Infectious Disease 3

Question 1

How do you treat First infection with C. Diff?

Answer 1

IF not severe: Oral Metronidazole

IF Severe: Oral Vancomycin

• wbc>15
• Cr increase 1.5X baseline
• Serum Albumin <3

Question 2

How do you treat FIRST RECURRENCE of Cdiff.

Answer 2

Oral Metronidazole (10-14 days)
or 

Oral Vancomycine (if severe: wbc>15, Cr increase 1.5x baseline, Albumin <3)

Question 3

How do you treat SECOND RECURRENCE of Cdiff?

Answer 3

Oral Vancomycin pulse and taper for 6-7 weeks.

Question 4

How do you treat THIRD AND SUBSEQUENT RECURRENCE of Cdiff?

Answer 4

Oral Vanc followed by…
Rifaximin or Fidaxomicin

Refer for Fecal transplant

Question 5

How do you treat an Abscess?

What are the 4 major indications for inpatient treatment/hospitalization?

Answer 5

Incision and Drainage = Gold standard of treatment.
ABX (Clindamycin or Vanc) if fever or cellulitis surrounding abscess.

Hospitalize if:

1. Fever
2. HD instability (low bp, persistent tachy)
   3) rapidly progressing lesion or multiple lesions
3. poor response or contraindication to PO abx

Question 6

Most common organism to cause abscess?

Answer 6

Staph Aureus

Question 7

What is the classic symptom of Giardia

Answer 7

Acutely -Bulky, greasy foul-smelling diarrhea.

Chronic infection- weight loss, malabsorption.

Question 8

Who should you treat for Giardia and with what agent?

Answer 8

TRX only symptomatic patient with positive stool assay. Asymptomatic carriers (+ stool but no symp) eventually clear the bug on their owns.

METRONIDAZOLE.

Question 9

How do you diagnose Giardia?

Answer 9

stool ELISA = best test.
O/P an option but less sensitive than ELISA.

IF ELISA AND O/P negative but clinical suspicion is high, then can do EGD with duodenal aspirate/bx.

Question 10

What is the pathophysiology of Toxic Shock syndrome?

What bacteria is most associated with it?

What setting do you commonly see TSS?

Answer 10

Exotoxin (superantigen) mediated massive global activation of T-cell, releasing cytokines. ]

Staph Aureus.

Commonly seen with nasal packing, tampons, retained surgical gauze..

Question 11

How do you treat TSS?

Answer 11

1) remove foreign body (nasal packing)
2) aggressive IVF
3) Clindamycin (prevents more toxin production)
4) Anti stapylococcal ABX
- Vanc (if MRSA suspected)
- or Nafcillin OR Oxacillin

Question 12

What organism causes cat scratch disease?

What is the classic presentation of cat scratch?

Answer 12

Bartonella Henselae

Classic presentation:

• Hx of exposure to cat.
• Papule/nodule on bite/scratch.
• 1-2 weeks of bite develop tender lymphadenopathy near bite/scratch.
• Fever (50%)

Question 13

Treatment of Cat scratch?

Answer 13

Azithromycin

Question 14

What bacteria is associated with marine environments and causes a rapidly progressive cellulitis, with hemorrhagic bullae and sepsis.

Answer 14

VIBRIO VULNIFICUS

Question 15

How do you diagnose VIBRIO VULIFICUS?

How do you treat VIBRIO VULNIFICUS?

Answer 15

Dx –> blood/wound culture.

Cefriaxone and Doxycycline (ASAP. Dont wait for culture results because can rapidly progress to death.)