Common Infectious Disease Presentations Flashcards by Anika Gouws

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

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

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What kinds of bacteria commonly cause Boils?

Staphylococcus aureus

Sometimes combined with streptococcus pyogenes

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What can be used for boils/carbuncles treatment?

Susceptible to penicillin, want to go narrow

1) Flucloxacillin

or amoxicillin

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What causes impetigo? (school sores)

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

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How is impetigo treated?

Gram +ve bact

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

Endemic = benzylpenicillin

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What bacteria causes erysipelas and how is it treated?

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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What bacteria causes cellulitis and how is it treated?

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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What bacteria causes diabetic foot and how is it treated?

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

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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Is antibiotic therapy used for skin/soft tissue wounds?

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

Vibrio –> doxycycline

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

Aeromonas –> trimethoprim/sulfamethoxazole

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What bacteria is found in fishtanks? How treat?

Mycobacterium marinium –> clarithromycin

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Does acute bronchitis require antibiotics?

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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What causes CAP and how is it treated?

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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What is used to investigate CAP?

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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What are the symptoms for boils?

Tender, painful, seldom systemic symptoms

cutaneous abscess

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What are the symptoms of impetigo?

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

bullous impetigo = irritating blisters that erode rapidly

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How is pneumonia diagnosed?

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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What acronyms are useful in determining CAP severity?

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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

What is HAP?

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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

What bacteria commonly cause HAP?

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Gram-ve bacilli
MRSA
MDR Enterobacteriaceae
Pseudomonas aeruginosa
Acinetobacter species

What causes aspiration pneumonia? How treat?

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

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

When should metronidazole be introduced into aspiration pneumonia treatment regimen?

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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

Discuss abx use in infective exacerbation of COPD

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

Discuss abx use in pharyngitis and tonsillitis

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

Is abx used to treat Otitis externa?

Self limiting, keep ear dry Combination of corticosteroids and antimicrobial drops

Is abx used to treat otitis media?

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)

What are the symptoms of pyelonephritis?

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

What are the symptoms of cystitis?

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

Should asymptomatic bacteriuria be treated?

Treatment not recommended unless: - preg, due to adverse preg - patient undergoing elective urological procedure

What commonly causes uncomplicated cystitis and pyelonephritis? How treat?

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

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

Staph saprophyticus

What commonly causes complicated UTIs?

E. coli = 20-50% of cases Occurs in people with functional or anatomical abnormalities

What other bacteria can cause complicated UTIs?

Proteus Klebsiella Enterococci Streptococcus agalactiae (grp B streptococcus)

What testing should be conducted for pylonephritis?

Hospital patients = blood samples for bact culture, urine culture

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

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

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

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

What commonly causes meningitis?

Neisseria meningitidis, S. pneumoniae Unvaccinated kids = Haemophilus influenzae type B Adults >50 = listeria monocytogenes

What should be done if someone presents with suspected meningitis?

Blood culture, lumbar puncture unless C/I

What abx is not effective in meningitis? Why?

aminoglycosides, clindamycin, erythromycin, moderate-spectrum cephalosporins Due to = poor penetration into CSF

What can be used to treat meningitis?

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)

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

S. aureus (MRSA 10-20 of S. aureus isolates) Bone affected =long bones (kids), vertebral (elderly)

How is osteomyelitis treated?

First line typically = flucloxacillin First line with high risk of MRSA = vancomycin

What is endocarditis?

Microbial infection of the endocardial surface of the heart --> vegetation on heart valve Often staph or strep species

How is endocarditis treated?

Empirical therapy = benzylpenicillin + gentamicin + flucloxacillin Directed therapy Strep = benzylpenicillin + gentamicin

What is the role of abx in surgical prophylaxis?

Single dose of abx = cefazoline abx is choice in low risk surgery Postop abx only for certain situations Prophylaxis should not be extended >24hrs

What is the treatment for sepsis?

Use broad spectrum --> greater risk of death Once known --> use directed therapy Sometimes CAP = gentamcin + flucloxacillin + vancomycin

What are symptoms of sepsis?

Fever, chills, confusion, apathy Difficult or rapid breathing Low blood pressure Low urine output

Common Infectious Disease Presentations Flashcards

(49 cards)