetrating injuries, stab wounds)

Severe/already infected wounds = anaerobic coverage req –> penicillin w/ clav or penicillin w/ metronidazole

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11
Q

What bacteria is found in salt/brackish water? How treat?

A

Vibrio –> doxycycline

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12
Q

What bacteria is found in fresh/brackish/mud? How treat?

A

Aeromonas –> trimethoprim/sulfamethoxazole

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13
Q

What bacteria is found in fishtanks? How treat?

A

Mycobacterium marinium –> clarithromycin

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14
Q

Does acute bronchitis require antibiotics?

A

No, self-limiting lower RT infection, typically viral

Cough can last 2-3wks and 90% of patients resolved by 4wks

Abx not indicated

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15
Q

What causes CAP and how is it treated?

A

Commonly caused by = streptococcus pneumoniae –> amoxicillin is drug of choice

Mycoplasma pneumonia –> doxycycline or macrolide (clarithromycin)

Haemophilus influenza –>benzyl-penicillin

Pseudomonas aeruginosa –> cefepime or (piperacillin + tazobactam) +azithromycin+ gentamicin (if septic)

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16
Q

What is used to investigate CAP?

A

Chest-Xray, O2 sat

Pathogen investigation = sputum gram stain cultures, blood sample for cultures (before abx tx)

Other investigations = pneumococcal urinary antigen assay, Legionella urinary antigen assay, nose and throat swabs, serology

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17
Q

What are the symptoms for boils?

A

Tender, painful, seldom systemic symptoms

cutaneous abscess

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18
Q

What are the symptoms of impetigo?

A

crusted = yellow crusts and erosions that are itchy or irritating, not painful

bullous impetigo = irritating blisters that erode rapidly

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19
Q

How is pneumonia diagnosed?

A

Based on chest x-ray and clinical findings

Elevated temp (not in bronchitis), resp rate, heart rate
Dec BP, O2 saturation
Acute onset confusion

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20
Q

What acronyms are useful in determining CAP severity?

A

CORB (acute confusion, O2 sat <90%, resp rate >30 breath/min, S-BP <90mmHg or D-BP <60mmHg)
- severe >2 greater of the above

SMART-COP = severe is a score >5

21
Q

What is HAP?

A

hospital acquired pneumonia (HAP) –> develops in a patient who has been hospitalised for longer than 48hrs

Intubation greatly inc risk, interferes with normal physiological mechanisms that limit bacterial contamination

Treat with amoxicillin + metronidazole

22
Q

What bacteria commonly cause HAP?

A

Gram-ve bacilli
MRSA
MDR Enterobacteriaceae
Pseudomonas aeruginosa
Acinetobacter species

23
Q

What causes aspiration pneumonia? How treat?

A

Acute inflammation w/in several hrs of aspiration of acidic gastric contents

Treated as CAP (amoxicillin) = role of anaerobic bact overestimated

24
Q

When should metronidazole be introduced into aspiration pneumonia treatment regimen?

A

Putrid sputum, severe periodontal disease or hx chronic hazardous alcohol consumption

Develop lung abscess, empyema or necrotising pneumonia

Do not respond to initial empirical therapy

25
Q

Discuss abx use in infective exacerbation of COPD

A

Infective COPD = worsening of symptoms from usual state triggered by bact/viral infections or by non-infective causes

Abx treatment is used to hasten recovery rather than eliminate colonising bacteria –> amoxycillin or doxycycline

26
Q

Discuss abx use in pharyngitis and tonsillitis

A

Strep pyogenes is greatest concern (doesnt always cause it), its part of normal flora

Abx shorten duration by <1 day, at day 7 no diff in improvement

27
Q

Is abx used to treat Otitis externa?

A

Self limiting, keep ear dry

Combination of corticosteroids and antimicrobial drops

28
Q

Is abx used to treat otitis media?

A

Viral or bacterial, self limiting

Avoid routine use of antibiotic therapy for acute otitis media

Use abx only for systemic symptoms (high fever, vomiting, lethargy)

29
Q

What are the symptoms of pyelonephritis?

A

flank pain, high fever
malaise
WBC and bact in urine
urinary symptoms similar to cystitis

30
Q

What are the symptoms of cystitis?

A

inc urinary freq, urgency
dysuria
pain above pelvic region
WBC and bact in urine

31
Q

Should asymptomatic bacteriuria be treated?

A

Treatment not recommended unless:

  • preg, due to adverse preg
  • patient undergoing elective urological procedure
32
Q

What commonly causes uncomplicated cystitis and pyelonephritis? How treat?

A

Uncomplicated UTI = non-pregnant who do not have functional/anatomical abnormality of UT

Commonly caused by E. coli (70-90% of cases)

Treat = trimethoprim –> 3 days

33
Q

What causes 5-10% of uncomplicated pyelonephritis and cystitis cases?

A

Staph saprophyticus

34
Q

What commonly causes complicated UTIs?

A

E. coli = 20-50% of cases

Occurs in people with functional or anatomical abnormalities

35
Q

What other bacteria can cause complicated UTIs?

A

Proteus
Klebsiella
Enterococci
Streptococcus agalactiae (grp B streptococcus)

36
Q

What testing should be conducted for pylonephritis?

A

Hospital patients = blood samples for bact culture, urine culture

37
Q

What class of antibiotic should not be used as first-line for UTI?

A

Quinolones –> use is associated with development of resistance, only oral drug available that can be used against pseudomonas aeruginosa

38
Q

What is commonly seen in UTIs in individuals with recent travel to indian subcontinent?

A

Extended-spectrum beta-lactamases –> penicillin + fam may not work

39
Q

What commonly causes meningitis?

A

Neisseria meningitidis, S. pneumoniae

Unvaccinated kids = Haemophilus influenzae type B

Adults >50 = listeria monocytogenes

40
Q

What should be done if someone presents with suspected meningitis?

A

Blood culture, lumbar puncture unless C/I

41
Q

What abx is not effective in meningitis? Why?

A

aminoglycosides, clindamycin, erythromycin, moderate-spectrum cephalosporins

Due to = poor penetration into CSF

42
Q

What can be used to treat meningitis?

A

Dexamethasone (before or w/ 1st dose of abx)= improve outcome in kids with Hib (hearing loss) and adults w/ pneumococcal meningitis (mortality)

Abx = benzylpenicillin or ceftriaxone (remote areas)

43
Q

What commonly causes long-bone osteomyelitis? What bones are affected?

A

S. aureus (MRSA 10-20 of S. aureus isolates)

Bone affected =long bones (kids), vertebral (elderly)

44
Q

How is osteomyelitis treated?

A

First line typically = flucloxacillin

First line with high risk of MRSA = vancomycin

45
Q

What is endocarditis?

A

Microbial infection of the endocardial surface of the heart –> vegetation on heart valve

Often staph or strep species

46
Q

How is endocarditis treated?

A

Empirical therapy = benzylpenicillin + gentamicin + flucloxacillin

Directed therapy Strep = benzylpenicillin + gentamicin

47
Q

What is the role of abx in surgical prophylaxis?

A

Single dose of abx = cefazoline abx is choice in low risk surgery

Postop abx only for certain situations

Prophylaxis should not be extended >24hrs

48
Q

What is the treatment for sepsis?

A

Use broad spectrum –> greater risk of death

Once known –> use directed therapy

Sometimes CAP = gentamcin + flucloxacillin + vancomycin

49
Q

What are symptoms of sepsis?

A

Fever, chills, confusion, apathy

Difficult or rapid breathing
Low blood pressure
Low urine output

7005PHM Pharmthera II (18 decks)

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