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Flashcards in Infectious Disease Deck (93):
1

What does meningitis affect?

Arachnoid, subarachnoid space
CSF

2

Most Common Bacterial Culprits in Meningitis

Strep pneumo
N. meningitidis
H. influenza

3

Most Common Viral Culprits for Meningitis

Enteroviruses
HSV
HIV
West Nile
VZV
Mumps

4

Most Common Fungal Culprit for Meningitis

Cryptococcus

5

NonInfectious Etiology of Meningitis

Tumor
Trauma
Brain abscess
Subdural empyema
Pharmacologic reaction

6

Community Acquired Culprits of Meningitis

Strep pneumo
N. menigitidis
H. influenza
Listeria monocytogenes

7

Healthcare Acquired Culprits of Meningitis

Staph
Aerobic gram negative bacilli

8

Classic Triad of Meningitis

Fever
Nuchal rigidity
Change in mental status

9

Other Symptoms of Meningitis

Intense headache
Photophobia
Lethargy
N/V
Joint pain
Seizures
Non-blanching petechial rash (N. meningitidis)

10

Red Flags for Diagnosing CNS Infections in the Elderly

Behavioral changes
Personality changes
Seizures
Lack of other source of infection
Headache
Nuchal rigidity
Exposure to infected persons
Low threshold to do LP

11

Indications for Head CT Prior to LP

Immunocompromised
Hx of seizure 1 week prior
Abnormal level of consciousness
Hx of CNS disease
Papilledema
Focal neurologic deficit
Possible focal infection

12

Meningitis Work Up

Blood cultures
CBC
Chem 7
CSF: cell count, gram stain, culture, glucose, protein

13

Treatment of Meningitis

Rocephin as soon as LP complete
Admit to hospital

14

Normal CSF Values

Pressure: 70-180
Appearance: clear, colorless
Protein: 15-45 mg/100mL
Glucose: 50-80 mg/100mL
Cell count: 0-5 WBCs, no RBCs
Chloride: 110-125 mEq/L

15

Bacterial Meningitis in Pediatric Population

2 months-2 years

16

Clues of Meningitis in Infants

Irritability
Poor feeding
Paradoxical irritability

17

Most Common Etiologic Agents of Meningitis in Pediatrics

Strep pneumo
N. meningitidis
HIB (rare)
Neonates: gram negative and Group B strep

18

Primary prevention of Meningitis

S. penumoniae vaccine
HIB vaccine
Meningococcal vaccine

19

Define Encephalitis

Inflammation of the brain

20

Etiologic Agents for Encephalitis

HSV-1
HSV-2
West Nile
CMV
Mumps
EBV

21

Difference Between Encephalitis and Meningitis

Encephalitis has: Altered brain function
Personality changes
Paralysis
Hallucinations
Altered smell
Problems with speech

22

Symptoms of Encephalitis in Adults

Flu like symptoms
Severe HA
Fever
Altered consciousness
Confusion
Agitation
Personality changes
Seizures
Loss of sensation
Paralysis
Muscle weakness
Hallucination
Double vision
Perception of foul smells
Speech/hearing problems
LOC

23

Symptoms of Encephalitis in Children

Bulging fontanels
N/V
Body stiffness
Inconsolable crying
Paradoxical irritability
Poor feeding

24

Work Up of Encephalitis

Head CT and/or MRI
CBC
CMP
LP

25

Treatment of Encephalitis

Acyclovir q8h

26

Most Common Site of Septic Arthritis

Knee

27

Signs and Symptoms of Septic Arthritis

Acute or subacute onset of pain
Erythema
Swelling
Limited joint motion
+/- systemic symptoms

28

What should you send joint fluid for?

Crystals
Glucose
Cell count
Culture + sensitivity
R/O gonorrhea

29

Treatment of Septic Arthritis

High dose IV antibiotics

30

Signs and Symptoms of Bacteremia

Fever +/- chills
Rigors
Disorientation
Hypotension
Respiratory failure
Sepsis
Septic shock
Skin lesions

31

Treatment for Gram Positive Sepsis +/- Shock

Empiric: vancomycin
MSSA: PCN, nafcillin, oxacillin, vancomycin
MRSA: vancomycin, daptomycin

32

Treatment for Gram Negative Severe Sepsis +/- Shock

Gentamicin or tobramycin or amikacin
PLUS cefepime
+/- vancomycin

33

What needs to be ruled out and what test needs to be run for it in gram positive bacteremia?

TEE
Infective endocarditis

34

Signs and Symptoms of Sepsis/Septicemia

Infection
General symptoms
Inflammatory symptoms
Hemodynamic symptoms
Poor urine output
Elevated creatinine
Elevated INR, PTT
Low platelets
Ileus
Elevated bilirubin
Elevated lactate
Decreased capillary refill
Arterial hypoxemia

35

General Symptoms with Infection for Sepsis

Temp: 38.3+ or less than 36
HR: 90+
RR: 20+
AMS
Significant edema
Hyperglycemia without DM: 140+

36

Inflammatory Symptoms with Infection for Sepsis

WBC: 12K+ or less than 4K, left shift
Elevated CRP
Elevated procalcitonin

37

Hemodynamic Symptoms with Infection for Sepsis

Hypotension
Wide pulse pressure

38

Treatment of Sepsis

Supportive
Treat most likely source of infection

39

3 Superficial Soft Tissue Infections that are Emergencies

Infection around the face and hand
Cellulitis in the presence of DM or PVD
Local infection with the presence of leukemia or HIV

40

Define Cellulitis

Acute spreading infection of the skin to and through the dermis

41

Drug of Choice for Cellulitis

Bactrim
Clindamycin

42

Most Common Culprit of Impetigo

Strep

43

Describe Impetigo

Small vesicles which rupture and form "honey-colored" crusts

44

Treatment of Impetigo

Bactroban

45

Define Endocarditis

Infection of the endothelial surface of the heart, most often the valves

46

Patients at High Risk for Endocarditis

Previous valve damage
Valve replacement
History of IVDU
Poor dental health

47

Symptoms of Subacute Endocarditis

Anorexia
Night sweats
Weight loss

48

Presentation of Acute Endocarditis

Cardiac failure
Stroke
Cold extremity

49

Cutaneous Lesions with Endocarditis

Conjunctival and palatal petechiae
Subungual hemorrhages
Oslers nodes
Janeway lesions

50

Describe Oslers Nodes

Painful and erythematous nodules
Located on pulp of fingers and toes

51

Describe Janeway Lesions

Erythematous, blanching macules
Nonpainful
Located on palms and soles

52

Diagnostics for Endocarditis

TTE/TEE
Normocytic, normochromic anemia
Elevated ESR
Obtain blood cultures

53

What does toxic shock syndrome result from?

Absorption of toxin from localized staph aureus colonization or infection

54

Signs and Symptoms of Toxic Shock Syndrome (TSS)

Fever: mild to 102.2+
Myalgias
Vomiting
Diarrhea
Pharyngitis
SBP less than 80 mmHg
Multiple organ failure
Diffuse, blanching, macular erythema
Pan-mucosal inflammation

55

Labs that Represent Multiple Organ System Involvement

Leukocytosis and thrombocytopenia
Elevated BUN and creatinine
Elevated LFTs and Bili
Sterile pyuria
Elevated CPK
Decrease serum albumin and total protein
Blood cultures NEGATIVE
Cultures of source

56

Treatment of TSS

Supportive care
Prevent additional toxin production

57

Culprit of Rocky Mountain Spotted Fever

Rickettsia rickettsi

58

Symptoms of Rocky Mountain Spotted Fever

Fever
Chills
Malaise
Myalgias
Severe frontal headache

59

Rocky Mountain Spotted Fever: Days 2-5

Pink, macular rash on palms of hands, soles of feet, hands, feet, wrists, and ankles
24-48 hours: petechial, purpuric, gangrenous
Rash spreads centripetally
Diffuse edema

60

Why diffuse edema in rocky mountain spotted fever?

Capillary leakage
Hypotension
Spenomegaly
Delirium

61

Treatment for Rocky Mountain Spotted Fever

Tetracycline (TCN)
Doxycycline
Chloramphenicol (children)

62

Spirochete that Causes Lyme Disease

Borrelia burgdorferi

63

Stage I of Lyme Disease

Erythema migrans
Fever/chills
Malaise
Regional adenopathy

64

Stage II of Lyme Disease

Days to weeks after infection
Multisystem involvement
Fatigue and lethargy

65

Stage III of Lyme Disease

Lingers for months
Arthritis
Neuropathy
Acrodermatitis chronica atrophicans

66

Treatment of Lyme Disease

Empirically while awaiting labs
Tetracycline x 30+ days

67

When do malaria symptoms occur?

12-35 days after exposure

68

Uncomplicated Malaria Case Symptoms

Fever
Malaise
Myalgias
Arthralgias
Headache
Anemia
Elevated WBC
Low platelets

69

Complicated Malaria Case Symptoms

Fever
Anemia
Splenomegaly
Altered consciousness
Seizures
ARDS
Circulatory collapse
Metabolic acidosis
Renal failure
Liver failure
Coagulopathy
DIC
Intravascular hemolysis
Hypoglycemia

70

PE Findings in Malaria

Pallor
Petechiae
Jaundice
Hepatomegaly
Splenomegaly
Splenic rupture

71

Treatment of Malaria

Consult CDC for treatment for region exposed

72

Describe Clostridium Botulinum

Gram positive
Rod-shaped
Spore forming obligate anaerobic bacteria

73

5 Forms of Botulism

Foodborne
Infant
Wound
Adult enteric
Inhalation

74

Presentation of Botulism

Bilateral cranial neuropathies
Symmetric descending weakness
Absence of fever
Responsive
Normal/slow HR
Normal BP
No sensory deficits except blurred vision

75

Botulism Testing in Infants

Evaluate stool for spores and toxin

76

Botulism Testing in Foodborne Botulism

Serum analysis for toxin

77

Botulism Testing for Wound Botulism

Culture positive
Negative serum assay
Anaerobic culture

78

Botulism Testing for Adult Enteric Botulism

Evaluate stool for spores and toxin

79

Treatment of Botulism

Admit to hospital
Monitor for respiratory failure
Antitoxin (1+ years)
Antibiotics (Wound)

80

Antibiotics for Treatment of Botulism

PCN G
Metronidazole

81

Transmission of Smallpox

Droplet
Contact
Airborne

82

When does smallpox spread most rapidly?

Cool, dry winter

83

Clinical Features of Smallpox

Non-specific prodrome
Rash prominent on face and extremities
Rash scabs over in 1-2 weeks
Synchronous onset

84

Diagnosis of Smallpox

Appearance of rash
Culture of lesions: by immunized person, alert lab

85

Control of Smallpox

Decontaminate
Prophylaxia
Vaccine
Contact/airborne isolation

86

Treatment of Smallpox

Supportive
Isolate
Immunize contacts
Cidofovir

87

Bacteria that Causes Anthrax

Bacillus anthracis

88

3 Clinical Forms of Anthrax

Cutaneous
Inhalation
Gastrointestinal

89

Clinical Course of Anthrax

Papule -> vesicular -> eschar
Edema, redness and/or necrosis

90

Diagnostic Testing for Cutaneous Anthrax

Gram stain, PCR, culture of vesicular fluid, exudate, or eschar
Blood culture (systemic symptoms)
Biopsy

91

Clinical Presentation of Inhalation Anthrax

Myalgia
Fatigue
Fever
+/- respiratory symptoms
Hypoxia
Dyspnea
Rad evidence of mediastinal widening
Meningitis

92

Clinical Presentation of Gastrointestinal Anthrax

Abdominal distress
Bloody vomiting or diarrhea
Fever
Signs of septicemia
Oropharyngeal ulcerations
Cervical adenopathy

93

Treatment of Anthrax

Ciprofloxacin
Doxycycline