Treatment based on clinical presentation- don’t wait for test results Treat with immunoglobulin

infectious stuff Flashcards by Karina Borges

HIV and Aids Related Infections

Ophthalmologic illnesses

*CMV Retinitis

Blurry or worsening vision
Eye pain
Treat with ganciclovir

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HIV and Aids Related Infections

GI/Diarrheal illnesses

Cryptosporidium
Isospora
Oral/Esophageal candida

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HIV and Aids Related Infections

Neurologic illnesses

Cryptococcus
Headaches
AMS
High opening pressure on LP
Diagnosed with India Ink or Ag titer
Treat with Amphotericin B +/- Flucytosine
Toxoplasmosis
More focal neuro symptoms
CT with “ring enhancing lesions”
Treat with Pyrimethamine + Sulfadiazine + Folinic Acid

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HIV and Aids Related Infections

Pulmonary illnesses

-Not always PCP!
-Most common sources for pneumonia are still the common bugs (Strep pneumo and H. flu)
- With AIDS also consider:
— TB
—Pneumocystis pneumonia
———-Bilateral “ground-glass” opacities on CXR
High LDH on labs
———-Treat with TMP-SMX
———-Add steroids if very unwell

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HIV and Aids Related Infections

Oncologic illnesses

*Kaposi Sarcoma

Most common cancer in AIDS patients
Subcutaneous, red/brown or red/blue nodules on face and extremities
Can also occur within GI tract
Call Oncology

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Many adverse drug reactions related to HIV/AIDS therapy including

Didanosine → pancreatitis
Indinavir → kidney stones
Efavirenz → psychosis
Pentamide → hypo/hyperglycemia

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Bacterial food poisoning

Reheated fried rice
what kind of bug?

Bacillus cereus

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Bacterial food poisoning

Traveler’s diarrhea
what kind of bug?

E. coli

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Bacterial food poisoning

Contaminated meat and poultry
what kind of bug?

Clostridium perfringens

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Bacterial food poisoning

Contaminated water or shellfish
Watery diarrhea
Dehydration
Metabolic acidosis
Rehydration therapy

what kind of bug?

Vibrio cholera

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Bacterial food poisoning

Tuna, mackerel, and mahi-mahi
Histamine release
Metallic or peppery taste

what kind of bug?

Scombroid

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Bacterial food poisoning

Snapper, barracuda and grouper
Paresthesias
Reversal of hot/cold perception

what kind of bug?

Ciguatera

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Potentially fatal neuroparalytic syndrome caused by Clostridium botulinum
Descending motor neuron process, no sensory component
Neurotoxin acts at motor end plate → weakness → affects diaphragm → causes respiratory failure

Botulism

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_________ is spread by:

Foodborne
Improper canning techniques
Honey ingestion before age of 1

*IV drug users contract it in wounds

Spectrum of disease in infants
Constipation → Poor feeding → Weak cry → Floppy baby

Botulism

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Botulism treatment

Treatment based on clinical presentation- don’t wait for test results
Treat with immunoglobulin

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Febrile Traveler

Africa

African Sleeping Sickness
Spread by tsetse fly
Present with lethargy, sometimes psychosis
Treat with pentamidine or suramin
Ebola
Spread via direct contact with blood or bodily fluids/tissues of infected animals/people
Supportive treatment

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Febrile Traveler

Central or South America

*Chagas Disease

Reduviid “kissing” bug
Edema, cardiac and GI problems
Treat with anti-trypanosomals (benznidazole or nifurtimox)

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Febrile Traveler

Southeast Asia and Australia

*Leptospirosis

Animal vectors, contaminated soil, water
Severe forms of illness cause pulmonary hemorrhage
Treat with doxycycline or ceftriaxone

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Febrile Traveler

Tropics in general

*Dengue

Aedes mosquito
Fever, rash, and joint pain
Supportive treatment

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African Sleeping Sickness

treatment:

Treat with pentamidine or suramin

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Ebola

treatment:

Supportive treatment

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Chagas Disease

treatment:

Treat with anti-trypanosomals (benznidazole or nifurtimox)

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Leptospirosis

treatment:

Treat with doxycycline or ceftriaxone

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Dengue

Supportive treatment

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what kind of fungal infection? - Rhizopus fungus, aggressive infections - Nasopharynx of immunocompromised patients - Prompt surgical debridement

Mucormycosis

what kind of fungal infection? - Pulmonary disease most common - Increased risk if have asthma or COPD - Cavitary lesions - Consider chronic form in patients whose respiratory symptoms do not respond to prolonged antibiotic therapy

Aspergillosis

Mucormycosis Treatment:

Prompt surgical debridement

what kind of fungal infection? - Southwest USA, aerosolized spores from soil - Pulmonary disease - Synovitis - Hepatosplenomegaly - Meningitis leading to hydrocephalus - Treat with “azoles”, amphotericin B if disseminated

Coccidioidomycosis

Coccidioidomycosis Treatment:

Treat with “azoles”, amphotericin B if disseminated

what kind of fungal infection? - Ohio, Missouri and Mississippi River Valleys, bird droppings in damp soil - Pulmonary disease to disseminated disease - Disseminated form includes GI, cardiac, ocular and CNS effects - Treat with “azoles”

Histoplasmosis

Histoplasmosis Treatment:

Treat with “azoles”

what kind of fungal infection? - Great Lakes region, inhalation of spores - Pulmonary disease - Skin lesions- sharply demarcated, grey to violet verrucal lesions, irregular borders - Lytic bony lesions - Prostatitis - Treat with “azoles”

Blastomycosis

Blastomycosis Treatment:

Treat with “azoles”

what kind of gangrene? - “Mummified” appearance - Poor vascular supply - Not infected - Toes/fingers often auto-amputate - Well-demarcated regions

Dry gangrene

what kind of gangrene? - Bacterial infection - Poor blood supply - Malodorous - Erythema - Drainage - Ulceration - Aggressive antibiotic therapy - Can cause sepsis

Wet gangrene

what kind of gangrene? - Gas forming bacterial infection (Clostridium, Strep, Vibrio) - Necrotizing soft tissue infection - Crepitus on palpation - Gas on X-ray - Aggressive resuscitation and early surgical debridement - Immunocompromised patients are at high risk

Gas gangrene

- South West USA, spread via aerosolized mouse urine - Non-specific viral prodrome → respiratory failure/ ARDS/cardiovascular collapse - Supportive treatment

Hantavirus

* Sudden onset high fever, myalgias, sore throat * Pediatric population often present with GI symptoms * Risk of primary influenza pneumonia or secondary bacterial pneumonia * Treat with antivirals for high risk groups

Influenza

* Water-borne (plumbing, sprinklers) intra-cellular bacteria * Does not spread person-to-person * Usually pneumonia PLUS one or more of the following - GI symptoms - Hyponatremia - Proteinuria - Hematuria) * CXR may look atypical * Confirmatory test is urine legionella Ag * Treatment is azithromycin/quinolone

Legionella

Legionella treatment:

Treatment is azithromycin/quinolone

* Spirochete Borrelia that uses deer tick as host * Tick must be attached approx. 72 hrs. or longer to transmit disease * Lyme disease progresses in stages (days-months-years) * Classic case description: - Pennsylvania hiker (Northeast USA) - Erythema migrans (target lesions) spreading out from bite within days - Bell’s palsy (bilateral in particular) - AV block within months * Treat with doxycycline, or ceftriaxone for the ixodes tick * No doxycycline if under age 8 or if pregnant * Jarisch-Herxheimer reaction - Spirochete deaths → SIRS-like response (usually syphilis, but so see in Lyme)

Lyme Disease

Lyme Disease treatment :

*Treat with doxycycline, or ceftriaxone for the ixodes tick

Malaria | Test

Thick and thin peripheral blood smear

Malaria | Treatment

* Depends on type of malaria and where contracted | * Antimalarials (quinidine, artemisinins) and/or antibiotics such as doxycycline or clindamycin

* Animal reservoirs - Raccoons - skunks - foxes - bats - coyotes - Spread via bites/scratches from these animals - If bat found in house, residents should be treated for rabies (bats = high risk reservoir) *Bite/scratch injects virus into muscle from where it travels into CNS * Presentation - Viral prodrome → Furious stage (agitation) → “Dumb” stage (incoordination, paralysis) → Death

Rabies

Rabies | treatment:

* Inject as much rabies IG as possible directly into bite (depends on bite size and location) * Inject remaining amount via IM route in thigh * Initiate rabies vaccine series

* Toxoplasma gondii from cat feces * If immunocompetent might have flu-like illness, not usually severe presentation * Immunocompromised patients at higher risk of more serious illness, including * CNS infections - Retinitis - Myelopathy * Primary infection during pregnancy can cause severe congenital infections * Ring enhancing lesions on head CT/MRI * See IgM (early) and IgG (late)

Toxoplasmosis

Toxoplasmosis Treatment:

Treat with pyrimethamine or TMP-SMX

*Mosquito-borne * Clinical features - Usually flu-like illness - 1% develop meningoencephalitis * Labs - CSF pleocytosis - Send for West Nile Ab - CSF negative gram stain - CSF high protein count

West Nile Virus

West Nile Virus | treatment:

- Start treating immediately, don’t wait for cultures - Antibiotics and steroids - Antivirals

what kind of worm? * Perianal itching, worse at night * “Scratch then ingest” cycle * Scotch tape tes

Pinworm

what kind of worm? * GI infection → bloodstream → lungs → GI tract * Can cause eosinophilia

Roundworms (common roundworm, hookworm, strongyloides)

what kind of worm? * Elephantiasis * River blindness * Pulmonary problems

Flukes from soil and stool cause

what kind of worm? * Pork variant → cysts in muscles and brain → seizures * Fish variant → B12 deficiency

Tapeworms from raw pork/beef/fish

Worms | tx:

Albendazole and mebendazole for most; ivermectin for river blindness

*Hospital-acquired Device infections Indwelling lines * Community-acquired “Spider bite”o PVL gene association in the bacteria itself People living in close quarters - Members of sports teams * I&D if abscess * Clindamycin, TMP-SMX, or vancomycin * If recurrent infections, consider decolonization protocol (mupirocin in nose and skin cleaning for one week)

MRSA

MRSA | tx:

Clindamycin, TMP-SMX, or vancomycin

*Group A Strep, Staph aureus or polymicrobial most common * Clinical Features: - Erythema with poorly defined regions - Edema extends beyond regions of erythema - Hemorrhagic bullae - “Dishwater fluid” - Crepitus - Pain out of proportion - Hyponatremia - Leukocytosis - Lactic acidosis - High CRP - Gas in soft tissues on X-ray or CT * May exhibit “la belle indifference” where they are clearly severely ill but don’t seem to care * Requires early and aggressive surgical debridement * Clindamycin or broad-spectrum antibiotics

Necrotizing Fasciitis

* Usually secondary to Candida albicans * Newborns and immunocompromised patients are more susceptible * White/gray plaques in mouth/throat that can be scraped off * Swab shows yeast and micro-hyphae * Treatment * Nystatin swish and swallow QID * If treating breastfeeding newborn treat the mother’s breasts as well

Oral Candidiasis (Thrush)

Oral Candidiasis (Thrush) treatment:

* Nystatin swish and swallow QID | * If treating breastfeeding newborn treat the mother’s breasts as well

*Bordetella pertussis, highly contagious acute respiratory infection * Different phases of Bordetella pertussis - Catarrhal (URI) → Paroxysmal (cough and whoop) → Convalescent (weeks to months) * Serious complications - Secondary bacterial/viral pneumonias or other infection - Neonates can present with apneic, seizures/encephalitis/ICH * Supportive treatment unless secondary bacterial pneumonia, then antibiotics * Admit neonates * Macrolides to shorten illness and for post-exposure prophylaxis * Vaccinations and involve public health

Pertussis

* SIRS criteria = at least 2 of the following: - Temp >38º (100.4º) or <36º (96.8º) - RR >20 bpm (or PaCO2 <32) - HR >90 bpm - WBC >12,000 OR <4,000 OR >10% bands * Sepsis = SIRS + confirmed Infection * Severe Sepsis = Sepsis + 1 or more signs of organ dysfunction * Septic Shock = Severe Sepsis + hypotension refractory to fluids

Sepsis & Bacteremia

Sepsis & Bacteremia | treatment:

- Fluids - Antibiotics - Pressors

Sepsis & Bacteremia | Treatment Goals

- MAP >65 - Urine output >0.5-1cc/kg/hr - Central venous pressure >8mm Hg - Central venous O2 sat >70% - Decreasing serum lactate levels

* Haemophilus ducreyi (gram negative rod) * Highly infectious genital ulcerative disease * Increases risk of HIV transmission (as do all ulcerative STIs) * Don’t confuse with HSV * Chancroid ulcerations and inguinal lymphadenitis * Ulcers and bubos usually present at same time

Chancroid

Chancroid Treatment

Options include azithromycin, ceftriaxone, ciprofloxacin or erythromycin

*Wide range of clinical presentations (e.g. discharge, cervicitis, pelvic pain, dysuria) * Fitz-Hugh-Curtis syndrome - Ascending PID infection, presents with RUQ pain - “Violin string” adhesions around liver capsule *NAAT test (urine or vaginal swab)

Chlamydia

Chlamydia | Treatment

Azithromycin or doxycycline

*Common co-infection with chlamydia * Common sites of infection - Oral - Pharyngeal - Conjunctival - Anorectal - Cervical - Urethral * Disseminated Gonococcal Infection (DGI) has two common presentations (that may overlap) - Arthritis-dermatitis syndrome - Purulent arthritis without skin findings * May not have mucosal symptoms at time of presentation with DGI * Tenosynovitis and skin lesions are common in DGI but rare in other forms of infectious arthritis

Gonorrhea

Gonorrhea | Treatment:

* Ceftriaxone IM PLUS azithromycin or doxycycline (for likely co-infection with Chlamydia) * Longer course of treatment for DGI * DGI may need repeated surgical wash-outs

* HSV-1 and HSV-2 * Common viral syndrome in children * Clinically see: - Grouped vesicles, sometimes painful or tingling rash - Viral prodrome * Classic anatomical presentations: - Gingivostomatitis/pharyngitis-Oral infections - Herpetic whitlow-Infections on fingers (do not I+D these!) - Herpetic keratitis-Periorbital infections (Ophtho consult!) - Herpetic gladiatorum-Lesions on head, neck or trunk (think wrestlers) - Neonatal HSV-After transmission from active maternal infection during delivery - Eczema herpeticum-With supra-infection of eczematous lesions (potentially fatal!) - Urogenital outbreak - Can cause urinary retention (always check the genital region!)

Herpes Simplex

Herpes Simplex | Labs

Tzanck smear

Herpes Simplex | Treatment

Acyclovir or other antivirals

*Bacteria usually Staph or Strep * Contracted from: - Prolonged use of tampons - Nasal packing - Burns - Surgical sites - Secondary infection *Classic sign is erythroderma * If Staph - Diffuse rash with erythroderma/desquamation - Mucosal hyperemia - Septic shock * Rule out necrotizing soft tissue infection * High mortality

Toxic Shock Syndrome

Toxic Shock Syndrome | Treatment:

- Aggressive resuscitation - Fluids - Antibiotics

* Unilateral dermatomal rash - “dew drops on a rose petal” * Patients may get neuropathic pain preceding rash * Post-herpetic neuralgia can occur and can be hard to control * Treat with antivirals if rash has been present for < 72 hours of rash * Hutchinson sign - If see lesions on tip of nose, look for dendritic pattern on cornea - If corneal lesions, consult Ophthalmology urgently

Varicella Zoster

* 8th cranial nerve | * Ipsilateral facial paralysis, ear canal/pinna lesions, ear pain and vertigo

Ramsay Hunt Syndrome

Ramsay Hunt Syndrome | Treatment

* Antivirals * Steroids * Pain meds

infectious stuff Flashcards

(78 cards)