ID Flashcards
(130 cards)
1
Q
2 places to ignore candida
A
Sputum and urine
2
Q
Treatment of Malaria
A
IV artesunate or IV quinidine
Exchange transfusion in severe cases
3
Q
Contact + airbone precautions
A
VZV, ebola, smallpox, covid, MERS-COV
4
Q
Dx of Blastomyces dermaitidis
A
Culture or antigen detection
5
Q
Sx: Anaplasmosis
Intracellular:
A
Febrile illness
Granulocytes
6
Q
A
Filamentous, branching Gram-positive rods
Note the long filaments as well as the beaded, “cocco-bacilli” appearance
- Modified acid-fast stain-positive
- On regular AFB stain, Nocardia is at best weakly positive
7
Q
Meningititis with petechiae and palpable purpura
A
N meningititis
8
Q
A
Coccidiodomycosis
Spherules with multiple endospores
9
Q
____ isolation indicated for patients with suspected N meningitides
A
respiratory
10
Q
A
Histoplasmosis
Small pink dots!
Small yeasts with narrow based budding grouped in clusters inside macrophages
11
Q
Dx of Histoplasma
A
Culture or antigen detection
12
Q
Empiric antibiotics for post neurosurgical brain abscesses:
A
Cefepime + metronidazole (or CNS penetrating carbapenem)
+ vancomycin
13
Q
Risk factors for mucor (in addition to risk factors for aspergillus and candida)
A
Iron overload
Diabetes mellitus
Deferoxamine
14
Q
3 diseases caused by Yernia pestis
A
Bubonic, septicemic or pneumonic plague
15
Q
A
Coccidiodes in soil
Filamentous mycelia
Thin septate hyphae
16
Q
Gas gangrene/ clostridial myonecrosis
Etiology
A
Necrotizing infection of muscles with gas formation
Traumatic from penetrating trauma/surgery or spontaneous (hematogenous spread) from GI tract
17
Q
Tx of Histoplasma
A
Mild: none or itraconazole
Severe: ampho B then itraconazole
18
Q
CSF WBC in encephalitis
A
Typically 5-1000 cells/uL
19
Q
Endemic fungi + pneuomonia, fibrosing mediastinitis
A
Histoplasma
20
Q
Posaconazole covers
A
Second line agent for most things
21
Q
Spectrum of Cryptococcus in lung
Where does it spread?
A
Focal pneumonitis to ARDS
Brain to lead to meningitis
22
Q
Round encapsulated yeast on India ink
A
Cryptococcosis
23
Q
Nocardia
A
Starts in lungs then disseminates to other organs, most common is brain
24
Q
Itraconazole AE
A
Heart failure, QTc prolongation, liver toxicity, pseudohyperaldosteronism, adrenal insufficiency
25
which endemic fungi has infectious cultures?
Coccidiodes
Alert lab!
26
Treatment of Invasive Aspergillus
1. Voriconazole
Alt:
Posavuconazole if neuro tox or skin issues
Isavuconazole if prolonged QT
Second line agents: echinocandins (caspo, micafungin) or amphotericin B
27
Aspergillus
Dicotimous branching (equally split)
Septated hyphae that branch at 45 degrees, and is visualized best with periodic acid-Schiff (PAS) or Gomori methenamine silver (GMS) staining
28
Intra-abdominal abscess treatment duration after drainage if uncomplicated
5 days
29
Pneumocystis pneumonia
Non-budding cyst
Oval, crescentric, collapsed or helmet shaped
(crushed ping-pong balls)
30
Giardiasis tx
Metronidazole
31
Endemic Fungi + broad-based budding yeast
Blastomyces dermaitidis
32
Tx of CMV esophagitis
Ganciclovir
(large, solitary, shallow ulcers)
33
Two things that are treated by Echninocandins
1. Candida!
2. Adjuvent therapy for aspergillus
34
Deep neck infection
Unasyn
If immunocompromised: cefepime + flagyl
35
Work-up for patient's with Nocardia
Brain imaging due to frequency of CNS involvement
36
Which endemic fungi can act like sarcoid
HIstoplasma
37
COVID tx
1. no oxygen
2. oxygen
3. NIV/HFNC
1. Remdesivir if high risk of progression
2. Dexamethasone + Remdes
3. Dexamethasone + toci or baricitinib + Remdez if immunoc
No Remdez if eGFR<30
38
Listeria meningitis is associated with increase rate of ___
Seizure, FND, papilledema
39
Endemic Fungi
Pneumonia + skin lesions + arthralgias + bone involvement + meningitis
Coccidiodes
40
Sx of Lyme disease
First stage: fever, erythema migrans (rash)
Second stage: multiple skin lesions, conjunctivitis, arthralgias, myalgias, headache, CN palsies
Third stage: arthritis, encephalopathy, peripheral neuropathy
41
Tx of coccidiodes
Mild: none
Mod: fluconazole
Severe: ampho-B-> fluconazole
42
Mucormycosis
Broad, ribbon-like with non-parallel cell walls
Hyphae may brand at obtuse angle
43
Tx Yersinia pestis
3 options for first line tx
1. Doxycycline
2. Aminoglycoside (streptomycin or gentamicin)
3. Fluoroquinolone (levofloxacin, cipro or moxi)
Monotherapy is fine unless bioterriosim, then use 2 or ask CDC
If pneumonia or plague, don't use doxycycline (option 2 or 3 instead)
44
AE of echinocandins
Overall fine
Some drug interactions, LFTs, anaphylaxis, hypoK
45
What can form sulfur granules as it invades through tissue planes, causing cutaneous fistulas throughout the thoracic cage?
Actinomyces
46
Treatment of invasive candida
Echninocandins (caspo, mica or anidulafungin)
47
Droplet precautions
1. precaution
2. which bugs
1. Private room preferred, surgical mask within 1 meter of patient, mask during patient transport
Vaxxed: Diphtheria, mumps, rubella, B pertussis
Influenza
H flu, N meningitidis, RSV
No vax: M pneumoniae, pneumonic plague, adenovirus, parvovirus B12, rhinovirus
48
2 abx with AE of cytopenias
Linezolid (thrombocytopenia)
TMP/SMX
49
Tx Lyme disease
3 options + one option if can't take doxy or beta-lactams
Doxycycline, amoxicillin, or cefuroxime
Azithromycin is 2nd line for patients
50
Voriconazole
AE 4
QTc prolongation
Active hepatitis or severe liver dz
Skin/bone
Visual disturbances
Neurotoxicity
51
Tx of mucor
Surgical debridement is the mainstay of treatment along with adjuvant antifungal therapy.
Liposomal amphotericin-B is preferred; posaconazole and isavuconazole are second-line or step-down
52
Blastomycosis
Broad-based budding yeast
53
Risk factors for invasive candida
1. Transplant recipients
2. Cancer, especially chemotherapies with GI toxicity or hematologic malignancies
3. ICU patients c CVC, TPN, ARF on HD, abdominal surgery (esp unfixed GI disruptions), colonization in multiple sites, MOF
54
Rhombencephalitis (encephalitis of brain stem +/− cerebellum) can be seen in:
1. Immunocompetent individuals who acquire Listeria through contaminated food
2. HSV
3. WNV
55
Penicillin allergy
1. ___ of reported PCN allergies do not have true allergy
2. ___ of patients with true PCN allergies that will also react to cephalosporin or carbapenem
3. No cross reactivity with PCN and ____
1. 90%
2. <5%
3. Aztreonam
56
Soft tissue infection of head/neck
Tx with prolonged course of vancomycin + ceftriaxone
Add anaerobic coverage if dental source suspected
57
MRI for WNV
Leptomeningeal enhancement
58
CSF in TB
Low glucose
Elevated protein
Lymphocytic pleocytosis
59
Which anti-fungal drugs bind ergosterol in the fungal cell membrane, inducing leakage of ions?
(polyenes): Amphotericin-B and nystatin
60
Endemic Fungi
Pneumonia + skin lesions + osteomyelitis
Blastomyces dermaitidis
61
Dx of candida on gram stain
Budding yeasts or pseudohyphae
62
Mucormycosis
Broad, non-septate hyphae
Irregular branching with greater angle (usually close to 90 degress)
63
Tx of invasive candida (1 med + 2 therapies)
Echinocandins (caspofungin) at first bc some forms of candida are resistant to fluconazole and voriconazole. You can switch to fluc if susceptible
Remove lines
Eye exam
64
Isavuconazole uses
Can be first line for invasive aspergillosis
Combination med or step down for mucormycosis
Short QTc
65
HAP tx
1. Low risk mortality, no MRSA risk
2. Low risk + MRSA
3. High mortality + recent IV abx (90D)
1. cefepime, zosyn, imipenem, meropenem
2. add vanc/linezolid
3. Double anti-pseudomonal coverage (avoid using dual B-lactam)
- add aztreonam, amikacin, gentamicin or tobra
66
Sx Rocky mountain spotted F
Rash + febrile illness
Blanching, erythematous macules
Petechial, beings on hands/soles of feet
67
Treatment of strongyloidiasis
Albendazole or ivermectin
68
Sx Ehrlichiosis
Intracellular:
Febrile illness
Granulocytes
69
Treatment of non-severe C diff and severe (WBC>15k, creatinine >1.5)
Fidaxomicin 200 mg 2 times daily
OR
oral vancomycin 125 mg 4 times daily
70
Aspergillosis
Thin, septated hyphae with regular branching
Angle of branching is around 45 degrees
71
Airborne precautions
1. type
2. bugs
1. Negative pressure room, N95, minimize transport/mask patient
2. TB and measles
72
Chest CT: single or multiple nodules with or without cavitation. The “halo sign”- ground glass surrounding a nodule- is a classic finding
Invasive aspergillosis
73
Contact precautions
1. Which precautions
2. Which bugs
1. Gloves/gown, dedicated medical equipment. Private room or cohort
MDR (MRSA, VRE, ESBL)
C diff
E coli O157:H7
Enteric viral infections (norovirus)
Scabies
74
Treatment of nec fas
MRSA treatment
AND carbapenem or β-lactam/β-lactamase inhibitor
AND clindamycin (if there is resistance to clindamycin, linezolid can be used)
75
Which of the 5 tick-borne infections is not treated with doxycycline?
Babesiosis (atov + azith or quine + clinda)
4 doxy mono: ana, ehril, rmsf, lyme
76
4 risk factors for aspergillus
1. severe/prolonged neutropenia
2. high-dose steroids
3. transplant patients on immunos
4. AIDS
77
Non-septated hyphae that branch at 90°
Rhizopus and Mucor
78
3 general classes of anti-fungal drugs
1. Polyenes (ampho-B and nystatin)
2. Azoles (vori, posa, itra, isa)
3. Echinocandins (caspof, micaf)
79
Tx Leptospira
Doxycycoline, penicillin or ceftriaxone
80
Empiric antibiotics for community-acquired brain abscesses:
Cefotaxime
Ceftriaxone + metronidazole
81
Tx Nocardia
Bactrim
82
Treatment of severe pulmonary disease and Cryptococcosis meningitis
Induction with amphotericin B and flucytosine
Consolidation/maintenance with fluconazole
Alt: fluconazole can replace either induction med
May require serial LPs to maintain normal ICP
83
Abx with AE of seizures
Imipenem
84
Tx Babesiosis
Atovaquone + azithromycin
OR
Quinine + clindamycin
85
Rose spots on trunk/abdomen, high fever without tachycardia, GI bleed (+ risk of perforation), aortitis
Typhoid fever secondary to Salmonella enterica
86
Tx Anaplasmosis
Doxycycline
87
Encapsulated yeast on India ink staining
Cryptococcosis
88
Tx of Actinomyces
High dose penicillin
89
Dx of Cryptococcosis
- detection of organisms with India ink staining
- cryptococcal antigen (blood or CSF), titer correlates with dz burden
- culture from csf/blood or sputum
90
Diagnosis of Coccidiodes immitis
Serology (IgM IgG) followed by complement fixation (titer)
91
Posaconazole is similiar to voriconazole but ___
Better tolerated but alternative agent for everything except prophylaxis in cancer
Watch for drug-interactions (increases tacro/siro, ventetoclax, amio, CCB)
92
Voriconazole is 1st line therapy and can also cover:
Doesn't cover:
Invasive aspergillosis
- candida as step-down
- endemic fungi
Zygomycetes (mucorales)
93
Fulminant C diff (shock, ileus or toxic megacolon)
Oral vancomycin 500 mg 4 times daily AND metronidazole 500 mg IV Q8 hr
If ileus, consider adding rectal vancomycin.
94
3 times to use ampho-B
2 times it can be alt agent
1. Mucormycosis
2. Cryptococcocus (+flucytosine)
3. Severe blasto or histo
Alt agent for:
1. Invasive asperilliosis
2. Candidemia without CNS involvement
95
Isavuconazole is _____ than voriconazole (2) and causes fewer ____ than voriconazole
Broader spectrum of activity
More favorable safety profile
Fewer drug-drug interactions
But not yet studied v much
96
Treatment of disseminated Mycobacterium avium complex (MAC)
Macrolide plus ethambutol
Options for macrolide: clarithromycin or azithromycin
Consider adding: Rifabutin if severe
97
Infection from unpasteurized dairy
Brucella
98
Conditions that increase risk of cryptococcus infection
1. Immunocompromised
2. Chronic disease (cirrhosis, renal failure, chronic lung dz, diabetes, sarcoid, cushing)
3. Malignancy
99
Nocardia and Actinomyces are both filamentous, branching, gram positive rods, however unlikely Nocardia, Actinomyces are ____ and modified acid-fast ____
anaerobes
acid-fast negative
100
Measures to reduce the risk of VAP
Early mobility
Head of bed to 30-45°
Daily sedation interruption and assessment for extubation
Use subglottic suction drainage if intubated >72 hr
Change the ventilator circuit if malfunctioning or visibly soiled only
101
Candida
Budding yeast and pseudohyphae
102
Prophylaxis for close contacts of N meningitides
Ciprofloxacin, rifampin, or ceftriaxone
103
Treatment of mild to moderate pulmonary disease from Cryptococcosis
Fluconazole
104
Febrile illness with ulcer at site of contaminantion and +LAD
Tuleremia
Animal workers
105
Tx Tuleremia
Doxycycline
Aminoglycoside (streptomycin)
106
CAP treatment if allergic to PCN
Respiratory fluoroquinolone + aztreonam
(Levofloxacin or moxifloxacin)
107
Sx of Babesiosis
Febrile illness
If severe/immunoc: ARDS, DIC, CHD, ARF, liver injury, splenic rupture
108
Tx RMSF
Doxycycline
109
Filamentous, branching Gram-positive rods
Nocardia
110
Pyomyositis
Necrotizing infection of muscles with purulence and abscess formation
111
When do you need a anti-pseudomonal cephalosporin or CNS penetrating carbapenem in bacterial meningitis? 3 answers
1. Head trauma (basilar skull fracture or penetrating trauma)
2. Post-neurosurgery
3. CSF shunt
112
Itraconazole Indications
Blasto + histo: mild to mod, or step down after ampho if severe
113
CAP treatment if prior pseudomonas or high risk for pseudmonas
Anti-pseudomonal B-lactam + cipro or levofloxacin
Options: zosyn, cefepime, meropenem, imipenem
114
Tx of salmonella enterica or typhoid fever
Flouroquinolone (levofloxacin or ciprofloxacin)
Ceftriaxone if you need IV
115
MRI for HSV encephalitis
Bitemporal enhancement
hemorrhage occurs late
116
Gas gangrene/ clostridial myonecrosis
Treatment
Empiric antibiotics same as nec fas
Once clostridia are isolated via tissue or blood culture, treatment is with penicillin PLUS clindamycin OR tetracycline
117
Empiric HAP or VAP: things to cover
S auerus + GNR including pseudomonas
118
Tx of Blastomyces dermaitidis
Mild: itraconazole
Severe: ampho B-> itraconazole
CNS: ampho B-> voriconazole
119
Tx encephalitis
1. HSV
2. VZV
3. CMV
1. acyclovir
2. acyclovir or ganciclovir
3. ganciclovir or foscarnet
120
Tx Ehrlichiosis
Doxycycline
121
4 Amionoglycosides
Amikacin
Streptomycin
Tobramycin
Gentamicin
122
3 times you can use streptomycin (aminoglycosides)
Tuleremia
Yersinia
Brucella (+doxy)
123
Aminoglycosides (amikacin, tobra, gent) can be added to _____ for VAP with high mortality rate
Anti-pseudomonal beta-lactam
124
3 Macrolides
Erythromycin (OG)
Azithromycin
Clarithromycin
125
Azithromycin
- Lung things:
- Other
1. MAC, CAP, legionella, H flu
2. Lyme
126
Clindamycin
- most important use:
- parasite use:
- bioterrioism use
- alternative tx for 2 things
- anti-toxic for GAS, NF, clostrium
- babesiosis c quinine
- anthrax c cipro
- PJP, PNA c cipro
127
3 fluroquinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
128
Aspergillosis
Acute-angle branching hyphae with septae
129
Ciprofloxacin
2 uses with clindamycin:
2 forms of prophyalxis
PJP and anthrax
SBP and N meningitis
130
Voriconazole’s complex pharmacokinetic properties and its extensive list of drug-drug interactions make therapeutic drug monitoring essential to ensure optimal treatment while mitigating toxicities.
A voriconazole plasma level concentration of 2.0 to 5.5 μg/mL is commonly recommended for invasive aspergillosis infection.
