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Neurology > Infectious Disease: Bacterial Infections I > Flashcards

Infectious Disease: Bacterial Infections I Flashcards

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1
Q

Who are at higher risk of infectious diseases?

A

Elderly, those with chronic diseases or immunosuppressive drugs

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2
Q

What are some transmission routes for infectious diseases?

A

Objects, Food, Water

Droplets, Animal vectors, Air

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3
Q

How do infectious agents cause disease?

A

1) Produce toxins
2) Invasion/Destruction
3) Triggering Immune response
4) Derangement of normal body functions

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4
Q

Innate immunity examples?

A

Physical Barriers (Skin)

Chemical systems (Gastic pH)

Phagocytosis (Macrophages)

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5
Q

Adaptive immunity examples?

A

New responses to memory antibodies

B-Cells (Antibodies)

T-Cells (Antigen Response)

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6
Q

What are the three was to classify bacteria?

A

Gram stains

Morphology

Growth conditions

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7
Q

What is the gold standard for testing bacteria?

A

Cultures

samples from CSF, Blood, Sputum and Urine

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8
Q

What are the three mechanisms that cause bacterial resistance?

A

Barriers to antibiotic entrance (Impermeability & Efflux Pumps)

Alterations to antibiotic receptor (Mutant PBP’s)

Inactivation of antibiotic by enzyme (Beta Lactamase)

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9
Q

How long to cultures take?

A

48 hrs finalized 5 days later

Test for SIR
Susceptibility
Intermediate
Resistance

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10
Q

What is an Antibiogram?

A

Test for local susceptibility patterns

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11
Q

Fine tuning antibiotic treatment includes?

A
  • De-escalate
  • Use single drugs
  • Least expensive
  • Smallest spectrum
  • Easiest to administer
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12
Q

Staphylococcus bacteria characteristics?

A

Gram Positive

Cocci Clusters (Purple Grapes)

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13
Q

What is the most common site of infections with Staph Aureus?

A

Skin and Soft tissue

Especially surgical sites

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14
Q

What are three high risk entry points for Staph Aureus?

A

1) Prosthetic implants
2) Traumatic wounds
3) Minor skin abrasions

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15
Q

What do Pt’s usually say when they present at clinic with Staph Aureus infections?

A

I think I got bit by a spider, Pt’s usually have an Abscess

Skin and Soft Tissue infection

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16
Q

What is the #1 causes of Bacteremia acquired infections (Community and Hospital) ?

A

Staph Aureus

Must remove source of infection

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17
Q

What are the primary infection sites of Staph. Aureus?

A

Skin & Soft Tissue infections

Bone and Joint infections

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18
Q

What are secondary infection sites of Staph. Aureus?

A

Indwelling vascular catheters

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19
Q

Can Staph Aureus causes Infective Endocarditis?

T of F

A

True, Yes

Bacteremia travels through blood and affects heart valves

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20
Q

What is the #1 common cause of Osteomyelitis?

A

Staph Aureus

Bacteremia (Hematogenous) or focal infection

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21
Q

What is the #1 common cause of Septic Arthritis?

A

Staph Aureus

Due to Prosthetic Joint

< 12 months
Focal infection

> 12
Hematogenous

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22
Q

Signs of Septic Arthritis are?

A

Joint pain

Swelling

Fever

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23
Q

1 cause of Infective Endocarditis?

A

Staph Aureus

Risk Factors

  • IV drug users
  • Prosthetic Heart valve
  • Bacteremia
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24
Q

Most common cause of Toxic Shock Syndrome?

A

Strep

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25
Most common cause of Scalded Skin Syndrome?
Staph Aureus Kinds mostly affected
26
Vomiting and Diarrhea from food borne illnesses usually start?
1 to 5 hours after the meal Due to the Staph Aureus Toxins in the prepared food
27
Most common cause of Pulmonary infections in the hospitals?
Staph Aureus from the Nares or Skin
28
What can be the cause of a Splenic Abscess?
1) Staph Aureus Sepsis | 2) Infective Endocarditis
29
What are the first steps in order to Dx a bacterial infection?
1) Gram Stain | 2) Culture Gold Standard
30
What is the percentage of MRSA at the hospital?
50% of Staph Aureus is Methicillin Resistant
31
What are the two main principles to treat Staph Aureus?
1) Remove infective cause | 2) Systemic Antibiotics
32
Incision and Drain (I&D) might be enough to treat Staph Aureus Boils and Abscesses? T of F
True
33
What is the drug of choice if you suspect MSSA ? Methicillin Susceptible Staph Aureus
B-Lactam's Cephalosporins Penicillin Carbapenems Monobactams
34
What are the only reasons why you wouldn't use a Beta Lactam to treat MSSA infection?
1) Pt is Allergic | 2) Pt has a serious reaction
35
MRSA Methicillin resistant strains of Staph Aureus are resistant to Beta Lactams - T of F What can you treat with instead?
True Treat with Ceftaroline
36
What are two ways to prevent MRSA infections? | High prevalence in hospitals
1) Basic infection control | 2) Decolonization (5 days)
37
Streptococcus characteristics
Gram Positive Cocci in Chains Beta Hemolytic Part of normal flora Humans only reservoirs Person to Person transmission
38
Streptococcus is most common in?
Children < 10 y/o Carry it without symptoms
39
Pharyngitis | Strep pyogenes is most common in?
Children in the Winter months
40
Pharyngitis | Strep pyogenes S&S
Abrupt onset Absent of cough Sore Throat Painful swallowing Fever/Chills
41
Pharyngitis | Strep pyogenes PE findings?
Enlarged anterior cervical lymph nodes Erythematous, edematous White to yellow tonsillar exudates Petechia on the soft palate may be present
42
Pharyngitis | Strep pyogenes prognosis?
Self limiting Better 3-4 days without treatment Complications can develop if treatment is not initiated
43
Pharyngitis | Strep pyogenes complications?
Acute Glomerulonephritis Acute Rheumatic Fever
44
What are the 4 Centor Criteria to diagnose strep pharyngitis? < 3 = Not likely Strep usually 75% Viral > 3 = Likely Strep
1) Tonsilar Exudates 2) Absence of cough 3) Tender anterior lymphadenopathy 4) History of fever
45
If a throat culture is positive for Strep how do you treat?
Penicillin x 10 days If PCN Allergies Erythromycin x 10 Days Azithromycin x 5 days
46
Drug of First Choice to treat GABS? Group A Beta Hemolytic Strep
#1 Penicillin #2Cephalosporins
47
Drug of First Choice to treat GABS in pt's allergic to Penicillin?
Macroglides 1) Azithromycin 2) Clarithromycin
48
Acute Rheumatic Fever is associated with?
2 to 3 weeks after a Pharyngeal infection with GAS Group A Strep
49
Acute Rheumatic Fever is most common in?
Children | 5 - 15 y/o
50
Acute Rheumatic Fever S&S
Arthritis Carditis Chorea
51
Acute Rheumatic Fever PE Findings?
1) Subcutaneous nodules | 2) Erythema marginatum (Worsens with heat)
52
Complications of Acute Rheumatic Fever?
1) Recurrence | 2) Cardiac involvement (Body attacks own heart)
53
Modified Jones Criteria for Acute Rheumatic Fever?
1) Two major criteria 2) One major and two minor PLUS evidence of strep infection
54
Modified Jones Criteria major S&S
- Migratory polyarthritis - Carditis - Subcutaneous nodules - Erythema marginatum - Sydenham’s chorea
55
Modified Jones Criteria minor S&S
- Fever - Arthralgia - Raised erythrocyte sedimentation rate or C-reactive protein - Leukocytosis - EKG showing heart block - Previous episode of rheumatic fever
56
If a child has Carditis or Chorea and Strep do you consider it Acute Rheumatic Fever?
Yes
57
Acute Rheumatic Fever Treatment consists of?
- Anti-inflammatories for arthritis - Heart failure management - Antibiotics for remaining strep bacteria - Monitor ESR and CRP -Prevention: Prophylaxis with antibiotics against recurrences
58
Do you treat a child with antibiotics if culture and swab is unknown?
Yes to cover for Acute Rheumatic Fever
59
Best marker to monitor inflammation in acute rheumatic fever?
CRP | C-reactive protein
60
Characteristics of Scarlet fever?
- Strep throat - Diffuse erythematous papular rash that blanches - Fine papules (Sand paper like texture) - Circumoral pallor - Strawberry tongue - Rash fades in 2-5 days
61
Erysipelas characteristics?
Females (50-60's) Abrupt onset Rapid progression Very Painful macular rash Fever Lymphadenopathy
62
Causative agent of Erysipelas?
Beta-hemolytic Group A Streptococcus bacteria
63
Impetigo commonly caused by?
1) GAS | 2) Staph. aureus
64
Impetigo usually affects?
Children 2 -5 y/o Superficial epidermis Honey colored crust
65
Most common cause of Cellulitis in the US?
Group A Strep Common in Pt's with 1) Lymphedema 2) Chronic Stasis 3) Venous Grafts
66
#1 Cause of Necrotizing Fasciitis?
Group A Strep Missed Dx from Cellulitis
67
Necrotizing Fasciitis S&S?
- Destruction of fascia and sub q fat - Infection spreads along the fascia - Systemic signs of toxicity will be present
68
Necrotizing Fasciitis PE findings?
- Severe pain, out of proportion to exam findings - Fever - Skin bullae, necrosis , or ecchymosis
69
Necrotizing Fasciitis treatment?
- Broad spectrum antibiotics - Surgical debridement - Hemodynamic support
70
What is Toxic Shock Syndrome?
- Life threatening condition | - Toxins released in the body by Staph or Strep bacteria
71
Streptococcal Toxic Shock Syndrome is due to ?
Group A Strep (GAS) Most severe infection
72
Streptococcal Toxic Shock Syndrome risk factors?
- Surgical wounds - Burns - Foreign body (tampons)
73
Toxic Shock Syndrome S&S?
- Influenza-like symptoms - Diffuse scarlatina-like rash followed by desquamation - Fever/Shock - Progression to necrotizing fasciitis or myositis within 72 hours with no visible break in the skin
74
Streptococcal Toxic Shock Syndrome Treatment?
- IV fluids - Antibiotics (penicillin G and clindamycin) - Pressors - Respiratory support - Surgical intervention
75
Most common cause of community acquired pneumonia?
Streptococcus Pneumoniae Gram positive Cocci Chains Catalase Negative
76
Risk factors for Streptococcus Pneumoniae ?
Crowded living conditions enhance transmission Military, Prisons, Nursing homes, Daycare
77
Streptococcus Pneumoniae is normally located where?
Nasopharynx Bacteria travels through 1) Eustachian tube 2) Sinuses
78
Streptococcus Pneumoniae risk factors preventing clearing of infection?
- Viral infections - COPD - Cigarette smoking
79
How is Streptococcus Pneumoniae spread?
- Inhaled or aspirated in the bronchioles or alveoli
80
S. pneumo pneumonia at risk population includes?
- Infants up to 2 y/o | - Elderly 55y/o
81
Peak incidence for adults of S. pneumo pneumonia ?
Midwinter months
82
High risk cultures for S. pneumo pneumonia?
- Native Americans - Native Alaskans - African Americans
83
S. Pneumo Pneumonia S&S?
Usually a Pre existing upper respiratory infection - Coryza - Non productive cough - Low grade fever
84
S. Pneumo Pneumonia S&S once pneumonia develops?
-Febrile -Sputum Thicker, green/yellow - Blood tinged sputum - Nausea and vomiting - Lateral chest wall pain - Splenectomy patients may quickly deteriorate and die within 24 hours
85
What are some of S. Pneumo Pneumonia PE findings ?
- Increased respiratory rate - Dullness to percussion (consolidation or pleural effusion) - Rales (consolidation)
86
What are some of S. Pneumo Pneumonia radiographic findings?
-Lung infiltrate | - Multilobar disease 50% of pt's Hallmark sign
87
When treating any form of pneumonia what must you determine?
- Hospital Acquired Pneumonia - Community Acquired Pneumonia - Risk factors specific to pathogens? - Is pt stable enough to be treated (out patient) or do they need to be admitted
88
Treatment of S. Pneumo Pneumonia
Initially therapy is started empirically
89
(CAP) Community Acquired Pneumonia treatment? No Comorbidities or Recent Antibiotics Low rate of Macrolide Resistance
Macrolide 1)Azithromycin 2)Clarithromycin
90
(CAP) Community Acquired Pneumonia treatment? No Comorbidities or Recent Antibiotics High rate of Macrolide Resistance
Doxycycline
91
(CAP) Community Acquired Pneumonia primary treatment? With Comorbidities or Recent Antibiotic Use
Combination Therapy Amoxicillin or Augmentin (Beta Lactams) Plus Azithromycin Clarithromycin or Doxycycline
92
(CAP) Community Acquired Pneumonia alternative treatment? With Comorbidities or Recent Antibiotic Use
Combination Therapy Alternative therapy Beta Lactams plus Cephalosporin Cefpodoxime Cefuroxime
93
Prognosis of (CAP) Community Acquired Pneumonia?
Healthy person, 60% show radiologic clearing by 1 month with treatment > 50y/o or with more severe infections or COPD, 25% clear radiographically by 1 month
94
(CAP) Community Acquired Pneumonia can be prevented by vaccines? T of F
True Vaccine the immunucompromised Pt's 1) Polysaccharide vaccine 2) Conjugated vaccine

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