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Flashcards in deck 8 Deck (36)
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1

What are key symptoms of Schlievert's story of Infectious Endocarditis?? (4)

Persistent fever-Severe night sweats-Weight loss 30 lbs-Excessive fatigue

2

What are key signs of Schlievert's story of Infectious Endocarditis? (4)

-Elevated PMN's-Abnormal heart sounds-Cultures show catalase-positive, coagulase-positive gram-positive cocci (S. Aureus)-Not in story but often: metastatic abscesses

3

What happens to the patient after hospitalization in Schlievert's story? (4)

-stroke left side, takes 2 yrs to recover movement and 1 yr to recover speech-Hospitalized 6 weeks w/ "suportive care"-Lost 60 lbs-Practices medicine today.

4

What are the common causes of infectious endocarditis? (3)

-Staph aureus [45%] highly valve-destructive-Viridans streptococci [35%]-Enterococcus faecalis & faecium [15%]

5

What makes enterococcus faecalis & faecium so bad?

-highly antibiotic resistant, including to vancomycin. Can transfer this resistance to other gram-positives.

6

How do we treat infectious endocarditis? (4)

-antibiotics-supportive care-valve replacement-manage complications (stroke)

7

What does staph aureus do to skin? (7) Important!!

Primary inflammation: boils (furuncles), carbuncles (multiple boils), pimples (folliculitis), paronychia (nail beds), impetigo, soft tissue abscesses, atopic dermatitis

8

What is staph aureus's virulence key is skin?

walling off organism by cell surface virulence factors, then spreading by secreted virulence factors

9

What does staph aureus do to mucous membranes thru inflammation? (6)

Primary inflammation (less inflammation than skin due to less alpha-toxin made by these strains):sinusitis, chronic otitis media, bronchial pneumonia, urinary tract infection vaginal infection, enterocolitis

10

What does staph aureus do to mucous membranes when non-inflammatory? (3)

-Scalded Skin syndrome-Toxic shock syndrome (TSS)!! (including menstrual)-Staphylococcal food poisoning (pre-formed toxins)

11

What is scalded skin syndrome?

-1-2 day old infant skin peeling due to exfoliative toxins (becomes very susceptible to secondary serious infections

12

What are symptoms of staph food poisoning?

vomiting, diarrhea 2-8 hrs after eating, lasts up to 48 hrs

13

What systemic infections does staph aureus cause? (5)

-Septicemia-TSS-Endocarditis-Osteomyelitis-Necrotizing fasciitis/myositis

14

What is septicemia?

high fever, hypotension, DIC & metastatic abscesses

15

What are necrotizing fasciitis/myositis symptoms?

fever, necrotizing tissue damage often with TSS

16

T/F S. aureus usually remains localized?

T

17

T/F S. aureus all give rise to systemic superantigens, and if so then which?

TTSST-1, SEB, SEC

18

TSS: What cytokines?

IL1-B (fever), TNF-alpha & beta (hypotension), IFN-gamma, IL-2 (rash 7 other symptoms)

19

Menstrual TSS is most common in which type of tampon?

absorbent. (oxygen)

20

What is TSS often a complication of?

influenza

21

How is TSS defined? (6)

-Fever over 102 degrees-hypotension systolic under 90-rash (macular erythroderma)-peeling of skin if survive-3 mulit-organ changes-Must rule out other causes

22

What if some criteria for TSS are missing?

-1 missing: "Probable TSS"-More missing: "Toxin-mediated disease"

23

Name "other" systemic signs of staph infection (see photos) (3)

-Kidney abscess-Splinter nails-gangrene (lack of perfusion from hypotension)

24

How do we treat staph aureus skin or mucous membrane infections?

antibiotics, surgery to drain abscess/furuncle, remove infected hair/nails

25

How do we treat more serious ones? (recall infectious carditis treatment earlier card)

-antibiotics (MRSA!)-B.P. support-Debridement in necrotizing illness-IVIG-Activated protein C (drotrecogin-alpha if needed)-Remove affected object (tampon etc)-Influenze vaccine to prevent future post-influenze TSS

26

how to do prevention in hospitals? (don't memorize)

hand-wash, antibiotic sensitivity monitoring, dust low, monitor infected patients, monitor visitors

27

Coagulase-negative staph group includes what 3 pathogens?

-Staph epidermidis-Staph saprophyticus-Staph lugdenensis

28

staph epidermidis causes what 2 problems?

-Septicemia (number 1 cause) & endocarditis associated w/ catheterization biofilms. [due to PIA & cytolysins, rarely superantigen]-UTI (urinary tract infection) associated w/ catheterization

29

Staph saprophyticus causes what problem?

UTI

30

Staph lugdenensis causes what problem?

endocarditis