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infectious disease Flashcards

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1
Q

causes of meningitis:

newborn 0-6 months

A

GBS
E coli/ gram negative rods
Listeria

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2
Q

causes of meningitis:

children 6 months - 6 years

A

S pneumoniae
N. meningitidis
H influenzae B
enterovirus

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3
Q

causes of meningitis:

6-60 years old

A

N meningitidis
enteroviruses
S pneumoniae
HSV

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4
Q

causes of meningitis:

60+ years

A

S pneumoniae
Gram negative rods
listeria
N meningitidis

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5
Q

causes of meningitis:

HIV patients

A 
cryptococcus
CMV
HSV
VZV
TB 
toxoplasmosis (brain abscess)
JC virus (PML)
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6
Q

meningitis
< 1 month of age
cause: GBS, E coli/ gram (-) rods, listeria
treatment _______

A

ampicillin + cefotaxime
or
gentamicin

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7
Q

meningitis
1-3 months
cause: pneumococci, meningococci, H influenzae
treatment: ______

A

vancomycin IV + ceftriaxone or cefotaxime

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8
Q

meningitis:
3 months - adulthood
cause: pneumococci, meningococci
treatment_______

A

vancomycin IV + ceftriaxone or cefotaxime

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9
Q

meningitis
> 60 years/ alcoholism/ chronic illness
pneumococci, gram (-) bacilli, listeria, meningococci
treatment: ______

A

ampicillin + vancomycin + cefotaxime or ceftriaxone

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10
Q

causes of brain abscesses

A

strep
staph
anaerobes

non-bacterial causes

  • toxoplasma
  • aspergillus
  • candida
  • zygomycosis if immunocompromised

can be polymicrobial

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11
Q

classic triad of brain abscess

A

headache
fever
focal neurologic deficit

note: if fever absent, primary and metastatic brain tumors should be considered in differential diagnosis

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12
Q

dx of brain abscess

A 
CT: ring-enhancing lesions
lab values: 
-peripheral leukocytosis
- increased ESR
-increased CRP

CSF not necessary (don’t want to cause an uncal herniation)

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13
Q

brain abscess treatment

A

initiate broad spectrum antibiotics and surgical drainage (if < 2 cm, can often do medically)

antibiotics:

  • third generation cephalosporin + metronidazole +/- vancomycin (IV therapy for 6-8 weeks)
  • serial CT/ MRIs

can give dexamethasone with taper to decrease cerebral edema
can give IV mannitol to decrease ICP
can give prophylactic anticonvulsants

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14
Q

HIV
CD4 count > 200
opportunistic infections:

A 
bacterial infections
tuberculosis
herpes simplex
herpes zoster
vaginal candidiasis
hairy leukoplakia
kaposi's sarcoma
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15
Q

HIV
CD4 count > 50 and < 200
opportunistic infections

A 
pneumocystosis
toxoplasmosis
cryptococcosis
coccidioidomycosis
cryptosporidiosis
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16
Q

HIV
CD4 count < 50
opportunistic infections

A

disseminated MAC infection
Histoplasmosis
CMV retinitis
CNS lymphoma

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17
Q

HIV-related opportunistic infection

p jiroveci pneumonia

A

indication for prophylaxis:

  • CD4+ < 200
  • prior P jiroveci infection
  • unexplained fever X 2 weeks
  • HIV related oral candidiasis

tx: TMP-SMX

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18
Q

HIV related opportunistic infection

mycobacterium avium complex (MAC)

A

indication for prophylaxis
-CD4+ < 50-100

tx: weekly azithromycin

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19
Q

HIV related opportunistic infection

toxoplasma gondii

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A

indication for prophylaxis
-CD4+ < 100 + (+) IgG serologies

tx: double strength TMP-SMX

20
Q

HIV related opportunistic infection

m tuberculosis

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A

indication for prophylaxis
-PPD > 5 mm or “high risk”

treatment: INH x 9 months (+ pyridoxine) or rifampin X 4 months

21
Q

HIV related opportunistic infection

candida

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A

indication for prophylaxis:
-multiple reoccurences

treatment:

  • esophagitis: fluconazole
  • oral: nystatin swish and swallow
22
Q

HIV related opportunistic infection

HSV

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A

indication for propylaxis:
-multiple reoccurences

treatment:
-daily suppressive acyclovir, famciclovir, or valacyclovir

23
Q

HIV related opportunistic infection

S pneumoniae

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A

indication for prophylaxis
-all patients

tx: pneumovax
- give every 5 years provided that CD4+ is > 200

24
Q

HIV related opportunistic infection

influenzae

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A

indication for prophylaxis:
-all patients

treatment: influenza vaccination annually

25
oropharyngeal candidiasis (thrush) - micro - dx - tx
KOH or gram stain - budding yeast and/ or pseudohyphae - germ tubes at 37C tx: - thrush: (nystatin suspension, clotrimazole tablets, or a PO azole such as fluconazole) - esophagitis: (PO azole therapy)
26
cryptococcal meningitis - micro - dx - tx
cryptococcus antigen testing CSF india ink stain -5-10 um yeast with capsular halo... narrow-based unequal budding tx: -IV amphotericin B + flucytosine X 2 weeks then flucanazole X weeks
27
histoplasmosis - buzzwords - dx - tx
spelunking, bird/bat excrement ohio and mississippi river valley dx: - urine and serum polysaccharide antigen testing - CXR: diffuse nodular densities, focal infiltrate, cavity or hilar lymphadenopthy tx: - mild: support +/- itraconazole - chronic cavitary lesions: itraconazole > 1 yr - severe or disseminated: liposomal amphotericin B or amphotericin B X 14 days followed by itraconazole X 1 year or longer
28
pneumocystis jiroveci pneumonia - micro - dx - tx
silver stain and immunofluorescence: comma-shaped spores CXR: diffuse bilateral interstitial infiltrates with a ground-glass appearance tx: - high dose TMP-SMX X 21 days - prednisone taper for moderate to severe hypoxemia
29
CMV - dx - tx
dx: viral isolation, culture, tissue histopathology, serum PCR tx: ganciclovir or foscarnet
30
MAC - dx - tx
dx: - mycobacterium blood cultures - Labs: anemia, hypoalbuminemia, increased serum alk phos and increased LDH - biopsy of bone marrow, intestines or liver: foamy macrophage with acid fast bacilli tx: -clarithromycin and consider HAART if drug naive -second line: ethambutol +/- rifampin continue > 12 months and until CD4+ > 100 for > 6 months
31
toxoplasmosis - buzzwords - dx - tx
ingesting raw or undercooked meat; changing cat litter dx: - serology - PCR (indicates exposure and risk of reactivation) - CT: hypodense ring-enhancing lesions - MRI: predilection for the basal ganglia tx: - high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog to prevent hematologic toxicity) X 4-8 weeks - prophylaxis: TMP-SMX or pyrimethamine + dapsone when CD4 < 100 or + toxoplasmosis IgG
32
chlamydia | -tx
doxycycline X 7 days or azithromycin X 1 pregnant patients: azithromycin or amoxicillin treat sexual partners
33
gonorrhea | -tx
ceftriaxone IM or cefixime PO disseminated: requires IV ceftriaxone for at least 24 hours treat sexual partners if possible
34
syphilis (treponema pallidum) - dx - tx
dx: - dark field microscopy - VDRL/RPR (many false +) - FTA-ABS tx: - primary and secondary: benzathine penicillin IM X 1 day...... if penicillin allergy: tetracycline or doxycycline X 14 days...... pregnant with penicillin allergy: desensitized and tx with penicillin - latent infection: benzathine penicillin (1 dose for early latent and weekly dose for 3 weeks for late latent infection) - neurosyphilis: penicillin IV X 10-14 days; penicillin-allergic patients should be desensitized prior to therapy
35
klebsiella granulomatosis - dx - tx
NOT painful beefy-red ulcer with rolled edge of granulation tissue granulomatous ulcers dx: clinical exam and donovan bodies tx: doxycycline or azithromycin
36
haemophilus ducreyi (chancroid) - dx - tx
painful irregular deep well demarcated, necrotic inguinal lymphadenopathy dx: clinical tx: azithomycin or ceftriaxone
37
HSV-1 or HSV-2 - dx - tx
painful malaise, myalgias, fever with vulvar burning and pruritus dx: tzanck smear shows multinucleated giant cells; viral culture, DFA or serology tx: acyclovir, famciclovir or valacyclovir for primary infection
38
HPV - dx - tx
NOT painful papule (condylomata acuminata; warts) irregular pink or white; raised; cauliflower dx: clinical; biopsy for confirmation tx: cryotherapy; laser or excision - topical agents: podophyllotoxin, imiquimod, or trichloroacetic acid
39
common UTI bugs
``` serratia e coli enterobacter klebsiella pneumoniae staph saprophyticus pseudomonas proteus mirabilis ```
40
diagnosis of UTI
dx by clinical symptoms urine dipstick / UA: - increased leukocyte esterase - increased nitrites (bacteria) - increased urine pH (proteus) - hematuria (cystitis) microscopic - pyuria (> 5 WBC/hpf) - bacteriuria urine culture: gold standard is > 10^5 CFU/mL
41
treatment of UTI
uncomplicated: -PO TMP-SMX or fluoroquinolone X 3 days or nitrofurantoin X 5 days complicated: same drugs but 7-14 days pregnant: -nitrofurantoin or amoxicillin X 3-7 days urosepsis: IV antibiotics: consider broader coverage
42
pyelonephritis - dx - tx
UA and culture: similar to cystitis but with WBC CASTS CBC: leukocytosis imaging: if not responding to therapy in 48-72 hours: CT or MRI (look for obstruction or abscess or complication) tx: - mild: 7-14 days of antibiotics outpatient (fluoroquinones are first line)... encourage fluids - serious or systemic: IV antibiotics (fluoroquinones, 3rd or 4th gen cephalosporin, b-lactam/b-lactamase inhibitors, or carbapenen)
43
malaria - dx - tx - prophylaxis
dx - giesma or wright-stained thick and thin blood film - CBC: normochromic normocytic anemia with recticulocytosis - serologic tests if available tx: - uncomplicated: chloroquine - P vivax and P ovale: chloroquine + primaquine (to eradicate hyponozoites) - severe: IV quinidine prophylaxis: -mefloquine (first line for chloroquine resistant malaria)
44
infectious mononucleosis (EBV, CMV, toxoplasmosis, HIV, HHV-6) - diagnosis - tx
diagnosis - heterophil antibody (may be (-) in first few weeks)... aka mono spot test - EBV specific antibodies can be ordered if (-) mono spot test.... if still (-) think CMV - CBC: thrombocytopenia, lymphocytosis, >10% atypical T lymphocytes - CMP: elevated transaminases, alk phos and total bilirubin tx: - support - can use corticosteroids if airway compromise
45
Borrelia burgdoferi - dx - tx
dx: (1) ELISA (2) confirm with Western blot tx: - doxycycline - amoxicillin if children < 8 years old or pregnant patient - advanced disease: ceftriaxone
46
rickettsia rickettsii (carried by american dog tick: Dermacentor variables) -dx -tx
dx: -clinical... confirm with biopsy and indirect immunoflourescense tx: - doxycycline - if pregnant: chloramphenicol
47
``` anthrax (spore-forming gram (+) bacterium Bacillus anthracis) -dx -tx -post-exposure prophylaxis ```
dx: - culture isolation or - two non culture supportive tests (PCR, immunohistochemical staining or ELISA) -CXR for inhalational: widened mediastinum and pleural effusion tx: - ciprofloxacin or doxycycline PLUS 1-2 additional antibiotics for at least 14 days (for inhalation disease or cutaneous disease of face, head or neck) - other cutaneous disease: treat 7-10 days postexposure prophylaxis: -ciprofloxacin (prevent inhalation anthrax... continue for 60 days)

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