Diseases

Question 1

CLABSI: when line must be removed (5+8)

Answer 1

Syndromes:
--severe sepsis
--septic thrombophlebitis
--venous obstruction
--endocarditis
--positive blood cx after 72hrs of appropriate tx
Organisms:
--Staph aureus
--atypical Mycobacteria
--Candida
--Proprionibacteria
--Pseudomonas
--Bacillus species
--Micrococcus
--Malassezia

Question 2

CLABSI: when is abx lock therapy appropriate (3)

Answer 2

1) short-term CVC and coag-negative Staph
2) long-term catheter, uncomplicated, coag-negative Staph or Enterococcus or GNR
3) tunneled HD catheter, bacteremia and fever resolves in 2-3 days, and coag-negative Staph or GNR

Question 3

Endocarditis: need for surgery based on echo (9)

Answer 3

1) persistent vegetation after embolization
2) anterior mitral valve vegetation >10mm
3) >1 embolic event after 2wks of therapy
4) increasing vegetation size on therapy
5) AR or MR with CHF
6) CHF refractory to medical therapy,
7) valve perforation, rupture, dehiscence, fistula
8) new heart block
9) abscess or perivalvular extension

Question 4

Endocarditis ppx (5+4)

Answer 4

High risk patient:

• -prosthetic valve
• -prior IE
• -unrepaired cyanotic CHD
• -repaired CHD with prosthetic material or residual defect
• -cardiac transplant with valvulopathy

AND

High risk procedure:

• -gingival dental procedure
• -oral surgery
• -surgery at site of bacterial infection
• -GU procedure/surgery with bacteruria

Question 5

Treatment for cx-negative endocarditis: Whipple’s disease, Coxiella, Bartonella, Brucella

Answer 5

• -Whipple’s disease (often accompanied by diarrhea): CTX for years
• -Coxiella: doxycycline and hydroxychloroquine
• -Bartonella: gent + CTX +/- doxy
• -Brucella: doxy + rif + amingoglycoside

Question 6

Treatment for Strep viridans or bovis endocarditis

Answer 6

PCN MIC >0.12 and <0.5 and native valve
–(PCN or CTX x4wks) + gent x2wks

Prosthetic valve
–(PCN or CTX x6wks) +/- gent x2wks

Question 7

Treatment for Enterococcus endocarditis

Answer 7

Native or prosthetic valve

• -PCN and gent susceptible: (ampicillin or PCN) + gent x4-6wks
• -PCN resistant: (amp-sulbactam or vanco) + gent x6wks

E. faecium native or prosthetic valve, vanco, PCN, gent resistant:
–linezolid or quinupristin-dalfopristin or dapto x8wks

E. faecalis, native or prosthetic valve, vanco, PCN, gent resistant:

• -imipenem + ampicillin x8wks
• -CTX + ampicillin x8wks

Question 8

Treatment HACEK endocarditis

Answer 8

Native valve

CTX or amp-sulbactam or cipro x4wks

Question 9

Treatment Staph endocarditis

Answer 9

Prosthetic valve:

–(nafcillin or vancomycin x>6wks) + gent x2wks + rif x>6wks

Question 10

Genital ulcer disease causes (5)

Answer 10

Painful:
–HSV 1/2
–chancroid: kissing lesions, raggd borders, suppurative LAD (H. ducreyi)
Painless
–primary syphilis: usually single, heaped borders
–LGV: LAD w/ groove sign (C. trachomatis, serotype L1-L3)
–granuloma inguinale: serpiginos, no LAD, Asia and Africa (K. granulomatis)

Question 11

Urethritis causes (4)

Answer 11

• -gonorrhea
• -Chlamydia
• -Mycoplasma genitalium
• -Trichomonas

Question 12

STD treatments (14)

Answer 12

• -Syphilis: PCN x1 for primary, secondary, early latent; PCN x3 over 2wks for late latent and tertiary, PCN for 14d for neurosyphilis
• -HSV: acyclovir, valacyclovir
• -LGV: doxy or azithro for 3wks
• -Chlamydia (non LGV): azithro x1, doxy x7d
• -Chancroid: azithro or CTX x1
• -Granuloma inguinale: doxy or azithro x3wks
• -Gonorrhea: CTX + (azithro or doxy)
• -NGU: azithro x1 or doxy x7d (if fails consider metronidazole or moxi)
• -Trichomonas: metronidazole or tinidazole x1
• -BV: metronidazole or clindamycin x7d
• -PID: CTX x1, doxy +/- metronidazole x14d
• -Epididymitis: CTX x1, doxy x10d
• -Crabs: permethrin 1% (ivermectin if failure)
• -Scabies: permethrin 5% or ivermectin

Question 13

Isolation precautions

Answer 13

Droplet: bacterial meningitis, pertussis, mumps, influenza
Contact: MDR bacteria, infectious diarrhea, chickenpox, pertussis
Airborne: TB, chickenpox, measles

Cat A Bioterrorism
Airborne and contact: smallpox, plague, viral hemorrhagic fever
Standard: anthrax, botulism, tularemia

Question 14

PEP for HCWs

Answer 14

HIV: you know this
HepC: none
HepB: HBIG, vaccine
HepA: vaccine and/or immunoglobulin
VZV: if no history of exposure and/or negative serology AND pregnant or immunosuppressed then give VZIG or acyclovir or vaccine (if not contraindicated); also furlough between 10-21d (or 10-28 if VZIG)
Pertussis: give a macrolide if seronegative or waned immunity
Parvovirus B19: no ppx but keep high risk HCWs away (seronegative and HIV, pregnant, or hemoglobinopathy)
N. meningitidis: ciprofloxacin and rifampin for close contacts