Infectious Disease in the ER: 2 infections you can't miss! Flashcards Preview

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Flashcards in Infectious Disease in the ER: 2 infections you can't miss! Deck (17):
1

What is the classic-triad of bacterial meningitis sx?

1. fever
2. neck stiffness
3. altered mental status (<50% cases)

*headache as well

- if all 3 absent, not meningitis
-2/4 present in 95% px

2

What are all of the sx of bacterial meningitis?

-headache
-fever
-meningismus
-altered sensorium
-vomiting
-seizure
-focal findings
-papilledema

3

What two signs are seen in meningitis?

1. Brudzinski's sign
2. Kernig's sign

4

When do you proceed to LP with suspected BM?

-if CT indicates absence of SOL (inc ICP)

*needle b/w L3/4

5

What is the CSF in lumbar puncture used to investigate in BM?

tube 1: cell count and ddx

tube 2: glucose, protein

tube 3: gram stain, culture, special ID studies (viruses etc)

tube 4: cell count, ddx (xanthrochromia)--ensure blood not from puncturing

6

What are the values for the following in BM?

cell count
glucose
protein
gram stain

-cell count: elevated WBC, elevated neutrophils (100-10,000x10^6/L)

-glucose: 1g/L

-gram stain: may be negative in 60% cases

7

What is the rx of BM?

-dexamethasone (blunt inflammation and edema/^ICP) - IV before/with AB, every 6 hrs for 48-96 hrs

8

What is necrotizing fasciitis?

deep infx of subcutaneous tissues--> destruction of subcutaneous tissue, fascia, vasculature, nerves

25% mortality

RF: drug use, DM, obesity, immunosuppression, PVD

9

what are the systemic findings of NF?

-fever
-tachycardia
-hypotension

10

What are the signs/sx of NF?

-tense edema outside involved skin
-disproportionate pain
-blisters/bullae
-crepitus
-subcutaneous gas
-necrosis

11

What are the 2 types of NF (describe)?

type 1: Polymicrobial NF:
-mixed aerobic/anaerobic infx
-most commonly after surgery, in px w DM/PVD

type 2: Monomicrobial NF
-usually Strep pyogenes (GAS)
-must consider CA-MRSA if common in community

12

What bacteria are often causal of NF type 1?

anaerobic: bacteroides sp., clostridium sp., peptostretococcus sp., strep sp. (not grp A), e.coli, enterobacter, klebsiella, proteus

13

What oral anaerobes usually cause head/neck NF type 1?

-fusobacteria, anaerobic strep, bacteroides, spirochetes

14

What is Fournier's gangrene? what bacteria are commonly involved?

-gangrene of groin (type 1 NF)

facultative organisms:
-e. coli, klebsiella, enterococci

anaerobes:
-bacteroides, fusobacterium, clostridium, anaerobic or microaerophilic streptococci

15

What are 3 types of type 1 NF?

-Fournier's gangrene

-Traumatic fresh water lesions-aeromonas hydrophila (Georgia)

-Traumatic salt-water lesions (gulf coast, SE US seaboard)- vibrio vulnificus

16

What causes type II NF (hemolytic streptococcal gangrene)?

-group A strep (GAS) or other beta-hemolytic strep** in combo with or alone:

-S aureus

-ca-MRSA if in community

17

Rx for NF?

-antimicrobial therapy: clindamycin, penicillin G Na, IVIG

-EARLY COMPLETE SURGICAL DEBRIDEMENT