Infectious Disease Flashcards by David Lowry

Microbial screening for cardiothoracic or orthopedic surgery to prevent surgical site infection. If positive, Management?

nasal swab for Staph aureus.

Preoperative mupirocin ointment, and/ or chlorhexidine body wash

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indication for postoperative antibiotics

peri-operative active infection treatment (not prophylaxis)

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indications for perioperative vancomycin instead of cefazolin

known MRSA or severe beta-lactam allergy

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definition: robust immune response resulting from treatment of HIV that may “unmask” a pre-existing infection

Dx: immune reconstitution inflammatory syndrome (IRIS)

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Definition: Empiric treatment for tuberculosis

Tx: rifamycin drug, isoniazid, ethambutol, pyrazinamide

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indication for prednisone for IRIS

hemodynamic instability, pericardial or CNS involvement

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Clues for coccidiomycosis

lives in an endemic area, increased exposure to outdoors, immunocompromised, peripheral eosinophilia

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treatment for coccidial mycosis

fluconazole

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sarcoidosis clues

black, 20s to 30s, female, bilateral hilar lymphadenopathy, diffuse parenchymal lung changes, indolent course

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Tuberculosis (primary) clues

mid to lower zone unilateral infiltrates, unilateral hilar lymphadenopathy, pleural effusions

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strep pneumo pneumonia clues

SOB, fever, productive cough, interstitial infiltrates, lobar consolidation

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Guideline-based recommendations for empiric therapy of community-acquired pneumonia requiring ICU admission

Cover: 1. Strep pna, GNB, H flu – cephalosporin or unasyn 2. legionella macrolie or quinolone
extra:
third-generation cephalosporin or ampicillin-sulbactam to treat Streptococcus pneumoniae, gram-negative bacilli, or Haemophilus influenzae plus an agent active against Legionella, such as a macrolide or quinolone.
ex. ceftriaxone, levofloxacin

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fever of unknown origin, Initial studies

complete blood count with differential, complete metabolic profile with kidney and liver studies, at least three blood culture sets and cultures of other bodily fluids (such as urine or from other sources based on clinical suspicion), an erythrocyte sedimentation rate, tuberculosis testing, and serology for HIV; it is reasonable to perform chest imaging (radiography or CT) as initial diagnostic imaging.

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bone marrow biopsy, indications in setting of fever

abnormal CBC, evidence of processes known to involve bone marrow such as TB, histoplasmosis, malignancy

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liver biopsy, indications

abnormal LFTs with abnormality on imaging

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lumbar puncture, indications

focal deficits, concerning imaging of head/brain

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aspergillosis, risk factors

neutropenia and stem cell and solid organ transplantation

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aspergillosis, signs/symptoms

fever, cough, chest pain, hemoptysis, imaging findings including: pulmonary infiltrates, nodules, wedge-shaped densities

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Aspergillosis, diagnosis

bronchoscopy with biopsy and bronchioalveolar lavage

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Leptospiral meningitis, clues. definitive diagnosis

uveitis, rash, conjunctival suffusion, sepsis, lymphadenopathy, kidney injury, hepatosplenomegaly. CSF culture.

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C difficile infection, SEVERE

Dx: C diff infection plus:
WBC ≥15 or creatinine >1.5
Tx: Oral vanc or fidaxomicin

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C difficile infection, FULMINANT

Dx: Severe C diff infection complicated by:
Ileus, hypotension, shock, or toxic megacolon.
Tx:

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C difficile infection, NON-SEVERE

Dx: C diff infection plus:
WBC <15 or creatinine <1.5
Tx: Oral vanc or fidaxomicin or oral metronidazole (initial episode only)

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C difficile infection, Clues

fever, diarrhea, recent antibiotics, health care exposure

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Post-Lyme disease syndrome, Dx, Tx

Dx: history of recent Lyme disease diagnosis or endemic area and erythema migrans Tx: Symptom management

Nonspecific flu-like illness with fever, in Northeast and upper Midwest, blood transfusion in the previous six months, hemolytic anemia

Babesiosis, clues

Babesiosis, non-severe

Dx: organisms on smear, detection by PCR, IgG ab titers (4x increase) Tx: oral Azithromycin plus oral atovaquone or clinda plus quinine

Babesiosis, severe

Dx: parasitemia ≥4%, complications, relapsing disease Tx: IV Azithromycin plus oral atovaquone or IV clinda plus oral quinine

Lyme disease, Late-stage

clues: history of untreated Lyme Dx: inflammatory arthritis in large joints or vague or indolent neuro findings Tx: initially, 28 days Doxycycline oral or amoxicillin, if persists, repeat course or IV CTX

Lyme disease, early

Dx: Days to weeks after exposure in Northeast and upper Midwest, erythema migrans Tx: oral abx doxycycline or amoxicillin or cefuroxime

Persistent fatigue, headache, myalgia, and arthralgia. history of recent treatment for Lyme disease, exposure in Northeast and/or Upper Midwest

Post-Lyme disease syndrome

Chronic, nonhealing ulcer on foot of 3 months from abrasian in sauna, does not respond several courses of antibiotics.

Mycobacterium fortuitum infection

Mycobacterium fortuitum infection, Dx, Tx

Dx: Bx w/ studies for bacteria, mycobacteria, and fungi Tx:

most common manifestation and cause of NTM infection

Pulmonary disease and Mycobacterium avium complex

Most common cause of NTM lymphadenitis

Mycobacterium avium complex

Fever, night sweats, weight loss, and gastrointestinal symptoms in patient with HIV who have CD4 cell counts less than 50/μL and are not receiving prophylaxis.

Disseminated MAC, clues

Mimics tuberculosis, with cough, fever, weight loss, and cavitary lung disease in patient with COPD, cancer, HIV, alcohol abuse, and drug-associated immunosuppression.

Mycobacterium kansasii, clues

Chronic skin lesions that fail to respond to treatment of common skin conditions or when sensory loss is observed within lesions or in extremities. Causative organism.

Leprosy. Mycobacterium leprae.

Lower abdominal pain with vaginal discharge, vaginal bleeding after intercourse, intrauterine device. uterine and cervical motion tenderness.

PID, non-severe clues

PID, indications and Tx for hospitalization

Indications: unstable clinically, abscess, intolerant of oral meds, nonadherence Tx: Cefoxitin/Cefotetan plus doxycycline or Clinda plus Gent

PID, outpatient

Empiric Intramuscular ceftriaxone and oral doxycycline

Indications for screening/treating asymptomatic bacteruria

Pregnancy and medical clearance before an invasive urologic procedure

Needlestick puncture on patient with HIV infection and is taking antiretrovirals, but the recent viral load is unknown: Tx

Tenofovir, emtricitabine, and either dolutegravir or raltegravir for 4 weeks. HIV testing immediately, in 4-6 weeks, and again 3 months. ?Same if low/undetectable viral load?

Fever and flank pain following 2 days of dysuria

Dx: Acute, complicated UTI with pyelonephritis Tx: fluoroquinolones (esp. cipro and levo), if pregnant post-Tx UA/UCx

Pyelonephritis in pregnant patients, patients with uncontrolled diabetes, kidney transplants, urinary anatomical abnormalities, acute or chronic kidney failure

Dx: Complicated pyelonephritis Tx: Inpatient IV carbipenem for critical illness or risk for gram negative MDR, otherwise CTX, zosyn, cipro, or levo

Intermittent fatty and foul smelling diarrhea with associated abdominal cramping, burping, and bloating. Dx. Tx in 1. healthy pt, 2. patient with selective IgA deficiency. 3. or with chronic symptoms

Dx: Giardia Lamblia infection Tx: 1. observe, 2/3. 1st line Tinidazole or nitazoxanide

Management of exposure to Zika virus in pregnant pt.

Zika virus IgM antibodies

Asymptomatic or present with acute febrile illness associated with frontal headache, retro-orbital pain, myalgia, and arthralgia, with or without purpura, melena, or conjunctival injection. Gastrointestinal or respiratory symptoms may predominate. Severe lumbosacral pain is characteristic (“breakbone fever”). As the fever abates, a macular or scarlatiniform rash, which spares the palms and soles and evolves into areas of petechiae on extensor surfaces, may develop.

Dx: Dengue Fever Tx: ??? if pregnant, serial ultrasonography every 3 to 4 weeks

Dengue prevention management.

Mosquito control and vaccine for individuals with history of previous dengue virus infection.

Geriatric pt presents with ear pain, a vesicular rash in the external ear (although the rash may be absent), and ipsilateral peripheral facial palsy.

Ramsay Hunt syndrome, clues

Ramsay Hunt Syndrome: Dx, Tx.

Dx: Clinical diagnosis of VZV reactivation with ear pain/rash and ipsilateral facial palsy. Tx: valacyclovir (1 g three times per day for 7 to 10 days) and prednisone (1 mg/kg for five days, without a taper)

Relatively mild pulmonary infection coupled with exposure to livestock

Q fever pneumonia, Coxiella burnetii infection, clues

In endemic areas (Central and South America, sub-Saharan Africa, Central and Southwestern Asia, and Southern and Eastern Europe), pulmonary infection in patient that owns goats and cattle.

Anthrax infection, clues

abrupt onset of fever, severe headache, and dry cough in bird owners or breeders and poultry farmers.

psittacosis, clues

nonproductive cough, dyspnea, and substernal or pleuritic chest pain. infiltrates, hilar lymphadenopathy, and pleural effusion. Pts: Hunters, skinners/dressers of rabbits or other wild game.

Tularemia, clues

Sudden high fever, pleuritic chest pain, a productive cough, and hemoptysis. Pt: Rat breeder/collector.

Pneumonic plague, Yersinia pestis infection, clues

CLABSIs

If lines --> Abx and remove lines | If prosthetics --> longer course of abx

Indications for removal of vascular catheters

Endocarditis, metastatic infection, hemodynamic instability, suppurative thrombophlebitis, or persistent bacteremia is evident.

CAUTI prevention strategies

when not voiding: use u/s to assess bladder volume first, try straight cath or condom cath, remove catheters early.

Patient with infected cat bite wound. Pathogens? Abx?

anaerobic and aerobic organisms, including streptococci, staphylococci, and Bacteroides, Fusobacterium, Porphyromonas, and Pasteurella species piperacillin-tazobactam, ampicillin-sulbactam, imipenem, and meropenem

Antibiotics with anaerobic coverage.

???

Antibiotics with aerobic coverage.

???

Patient in/from mid-Atlantic, southern, and southeastern United States with nonfocal febrile illness associated with leukopenia, thrombocytopenia, elevated hepatic enzyme levels, and a rapid response to a tetracycline.

Human monocytic ehrlichiosis (HME), clues

Tetracycline abx:

Doxycycline

Human monocytic erlichiosis (HME): Dx, Tx.

Dx: Serologies (Seroconversion at 2-4 weeks), buffy-coat staining (to find morulae) or polymerase chain reaction of whole blood

Human monocytic ehrlichiosis (HME), clues

Pt with suspected human monocytic ehrlichiosis with no improvement within 48 hours of starting doxycycline the.rapy.

Heartland Virus, clues

Patient with outdoor exposure in/from mid-Atlantic, southern, and southeastern United States with nonfocal febrile illness associated with leukopenia, thrombocytopenia, elevated hepatic enzyme levels, and the key clue: a rapid response to a tetracycline.

Human monocytic ehrlichiosis (HME), clues

Tetracycline abx:

Chlortetracycline, doxycycline, minocycline, oxytetracycline, and tetracycline

Human monocytic erlichiosis (HME): Dx, Tx.

Dx: Serologies (Seroconversion at 2-4 weeks), buffy-coat staining (to find morulae) or polymerase chain reaction of whole blood Tx: Tetracyclines

Pt with suspected human monocytic ehrlichiosis with no improvement within 48 hours of starting doxycycline therapy.

Heartland Virus, clues

Heartland Virus: Dx, Tx.

Dx: Clinically, no response to tetracyclines Tx: Supportive care

Patient with outdoor exposure in/from mid-Atlantic, southern, and southeastern United States with nonfocal febrile illness associated with rash, thrombocytopenia, elevated hepatic enzyme levels, and a rapid response to a tetracycline.

Rocky mountain spotted fever, clues

Rocky Mountain Spotted Fever: Dx, Tx.

Dx: clinical Tx: Tetracycline

Worsening mental status, new fever, or stiff neck in a patient who recently underwent surgery

Health-care associated ventriculitis or meningitis (HCAVM), clues

CSF findings most concerning for infection

Lactate > 4, elevated procalcitonin

Health-care associated ventriculitis or meningitis: Dx, Tx.

Dx: infected CSF in pt with AMS, fever, stiff neck, or recent intracranial surgery Tx: Abx with MRSA and pseudomonas coverage and device removal

Gram stain reveals many polymorphonuclear cells and abundant gram-negative coccobacilli demonstrating bipolar staining.

Pneumonic plague (Yersenia pestis), clues

Pneumonic plague (Yersenia pestis): Dx, Tx.

Dx: hemorrhagic lymphadenitis, gram negative coccobacilli Tx: Streptomycin, gentamicin, tetracyclines

Disseminated histoplasmosis: Dx, Tx.

Dx: urinary antigen for histoplasmosis (95% specificity), blood cultures, or a biopsy of the oral lesions Tx: liposomal amphotericin B then itraconazole for months

Hypotensive, diaphoretic, oral ulcerations, hepatosplenomegaly, pancytopenia. Patient from Ohio River Valley, immunosuppressed, works in an old barn with bats

Histoplasmosis (disseminated), clues

Histoplasmosis (disseminated): Dx, Tx.

Dx: urinary antigen for histoplasmosis (95% specificity), biopsy, blood cultures

Recurrent painful oral and genital ulcerations, hypopyon, pathergy, CNS (headaches, stroke, and behavioral changes), GI (IBD like)

Behcet Syndrome (vasculitis), clues

Behcet Syndrome: Dx, Tx.

Dx: Oral lesions plus 2 of 4: eye inflammation, genital ulcers, pathergy, skin lesions Tx: mild --> Low-dose prednisone or colchicine severe --> high-dose prednisone and immunomodulating agents

Infectious Disease Flashcards

(84 cards)