Infectious Dz-Panre Flashcards
(241 cards)
1
Q
What is Botulism
A
Produces a toxin that inhibits release of acetylcholine at the neuromuscular junction
● Botulism is a Paralytic Disease (mortality from respiratory paralysis)-
Associated with home-canned food products and honey in infants (pediatricians recommend waiting until your baby is at least 12 months before introducing honey)
2
Q
Botulism s/s? Pearls?
A
Symptoms: “D’s”: double vision (diplopia), dysarthria, droopy eyes (ptosis), dilated
pupils, dry mouth, dysphonia
● No mental status changes or sensory symptoms; muscle weakness leading to respiratory paralysis; symmetric descending weakness and flaccid paralysis without sensory deficits.
3
Q
Botulism DX? Types?
A
Toxin assays
Sometimes electromyography; Food, Wound
4
Q
Food Botulism?
A
,Canned foods; the pattern of neuromuscular disturbances and ingestion of a likely food source are important diagnostic clues. The simultaneous presentation of at least 2 patients who ate the same food simplifies diagnosis, which is confirmed by demonstrating C. botulinum toxin in serum or stool or by isolating the organism from the stool. Finding C. botulinum toxin in suspect food identifies the source.
5
Q
Wound Botulism?
A
, finding toxin in serum or isolating C. botulinum organisms on the anaerobic culture of the wound confirms the diagnosis.; Contamination of wound
■ Seen in skin poppers who use black-tar heroin
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Infectious Diseases
4
■ Pearl: may look like heroin overdose (droopy head, fatigued), but no mental
status changes
6
Q
Botulism Tx?
A
Supportive care, administration of activated charcoal may be helpful for food botulism.; atients should be hospitalized and closely monitored with serial measurements of vital capacity. Progressive paralysis prevents patients from showing signs of respiratory distress as their vital capacity decreases. Equine heptavalent antitoxin may be given; Antitoxin is less likely to be of benefit if given > 72 h after symptom onset
7
Q
What is greatest threat to life that results from botulism?
A
respiratory impairment
8
Q
C. botulinum spores are resistant to heat but at temperature they are not?
A
However, exposure to moist heat at 120° C for 30 min kills the spores. Toxins, on the other hand, are readily destroyed by heat and cooking food at 80° C for 30 min safeguards against botulism.
9
Q
What type of organism is Botulism?
A
Botulism is an anaerobic gram-positive rod
10
Q
Infant Wound: Botulism
A
Honey
■ Colonizes intestines
■ Poor feeding, weak cry, poor head control, loss of facial expression (bulbar
palsies)
11
Q
Botox botulism:
A
Medical uses: sweating, strabismus, cervical dystonia, spasms, twitching eyelids(botox is used to paralysis muscle)
12
Q
What is Tetanus ? *
A
Clostridium tetani (ubiquitous in soil); Puncture wounds are most susceptible
● A spore-forming gram- positive anaerobic organism
● Spores germinate in wounds and bacteria produce a neurotoxin
● Tetanospasmin (neurotoxin) blocks release of GABA/glycine (inhibitory transmitters)
resulting in unopposed excitatory discharge (causing severe muscle spasms)
○ Affects sympathetic and parasympathetic neurons
13
Q
Tetanus Presentation? *
A
Classic presentations: Risus sardonicus (spasm of the facial muscles causing a “joker
smile”) and opisthotonus (spasm causing body to go into extreme hyperextension); muscle spams, truisms, lockjaw, drooling, increase DTR, autonomic dysfunction
Painful tonic convulsions, but no mental status changes
14
Q
Tetanus Dx? *
A
Clinical
15
Q
Tetanus TX? *
A
Prevention via immunizations starting in childhood
○ booster every 5-10yrs
○ Tetanus Immunoglobin (given IM)
● Supportive Care: Benzodiazepines for muscle spasms, intubation; Metronidazole or Penicillin G, in addition to Tetanus immune globulin IM
● Prophylaxis with any laceration/skin break
○ Vaccinated: Tdap or Td vaccine q10 years or if major cut with booster >5yr
old
○ Never vaccinated: Tetanus immune globulin and tetanus toxoid vaccine
16
Q
Cholera
A
Vibrio cholerae
● Produces a toxin that activates adenyl cyclase in intestinal epithelial cells of small
intestine → hypersecretion of water & chloride → massive diarrhea → hypovolemia
and metabolic abnormalities
● Common during epidemics, war-time, overcrowding, famine, poor sanitation
17
Q
Cholera Presentation? *
A
Rice water diarrhea (severe, frequent, watery diarrhea)
○ Dehydration causes death
18
Q
Cholera Treatment? *
A
Prevention via clean water and food supply
● Replace fluids and electrolytes
● Oral rehydration for mild to moderate disease
○ 1 cup water, 1 tsp salt, 4 tsp sugar
● Severe presentations require IVF
● Antibiotics will shorten duration and reduce severity:
○ Tetracycline, ampicillin, TMP/SMX, quinolones
● Vaccine available but need booster every 6 months
○ Good for health care professionals, Peace Corp volunteers
19
Q
Cholera Key points?
A
Rice water diarrhea, severe dehydration, oral rehydration for mild to moderate
cases, antibiotics to shorten duration
20
Q
Diphtheria?
A
Corynebacterium diptheriae ● Affects mucous membranes in respiratory tract ● Transmitted by respiratory secretions ● Exotoxin causes myocarditis/neuropathy ● Deadly for infants
21
Q
Diphtheria Presentation?
A
Pharyngeal infections (most common form)
● Pseudomembrane
○ visible, adherent gray membrane that covers tonsils and pharynx (corn flake
membrane)
22
Q
Diphtheria Dx?
A
Clinical, culture
23
Q
Diphtheria tx:
A
Horse serum antitoxin from CDC
● Airway protection
● Antibiotics: Penicillin or Erythromycin/Azithromycin
● Vaccination = key to prevention (“D” in Tdap vaccine)
24
Q
Diphtheria Key points
A
pseudomembrane or corn flake membrane, pharyngitis, exotoxin, key to
prevention is vaccination with Tdap, horse serum antitoxin from CDC
25
Salmonella*
Salmonella species
| ● All types transmitted by food/water; 3 types Gastroenteritis, enteric fever and bacteremia
26
Salmonella Gastroenteritis? *Hours of incubation?
Most common form of Salmonella, esults from improperly handled food that has been contaminated by animal or human fecal material. It can also be acquired via the fecal-oral route, either from other humans or farm or pet animal
● 8-48 hrs incubation
27
Salmonella Gastroenteritis s/s? *
fever, nausea/vomiting, crampy abdominal pain, bloody diarrhea for 3-5 days
28
Salmonella Gastroenteritis Dx?
clinical, stool culture
29
Salmonella Gastroenteritis Tx?
Self-limited with normal immune systems
○ Symptomatic care
○ Severe cases require antibiotics: TMP/SMX, ampicillin or ciprofloxacin
30
Salmonella Enteric fever (typhoid fever)?
Organisms enter intestinal epithelium: 5-14 day incubation period
● Children may have abrupt onset
● 15% relapse
● Disease course
○ Gradual onset of ‘viral syndrome-like’ symptoms with abdominal distension/pain,
constipation and/or pea soup diarrhea
○ Fever peaks days 7-10 (at this time patients appear most toxic)
○ Symptoms improve over next 7-10 days
31
Salmonella Enteric fever *(typhoid fever) Pe /TX?
Exam
○ Splenomegaly, abdominal distension/tenderness, paradoxical bradycardia (low HR
even with fever), rash in week 2 (faint pink papular rash on trunk that fades with
pressure)
● Treatment
○ Ceftriaxone or quinolones for 2 wks
32
Salmonella Bacteremia*
Causes prolonged/recurrent fevers and infection in joints, bones, pleura, pericardium,
lungs
● Associated with osteomyelitis
○ typically seen in immunocompromised patients (like Sickle Cell Disease)
● Treatment
○ same as typhoid feve
33
Bacillary Dysentery*
Shigella dysenteriae; ram-negative bacteria shigella
34
Bacillary Dysentery; Shigella *s/s
Sudden onset diarrhea, abdominal cramps, tenesmus (feeling as if you constantly need
to evacuate bowels), fever, malaise, headache, loose stools with blood and mucous
● Dehydration is common
35
Bacillary Dysentery; Shigella dx?
Stool positive for fecal leukocytes and RBC
| ● Stool culture
36
Bacillary Dysentery; Shigella *TX?
TMP/SMX (Bactrim) is 1st choice (Note: many references also state ciprofloxacin is 1st choice)
○ Quinolone if allergic
● Replace fluid loses
37
How is Shigella transmitted? *
ransmission is via direct person-to-person contact and contaminated foods and water.
38
Diphtheria
is an acute pharyngeal or cutaneous infection caused mainly by toxigenic strains of gram (+) bacilli Corynebacterium diphtheriae
Corynebacterium diptheriae
● Affects mucous membranes in respiratory tract
● Transmitted by respiratory secretions
● Exotoxin causes myocarditis/neuropathy
● Deadly for infants
39
Diphtheria presentation?
Pharyngeal infections (most common form)
● Pseudomembrane
○ visible, adherent gray membrane that covers tonsils and pharynx (corn flake
membrane)
Pseudomembranes: Friable gray/white membrane on pharynx that bleeds if scraped + Bull neck: Neck swelling due to enlarged cervical lymphadenopathy.
40
Diphtheria Dx?
Clinical, culture confirms dx, pcr used for rapid detection of the toxigenic strain.
41
Diphtheria TX?
Horse serum antitoxin from CDC
● Airway protection
● Antibiotics: Penicillin or Erythromycin/Azithromycin
● Vaccination = key to prevention (“D” in Tdap vaccine); Diphtheria antitoxin + erythromycin or penicillin x 2 weeks
42
Diphtheria transmission?
Transmission is through inhalation of respiratory excretions
43
Pertussis
Bordetella pertussis (bacteria)Whooping cough; Infection in premature infants and those with chronic disease = most severe
presentation (especially kids with cystic fibrosis); Consider in adults with cough greater than 2 weeks who have no evidence of other
disease
44
Pertussis Presentation ? Phases?
3 phases of disease
○ Catarrhal: gradual onset of common cold-type symptoms and hacking cough
(mostly at night); most infectious stage
○ Paroxysmal: coughing spasms followed by high-pitched inspirations (whoops,
gasping for air); Infants at risk for apnea
○ Convalescent: happens about 4 wks after the onset of cough; paroxysms
improves; lasts another 2-3 wks
45
Pertussis DX
Clinical, PCR
46
Pertussis TX
Erythromycin to decrease transmission
● Vaccination of children
● Tdap vaccine needed in adulthood as immunity is not lifelong
47
Acute Rheumatic Fever (ARF*
Group A Streptococcus (S. pyogenes)
● A complication of group A ß-hemolytic strep infection
○ seen 2-3wks post infection (an acute autoimmune multi-system post strep)
● Peak age 5-15 yrs
● Common cause of valvular abnormalities in adulthood (think ARF w/ adult from
another country with valvular abnormality
48
Acute Rheumatic Fever (ARF) *Dx
JONES CRITERIA: Evidence of recent strep infection (ASO Titer) PLUS 2 major criteria
OR 1 major + 2 minor criteria
49
Acute Rheumatic Fever (ARF) TX
Complications: Rheumatic valvular disease
○ Mitral > Aortic > Tricuspid and Pulmonic.
Prevention is key: treat strep throat early with PCN, cephalosporin, macrolides; Aspirin + steroids
○ Penicillin G or erythromycin if penicillin-allergic
● Prevention is key; treat all GABHS with antibiotics
50
Acute Rheumatic Fever (ARF Complications?
Rheumatic heart disease (carditis) has poor prognosis:
○ 30% die within 2 yrs; ⅔ get valvular disease
○ 10% permanent serious heart disease or cardiomyopathy
● Acute glomerulonephritis is another complication of group A ß-hemolytic strep
infection
51
Major Criteria for Jones of Rheumatic Fever?
Major criteria: polyarthritis, carditis, nodules, chorea, (JONES-JOINT, OH MY HEART, N-NODULES E-ERYTHEMA MARGINATUM, SYNDENHAM'S CHOREA"-SAINT VITUS DANCE) erythema marginatum; J oint - Migratory polyarthritis (75% of cases)
● 2+ joints or migratory, med/large joints- knees, hips, wrists,
elbows
● Heat, redness, swelling, tenderness
● Lasts 3-4 wks
■ O h my heart - Active carditis (40-60% of cases)
● Valvular, myocarditis or pericarditis
■ N odules (subcutaneous)
● Rare, seen over extensor surfaces, scalp
■ E rythema marginatum
● Macular, red, non-pruritic annular rash with sharply
demarcated rounded borders
● Seen on trunk and extremities, not face
■ S ydenham’s chorea (<10% of cases)
● Classically called “Saint Vitus Dance”
● Develops weeks to months after initial infection
● Sudden involuntary jerky non rhythmic purposeful
movements
52
Minor criteria for Rhuematic Fever
arthralgias, fever, leukocytosis, elevated CRP/ESR, prolonged PR; Minor Criteria: CAFE PAL
C - C reactive protein, A - arthralgia, F - fever, E - ESR elevated, P - Prolonged PR, A - anamnesis of rheumatism, L - leukocytosis
53
Chlamydial infections?*
Chlamydia trachomatis, presents as urethritis, cervicitis/PID and LGV (lymphogranuloma venereum)
54
Chlamydial infections in male?
Urethritis: penile discharge (usually watery vs. purulent)
| ■ less painful than gonococcus
55
Chlamydial infections in *females?
Cervicitis/PID
■ usually asymptomatic
■ PID is a leading cause of infertility-Pelvic Inflammatory Disease (PID): Cervical motion tenderness, fever,
abdominal pain
56
Chlamydial infections can cause what type of ulcers? -
LGV (lymphogranuloma venereum); Vesicular lesions or ulcers spreading to lymph nodes (inguinal buboes)
○ Anorectal involvement possible
57
Most common STI in US?
Chlamydia trachomatis
58
Chlamydial infections Dx ?
High clinical suspicion warrants treatment
| ● ELISA/DNA test to confirm (cervical or urethral swab, or urine (nucleic acid amplification) sample)
59
Chlamydial infections TX?
Azithromycin (1gram PO x 1) or Doxycycline course
○ Azithromycin (single dose, better tolerated) or Erythromycin in pregnancy
● Treat all partners
● Treat concomitantly for Gonococcus as diseases are clinically identical
60
Chlamydial infections results in what type of arthritis?
Reactive arthritis: Autoimmune reaction to bacteria, +HLA-B27
■ Uveitis, urethritis, arthritis → “can’t see, can’t pee, can’t climb a tree”
61
Gonorrhea*
Neisseria gonorrhoeae-gram-negative intracellular
diplococci)
● Incubation is 2-8 days after exposure
62
Gonorrhea in Men
more painful than Chlamydia
○ milky discharge and dysuria initially, then days later have worsening symptoms
with profuse, yellow discharge
63
Gonorrhea in Women
asymptomatic or with dysuria
| ○ can cause PID, infertility
64
Gonorrhea can cause what eye condition?
If you touch your gonorrhea in GE and touch your eye -Conjunctivitis via direct inoculation-copious purulent discharge (pus pouring out of eye)
65
Gonorrhea bacteremia consists of?
Bacteremia
○ skin lesions (small pustules, gun metal gray, hemorrhagic component) seen on
hands and extremities, septic arthritis, tenosynovitis
○ more common in women since mostly asymptomatic
66
Infant conjunctivitis must think?
occurs at birth if mom infected with gonorrhea
67
Gonorrhea dx?
Culture from infected area
● Infant gonococcus: gram stain of discharge (will see gram-negative intracellular
diplococci)
68
Gonorrhea tx?
IM Ceftriaxone (250mg IM x 1)x 1 PLUS doxycycline 100 mg PO bid x 10 day or
azithromycin 1g PO x 1
● Treat all partners
● Treat concomitantly for Chlamydia as diseases are clinically identical
69
What is the mc cause of septic arthritis in young adults?
Gonorrhea
70
Urethritis & Cervicitis, PID, Epididymitis , Prostatitis ?
Gonorrhea CM
71
Herpes Family
```
HHV 1 & 2 → Herpes simplex 1 & 2
HHV 3 → Varicella zoster (chicken pox and shingles)
● HHV 4 → Epstein-Barr virus
● HHV 5 → CMV
● HHV 6 & 7 → Roseola
● HHV 8 → Kaposi sarcoma
```
72
Varicella zoster is also known as (hint what type of family)
HHV 3
73
Epstein-Barr virus-is also known as?
HHV 4
74
CMVis also known as?
HHV 5
75
Roseola is also known as?
HHV 6 & 7
76
Kaposi sarcoma is also known as?
HHV 8
77
Herpes Simplex: HHV 1 & 2
Only in humans – transmission by direct inoculation
● Latent in Dorsal Root Ganglia
● Reactivation with stress, immunocompromised state, trauma
Can result in Herpes encephalitis ;
Treatment: Acyclovir
78
HHV 2
Genital herpes, 25% of US population. Painful lesions, with
burning/stinging/malaise before full outbreak. Females have more severe disease –
can involve the cervix.
● Genital herpes at time of labor → Dangerous for mother and baby → higher
dissemination rate. C-section is recommended in the setting of active outbreak.
● People with severe or frequent outbreaks can get suppressive therapy
79
HHV 1 →
Oral, cold sores, 85% of the US population
80
HHV 3
Varicella Zoster Virus (shingles); Chicken Pox
81
Chicken Pox?
Transmission: Respiratory droplets, direct contact
● Incubation period: 10-20 days
● 1º infection: Varicella aka Chicken Pox
○ Fever, malaise
○ Rash characteristics: Vesicles on erythematous base “dew drops on a rose
petal”
■ Rash seen in different stages (macules, vesicles, crusted lesions)
○ Usually beginning on face and truck and moves to extremities
○ Pruritic;
Mucous membranes involved
82
Chicken pox Tx?
Symptomatic. Try to prevent super infection. If pt immunocompromised, Rx acyclovir
● Prevention: Vaccination
83
Chicken pox complications? Prevention
Bacterial infection, pneumonia, encephalitis, Guillain Barre
| ○ 1º infection: More serious and worse in adults; Chicken Pox vaccine for children
84
Shingles/Herpes Zoster
Culprit: Varicella Zoster Virus
● Transmission: Respiratory droplets, direct contact. VZV reactivation along one dermatome
Zoster is reactivation of dormant varicella zoster virus (VZV) – remains dormant in
nerves
85
Shingles/Herpes Zoster TX?
Shingles: Acyclovir, Valacyclovir
| ■ Given within 72 hours helps to prevent incidence of PHN
86
Herpes Zoster Ophthalmicus (op THAL mi cus)
CN V (trigeminal nerve) 1st division
■ Hutchinson’s sign: Lesion on nose strongly suggestive of ocular
involvement
■ Dendritic lesions seen on slit lamp exam with keratoconjunctivitis
87
Herpes Zoster Oticus aka Ramsey-Hunt Syndrome
CN VII (facial nerve)
■ Otalgia, lesions on ear, auditory canal and tympanic membrane, facial
palsy, tinnitus, vertigo, deafness, ataxia
88
Postherpetic neuralgia (PHN)
○ Pain > 3 mo, hyperesthesias or decreased sensation; may be prevented with steroids (poor
evidence) can treat neuralgia as chronic pain with TCA’s, capsaicin, gabapentin
89
Ramsey-Hunt Syndrome tx?
Ramsay-Hunt: PO antivirals + steroids
90
Postherpetic neuralgia (PHN) Tx?
Gabapentin, tricyclic antidepressant, topical lidocaine gel
91
Herpes Zoster Ophthalmicus TX?
PO antivirals, may need ophthalmic antiviral
92
Shingles/Herpes Zoster incubates?
10-20 days; Highly contagious starting the day before the rash
93
How does chicken pox differed from small pox?
Differentiated from small pox because small pox lesions are all in the same stage
94
MC areas that shingles present?
Thoracic or lumbar area most common
95
Epstein-Barr Virus
HHV 4:Infectious mononucleosis or “kissing disease”
| ● Transmitted via saliva
96
Epstein-Barr Virus triad?
Pharyngitis, POSTERIOR lymphadenopathy, fever
97
Epstein-Barr Virus is associated with 2 other dz?
Burkitt lymphoma and nasopharyngeal carcinoma
98
Epstein-Barr Virus PE?
Fever, exudative pharyngitis, posterior cervical lymphadenopathy, malaise, myalgias,
splenomegaly
○ Petechial rash especially if given ampicillin
99
Epstein-Barr Virus dx?
Heterophile antibody/monospot → positive within 4 weeks
| ○ Peripheral smear will show >50% lymphocytes with > 10% of those atypical
100
Epstein-Barr Virus complications ?
secondary bacterial pharyngitis, splenic rupture, pericarditis,
encephalitis, chronic fatigue syndrome
101
Epstein-Barr Virus tx?
Supportive, steroids if only airway obstruction due to lymphadenopathy
● Avoid contact sports at least 1 mo if splenomegaly present; supportive (do not give ASA b/c of concern for Reyes syndrome), No contact sports!
102
How is Epstein Barr diff from strep in PE findings?
Epstein Barr has POSTERIOR lymphadenopathy vs strep has ANTERIOR
103
CMV – Cytomegalovirus
HHV 5:
Most infections are asymptomatic
● 2 scenarios with serious complications
○ 1. Congenital CMV
■ Primary CMV in pregnancy: 10% of babies will have low birth wt, microcephaly,
seizures, rash, hepatosplenomegaly, jaundice, pneumonia, retinal damage
○ 2. AIDS or post-transplant pt’s
■ Retinitis in AIDS pt’s with CD4 < 50, “pizza pie” lesions on retinal exam
■ GI: esophagitis
■ Lung: 15% of bone marrow transplant pt’s, this is often fatal
■ Neuro: radiculopathy, transverse myelitis, encephalitis
● Tx: Ganciclovir, Foscarnet
● Prevention: limit blood transfusions, if necessary use leukocyte depleted PRBC’s
104
Roseola/“Sixth disease” “Exanthem subitum”
HHV 6 & 7
Culprit: Human Herpes virus strain 6 or 7
● Aka “6th disease”
● Incubation period: Approximately 10 days
● Transmission: Respiratory droplets
● Demographic: Common in kids < 5y-6 months to 2 years old
105
Roseola/“Sixth disease” “Exanthem subitum” S/S?
Prodrome: High fever x 3-5 days, resolves before onset of rash
○ Pink maculopapular blanchable rash starts on trunk/back proceeds to face
○ ONLY childhood viral exanthem to start on trunk and spread to face
○ Child appears well and alert during febrile phase
106
Roseola/“Sixth disease” “Exanthem subitum” tx?
Tx: No ASA, treat with Tylenol
107
Rubella (Level 2)
Culprit: Togavirus family
● Aka “German measles”
● Incubation period: 2-3 weeks
● Transmission: Respiratory droplets
108
Rubella (Level 2) s/s
Low grade fever, cough, lymphadenopathy
○ Pink/light-red spotted maculopapular rash starts on face then moves out to
extremities
■ “3 day rash”
■ Spreads faster than rubeola and does not darken
○ Forchheimer spots: Small red macules/petechiae on soft palate (seen also
with scarlet fever)
○ May have transient photosensitivity and joint pain
109
Rubella (Level 2) (dx )
Clinical rubella specific IgM antibody
110
Rubella (Level 2) (Tx )
Supportive, generally no complications in kids
111
Rubella (Level 2) (complications)?
Teratogenic esp in 1st trimester
○ Congenital syndrome: Deafness, cataracts, blueberry muffin rash, mental
retardation, heart defects; BAD in Pregnancy! – Congenital Rubella syndrome
○ Microcephaly
○ PDA (patent ductus arteriosus)
○ Cataracts
112
Rubeola: Measles what is the culprit?
Paramyxovirus
113
Rubeola: Measles s/s
```
Fever, cough, coryza, conjunctivitis
● Koplik spots (not always seen)
● Rash starts on head and spreads
● Rash “stains” (turns brown)
● Diarrhea/pneumonia/ encephalitis/corneal complications
```
114
Erythema Infectiosum: “Fifth Disease” PE?
Slapped cheek” syndrome
● Most infectious before rash starts
● Can also occur in adults; may cause arthralgias
115
Rubella is not common in what age group?
Uncommon in infants or people > 40 yrs old
116
influenza?
Orthomyxovirus
● 3 strains: A, B & C – typed based upon surface antigens (hemagglutinin and
neuraminidase)
● Type A: most common and more pathogenic
117
How is influenza transmitted?
Airbone respiratory secretions
118
Influenza s/s?
Sudden onset fever, sore throat, headache, myalgias, nonproductive cough
119
Influenza TX?
No more amantadine/rimantadine because of resistance! Neuraminidase inhibitors (zanamivir or oseltamivir-s/e N/V ) only recommended if given within 48 hours of Sx onset. Also,
give to patients being hospitalized
120
Influenza complications?
1º viral pneumonia, 2º bacterial pneumonia, COPD or asthma
| exacerbation; Reye’s syndrome in kids with aspirin use
121
Influenza MC cause of death?
secondary pneumonia (often staph
122
Influenza prevention?
Influenza vaccine
■ Contraindication (CI): Egg, gelatin, thimerosal allergy
○ Intranasal live attenuated
■ CI: > 50y, pregnant, DM, chronic lung dz, h/o Guillain-Barre
123
Rabies (Level 1)
Culprit: Rhabdovirus family
● Life threatening CNS infection
● Incubation period: 3-7 weeks
124
Rabies (Level 1) transmission?
Transmission: infected saliva from bites of rapid animals
○ Bats, raccoons, skunks, foxes
○ Dogs cause > 90% in developing countries
○ Very unlikely with rodents and rabbits
NOT RODENTS OR LAGOMORPHS
(rabbits)
125
Rabies (Level 1) s/s
Prodrome: Pain, paresthesias, itching at bite site
○ CNS phase: Hydrophobia (painful laryngospasm after drinking liquids),
encephalitis, numbness, paralysis, rage, hypersalivation (foaming at the
mouth)
○ Respiratory phase: Respiratory muscle paralysis → death
126
Rabies (Level 1) s/s
Prodrome: Pain, paresthesias, itching at bite site
○ CNS phase: Hydrophobia (painful laryngospasm after drinking liquids),
encephalitis, numbness, paralysis, rage, hypersalivation (foaming at the
mouth)
○ Respiratory phase: Respiratory muscle paralysis → death
127
Rabies (Level 1) Dx
Dx: Negri bodies in the brain of the dead animal or animal observation 7-10 days
128
Rabies (Level 1) TX?
No tx or cure !! Once symptoms start, survival is unlikely
| ○ Coma induction, amantadine and ribavirin
129
RAbies Post exposure prophylaxis for 1st exposure
If person asleep in room where a bat is found/seen, they need prophylaxis
even without visible bite**
○ HDCV (Rabies vaccine) on days 0, 3, 7, 14 PLUS rabies immunoglobulin (½
dose in the wound and ½ dose IM)
Exception is in immunosuppressed patients who should get a 5th shot on day 28
■ Ideally within 6 days of exposure
○ Subsequent exposures: Vaccine on day 0 and 3 only, no immunoglobulin
Pre-exposure vaccination of high-risk individuals (vets, animal handlers
130
Human papillomavirus (HPV) infections (Level 2)? Types?
Clinical manifestation: Infects keratinized skin causing excess proliferation which
leads to papules
● Types:
○ Cutaneous HPV: Warts (verruca)
■ Common, plantar and flat
○ Mucosal HPV: Genital warts (condyloma acuminata), cervical
dysplasia/cancer and anogenital cancer
131
Human papillomavirus (HPV) infections (Level 2)? Types?
Clinical manifestation: Infects keratinized skin causing excess proliferation which
leads to papules
● Types:
○ Cutaneous HPV: Warts (verruca)
■ Common, plantar and flat
○ Mucosal HPV: Genital warts (condyloma acuminata), cervical
dysplasia/cancer and anogenital cancer
132
Human papillomavirus (HPV) infections (Level 2) s/s?
Common/plantar warts: Firm papules with red-brown punctuations
(thrombosed capillaries are pathognomonic)
○ Flat warts: Numerous, small flesh colored papules
■ Typical on hands, face
○ Genital: Small, painless papules evolve into soft, fleshy cauliflower like
lesions May persist for months
133
Human papillomavirus (HPV) infections (Level 2) DX?
Clinical appearance
| ○ Mucosal: Whitening of lesion with acetic acid application
134
Human papillomavirus (HPV) infections (Level 2) Tx?
Most warts resolve spontaneously within 2 years if immunocompetent
○ Common/plantar: Topical salicylic acid, cryotherapy
○ Genital: Cryotherapy, podophyllin
135
Human papillomavirus (HPV) infections (Level 2) Prevention?
HPV vaccine against strains 6,11,16,18 and new HPV vaccine
| also covers 9, 31, 33, 45, 52, 58
136
HIV infection (Level 1)
HIV is a retrovirus that converts viral RNA into DNA via reverse transcriptase; Spectrum – time from infection to symptomatic disease averages 10 years but quite
variable
137
HIV infection (Level 1) Transmission?
Mucosal contact with infected blood, needle stick injuries, sexual
intercourse, IV drug use, mother to child during childbirth/breastfeeding
138
HIV infection (Level 1) s/s
Acute seroconversion: Flu-like symptoms, fever, malaise, generalized rash,
lymphadenopathy
○ AIDS: CD4 count < 200 or development of AIDS defining illness
139
HIV infection (Level 1) opportunistic infections?
CD4 > 500 LN
○ CD4 500-200 Tuberculosis, Kaposi sarcoma, oral candidiasis (thrush),
herpes zoster Salmonella, C diff colitis, HSV
○ CD4 ≤200 Pneumocystis pneumonia (PCP) or Pneumocystis jiroveci
pneumonia; Candidiasis, HIV encephalopathy, AIDS dementia. , Non-Hodgkin B-cell lymphoma
○ CD4 ≤150 Histoplasmosis
○ CD4 ≤100 Toxoplasmosis, Cryptococcus
○ CD4 ≤50 Mycobacterium Avium Complex (MAC), CMV retinitis
140
HIV infection (Level 1) dx?
Rapid HIV tests now available
○ ELISA test : Detects anti-HIV antibody in blood
■ Can take up to 6 mo to appear after exposure
■ High sensitivity, moderate specificity
○ Western blot: Confirmatory
○ HIV RNA PCR: Detects viral load
■ Used to monitor infectivity and treatment effectiveness
○ CD4+ count
■ Indicates degree of immunosuppression
141
HIV infection (Level 1)Tx ?
Combinations of NNRTI, NRTI, PI (non-nucleoside reverse transcriptase
inhibitors, nucleoside reverse transcriptase inhibitors, protease inhibitors
142
Hiv post exposure prophylaxis ?
Post exposure prophylaxis: Start within 72 hours of exposure
143
NRTI Drugs?
Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC),
Stavudine (Zerit), Lamivudine (Epivir), Abacavir
(Ziagen)
144
NRTI Drugs?
| nucleoside reverse transcriptase inhibitor
Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC),
Stavudine (Zerit), Lamivudine (Epivir), Abacavir
(Ziagen)
145
NNRTI
Nevirapine (Viramune), Delaviridine (Rescriptor),
| Efavirenz (Sustiva)
146
NNRTI nonnucleoside RTI drugs?
Nevirapine (Viramune), Delaviridine (Rescriptor),
| Efavirenz (Sustiva)
147
PI drugs? proease
| inhibitor
Saquinavir (Invirase), Ritonavir (Norvir), Inidinavir
(Crixivan), Nelfinavir (Viracept), Lopinavir/ritonavir
(Kaletra
148
PI s/e ?
Headache, GI,
| Crixivan – kidney stones
149
Entry inhibitor drugs?
Enfuviritide (Fuzeon)
150
Entry inhibitor s/e?
Injection site pain,
| allergic rxn
151
Lyme disease (Level 2
Borrelia burgdorferi ; gram-neg spirochete
| ● Vector: Ixodes (deer) tick
152
Lyme disease (Level 2
Borrelia burgdorferi ; gram-neg spirochete
| ● Vector: Ixodes (deer) tick; Most common vector borne disease in the USA
153
Lyme disease (Level 2) typically located in what part of the country?
EAST -Northeast, Midwest, Mid-Atlantic
154
Lyme disease (Level 2) -Stage 1
Erythema migrans (EM): Expanding warm annular red rash with
central clearing, “bull’s eye” in appearance
● Usually appears within 1 mo of bite
● Expands slowly days to weeks
■ Viral-like syndrome, fatigue, HA, lymphadenopathy
155
Lyme disease (Level 2) Stage 2
1-12wks
■ Arthritis in large joints, HA, CN palsies especially VII( ESPECIALLY IF YOU SEE BL BELL'S PASLY THINK LYME) AV block,
pericarditis, weakness
156
Lyme disease (Level ) stage 3
Persistent synovitis and neuro symptoms, subacute encephalitis
157
Lyme disease (Level 2) Dx ?
ELISA followed by Western Blot; Presence of EM, h/o tick bite, arthritis
■ May be seronegative early even with EM
158
Lyme disease (Level 2) Tx?
Early: Doxycycline, azithromycin/erythromycin
■ Amoxicillin if <8y, pregnancy
○ Late/severe: IV Ceftriaxone if AV heart block, syncope, dyspnea, meningitis; Doxycycline 200 mg x 1 within 72 hours of tick removal, if tick attached for
≥36hr and >20% of ticks infected in area
159
Rocky Mountain Spotted Fever (Level 2)
```
Rickettsia ricketsii (gram neg)
● Vector: Dermacentor andersoni/variabilis (wood/dog tick
```
160
Rocky Mountain Spotted Fever (Level 2) located where in us?
South-east/South-central US
161
Rocky Mountain Spotted Fever (Level 2) located where in us?
South-east/South-central US; ● Mostly Eastern US
162
Rocky Mountain Spotted Fever (Level 2) dx?
Don’t wait for serology
○ Clinical picture: H/o tick bite, fever, rash
○ Serology: indirect immunofluorescent antibody test
■ 4x ↑ in titers = acute disease
○ Skin biopsy
○ CSF
163
Rocky Mountain Spotted Fever (Level 2) Tx?
Ideal to start within 5 day of symptom onset
○ Doxycycline; even in kids <8y
■ Benefits outweigh risk in kids of permanent teeth staining (<8y)
○ Chloramphenicol in pregnancy
■ Associated with gray baby syndrome in 3rd trimester
164
Syphilis (Level 2)
Treponema pallidum; a spirochete
165
Syphilis (Level 2) Incubation period?
Incubation period: “Remember the 3s”
| ○ 3 days to 3 months and there are 3 phases
166
Syphilis (Level 2) Transmission period?
Direct contact of infected lesion during sexual activity and/or
contact with lesions on mucous membranes
167
Syphilis (Level 2) Primary
Chancre: Painless ulcer at/near inoculation site with raised edges, resolves
usually in 3-4 weeks with no medical management
○ Nontender lymphadenopathy near chancre for 3-4 weeks as well
168
Syphilis (Level 2) 2nd
Weeks to months after primary
○ Diffuse maculopapular rash typically on palms/soles
○ Condyloma lata: Moist wart-like lesion usually near chancre site, highly
contagious
○ Fever, lymphadenopathy, arthritis, headache
169
Syphilis (Level 2)3rd
Late, may be > 20 years after initial or latent infection
○ Non cancerous granulomas of skin called gummas
Neurosphylis. Argyll-Robertson pupil: Small, irregular pupil that does not constrict/react
to light but constricts normally to near accommodation
○ Aortitis, aortic regurgitation, aortic aneurysms
170
Syphilis (Level 2)-neurosphyilis
HA, dementia, Tabes dorsalis (demyelination of posterior
| column causing ataxia, areflexia, weakness)
171
Argyll-Robertson pupil:
Small, irregular pupil that does not constrict/react
to light but constricts normally to near accommodation; learning aid: like a prostitute they
accommodate but do not react)
172
Syphilis (Level 2)-Latent
Defined as asymptomatic infection with normal physical exam and positive
serologic testing
173
Syphilis (Level 2)-Congential
Hutchinson teeth (notches noted on teeth)
○ Hearing loss
○ Saddle-nose deformity
○ ToRCH syndrome
174
Syphilis (Level 2)Dx
Dx: RPR/VDRL, confirm with FTA-ABS (because there are lots of false positives)
175
Syphilis (Level 2) Tx?
Penicillin G
■ Desensitization for penicillin allergic patients
● Doxycycline, macrolide, ceftriaxone if unable to give PCN but
not as effective
■ S/E of Pen tx: Jarisch-Herxheimer reaction
● Acute febrile response to rapid spirochete destruction
● Myalgias, HA
● Give antipyretics in first 24 hr of treatment to reduce
incidence; Followup
○ Clinical and serologic reexamine at 6 and 12 mo
○ If not a 4x ↓ in titers at 6 mo, considered a treatment failure or reinfection
scenario
176
Tuberculosis (Level 2)
Mycobacterium tuberculosis
| ● High mortality in untreated 50-80%, <5% when treated
177
TB high risk populations?
High risk populations
○ Health care workers with close contact with TB patients = ↑ exposure risk
○ Immigrants from high prevalence countries, homeless =↑ infection risk
○ Immunodeficiency = ↑ risk to have active TB infection
178
Tuberculosis (Level 2) transmission ?
Transmission: Airborne droplets
179
Tuberculosis (Level 2) primary?
```
1º TB is usually self limiting
● Primary rapidly progressive TB
○ Active infection with clinical progression, common in kids < 4y in endemic
areas
○ Contagious
```
180
Tuberculosis (Level 2) primary?
```
1º TB is usually self limiting
● Primary rapidly progressive TB
○ Active infection with clinical progression, common in kids < 4y in endemic
areas
○ Contagious
```
181
Tuberculosis (Level 2) Chronic latent infection ?
90% of patients control primary infection via granuloma formation
○ Caseating granulomas have central necrosis and low O2 which make it
hostile for Mycobacterium to live/grow PPD positive after 2-4 weeks
○ Not contagious
182
2nd reactivation of TB?
2º reactivation
○ Reactivation of latent TB due to waning immune defenses
■ HIV, elderly, steroid use
○ PE: Cavitary lesions seen in apex/upper lobes
○ Contagious
183
TB s/s of Pulmonary?
Chronic productive cough, pleuritic chest pain, hemoptysis with
advanced disease
■ Night sweats, fever/chills, fatigue, weight loss
■ Consolidation near apices on physical exam
184
TB s/s of Extrapulmonary TB?
Extrapulmonary TB can affect any organ
■ Vertebral involvement: Pott’s disease
■ Lymph nodes (scrofula)
■ Meningitis, pericarditis
185
TB Screening ?
Skin PPD read within 48-72h
○ Positive PPD criteria
■ If ≥ 5mm in HIV/immunocompromised, in close contacts of active TB,
with CXR showing old TB
■ If ≥ 10mm in all other high risk populations
■ If ≥ 15mm in everyone else with no risk factors
○ False positive if within 2-10 yrs of BCG vaccine
186
TB dx?
Acid fast smear *gold standard* and sputum culture x 3 days
■ TB ruled out after 3 negative smears
○ CXR to exclude active TB with positive PPD, yearly as screening with
patients with known positive PPD
■ 1º TB also seen middle/lower lobe
■ Reactivation seen in apices
■ Miliary: Small “millet seed” 2-4 mm nodules
■ Granuloma: Evidence of healed TB
○ Interferon gamma release assay
■ Blood test, ↑specificity, not affected by BCG
187
TB Tx for active?
Active TB treated with 4 drugs x2 mo, then 2 drugs x additional 4mo (total
treatment 6 mo or 3 mo after negative sputum culture)
■ Isoniazid (INH) + Rifampin (RIF) for full 6 mo, Pyrazinamide (PZA) +
Ethambutol (EMB) for first 2 mo
● INH, RIF, PZA are hepatotoxic; LFTs at baseline and during
therapy
● May need individual case management with direct observed
therapy (DOT) to ensure compliance of meds
Respiratory precaution/isolation: Patients are no longer contagious 2
weeks after meds started
○
188
TB tx for Latent TB?
Latent TB
■ INH, Pyridoxine x9 mo or x12 mo if HIV positive
■ To be latent: Positive PPD plus no symptoms plus no evidence of
active infection on CXR/CT
189
Vaginal candidiasis (Level 2)
Culprit: Candida albicans overgrowth
| ● Risks: DM, recent antibiotic or steroid use, pregnancy
190
Vaginal candidiasis (Level 2) s/s ?
/S: Pruritus, vaginal discharge, dysuria, dyspareunia
| ● Discharge: Thick, white, “cottage cheese” texture with no odor
191
Vaginal candidiasis (Level 2) dx?
Hyphae, yeast on KOH prep
192
Vaginal candidiasis (Level 2) tx?
Fluconazole PO x 1, intravaginal antifungal creams
193
Pinworm infestation (Level 2)
Culprit: Enterobius vermicularis; Demographic: Common in kids
194
Pinworm infestation (Level 2)
Culprit: Enterobius vermicularis; Demographic: Common in kids, Humans are the only host
195
Pinworm infestation (Level 2) Transmission? Life cycle?
Transmission: Fecal-oral (ex hands, fomites, food-swallow eggs ); Life cycle-Adult worms attach to cecal mucosa, gravid female migrates distally and lays eggs on
perianal skin causing itching → hand to oral ingestion → eggs hatch in duodenum Eggs are viable for 2-3 weeks
196
Pinworm infestation (Level 2) dx?
Scotch tape test to look for eggs
197
Pinworm infestation (Level 2) ?
Albendazole, Mebendazole, Pyrantel pamoate
198
Measles (Level 2)
Culprit: Paramyxovirus family
| ● Incubation period: 10-12 days
199
Measles (Level 2) Transmission?
Respiratory droplets, airborne, person to person
200
Measles (Level 2) s/s?
The “3 Cs”: Cough, coryza, conjunctivitis
○ Fever coincides with rash
○ Koplik spots: Small red spots on buccal mucosa with blue/white pale center
■ Precedes rash by 1-2 days
○ Rash characteristics: Brick red maculopapular begins on face and moves to
extremities
■ Darkens and coalesces
■ Usually lasts 7 days, fades from top to bottom
201
Measles (Level 2) tx?
Supportive, anti-inflammatories
202
Measles (Level 2) complications? prevention?
Otitis media, diarrhea, pneumonia; Prevention: MMR vaccine
203
Mumps? Incubations time?
Culprit: Paramyxovirus family; 12-14 days
204
Mumps Transmission?
Respiratory droplets
○ Incidence ↑ in spring
○ Infectious for 48 hours before and 9 days after parotid swelling
205
Mumps s/s ?
Low grade fever, myalgias, headache then painful parotid gland swelling
206
Mumps Dx?
Serologies, ↑amylase
207
Mumps tx?
Supportive, illness last about 7-10 days
208
Mumps complications?
Orchitis, Most common cause of pancreatitis in kids
| ○ Deafness, infertility; Prevention: MMR vaccine
209
Toxoplasmosis
oxoplasma gondii (Protozoa)
● Infects all warm blooded animals
● One of the most common focal brain lesions in patients wit AIDS (ring enhancing
lesions on CT)
● Congential sydrome: causes birth defects
210
Toxoplasmosis life cycle? Transmission?
Lifecycle
● Cat eats infected rodent → cysts in feces → into soil/litter box → oral intake after
gardening or cleaning the litter
● Ingestion of cysts in raw meat or from handling raw meat/utensils/cutting board
Transmission
● Raw pork/lamb/venison (ingestion of toxoplasma cysts), cat feces (lives up to 1 year in
the environment
211
Toxoplasmosis presentation?
Primary: mild or asymptomatic, unless pt is pregnant → worst in early pregnancy
● Causes premature birth, eye/CNS/skin deformities, jaundice, splenomegaly
● Reactivation: HIV pts → encephalitis, focal brain lesions, retinal damage
212
Toxoplasmosis treatment?
Pyrimethamine
213
Malaria
Falciparum is the worst
● Common worldwide
● Anopheles mosquito transmits
214
Malaria Lifecycle?
Mosquito bites you with organism in saliva which migrates to your liver and then your
RBCs where it multiples and then causes RBC rupture... leading to anemia
215
Malaria Presentation? Dx? Tx?
chills, sweats, myalgias, headache
● Dx: by blood smear stains (not easy)
● Tx: chloroquine
● Prevention is key
216
MRSA Infection
Methicillin-resistant Staphylococcus aureus (MRSA) → defined as oxacillin minimum
inhibitory concentration (MIC) ≥ 4 μg/mL
o Hospital-associated MRSA (HA-MRSA)
o Community-associated MRSA (CA-MRSA)
217
MRSA Infection ? Gram stain?
Methicillin-resistant Staphylococcus aureus (MRSA) → defined as oxacillin minimum
inhibitory concentration (MIC) ≥ 4 μg/mL
o Hospital-associated MRSA (HA-MRSA)
o Community-associated MRSA (CA-MRSA); gram positive cocci occurring in clusters
218
MRSA Infection Skin & soft tissue
Cellulitis, abscess, necrotizing fasciitis, diabetic foot ulcer
219
MRSA Infection Bone & joint:
Osteomyelitis, septic arthritis (native & prosthetic joints)
220
MRSA Infection Pneumonia:
Necrotizing pneumonia following influenza infection, hospital-acquired &/or
ventilator-associated pneumonia
221
MRSA Infection Bacteremia:
ICU pts with central line placement
222
MRSA Infection Endocarditis:
Right-sided endocarditis commonly associated with IV
| drug use
223
MRSA Infection Clinical evaluation:
Initial gram stain & culture
o DNA polymerase chain reaction (PCR): most sensitive test
o DNA PCR from nares: used to r/o colonization
224
MRSA Infection Treatment: & Prevention
Removal of source if feasible (vascular catheters, etc)
o Oral: trimethoprim/sulfamethoxazole, tetracyclines, clindamycin
o Parenteral: vancomycin, daptomycin
● Prevention:
o Hand hygiene (hand washing), contact precautions (gloves, gown), isolation, screening
for MRSA colonization in outbreaks
225
Prenatal Transmission of HPV ? s/s?
Maternal → fetal vertical transmission of human papilloma virus (HPV) occurs in juvenile
laryngeal papillomatosis, infection of conjunctival, oral & genital mucosa
o Usually due to direct fetal contact with infected maternal cells during vaginal or
cesarean section delivery
o In utero & transplacental transmission can also occur;; most HPV infections are asymptomatic
226
Prenatal Transmission of HPV Treatment ?
usually none; most individuals clear infection within 12-24 months
o However, rates & determinants of perinatal transmission or of persistent infection,
and long-term sequelae in children are not known
227
Zika Virus organism?
Arthropod-borne flavivirus transmitted by mosquitos
228
Zika Virus transmission?
Transmission: infected mosquito bite (most common), maternal-fetal, sex, blood products,
organ/tissue transplant
o Zika RNA can be detected in: CSF, saliva, blood, urine, semen, ♀genital tract
secretions, amniotic fluid & breast milk
229
Zika Virus CM ?
Occurs in ~20-25% of infected adults; incubation: 2-14 days; usually mild dz lasting
2-7 days followed by immunity
o S/Sx: acute onset low-grade fever, maculopapular pruritic rash, arthralgia &
conjunctivitis; fetal loss may occur during pregnanc
230
Zika Virus RF?
travel advisories to locations <6,500 ft where Zika occurs; in the US,
includes Florida & Texas (check CDC website for current information)
231
Zika Virus Dx?
Sx ≤14 days, nucleic acid test (NAT) for Zika virus RNA
o (serum, urine, or whole blood); if negative or ≥14 days, Zika
o virus serology (IgM)
232
Zika Virus tx?
symptomatic (rest, fluids, acetaminophen)
233
Zika Virus prevention
```
mosquito protection (eg. repellent), environmental control (eg. standing
water), sexual protection or abstinence; currently, Ø vaccine
```
234
Zika Virus Main complications ?
In babies born to women infected during pregnancy → congenital Zika syndrome
(microcephaly, facial disproportion, irritability, hypertonia/spasticity, hyperreflexia,
seizures, sensorineural hearing loss, limb & ocular abnormalitiesGuillain-Barré, myelitis, meningoencephalitis
235
Prenatal Transmission of Zika Virus
Maternal → fetal vertical transmission of Zika virus can occur throughout pregnancy in
mothers with/without s/sx of dz
o Greatest risk to fetus: 1st & 2nd trimester infection (serious sequelae can occur in any
trimester)
o Mother’s dz severity or viral load do not predict infant outcomes
236
Prenatal Transmission of Zika Virus Pathogenesis:
Maternal infection → infection & injury of placenta
o Virus crosses placenta → targets fetal neural progenitor cells
o Affects neuronal growth, proliferation, differentiation & migration
237
SIRS/Sepsis
Systemic inflammatory response syndrome (SIRS)
o ± infection → dysregulated inflammatory response
o Non-infectious etiologies: autoimmune dz, pancreatitis, vasculitis, trauma, burns,
surgery
238
SiRS
Systemic inflammatory response syndrome (SIRS)
o ± infection → dysregulated inflammatory response
o Non-infectious etiologies: autoimmune dz, pancreatitis, vasculitis, trauma, burns,
surgery
239
SIRS/Sepsis Risk Factors?
ICU admission, nosocomial infection, bacteremia, ↑ age,
| immunosuppression, previous hospitalization, CAP
240
SIRS/Sepsis CM?
(high mortality rate):
o Sepsis: s/sx specific to infectious source (eg. cough), hypotension, tachycardia,
tachypnea, fever, leukocytosis, left shift, organ dysfunction (eg. oliguria)
o Septic shock: requirement of vasopressors despite adequate fluid resuscitation, ↑
lactate, multiple organ dysfunction syndrome (ARDS, AKI, AMS, DIC)
241
SIRS/Sepsis TX?
Sepsis: early administration of appropriate antibiotics
o SIRS/septic shock: aggressive fluid resuscitation, vasopressor agents; SIRS – specific
tx directed at underlying cause
