Flashcards in Infectious Disease in the ER: 2 infections you can't miss! Deck (17):
What is the classic-triad of bacterial meningitis sx?
2. neck stiffness
3. altered mental status (<50% cases)
*headache as well
- if all 3 absent, not meningitis
-2/4 present in 95% px
What are all of the sx of bacterial meningitis?
What two signs are seen in meningitis?
1. Brudzinski's sign
2. Kernig's sign
When do you proceed to LP with suspected BM?
-if CT indicates absence of SOL (inc ICP)
*needle b/w L3/4
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
What are the values for the following in BM?
-cell count: elevated WBC, elevated neutrophils (100-10,000x10^6/L)
-gram stain: may be negative in 60% cases
What is the rx of BM?
-dexamethasone (blunt inflammation and edema/^ICP) - IV before/with AB, every 6 hrs for 48-96 hrs
What is necrotizing fasciitis?
deep infx of subcutaneous tissues--> destruction of subcutaneous tissue, fascia, vasculature, nerves
RF: drug use, DM, obesity, immunosuppression, PVD
what are the systemic findings of NF?
What are the signs/sx of NF?
-tense edema outside involved skin
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
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
What oral anaerobes usually cause head/neck NF type 1?
-fusobacteria, anaerobic strep, bacteroides, spirochetes
What is Fournier's gangrene? what bacteria are commonly involved?
-gangrene of groin (type 1 NF)
-e. coli, klebsiella, enterococci
-bacteroides, fusobacterium, clostridium, anaerobic or microaerophilic streptococci
What are 3 types of type 1 NF?
-Traumatic fresh water lesions-aeromonas hydrophila (Georgia)
-Traumatic salt-water lesions (gulf coast, SE US seaboard)- vibrio vulnificus
What causes type II NF (hemolytic streptococcal gangrene)?
-group A strep (GAS) or other beta-hemolytic strep** in combo with or alone:
-ca-MRSA if in community