Infectious Disease Flashcards
Less Common UTI Organisms (7)
Staph saprophyticus
Enterococcus
Klebsiella
Proteus
Pseudo
Enterobacter
yeast (Candida)
Indications for Urine Cx in UTI
> 65 yo
diabetic
used diaphragm
abnormal sx
recurrent UTIs
suspect complicated infection
if sx persist after abx use
**Otherwise just dipstick (leuks, nitrites) and gram stain
Tx Uncomplicated UTI
- Bactrim x3
- Nitro 5-7 days -do not give if pyelo
- Fosfomycin single dose - do not give if pyelo
- Cipro x3
- **If does not respond to 3 days course then suspect pyelonephritis and treat
Tx Pregnancy UTI
- Amp, amoxicillin, cephalosporins - 7 to 10 dys
- Fluoroquinolones can cause arthropathy in fetus
UTI Tx in Men
- Same meds as uncomplicated women but 7 day course
- Do urology work-up unless obvious risk like indwelling catheter
Recurrent UTI Tx
- If w/in 2 wks just cont abx for 2 more wks; obtain urine cx
- If > 2 wks treat like uncomplicated
- If > 2 UTIs per yr give ppx - single dose Bactrim after sex or after first signs/sx OR low dose Bactrim for 6 mo
Pyelonephritis Tx
- Based on urine cx
- Gram neg rods - Bactrim or fluoroquinolone 10-14 days
- Gram pos cocci -amoxicillin
- Repeat urine cx after 2-4 days after stopping abx
- Failure to respond - urology workup
- Hospitalize for IV abx if …
- Elderly
- Pregnant
- Too ill for oral meds
- Urosepsis
- Co-morbidities
- IV - start broad (amp + gentamicin OR cipro)
- If blood cx is pos then 2-3 wks
- If blood cx is neg then IV until afebrile 24 hrs then can go home on 14-21 days oral abx
- Recurrent pyelonephritis - same organism then 6 wks abx; new organism then treat w/ same 2 wk regimen
Chlamydia Complications
- Epididymitis or proctitis in men
- PID, salpingitis, TOA
- Fitz-Hugh Curtis
- Infertility/ inc risk ectopic
- Reactive / Reiter arthritis
Gonorrhea Complications
- PID
- Salpingitis, TOA
- Fitz-Hugh Curtis (RUQ pain and elevated LFTs)
- Disseminated gonorrhea infection - fevers, arthralgia, tenosynovitis in hands and feet, migratory polyarthritis, septic arthritis, endocarditis, meningitis, skin rash on distal extremities
**Can also have infection of pharynx, conjunctiva and rectum
Manifestations of HSV1 v. HSV2
HSV-1
- Grouped vesicles or cold sores on lips lasting 2-6 wks (herpes labialis)
- Bell’s palsy
HSV-2
- Primary infection may have fever, malaise, headache; lasts longest (3 wks)
- Recurrent infections generally shorter and more mild - 10 days
- Painful ulcers or pustules + tender inguinal nodes + d/c
HSV Dx
usually clinical diagnosis
cx at vesicle base (gold std)
Tzanck smear (swab base and use Wright stain - see multinucleated giant cells) -Usually used in cases when not 100% sure
Syphilis Stages
- Primary - painless chancre (crater-like ulcer that forms 3-4 wks after exposure and may last 14 wks)
- Secondary - flu-like sx and maculopapular rash of soles/palms (develops 4 to 8 wks after chancre heals); may also have hepatitis or aseptic meningitis picture
- Still contagious
- Latent - means pos serology no sx
- Early latent - < 1 yr - can still revert to secondary
- Late latent - > 1 yr - no longer contagious
- Tertiary (happens to 1/3) - cardiovascular, neuro (tabes dorsalis, dementia, personality changes) and gummas (subQ granulomas) yrs later
Syphilis Dx (what can affect it)
- 1- screen w/ non-treponemal - VLDR or RPR
- **May be falsely pos if SLE
- 2- confirm w/ treponemal - FTA-ABS or MHA-TP
- CO-TEST FOR HIV
Syphilis Tx
- 1 dose IM PCN
- Oral doxy or tetracycline if allergic - 2 wks (not in pregnancy)
- If latent or tertiary IM PCM 1/wk for 3 wks
- Non-treponemal test of cure at 3 mo; if titers do not dec 4-fold in 6 mo suspect reinfection or tx failure
Chancroid
- H ducreyi (gram neg rod)
- Painful genital ulcers w/ ragged border and white/purulent base
- Unilateral tender inguinal nodes (buboes) 1-2 wks after ulcer
- Clinical dx - r/o syphilis, HSV
- Tx - azithromycin (single oral dose) or ceftriaxone (single IM dose)
