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Infectious Disease
infectious diseases and causative agents, presentation, epidemiology, and manage
| Question | Answer |
|---|---|
| Cause of PNA in ages <1 month | Group B Strep Enteric GNR Listeria Staph |
| Cause of CAP in ages >1 month | S. Pneumo H. Flu Mycoplasma Legionella |
| Cause of HCAP | CAP + Staph Enteric GNR Pseudomonas |
| Causes of VAP/HAP | HCAP + strenotrophomonas Aspiration PNA Lung abcess klebsiella |
| Empyema | Extension of PNA Poss. polymicrobial |
| E. Coli causes: | 80% of UTI's |
| Causative Agent: Impetigo | Staph Aereus Strep Pyogenes |
| Presentation: Impetigo | Honey crusted lesions on face or extremities |
| Cause of PNA in ages <1 month | Group B Strep Enteric GNR Listeria Staph |
| Epidemiology: Impetigo | summer poor hygiene crowded/impoverished settings |
| Cause of CAP in ages >1 month | S. Pneumo H. Flu Mycoplasma Legionella |
| Cause of HCAP | CAP + Staph Enteric GNR Pseudomonas |
| Causes of VAP/HAP | HCAP + strenotrophomonas Aspiration PNA Lung abcess klebsiella |
| Treatment for Impetigo with >5 lesions or ineffective topical treatment after 2-3 days: | Cephalexin (cephalosporin) Augmentin Dicloxicillin If PCN allergy: macrolide |
| Empyema | Extension of PNA Poss. polymicrobial |
| E. Coli causes: | 80% of UTI's |
| Causative Agent: Impetigo | Staph Aereus Strep Pyogenes |
| Presentation: Impetigo | Honey crusted lesions on face or extremities |
| Epidemiology: Impetigo | summer poor hygiene crowded/impoverished settings |
| Management: Impetigo | Mupirocin (Bactroban) Neomycin Bacitracin Polymixin B Neosporin |
| Treatment for Impetigo with >5 lesions or ineffective topical treatment after 2-3 days: | Cephalexin (cephalosporin) Augmentin Dicloxicillin If PCN allergy: macrolide |
| Causative Agent: Furuncle/Carbuncle | Staph Aureus Poss. need to I & D and culture bacteria Suspect MRSA |
| Epidemiology: Furuncle/Carbuncle | Healthy individuals with no predisposing conditions immunosuppression edema r/t lymph drainage bug bite, trauma, wound, ulcers |
| Management: Furuncle/Carbuncle | Cephalexin (cephalosporin) Augmentin Dicloxicillin All for 7 - 10 days If MRSA - Bactrim |
| Presentation: Furuncle/Carbuncle | cluster collection of pus within the dermis or subcutaneous space painful can have spontaneous drainage |
| Causative Agent: Cellulitis | bacterial infection of soft tissue Staph Group A Strep S Pneumoniae H. Influenza |
| Presentation: Cellulitis | Skin erythema edema warmth superficial bullae Lower extremities most common Usually unilateral |
| Epidemiology: Cellulitis | Middle aged and older adults immunosuppression edema r/t lymph drainage bug bite, trauma, wound, ulcers |
| Treatment: Celullitis: | Ceftriaxone (3rd generation Cephalosporin) Cefazolin (1st gen) for rapid spreading cellulitis Keflex if PCN allergy Include in strep in med coverage |
| Management: Cellulitis progresses to osteo think: | anaerobes pseudomonas staph group a strep gm neg cocci |
| Causative Agent: Acne Vulgaris | inflammatory disorder of pilosebaceous unit cellular immune responses genetics diet, obesity, stress androgen mediated stimulation of sebaceous glands |
| Presentation: Acne Vulgaris | recurrent papules, pustules, nodules on face/neck/trunk, proximal upper extremities |
| Epidemiology: Acne Vulgaris | adolescents and young adults |
| Treatment: Acne Vulgaris | benzoyl peroxide and clindamycin (lincosamide) erythomycin (macrolide) tetracycline acutane |
| Acutane | Treatment for Acne bad for pregnant women (teratogenic effects) need monthly pregnancy tests and two forms of birth control |
| Treatment for MRSA: | Bactrim (sulfonamides) Clindamycin (lincosamide) Doxycycline (Tetracycline) |
| Causative Agent: Herpes | Spread from infected person to infected person |
| Presentation: Herpes | HSV1: blisters on lips/mouth/face HSV2: Genital blisters Varicella Zoster: pruritic vesicles on skin and mucous membrane |
| Treatment: Herpes | Acyclovir prevention of recurrent HSV and tx of Varicella Shortens infection of genital herpes |
| Causative Agent: Tinea capitus/corporis/capitis | capitis: T. tonsurans 90% Corporis: T. rubrum Cruris: pt's own tinea pedis (foot to groin while dressing) - t rubrum JOCK ITCH OR RING WORM get infection from infected animal, soil, or person |
| Presentation: Tinea Capitius | fungal infection of scalp hair black dots from broken hair |
| Presentation: Tinea Corporis | fungal infection face, trunk, and/or extremities ring shaped lesions "ring worm" |
| Presentation: Tinea Cruris: | fungal infection of crural fold and gluteal cleft |
| Epidemiology: Tinea capitus/corporias/cruris | Capitus: children 3 - 9 Corporis: all ages Cruris: any age (rare in kids) males more |
| Treatment: Tinea capitus/corporis/cruris | Topical azoles: chlortrimazole, keotconazole, miconazole Terbinafine (lamisil) - MONITOR HEPATIC FUNCTIOn |
| Causative Agent: Onychomycosis | Dermatophytes - 90% (T. Rubrum) Yeasts Molds |
| Presentation; Onychomycosis | fungal infection of fingernails/toenails nail splitting nail destruction nail hyperkaratosis |
| Epidemiology: Onychomycosis | 50% adults > 70 15 -40% in persons with human immunodeficiency PVD Communal swimming pools Smoking history of nail trauma genetic cancer/diabetes/psoriasis |
| Treatment: Onychomycosis | Penlac topical ketaconaole oral lamisil (terbinafine) Very difficult to get rid of |
| Tinea Capitis med: | Griseofulvin caution in pregnant women (Cat C) |
| Causative Agent: Candidiasis | classified by site esophagus, vagina, mouth affected by use of corticosteroids, abxs, DM, HIV |
| Presentation: Candidiasis | Mouth: thrush - white plaques on tongue, buccal mucosa, palate Esophagus: pain on swallowing, white lesions noted on endoscopy Vulvovaginitis: itching and discharge |
| Epidemiology: Candidiasis | Mouth: infants, adults with dentures, pt on abx, chemo.radiation Esophagus: HIV or hematologic malignancy patients Vagina: women, oral contraceptives, increased estrogen levels, abx, glucocorticoids |
| Treatment: Candidiasis | 1st line treatment OTC azoles (miconazole) Thrush: Nystatin oral rinse Fluconazole (Diflucan used if failure of other topicals or multilple lesions) |
| Causative Agent: Acute Otitis Media | S. pneumoniae H. Influenzae M. Catarrhalis Inflammation of the middle ear |
| Presentation: Acute Otitis Media | unilateral muffled hearing ear pain |
| Treatment: Acute Otitis Media | Treat if fever or facial swelling Augmentin (beta lactamase inhibitor) If Penicillin allergy - use doxycycline Fluoroquinolones in adults (not kids) Amoxicllin or Augmentin in kids |
| Epidemiology: Acute Otitis Media | 6 - 24 months rare in adults increase in fall and winter |
| Causative Agent: Pharyngitis | Viral Treat only group a beta hemolytic strep or strep pyogenes (can cause rheumatic fever) |
| Presentation: Pharyngitis | sore throat worse with swallowing poss. headache/fever/malaise anterior chain lymphadenopathy |
| Epidemiology: Pharyngitis | GAS most common Use Centaur Criteria (4pts treat) all age groups |
| Treatment: Pharyngitis | Treat based on Centaur Criteria Rapid Strep to dx Pen V first choice If PCN allergy - 1st gen cephalosporin or macrolide |
| If patient with posterior cervical lymph nodes: | EBV |
| Causative Agent: Bronchitis | Viral if prolonged cough and/or dx of bordetella pertussis or mycoplasma pna can treat with abx |
| Presentation: Bronchitis | bronchial inflammation cough 1 - 3 weeks usually self limited |
| Treatment: Bronchitis | No abx unless micropurulent rhinitis with no improvement aftr 10 - 14 days or dx of bordetella pertussis or mycoplasma PNA |
| Causative Agent: Rhinosinusitis | majority are viral |
| Presentation: Rhinosinusitis | congestion obstruction facial pain tooth discomfort facial pressure worse with bending forward purulent nasal discharge |
| Epidemiology: Rhinosinusitis | early fall through early spring cigarette smoking dental infections/procedures cystic fibrosis asthma allergic rhinitis Viral URI |
| Treatment: Rhinosinusitis | Abx only if bacterial - use Augmentin or doxy as alternative No Sulfas or 3rd gen cephalosporins |
| Causative Agent: CAP - young children | S. Pneumoniae |
| Presentation: CAP - young children | fever cough (may not be featured due to underdeveloped alveoli cough receptors) respiratory findings |
| Treatment: CAP - young children | Amoxicillin Augmentin as alternative |
| Epidemiology: CAP - young children | >6 months to 5 years |
| Causative Agent: PNA infant 2 - 19 weeks | chlaymidia trachomatis |
| Presentation: PNA infant 2 - 19 weeks | fussy restlessness difficulty feeding fever leukocytosis |
| Treatment: PNA infant 2 - 19 weeks | PO azithromycin |
| Causative Agent: PNA in young adults | mycoplasma |
| Presentation: PNA in young adults | headache malaise low grade fevers nonproductive or worsening cough |
| Treatment: PNA in young adults | if pregnant and 1st line treatment- azithromycin (macrolide) 2nd line - levofloxacin (fluoroquinolone) |
| Causative Agent: Older Adult PNA | S. Pneumoniae H. Influenzae (older adults that smoke) |
| Presentation: Older Adult PNA | headache malaise low grade fevers nonproductive or worsening cough multiple comorbidities put patient at risk in this population |
| Treatment: Older Adult PNA | Pt with CV disease or risk for DRSP fluoroquinolone (levaquin, avelox) (NOT FIRST CHOICE IN HEALTHY ADULT) augmentin beta lactam ane a macrolide doxy |
| Epidemiology: Older Adult PNA | communal living nursing homes |
| Causative Agent: Bacterial GI Infections | Atypicals E. Coli, Shigella, Campylobacter Pseudomonas MRSA Enterobacteriaceae |
| Presentation: Bacterial GI Infections | N/V/D |
| Treatment: Bacterial GI Infections | Generally self limiting consider ABX in immunocompromised patients (fluoroquinolone, bactrim, ceftriaxone |
| Causative Agents: UTI | E. Coli 85% (50% of hosp acquired) gram negative bacilli S. Saphrophyticus (sexually active females) Klebsiella Proteus (in boys) poss. UTI or pregnancy |
| Presentation: UTI | burning upon urination dysuria urgency frequncy sensation of incomplete bladder emptying hematuria maladorious urine AMS nocturia sudden urinary incontinence |
| Epidemiology: UTI | young adults older adults mainly female |
| Treatment: UTI | Uncomplicated: Bactrim (sulfa) x3 days (covers E. Coli, klebsiella, proteus, enterobacter) If Sulfa resistant: fluoroquinolones (Cipro) broad spectrum Keflex (covers e. coli, klebsiella, proteus, staph) Amp/Amox: covers e.coli (poorly) |
| Treatment: UTI good first choice | Nitrofurantoin: covers E. Coli (do not use in complicated UTI) - good first choice because it is narrow spectrum, works in bladder |
| Causative Agent: Chlaymidia | bacterial |
| Treatment: UTI for <19 | Treat for complicated UTI even if not treat for 7 days instead of 3 |
| Presentation: Chlaymidia | purulent vaginal discharge dysuria bartholinitis abdominopelvic pain scrotal pain rectal pain or discharge acute arthritis |
| What should you always do with urine specimen? | URINE CULTURE |
| Epidemiology: Chlamydia | Increases risk of HIV Gram - ATYPICAL (macrolide) females ethnic minorities |
| Treatment: Chlamydia | Cotreat chlamydia with gonorhea pregnant: azithro not prego: doxy (more resistance to azithro) need to do test of cure |
| Causative Agent: Syphilis | Spirochete Treponema pallidum transmitted by blood transfusion can survive for decades transmitted via direct contact with active lesion also maternal-fetal |
| Presentation: Syphilis | rash alopecia gential lesions (chancre - primary syphillis) headache nausea fatigue (secondary) mental status changes (tertiary) |
| Epidemiology: Syphilis | congenital HIV co infection primarily in men |
| Treatment: Syphilis | Benzathine Penicillin G 2.4 million units IM x1 Recommended to desensitize patient to PCN if allergic |
| Causative Agent: Periorbital Cellulitis | bacterial |
| Presentation: Periorbital Cellulitis | erythema, warmth, induration of the periorbital soft tissue normal eye movement normal vision chemosis can have pain with EOM (if with fever, r/o orbital cellulitis) |
| Epidemiology: Periorbital Cellulitis | children average age of 21 months r/o orbital cellulitis sinusitis dental abscess infection to septum foreign bodies staph strep |
| Treatment: Periorbital Cellulitis | Cephalexin (uncomplicated) or clinda or sulfa Ceftriaxone and vanco (bacterial) |
Created by:
nicolellac
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