Gram Negative

Question 1

Salmonella Typhi SX, DX, TX

Answer 1

SX of typhoid fever-
-leukopenia & “rose spots” 2-3mm angiomas
DX- 3 blood cultures & BM culture
TX-
-Prophylaxis typhoid vaccine pt >2yo
- TX- w/out gallstones amp + probenecid x 6 weeks OR
- cephalo, TMP-SMX, quinilones or chloramphenicol

Question 2

Salmonella Typhi SX, DX, TX

Answer 2

SX of typhoid fever-
-leukopenia & “rose spots” 2-3mm angiomas
DX- 3 blood cultures & BM culture
TX-
-Prophylaxis typhoid vaccine pt >2yo
- TX- w/out gallstones amp + probenecid x 6 weeks OR
- cephalo, TMP-SMX, quinilones or chloramphenicol

Question 3

Shigella SX, DX, TX

Answer 3

SX- fever, watery stools–> dysentery , SEIZURES
DX-High WBC & bandemia
TX- CTX, Cipro, azithro

Question 4

Haemophilus influezae

Answer 4

Meningitis

– CTX/Cefotaxime PLUS Dexamethasone 0.6m/k/da (prevent sequelae esp sensorineural hearing loss-most common )

Question 5

Yersenia pestis

Answer 5

• Bubonic type can lead to pnuemonic form transmitted by coughing
• Location- Desert southwest
• DX-aspiration lymph nodes or serology
• TX-streptomycin

Question 6

Yersenia enterocolitica

Answer 6

• Pigs are carriers
  SX-
  -Adolescent p/w “pseudo-appendicitis syn”
  -Adults reactive arthritis & erythema nodosum
  TX-
• TMP/SMX, aminogly, tetracy, cephalo, quinolones

Question 7

Legionella

Answer 7

• Found in water
  SX- diarrhea, CNS sx (HA, confusion), pneumonia
  TX- Azithro/quinolones

Question 8

Brucella

Answer 8

• Found in: milk/cheese, inhalation, carcasses
  SX- sacroiliitis, culture neg endocarditis
  TX-
  
  • Doxy x 4-6 weeks + Aminogly 2 weeks
  • Doxy + rifampin 4-8 weeks
    
    • Children < 8yo TMP/SMX 4-6 weeks
      -IF serious infec + gent + rifampin

Question 9

Francisella tularensis “rabbit fever”

Answer 9

-Found: Arkansas, Missouri, Oklahoma
SX- sudden fever, arthralgias/myalgias, irregular ulcer @ site inoculation
TX- Gent, tetracy or Streptomy

Question 10

Bartonella Cat Scratch Disease

Answer 10

• SX- chronic & tender cervical/axillary lymphadeno & small pink papule, 10% systemic sx- encephalopathy, seizure, blindness
• DX- clinical NO incise & drain
• TX- Azithro & rifampin

Question 11

If Citrobacter + BCX or CSFCX

Answer 11

• CT/MRI brain to look for brain abscess

Question 12

Most common cause Guillain-Barre Sy

Answer 12

• Campylobacter

Question 13

Rickettsia rickettsii

Answer 13

SX- Rocky Mountain Spotted fever - rash of distal extremities (maculopapular–> petechia), HA, arthralgias
Locations- Carolina, Georgia, Virginia
DX- hyponatremia, thrombocytopenia
Tx- Doxy

Question 14

Coxiella burnetti

Answer 14

SX- Q fever
Location- slaughter house or during birth animals
Tx- Doxy

Question 15

Erlichia chaffeensis

Answer 15

• Human monocytic ehrlichiosis (HME)

Location- Texas, Oklahoma, Missouri, Arkansas

Question 16

Anaplasma phagocytophila

Answer 16

Huma granulocytic ehrlichiosis (HGE)

Location- Northeast & midwest

Question 17

Erlichiosis

Answer 17

Sx/DX- fever, HA, leukpenia & thrombocytopenia

TX- Doxy/Tetracy

Question 18

Mycobacterium marinum

Answer 18

Found- pt work w/ fish tanks

SX- non-healing skin ulcerations over lymphatic channels