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Flashcards in Infectious Diseases Deck (53)
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1

Most common CAP vs Nosocomial pneumonia

CAP=Strep. Pneumo
Nosocomial=E. coli, Pseudo, and S. Aureus

2

Atypical pneumonia common bugs and signs

Mycoplasma pneumonia, Chlamydia pneumonia, Coxiela, legionella, influenza

Dry cough, headache, sore throat
Normal pulse with high fever

3

Legionella common demographics

Organ transplant recipeients, renal failure, patients with chronic lung disease, and smokers

4

Nursing home residents common infection

Psuedomonas predilection for upper lobes

5

CD4 count less than 500 infections

Tb, recurrent pneumonias, vaginal candidiasis, and herpes zoster

6

CD4 count less than 200 infections and prophylaxis

pneumocystis jirovecii, cryptococcis (treat with IV amphotericin B plus flucytosine and chronic suppression with fluconazole, frequent lumbar punctures), histoplasmosis, or cryptospordiosis

Prophylaxis with TMP-SMX for pneumocystis one double strength tablet daily
P02 less than 70 and A-a gradient more than 35 have poor prognosis and should be given prednisone before TMP-SMX

7

CD4 count less than 50 infections

Mycobacterium aviium intracellulare complex, disseminated histoplasmosis, CMV retinitis, colitis, adrenalitis, and esophagitis (IV ganciclovir, foooscarnet or cidofovir), CNS lymphoma (diagnose with stereotactic brain biopsy or with CSF for epstein barr virus)

8

MAC with CD4 count less than 50 treatment

Clarithromycin, ethambutol, and rifabutin for weeks

MAC prophylaxis-clarithromycin 500 mg twice daily
Azithromycin 1200 mg weekly

Don't need concomitant HAART therapy with prophylaxis once CD4 counts recover

9

CD4 count less than 100

Prophylaxis with daily dosing of TMP-SMX

toxoplasmosis (sulfadiazine and pyrimethamine)

10

CURB 65 guidelines

Confusion
Uremia >20 BUN
RR >30
BP less than 90/60
>65
More than 2= inpatient
More than 4=ICU

11

Outpatient younger than 60 with pneumonia bugs and treatment

S. pneumo, Mycoplasma, Chlamydia or legionella

Treatment: Macrolides (azithromycin or clarythromycin)
or doxycycline

For 5 days

12

Older than 60 or with comorbidiites outpatient pneumonia treatment

Fluroquinolone (levofloxacin, moxifloxacin)
Second or third cephalosporin
For 5 days

13

Co morbidities to consider for pneumonia

Heart disease, sickle cell, pulmonary disease, diabetes, alcoholic cirrhosis

14

Inpatient CAP treatment

Macrolides + cephalosporin
Or fluorquinolone

15

ICU CAP treatment

Cephalosprin + macrolide (IV)
Cephalsoprin + flluoroquinolone

16

Hospital acquired pneumonia (in hospital for >72 hours)

ceftazidime or cefepime
Imipenem
piperccillin/tazobactam

17

Ventilator associated pneumonia diagnosis and treatment

Diagnosis: new inflitrate on CXR, purlent secretion from endotracheal tube
Bronchoalveolar lavage

Treatment: 3 drugs
1. ceftazdimine/cefipime OR pipercillin/tazobactam OR carbapenem (Pseudo)
2. Aminoglycoside or fluoroquinolone (Pseudo)
3. Vanco or linezolid (gram +)

18

Lung abscess treatment

Postural drainage
Antibiotics:
Gram positive: ampicillin or amoxicillin/clavulanic acid, ampicillin/sulbactam, or Vanco
Anaerobes: clinda or metro
Gram negative: fluoroquinolone or ceftazidime

Continue until cavity is gone or until CXR have improved considerably

19

Results of PPD test results and treatment

Used for latent TB not active TB (active TB order a sputum culture)
Positive if >15 mm in patients with no risk factors

High risk (high prevelance areas, immigrants, health care workers, nursing home residents, close contact with TB, alcoholics, diabetics)=10 mm positive

HIV, steroid users, organ transplant, close contact with active TB, radiographic evidence of primary TB=5 mm is positive

Never have had a PPD test before do another test in 1-2 weeks

If positive use chest X ray to rule out active disease-if excluded use 9 months of isoniazid (even if have had BCG vaccine)

20

Treatment of TB

2 months of RIPE (or streptomycin) and then 4 months of INH and rifampin

21

Ages and treatment of suspected meningitis

less than 4 weeks: aminoglycoside
Infants (less than 3 mos): cefotzxime +ampicillin +vanco
3 mos to 50 years: ceftriaxone or cefotaxime + vanco
greater than 50: ceftriaxone or cefotaxime+vanco+ampicilin
Impaired cellular immunity: ceftazidime +ampicilin +vanco

Aseptic is supportive

22

Diagnosis and treatment of encephalitis

CSF PCR
MRI of brain-T2 signal in frontotemporal region=HSV encephalitis
EEG=tempral lobe discharges

Treatment: HSV=acycylovir for 2-3 weeks
CMV=ganciclovir or foscarnet

23

Importance of HBeAg, HBsAg, anti-HBs, anti-HbC

HbeAg: indicates infectivity
HbsAg: earliest to arrive
anti-HBs-natural or vaccine induced immunity
Anti-HbC: present during window period

24

diagnosis of Hep C

PCR detects viral load

25

Diagnosis Treatment of botulism

Diagnosis: ID toxin in serum, stool or gastric contents (bioassay)

gastric lavage if within several hours

High suspicion=antitoxin

Wounds=penicillin and wound cleansing

26

Complicated UTI

extends beyond blader: pyelo, prostatits, urosepsis)

Risks: men, diabetes, pregnancy, RF, history of pyelo, obstruction, catheter, resistant organism, immunocompromised

27

Treatment of UTI

uncomplicated:
TMP/SMX (bactrim): 3 days
nitrofurantoin: 5-7 days
Fosfomycin: single dose
Ciprofloxacin: 3 days

Pregnant: ampicllin, amoxicciln or oral cephalosporins: 7-10 days

Men: same as uncomplicated but for 7 days

Recurrent: 2 more weeks of treatment and culture

2+ UTIs per year: TMP/SMx after sex or at first symptoms
or low dose TMP/SMX for 6 months

Phenzopyridine: urinary analgesic

28

Treatment of Pyelonephritis

Uncomplicated
TMP/SMX or fluroquinolone for 10-14 days
Amoxcillin
Single dose of ceftriaxone or gentamicn

Ill, elderly, pregnant, unable to tolerate orals, urosepsis
Hospitalize and give IV fluids
Ampicillin plus gentamicn or cipro-parenterally
Treat until patient is afebrile for 24 hrs then 14-21 day course
Urosepsis: IV antibiotics for 2-3 weeks

Recurrent:
same organism: 6 week treatment
dif. organism: 2 week treatment

29

Treatment of acute and chronic prostatits

Acute: IV TMP/SMX if extremely ill
Mild: TMP/SMX or fluoroquinolone or doxycycline for 4-6 weeks

Chronic: fluroquinolone

30

HPV treatment

ticholracetic acid, podophyllin, inqiquimoid, surgery