Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
ID2 C/P
Infectious Diseases II - Clinical pearl
| Question | Answer |
|---|---|
| Initiate Bactrim DS or SS daily if CD4 < 200 cells/mm3 and UNdetectable viral load | - PPx for Pneumocystis jirovecii pneumonia (PJP or PCP) - FALSE - CD4 < 200 AND a detectable viral load - OR CD4 < 100 regardless of viral load |
| If sulfa allergy, CD4 < 100 what test should be done prior initiating dapsone | - PPx for Pneumocystis jirovecii pneumonia (PJP or PCP) - dapsone can cause hemolysis if G6PD deficiency - Alternative • atovaquone - D/c PPx if CD4 ≥ 200 for ≥ 3 months AND remains on ART |
| IgG positive AND CD4 < 100 cells/mm | - A positive IgG indicates prior exposure (focal neurologic deficits) - SMX/TMP DS daily |
| Initiate Bactrim SS daily if IgG positive AND CD4 < 100 cells/mm3 | - FALSE - Bactrim DS daily - Covers: PCP and toxoplasmosis - Alternatives: atovaquone - Or dapsone + pyrimethamine + leucovorin - D/c PPx if CD4 ≥ 200 for ≥ 3 months AND remains on ART |
| Not taking ART, CD4 count < 50 cells/mm | - Ppx for Mycobacterium avium complex (MAC) - Azithromycin 1,200 mg QW - Azithromycin 600 mg Q2W (if nause w 1,200mg) - |
| If CD4 count < 50 cells/mm, Ppx for Mycobacterium avium complex (MAC) | - FALSE - Ppx if Not taking ART AND CD4 count < 50 |
| What PPx if CD4 drop below 200 cells/mm3, 100, 50 (plus other conditions) | - PCP prophylaxis (< 200 AND detectable virus load OR < 100) - Toxoplasma gondii prophylaxis (< 100 AND IgG positive) - MAC prophylaxis (< 50 AND not on ART) |
| Primary prophylaxis in transplant recipients | - Vaccinate prior to immunosuppressive therapy - High risk for CMV: letermovir or valganciclovir |
| Cytomegalovirus | CMV |
| Transplant recipients | - PPx CMV - Letermovir: kidney or bone marrow transplant - Valganciclovir in other solid organ transplants |
| PPx for CMV IF CD4 < 50 and NOT on ART | - FALSE - PPx for MAC w azithromycine 1,200mg QW - PPx for CMV in transplant recipients |
| Opportunistic infections: primary vs secondary prevention | |
| Opportunistic infections treatment | - PCP - Toxoplasma gondii encephalitis - MAC - CMV - Candidiasis "thrush" |
| Candidiasis "thrush" | - Oropharyngeal/esophageal - White film in mouth/throat - Prefer Fluconazole (HIV) ALTERNATIVE - Oropharyngeal: itraconazole, posaconazole, topicals (eg, clotrimazole troche, nystatin) - Esophageal: voriconazole, or echinocandin (eg, caspofungin) |
| Candidiasis "thrush" secondary PPx | - NOT recommend |
| Cryptococcal meningitis | - Headache, fever, blurred vision INDUCTION - Amphotericin B (liposomal) + flucytosine - Fluconazole + flucytosine - Fluconazole + Amphotericin B CONSOLIDATION - High-dose fluconazole MAINTENANCE - Low dose fluconazole (Secondary Prophylaxis) |
| Cytomegalovirus (CMV) | - Herpesvirus - Retinitis (most severe), GI tract, lungs, CNS - Valganciclovir (Produg PO for out pt), Ganciclovir (IV in pt): bone marrow suppression - Foscarnet, cidofovirIf (toxicity, resistant): nephrotoxicity - NON 2nd PPx |
| CMV Retinitis | Blurry vision, floaters, or even vision loss |
| Mycobacterium avium complex (MAC) | - Nontuberculous mycobacteria - Disseminated infection - Fever, night sweats, weight loss, anemia - Clari / azithromycin + ethambutol - Server /high virus: Add 3rd or 4th drug: Rifabutin, amikacin, streptomycin, moxifloxacin, levofloxacin |
| 2nd PPx MAC | - Same as treatment |
| 2nd PPx CMV | NON |
| Pneumocystis jirovecii pneumonia (PCP) | - Fungal infection - Subacute pneumonia - Progressive shortness of breath, dry cough, fever - Bactrim (15-20mg/d in multi doses) +/- prednisone /methylprednisolone 21Ds - Alternative: Pentamidine IV |
| 2nd PPx PCP | - SAME as primary PPx - Bactrim DS / SS QD - Alternative • atovaquone |
| Toxoplasma gondii encephalitis | - Protozoan parasite - Encephalitis - Risks: exposure to undercooked/raw meat, cat feces/litter - Pyrimethamine + leucovorin + sulfadiazine OR bactrim - Pyrimethamine + leucovorin + Clindamycin |
| Role of leucovorin in regimen for Toxoplasma gondii encephalitis | - Decrese bone marrow toxicity associated with pyrimethamine |
| 2nd PPx Toxoplasma gondii encephalitis | Same as treatment (reduced dose) |
| Toxoplasma gondii encephalitis: regimen for primary and secondary are the same | - Same if Bactrim Alternative - 1st PPx: atovaquone OR dapsone + pyrimethamine + leucovorin - 2nd PPx: Pyrimethamine + leucovorin + sulfadiazine OR Pyrimethamine + leucovorin + Clindamycin |
| 2nd OIs PPx for | - PCP - Toxoplasma gondii encephalitis - MAC |
| Meningitis causes | - Virus (most common) - Bacteria - Fungi |
| Meningitis common bacteria: - Group B Streptococcus - Streptococcus pneumoniae - Neisseria meningitidis | GRAM (+) - Group B streptococcus (cocci chain); Streptococcus pneumoniae (diplococci) - Listeria monocytogenes (rods) GRAM (-) - Neisseria meningitidis (diplococci): - Haemophilus influenzae (Coccobacilli) - E. coli (rods) |
| Meningitis clinical presentation | - Severe headache - HIGH Fever - Confusion - Stiff neck (pain with flexion: đau khi cúi cổ) / Nuchal rigidity - Other: • Chills • Vomiting • Seizures • Characteristic rash • Photophobia |
| Meningitis: Dx | - Lumbar Puncture (cerebral spinal fluid, CSF) prior initiate ABx - Culture - CSF analysis (LOW Glucose content, HIGH protein & WBC) - PCR (quicker) |
| Meningitis treatment: when to initiate IV dexamethasone | - Just before or with first-dose ABx - Cnt 4 days - D/C If S. pneumoniae |
| Agents do NOT penetrate into the CSE | - Zosyn - Clindamycin - Cefazolin |
| Meningitis treatment for neonant: can replace Zosyn to other ceftriaxone | - NO - Zosyn does NOT penetrate into CSF |
| Suspected bacteria in neonate with meningitis | - E. coli - Group B streptococci (strep agalactiae) - Listeria spp. - ABx: Ampicillin + Cefotaxime or gentamicin |
| Suspected bacteria in 1-23 months with meningitis | - S. pneumoniae - N. meningitidis - H. influenzae - E. coli - Group B streptococci |
| Suspected bacteria in 2-50 years with meningitis | - S. pneumoniae - N. meningitidis |
| Empiric Abx for 1m - 50 yrs w meningitis | - Ceftriaxone or cefotaxime - Vancomycin (double coverage for Streptococci) |
| Meningitis - Duration of therapy | • 7 days: HN • 10-14 days: S. pneumoniae • 14-21 days: Group B streptococcus (S. agalactiae) • ≥ 21 days: Listeria, gram-negative rods |
| cefazolin (t½ = 2 hours), redose every 4 hours | |
| Cardiac, Orthopedic, and Vascular Surgeries: Concerning organisms | - Skin flora: staphylococci & streptococci - Preferred ABx: Cefazolin or cefuroxime - Beta-lactam allergy: Vancomycin or clindamycin - Suspected MRSA as well: Cefazolin + Vanco |
| Gastrointestinal Surgeries: Concerning organisms | - Skin flora, AND - GI flora: E.coli, Klebsiella, Bacteroides fragilis (anaerobes) |
| Gastrointestinal Surgeries: selecting ABx | - Unasyn or - Cefoxitin or cefotetan or - Cefazolin + metronidazole Beta-lactam allergy - Metronidazole or clindamycin, PLUS - Fluoroquinolone or aminoglycoside |
| Otalgia (ear pain): tugging or rubbing the ears Irritability: crying, "fussiness" | |
| Initial Management Otitis Media if < 6 mos | - ABx |
| Initial Management SERVER Otitis Media: - Lotalgia-Đau tai- lasting 48 hours - Fluid draining from the ear - Tem: 102.2oF or 39oC | - ABx |
| Initial Management w both ears and 6-23 mo | - ABx |
| Initial Management if - 6-23 months w one ear - > = 2yrs 1 or 2 ears | ABx or Observation (2-3 days) |
| Otitis Media causative | - Virus - Bacteria: S. pneumoniae, H. influenzae, and Moraxella. catarrhalis |
| Otitis Media ABx selection | - ABx: : amoxicillin or augmentin : 90 mg/kg/day (High dose to penetrate) - Mild pen allergy: 2nd or 3th cepha - True allergy: Azithromycin - Treatment failure w amoxicillin: Augmentin - Treatment failure w Augmentin: Ceftriaxone IM x 3 days |
| Otitis Media: when Augmentin is indicated instead of amoxicillin | - Taken Amoxicillin within 30 Ds |
| Otitis Media: duration of treatment | 5-10 days |
| Types of Upper Respiratory Tract Infections | - Common cold - Influenza - Pharyngitis - Acute sinusitis - Acute Otitis Media |
| Common cold | - Rhinovirus, seasonal coronavirus - Sneezing, runny nose, congestion, mild sore throat and/or cough - Less than 101ºF, no myalgias - OTC |
| Influenza | - Influenza virus - Acute/sudden onset, fever, chills, fatigue, myalgias, dry cough, sore throat, headache - More severe than common cold - Antivirus |
| Influenza | - Oseltamivir (Tamiflu) - Baloxavir marboxil (Xofluza) - Out pt: Onset is ≤ 48 hours - Server (hospitalize, CHF, Lung, Liver, renal) : START |
| Neuraminidase inhibitors | - Oseltamivir (Tamiflu) |
| Endonuclease inhibitor (inhibit influenza viral replication) | - Baloxavir marboxil (Xofluza) - Single ONE-time dose |
| Pharyngitis | - Respiratory viruses - Group A Streptococcus (S. pyogenes) - Rapid antigen test: tonsil swab; Culture - Severe sore throat, fever, swollen lymph nodes, white patches (exudates) on the tonsils - Absence of cough, runny nose, congestion |
| Pharyngitis - ABx option | - Penicillin VK - Amoxicillin - Alternatives: 1st / 2nd cepha, macrolide, clindamycin |
| Acute sinusitis causations | - Respiratory viruses - S. pneumoniae, H. influenzae, M. catarrhalis |
| Acute sinusitis symtoms | - Nasal congestion, purulent nasal drainage, facial/ear/dental pain or pressure, headache, fever - Absence of cough |
| Acute sinusitis - Anti-infective therapy criteria | - Symptoms ≥ 10 days or - Symptoms worsen after initial improvement |
| Acute sinusitisTreatment options | - Symptom-specific OTC products - Watchful waiting - Amoxicillin +/- clavulanate if s/x not improved w/t 7 Ds. Doxycilline (allergy), NOOO azithromycin (strep pneu) |
| Acute Bronchitis pathogens | VIRUSES • Rhinovirus • Influenza • Seasonal coronavirus BACTERIA: rare • S. pneumoniae • H. influenzae • Atypicals • Bordetella pertussis |
| Acute Bronchitis s/x | • Cough for 1-3 weeks • +/- sputum production • LACK systemic symptoms (eg, fever, chills, malaise) • Wheezing or rhonchi audible on auscultation • NORMAL chest x-ray NO ABx |
| Pertussis (Whooping Cough) | - Bordetella pertussis - Droplet - highly contagious - Azithromycin, clarithromycin |
| COPD exacerbation | - H. influenzae, M. catarrhalis, S. pneumoniae - Pollution - Unknown |
| Management of acute COPD exacerbation | Supportive treatment: • Oxygen • Short-acting inhaled bronchodilators • IV or PO steroids |
Created by:
dao.vo11017