Infectious Disease Flashcards

Question

Specify what a Gram stain of Red color most likely represents.

Answer 1

Gram-negative organism

Answer 2

Streptococci

Answer 3

Staphylococci

Answer 4

Streptococcus pneumoniae

Answer 5

Haemophilus sp.

Answer 6

Neisseria sp. (sexually transmitted disease, septic arthritis, meningitis) Moraxella sp. (lungs, sinusitis)

Answer 7

Klebsiella sp.

Answer 8

Clostridium sp. Bacillus sp.

Answer 9

Candida sp.

Answer 10

Mycobacterium (usually M. tuberculosis) Nocardia sp.

Answer 11

Actinomyces sp. (PID in patients with IUDs; rare cause of neck mass/cervical adenitis)

Answer 12

Pneumocystis jiroveci and cat-scratch disease

Answer 13

Cryptococcus neoformans

Answer 14

Treponema sp., Leptospira sp. (both seen only on dark-field microscopy) Borrelia sp. (seen on regular light microscope)

Answer 15

**Sputum culture** - obtain the culture before starting antibiotics, although many physicians treat empirically without culture in routine cases. Obtain **blood cultures** as well because bacteremia is common with pneumonia.

Answer 16

Streptococcus pneumoniae. Presentation: rapid onset of rigors 1-2 days of URI symptoms (sore throat, runny nose, dry cough), followed by fever, pleurisy, and productive cough (yellowish-green or rust-colored from blood) Diagnose: CXR - lobar consolidation, CBC - elevated WBC with large PMN% Treatment: * macrolide (e.g., azithromycin, clarithromycin) * doxycycline * third-generation cephalosporin + macrolide or doxycycline * fluoroquinolone that provides atypical coverage (e.g., levofloxacin, moxifloxacin).

Answer 17

**Vaccination!** Give pneumococcal vaccine to: * all children as well as adult patients over 65 years old * splenectomized patients * patients with sickle-cell disease (who have autosplenectomy) or splenic dysfunction * immunocompromised patients (HIV, malignancy, organ transplant) * patients with chronic disease (e.g., diabetes, cardiac disease, asthma and other pulmonary disease, renal disease, liver disease, or tobacco use)

Answer 18

H. influenzae is now **uncommon** in children because of vaccination, but is still an important cause of pneumonia in **older adults** and in those with **underlying lung disease** such as COPD Often it resembles pneumococcal pneumonia clinically, but look for **gram-negative coccobacilli on sputum Gram stain**. Treat with **amoxicillin or a second- or third-generation cephalosporin.**

Answer 19

S. aureus tends to cause * hospital-acquired (nosocomial) pneumonia * pneumonia in patients with cystic fibrosis (along with Pseudomonas sp.) * patients who abuse IV drugs * patients with chronic granulomatous disease (look for recurrent lung abscesses). **Empyema** and **lung abscesses** are relatively common with S. aureus pneumonia.

Answer 20

1. **Pseudomonas** infection is classically associated with cystic fibrosis 2. **Klebsiella infection** may be found in patients who are homeless and/or suffer from alcoholism (watch for classic description of currant jelly sputum) 3. **Enteric gram-negative organisms** (e.g., Escherichia coli) are associated with aspiration, neutropenia, and hospital-acquired pneumonia. High mortality rate because often patients are already in poor health and the severity of the pneumonia (abscesses are common). Treat **empirically** with an **antipseudomonal penicillin (e.g., ticarcillin, piperacillin)** +/- **beta lactamase inhibitor (e.g., clavulanate, tazobactam).** * Alternatives include ceftazidime or ciprofloxacin.

Answer 21

cause of **atypical pneumonia;** most common in adolescents and young adults (the classic patient is a college student or soldier who lives in a dormitory/barracks and has sick contacts) sx: has a long prodrome with gradual worsening of malaise, headaches, dry, nonproductive cough, and sore throat; the fever tends to be low-grade dx: * CXR: patchy, diffuse bronchopneumonia and classically looks impressive, although the patient often does not feel that bad * **Positive** cold-agglutinin antibody titers, which may cause hemolysis or anemia (compared to chlamydial pneumonia, which has negative cold-agglutinin antibody titers) Tx: * macrolide antibiotic (azithromycin) * doxycycline * broad-spectrum fluoroquinolone (e.g., levofloxacin, moxifloxacin).

Answer 22

cause of atypical pneumonia in adolescents and adults presents similarly as mycoplasma pneumonia (a long prodrome with gradual worsening of malaise, headaches, dry, nonproductive cough, and sore throat; the fever tends to be low-grade) dx: * CXR: patchy, diffuse bronchopneumonia and classically looks impressive, although the patient often does not feel that bad * **negative** cold-agglutinin antibody titers, which may cause hemolysis or anemia (compared to mycoplasma pneumonia, which has positive cold-agglutinin antibody titers) Tx: * erythromycin in children \< 8 years of age * azithromycin or doxycycline in children \> 8 years of age, adolescents, and adults.

Answer 23

1. HIV-positive patients with CD4 counts \< 200/mm3 (AIDS) * CXR: bilateral interstitial lung infiltrates * may require bronchoalveolar lavage with silver stain for diagnosis * trmt: TMP-SMX + corticosteroids 1. severely immu- nosuppressed patients (organ transplant recipients on immunosuppressants, patients on cancer chemotherapy) * intracellular inclusion bodies * trmt: valganciclovir

Answer 24

**Before it happens.** PCP is acquired when the CD4 count is \< 200/mm3. At that point, initiate PCP prophylaxis in an HIV-positive patient with TMP-SMX. Alternatives include dapsone or atovaquone.

Answer 25

Sporothrix schenckii Treat with itraconazole

Answer 26

Parvovirus B19

Answer 27

Streptococcus pneumoniae Haemophilus influenzae Neisseria meningitis (all encapsulated bacteria)

Answer 28

Coccidioides immitis Treat with itraconazole or fluconazole; amphotericin B for severe disease

Answer 29

Histoplasma capsulatum

Answer 30

Chlamydophila psittaci

Answer 31

Aspergillus sp.

Answer 32

Tuberculosis

Answer 33

Giardia lamblia (look for stool cysts) treat with metronidazole

Answer 34

Toxoplasma gondii Treat infected pregnant women with **spiramycin**

Answer 35

Diphyllobothrium latum (intestinal tapeworm)

Answer 36

Taenia solium (cysticercosis) or toxoplasmosis Treat neurocysticercosis with albendazole or praziquantel, usually with steroids; consider anticonvulsants

Answer 37

Schistosoma haematobium

Answer 38

Enterobius sp; Perianal itching, positive tape test Treat with mebendazole or albendazole

Answer 39

Trichinella spiralis (trichinosis)

Answer 40

Rotavirus, Norwalk virus

Answer 41

Bacillus cereus

Answer 42

Vibrio parahaemolyticus

Answer 43

Escherichia coli (Montezuma revenge) Treat with ciprofloxacin

Answer 44

C. diff Treat with oral metronidazole or oral vancomycin

Answer 45

Clostridium botulinum (toxin blocks ACh release)

Answer 46

Molluscum contagiosum

Answer 47

Pasteurella multocida Treat with prophylactic amoxicillin-clavulanate

Answer 48

Brucellosis

Answer 49

Legionella pneumophila Treat with azithromycin or levofloxacin

Answer 50

Pseudomonas sp.

Answer 51

rapid plasma reagin (**RPR**) or venereal disease research laboratory (**VDRL**) test confirm with: * fluorescent treponemal antibody absorbed (**FTA-ABS**) or microhemagglutination (**MHA-TP**) test because false-positive results occur with the RPR and VDRL tests, classically in patients with lupus erythematosus. * scrape the base of a genital chancre or condyloma lata and look for spirochetes on **dark-field microscopy** Once syphilis is treated, the RPR and VDRL tests become negative, whereas the FTA-ABS and MHA-TP tests often remain _positive for life._

Answer 52

Pregnant women. Early treatment can prevent birth defects.

Answer 53

With penicillin. Use doxycycline for penicillin-allergic patients.

Answer 54

**Primary stage:** painless chancre that resolves on its own within 8 weeks **Secondary stage**: condyloma lata, maculopapular rash (palms and soles of feet), lymphadenopathy; 6 weeks - 18 months later **Tertiary stage:** gummas (granulomas in many organs), neurologic symptoms and signs (neurosyphilis, Argyll-Robertson pupil, dementia, paresis, tabes dorsalis, Charcot joints), thoracic aortic aneurysms.; occurs years after initial infection after a latent phase

Answer 55

Look for a **lack of immunization**, pathognomonic **Koplik spots** (tiny white spots on buccal mucosa) are seen **_3 days_** after **high fever**, **cough**, **runny nose**, and **conjunctivitis** +/- **photophobia.** On the next day, a **maculopapular rash** begins on the head and neck and spreads ***_downward_*** to cover the trunk (cephalocaudal progression). Treat supportively.

Answer 56

* giant-cell pneumonia, especially in very young and immunocompromised patients * otitis media * encephalitis, either acute or late (subacute sclerosing panencephalitis, which usually occurs years later).

Answer 57

in **pregnant mothers** because an infection can **cause severe birth defects in the fetus.** Screen all women of reproductive age and immunize those without evidence of rubella antibodies **_before_** pregnancy to avoid this complication. However, the **vaccine is contraindicated** in pregnant women.

Answer 58

Rubella is milder than measles. Signs and symptoms: **low-grade fever, malaise**, and **tender swelling of the suboccipital and postauricular lymph nodes; forchheimer spots on soft palate, arthralgias** are common. After a 2- to 3-day prodrome, a faint **maculopapular rash** appears on the face and neck and spreads to the trunk (**cephalocaudal** **progression,** just as in measles) Complications: encephalitis and otitis media, and either acute or late (subacute sclerosing panencephalitis, which usually occurs years later).

Answer 59

sx: high temperature (may be ≥ **4**0°C, 10**4**˚F) with no apparent cause for **4 days**, which may result in **febrile seizures**, followed by an **abrupt return to normal temperature** just as a **diffuse** **macular/maculopapular rash appears on the chest/abdomen**. Cause: human herpesvirus type 6 Rare in children \> 3 yo

Answer 60

**“slapped-cheek” rash** accompanied by **mild constitutional symptoms** (low-grade fever, malaise). One day later, a **maculopapular rash appears on the arms, legs, and trunk**. Cause: parvovirus B19, the same virus that causes aplastic crisis in sickle cell disease.

Answer 61

**discrete macules** (usually on the trunk) turn into **papules**, which turn into **vesicles** that rupture and **crust** **over; l**esions appear in successive crops, the **rash will be in different stages of progression in different areas.** cause: varicella virus avoid: aspirin in a child with a fever unless you have a diagnosis that requires its use because of the risk of Reye syndrome.

Answer 62

A **Tzanck smear** of tissue from the base of a vesicle shows multinucleated giant cells, but a presumptive diagnosis can be made if the rash is classic. Infectivity ceases only **when the last lesion crusts over.**

Answer 63

* infection of the lesions with streptococci or staphylococci, which cause erysip- elas, cellulitis, and/or sepsis * pneumonia (especially in very young children, adults, and immunocompromised patients) * encephalitis * shingles (years later; infectious state)

Answer 64

**Supportive** treatment (acetaminophen, fluids, avoidance of infecting others), but **acyclovir** can be used in severe cases Prophylaxis * **varicella vaccine** is recommended for all children in the US * **varicella zoster immune globulin** for patients with debilitating illness (leukemia, AIDS) within 4 days of exposure and for newborns of mothers with chickenpox * **IVIg** can be given if varicella zoster immune globulin is not available

Answer 65

a **febrile illness** **with a rash** caused by certain **Streptococcus species**. Look for: * history of untreated streptococcal pharyngitis; only streptococcal species that produce erythrogenic toxin can cause scarlet fever * Pharyngitis is followed by a sandpaper-like rash on the abdomen and trunk with classic circumoral pallor and strawberry tongue. The rash tends to desquamate once the fever subsides. Treatment * **Oral penicillin V** is the treatment of choice for streptococcal pharyngitis to prevent rheumatic fever. * Alternative therapies: amoxicillin, cephalosporins, macrolides, or clindamycin.

Answer 66

* **Asian Children** * **\< 4yo** * **fever for more than 5 days**, **cervical lymphadenopathy**, bilateral conjunctivitis, changes in lip/oral mucosa “strawberry tongue”, desquamating rash * also look for arthritis or arthralgias complication: **coronary artery aneurysms** (can result in thrombosis -\> MI/rupture)

Answer 67

Complications involve the heart (**coronary artery aneurysms**, congestive heart failure, arrhythmias, myocarditis, and MI) Prevent with **aspirin + IVIg** - both proven to reduce cardiac lesions Follow with **ECHO** to detect cardiac involvement

Answer 68

Look for: **fatigue**, fever, pharyngitis, and cervical lymphadenopathy in a young adult. * s/sx are similar to those of streptococcal pharyngitis, but malaise tends to be **prolonged** **and pronounced** in EBV infection * to differentiate from streptococcal pharyngitis, look for the following in EBV * **Splenomegaly** (patients are at increased risk for splenic rupture and should avoid contact sports and heavy lifting). * **Hepatomegaly**. * **Atypical lymphocytes** (bizarre forms that may resemble leukemia) with lymphocytosis, anemia, or thrombocytopenia. * **Positive serology** (heterophile antibodies [Monospot test]) or specific EBV antibodies (viral capsid antigen, Epstein-Barr nuclear antigens).

Answer 69

Acute HIV infection, which can cause a mononucleosis-type syndrome.

Answer 70

EBV is associated with ## Footnote **nasopharyngeal cancer** **African Burkitt lymphoma** **posttransplant lymphoproliferative disorder.**

Answer 71

Look for * history of a **tick bite** **(Rickettsia rickettsii,** especially in a patient on the East Coast) **_1 week before_ development of high temperature/chills, severe headache, and prostration or severe malaise.** * A **rash appears 4 days later** on the **palms/wrists and soles/ankles and spreads rapidly to the trunk and face** (unique pattern of spread). * Patients often look **quite ill** (DIC, delirium). Treat with **doxycycline**; chloramphenicol is a second choice.

Answer 72

caused by Streptococcus and Staphylococcus species look for * a history of a break in the skin (previous chickenpox, insect bite, scabies, cut), usually on the face * localized rash that starts as thin-walled vesicles that rupture and form yellowish crusts; skin is classically described as “weeping.” * The rash is infectious Trmt: **dicloxacillin, cephalexin, or clindamycin** to cover both Streptococcus and Staphylococcus species. **Topical mupirocin** also may be used.

Answer 73

**Acute (fulminant) endocarditis -** typically affects normal heart valves * commonly caused by S. aureus. **Subacute** **endocarditis -** insidious onset and typically affects previously damaged or prosthetic valves * commonly caused by: Streptococcus viridans, but other streptococcal and staphylococcal species may also be involved (e.g., Staphylococcus epidermis, Streptococcus bovis, enterococci). * Suspect colon cancer if S. bovis is found on blood culture.

Answer 74

dx: blood culture trmt: empirical treatment is begun before C/S results are known; typical abx used are: * for native valve: * antistaphylococcal penicillin (e.g., oxacillin, nafcillin) + aminoglycoside * third-generation penicillin or cephalosporin + aminoglycoside * for prosthetic valve: * vancomycin plus gentamicin + cefepime or a carbapenem.

Answer 75

* general signs of infection (e.g., fever, tachycardia, malaise) * new-onset heart murmur * embolic phenomena (stroke and other infarcts) * Osler nodes (painful nodules on tips of fingers) * Janeway lesions (nontender, erythematous lesions on palms and soles) * Roth spots (round retinal hemorrhages with white centers) * septic shock (more likely with acute than subacute disease)

Answer 76

Look for patients who are more likely to be affected by endocarditis: * IVDU - usually have right-sided lesions, although left-sided lesions are much more common in the general population. * Patients with abnormal heart valves (prosthetic valves, rheumatic valvular disease, congenital heart defects such as ventricular septal defects or tetralogy of Fallot). * Postoperative patients (especially after dental surgery).

Answer 77

antibiotic prophylaxis for **DENTAL** procedures, esp. if patient has a history of * prosthetic cardiac valve * previous infectious endocarditis * congenital heart disease * cardiac transplant recipients who develop valvulopathy Note: antibiotic prophylaxis is no longer recommended for GU or GI procedures. Prophylaxis: * single dose Amoxicillin * Cephalexin, clindamycin, azithromycin, or clarithromycin may be used in patients with penicillin allergy. * Ampicillin, cefazolin, ceftriaxone, or clindamycin may be used for patients unable to take oral medication.

Answer 78

**Neonates** are the classic age group for meningitis; 75% of all cases occur in children younger than 2 years. Sx: lethargy, hyperthermia or hypothermia, poor muscle tone, bulging fontanelle, vomiting, photophobia, AMS, and signs of generalized sepsis (hypotension, jaundice, respiratory distress), seizures

Answer 79

**do a lumbar puncture immediately** **begin broad-spectrum antibiotics and intravenous fluids** Do not wait for culture or other results before starting antibiotics.

Answer 80

Hearing loss Other: mental retardation, motor deficits/paresis, epilepsy, and learning/behavioral disorders.

Answer 81

* **Mumps and measles meningitis** may be seen in children who are **unimmunized**. * Watch for **neonatal herpes encephalitis (HSV-2)** if the mother has genital lesions of herpes simplex virus at the time of delivery * Other children and adults can develop **HSV-1 herpes encephalitis**, which classically affects the temporal lobes on a head CT or MRI. The best treatment is prevention via **immunization**. Give **intravenous acyclovir**.

Answer 82

**N. meningitidis and H. influenzae.** if Neisseria sp., give all contacts **rifampin, ciprofloxacin, ceftriaxone, or azithromycin** If H. influenza, give all contacts **rifampin**.

Answer 83

Croup (parainfluenza, influenza) epiglottitis (H. influenza type B) bronchiolitis (RSV)

Answer 84

**parainfluenza virus (75% of cases); influenza virus** Look for * a child 1 to 2 years of age. * usually occurs in the fall or winter * begins with symptoms of viral URI (rhinorrhea, cough, fever);1 to 2 days later patients develop a “barking” cough, hoarseness, and inspiratory stridor * “steeple sign” (subglottic narrowing of the trachea) on chest/neck xray Treat with **dexamethasone, racemic epinephrine, a mist tent, and humidified oxygen**.

Answer 85

**H. influenzae type b** (most common), S. aureus, S. pyogenes, and S. pneumoniae Look for: * children 2 to 5 years old that were not vaccinated against H. influenza * little or no prodrome with rapid progression to high temperature, toxic appearance, drooling, and ***respiratory distress with no coughing***. * The thumb sign (swollen, enlarged epiglottis) on lateral neck xray Treatment * **Do not examine the throat** or irritate the child in any way. You may precipitate airway obstruction. * be prepared to establish an airway (intubation and, if needed, tracheostomy). * treat with **oxacillin or cefazolin or clindamycin or vancomycin _plus_ cefotaxime or ceftriaxone.**

Answer 86

**RSV** (75% of cases), parainfluenza, influenza (25% of cases) Look for: * children aged 0 to 18 months * usually occurs in the fall/winter * first develop symptoms of viral URI (rhinorrhea, cough, fever), followed 1 to 2 days later by rapid respirations, **intercostal retractions**, and **expiratory wheezing** * The child may have **crackles** on auscultation of the chest. * **Diffuse hyperinflation of the lungs with flattened diaphragms on CXR** ****Trmt: * supportive (oxygen, mist tent, bronchodilators, IV fluids). * **Ribavirin** only in patients with severe symptoms or who are at high risk (e.g., patients with cyanosis or other chronic health problems).

Answer 87

**Diphtheria (Corynebacterium diphtheriae)** * Pseudomembranes pharynx, tonsils, and uvula and myocarditis * Treat diphtheria with antitoxin and either penicillin or erythromycin. **pertussis (Bordetella pertussis)** * Paroxysmal cough + whooping inspiratory noise * Treat with azithromycin or erythromycin Common in children who are **unimmunized** (ie **child of immigrants**)

Answer 88

**bites from infected animals, such as bats, skunks, raccoons, or foxes**; rabies as a result of bites from dogs is rare because of vaccination. incubation period: **1 to 2 months.** classic findings: **hydrophobia** (fear of water as a result of painful swallowing) and **CNS signs** (paralysis).

Answer 89

1. **Cleanse the wound thoroughly with soap and give _amoxicillin-clavulanate_ for cellulitis prophylaxis** 2. **Observe the animal**. If possible, capture and observe the dog or cat to see if it develops rabies. If a wild animal is caught, it should be killed and the brain tissue examined for rabies. 3. If the wild animal escapes or has rabies, **give rabies immunoglobulin and rabies vaccine.** 4. In cases of a dog or cat bite, do not give immunoglobulin or vaccine *unless* the animal acted strangely or bit the patient without provocation and rabies is prevalent in the area (rare). 5. Do not give prophylaxis or vaccine for rabbit or small rodent bites (e.g., rats, mice, squirrels, chipmunks).

Answer 90

pharyngitis and erysipelas Sequelae include rheumatic fever, scarlet fever, and poststreptococcal glomerulonephritis.

Answer 91

Look for * sore throat * fever * tonsillar exudate * enlarged tender cervical nodes * leukocytosis Dx: * (+) streptococcal throat culture * Elevated titers of antistreptolysin O (ASO) and anti-DNase antibody for a retrospective diagnosis in patients with rheumatic fever or poststreptococcal glomerulonephritis. Trmt: penicillin, amoxicillin, cephalosporin, macrolide, or clindamycin to avoid rheumatic fever and scarlet fever.

Answer 92

major: migratory polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and chorea minor: elevations in ESR, CRP, WBC, and ASO titer; prolonged PR interval on ECG; and arthralgia. The diagnosis of rheumatic fever requires: * a history of streptococcal infection **_AND_** * the presence of two major criteria **_OR_** one major + two minor criteria. **Treatment of streptococcal pharyngitis with antibiotics** markedly reduces the incidence of rheumatic fever; thus it is less common today. Give all patients affected by rheumatic fever endocarditis **antibiotic** **prophylaxis** before surgical procedures, especially dental procedures

Answer 93

occurs commonly after **streptococcal skin infection**, but also after **pharyngitis** Look for * children with a history of infection with a nephritogenic strain of Streptococcus species **1 to 3 weeks earlier** * an abrupt onset of **hematuria**, **proteinuria** (mild, not in nephrotic range), **RBC casts**, **hypertension**, **edema** (especially periorbital), and **elevated BUN/Cr**. Treat supportively. Control BP and use diuretics for severe edema. Treatment of streptococcal infections does **_not_** reduce the incidence of poststreptococcal glomerulonephritis.

Answer 94

**Superficial skin infections** caused by **Strep or S. aureus** and often occur after a break in the skin (e.g., trauma, scabies, insect bite). Impetigo * classically changes first from maculopapules to vesicopustules and bullae and then to honey-colored, crusted lesions. * contagious! * Staphylococci are a more frequent cause than streptococci * think of staphylococci if a furuncle or carbuncle is present * think of streptococci if glomerulonephritis develops * trmt: dicloxacillin, cephalexin, or clindamycin Erysipelas * superficial cellulitis that appears red, shiny, and swollen * tender * be associated with vesicles and bullae, fever, and lymphadenopathy * trmt: penicillin or amoxicillin, may require parenteral therapy with cephalosporin (ceftriaxone or cefazolin) if systemic symptoms such as **fever and chills** are present

Answer 95

* Streptococci and staphylococci cause most cases * Pseudomonas with burns or severe trauma * Pasteurella multocida after dog or cat bites (treat with ampicillin) * Vibrio vulnificus in fishermen or other patients exposed to salt water (treat with tetracycline). * Diabetic patients with foot ulcers tend to have polymicrobial infections and need powerful, broad-spectrum antibiotic coverage.

Answer 96

Both manifest as areas of **skin erythema, edema, warmth, and tenderness,** BUT * Erysipelas involves the upper dermis and superficial lymphatics * Cellulitis involves the deeper dermis and subcutaneous fat. * Antibiotic selection depends on whether the cellulitis is purulent or nonpurulent. * purulent (think s. aureus) -\> give TMP-SMX, doxycycline, clindamycin, linezolid * non-purulent -\> give dicloxacillin, cephalexin, and clindamycin

Answer 97

infection of the deeper layers of skin and subcutaneous tissues, **spreads across fascial planes** within the subcutaneous tissue progression of cellulitis to necrosis and gangrene quickly, with signs of **crepitus** and signs of **systemic toxicity** (e.g., tachycardia, fever, hypotension) evident Trmt: **IV fluids, surgical debridement, and broad-spectrum antibiotics** (carbapenem (imipenem or meropenem) + clindamycin)

Answer 98

**infection of the endometrial lining; cause of postpartum fever** look for: uterine tenderness most common cause: Streptococcus spp. treat: **clindamycin + gentamicin** after local cultures are obtained.

Answer 99

neonatal meningitis or sepsis the organism is often part of normal vaginal flora and may be acquired as the baby passes through the birth canal treatment: Expectant mothers are cultured for group B strep, and if it is present around the time of delivery, then **prophylactic IV penicillin (preferred**) **or IV ampicillin** is given to the mother to prevent meningitis in the newborn

Answer 100

Otitis media meningitis sinusitis spontaneous bacterial peritonitis

Answer 101

* Pneumonia (often forms lung abscess or empyema) * Endocarditis (especially IVDU) * Osteomyelitis (the most common cause unless sickle cell disease is present) * Septic arthritis * Food poisoning (via a **preformed toxin**) * Toxic shock syndrome (via a **preformed toxin**) * Skin * Furuncles and carbuncles * Scalded skin syndrome (via a **preformed toxin**; affects younger children who often present with impetigo, then desquamate) * Impetigo * Cellulitis * Wound infections * Skin and soft-tissue abscesses (especially after breast feeding or after a furuncle)

Answer 102

**antistaphylococcal penicillin** (e.g., methicillin, dicloxacillin) Use **vancomycin, clindamycin, doxycycline, TMP-SMX,** **linezolid** if the staphylococcal species is or suspected to be MRSA Most abscesses must be treated first with surgical I&D because antibiotics cannot penetrate through the walls of an abscess cavity.

Answer 103

INH (isoniazid) for 3 months, then repeat PPD

Answer 104

INH (isoniazid) for 9 months

Answer 105

INH/rifampin/pyrazinamide/ethambutol for 2 months, then INH/rifampin for 4 months in most patients

Answer 106

* **_Multidrug resistant strains_** - an increasing problem; **require 4-drug therapy** (pyrazinamide, isoniazid, ethambutol, and rifampin) * **_Noncompliance with medications_** **-** directly observed therapy (someone watches the patient take medications every day) is recommended. * **_B6 deficiency_** - supplementation with vitamin B6 (pyridoxine) for patients on isoniazid (INH), or watch for neuropathy, confusion, angular chilitis, or a seborrheic dermatitis-like rash. * **_Liver dysfunction in patients on therapy_** **-** advise patients to abstain from alcohol while on treatment and should have their transaminase levels monitored

Infectious Disease Flashcards

(131 cards)