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138 Cards in this Set
- Front
- Back
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Symptoms & Signs of cystitis are...
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PHD FB
-Pyuria, polyuria -Hematuria -Dysuria -Frequency -Bacteriuria NO FEVER!! |
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Symptoms & Signs of Upper UTI (e.g. pyelonephritis) are...
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FLDD
-Fever -Loin pain - abd pain radiates along flank to back -Dysuria -Decr'd renal function + signs/symptoms of cystitis] Renal abscess |
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Urethritis
- symptoms - cause |
Genital tract infection so...
- genital symptoms alone and no bladder symptoms - caused by gonorrhea, chlamydia, ureaplasma |
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What are complicated & uncomplicated UTI's?
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complicated = in males [almost always complicated]
uncomplicated = usually acute cystitis/pyelonephritis |
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Name the major pathogens of UTI (with ref to CA & HA)
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Gram -ve enteric (PEK)
-E coli CA75, HA50 -Klebsiella aerogenes HA20, CA10 -Proteus mirabilis HA20, CA10 Staphylococci CA=HA10 Others: e.g. Enterococci & Candida -HA20, CA10 |
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Name viruses that can cause UTI
- their characteristic feature is... - and lead to... |
- Adenovirus
- Polyoma virus [esp renal transplant = immunocompromised] - asymptomatic shedding -> causes: Nephropathy Hemorrhagic cystitis [dmg kidney->bladder inflam->hemorrhage] |
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Name a parasite causing UTI
-typically affects who? |
Schistosoma haematobium
- located in veins of bladder, affecting bladder - eggs come thru bladder wall into urine - typically in travelers who have returned from tropical countries (Portugal, Africa, India, Middle East) |
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Describe the pathogenesis of uropathogenic E coli
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i) Binding
-Type I pili = adhere, help colonize vagina, urethra -Type II pili = help colonize kidney ii) apoptosis & exfoliation of bladder epithelium -> Inflammation [leukoC] iii) Sat protease damages glomeruli, vacuolates epithelium Summary: uropathogenic E coli has specific virulence factors incl: -adherence -exo-&endo-toxins -Sat protease |
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How does Proteus cause calculi?
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Has urease: urea -> NH4+
->incr urine pH -> (+) Mg&Ca salt deposition -> calculi Result:blocks... -kidney: nephrolithiasis -ureter: ureterolithiasis |
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When does incidence of UTI incr in female and male?
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F = puberty
M = age50 = enlarged prostate, prostate cancer |
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Describe the body's defense mechanism against UTI
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HUMP
Hydrodynamic -ureteric peristaltic action -ureteral valves prevent reflux -periodic flushing of urethra [flush out bacteria] Urine constituents =antimicrobial @night [because it's too conc'd for bacteria] Mucosal immunity= sIgA [secretory: inhibits bacterial adhesion] IgG Prostatic fluids =antimicrobial [problem if prostate cancer] |
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Describe the tx for asymptomatic bacteriuria
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Non-pregnant = benign, no tx needed
Pregnant - incr'd risk of: ---pyelonephritis, esp in 2nd trimester ---?low birth weight, preterm delivery Antibiotic tx: - Beta lactam - Nitrofurantoin (cystitis) AVOID "ttfs": tetracycline, fluoroquinolone, trimethoprim/sulfamethoxazole |
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Tx for Uncomplicated Cystitis in non-pregnant woman is...
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1st line "cnt":
co-amoxyclav [single high dose/3d ] trimethoprim [single high dose/3d] nitrofurantoin [>3d] 2nd line: -oral cephalosporins -fluoroquinolone |
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Tx for Upper UTI
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Tx dep on severity:
-mild/moderate = ciprofloxacin [3-5d] -severe e.g. acute pyelonephritis = gentamicin iv HA/complicated TI's = IV may be more appropriate Asymptomatic = treat only children & pregnant woman |
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Distant effects: Name 2 urinary tract sequelae
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Impetigo (Streptococcus pyogene) -> Glomerulonephritis
Shigatoxin producing E coli (STEC) e.g. E Coli O157 -> Hemolytic Uraemic Syndrome (HUS) in age<12 |
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What is ESBL?
Which bacteria have ESBL? |
Extended Spectrum Beta Lactamases
- resistant to ALL penicillin, cephalosporin, and aztreonam (i.e. all β-lactams and aztreonam) -E coli and Klebsiella species |
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What Beta-lactam is used for empiric tx?
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cephalosporin
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Which 2 antibiotics are used exclusively in hospital?
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Aminoglycoside & metronidazole
-admin: IM/IV; no oral!! |
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Adjunctive drugs to overcome resistance against B-lactamase enz is...
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clavulanic acid & tazobactam (B-lactamase inhibitor)
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Penicillin
-spectrum? -for... -exception |
-narrow spectrum
-G+ve -Exception Neisseria (G-ve) |
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Name 2 broad spectrum penicillins
-current problem? |
Ampicillin
Amoxycillin -Problem: G+/- resistance |
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1st line tx for Staphylococcus aureus is...
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flucloxacillin
-B-lactamase stable -but ineffective against MRSA |
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Piperacillin
-what is it? -good for... |
-ESBL (Extended spectrum B-lactam antibiotic)
-Good for G-ve, Pseudomonas |
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Co-amoxyclav
-what is it? -good for... |
-Amoxycillin + Clavulanic acid
-Good for (sans): --Staphyloccocus --Streptococcus --Anaerobes --many G-ve |
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Tazocin
-what is it? -good for... |
-Piperacillin + Tazobactam
-Good for most bacteria |
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Carbapenems
-what is it? -name 2 examples -characteristic -good for... -it's use is... |
-B-lactam antibiotic
-imipenem, meropenem -extremely broad spectrum [for serious microbes] -Good for: --mixed infections --ESBL producers --it's use is limited - prevent development of resistance |
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Aztreonam
-what is it? -Good for... |
-B-lactam antibiotic (monobactem)
-limited to G-ve, good for carbapenemase producers |
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Cephalosporins
-compared to penicillin, it's... -good for... -poor activity against... |
-Compared to penicillin it's more B-lactamase stable
-wide range of microbes (ICU, empiric) -Poor activity against Enterococcus |
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Antibacterial activity of B-lactams depend on...
- |
-time above MIC (minimum inhibitory concentration)
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Problem with using B-lactam is...
What drug can be used to counter it? |
-it is rapidly excreted
-Probenicid = slows excretion |
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ADR to B-lactams are...
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AGNC
Allergic: cross-reactivity - <10% patients have cephalosporin allergy GI: diarrhea/antibiotic assoc'd colitis (Clostridium difficile) esp. Co-Amoxyclav Others: -Nephrotoxicity (penicillin) -inhibit blood Clotting (cefamandole, cefotetan) |
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NDM-1
-what is it? -tx? |
MDR-carbapenamase producer
Tx (ct): -colistin -tigecycline |
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Aminoglycoside
-For... -e.g. -route -risk -synergy with... -effective against... |
For:
-serious G-ve -Staphylococcus aureus E.g. TAG -Tobramycin (anti-pseudomona) -Amikacin (for gentamicin-R) -Gentamicin Route -IV [poorly absorbed in GI] -cf. IM more toxic Risk -nephrotoxic -low TI [need blood monitoring] Synergy with B-lactams =better functioning Effective against: -G-ve sepsis -Sepsis due Staph aureus |
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As opposed to conventional regime, "Once Daily Regime" for gentamicin is...
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-less nephrotoxic
-has post-antibiotic effect = killing continues despite sub-MIC -concentration-dep killing cf. conventional is MIC-dep |
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Macrolide/Azalide
-is for... -no activity against... -original macrolide is... -newer macrolides are... |
-for an alternative B-lactam to G+ve
-penetrate cell Good for: (Mars) -some Mycobacteria -Allergic to penicillin -Respiratory TI -STI's No activity against: -G-ve rods -Pseudomonas -Biofilm infection RACE-thromycin: -Erythromycin -CAR: -clarithromycin -azithromycin -roxithromycin |
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Fluoroquinolones
-good for... -e.g. |
-Good alternative B-lactam, esp G-ve aerobic rods
E.g. Nu Mr Cg Norfloxacin (UTI + G+ve) Moxifloxacin (RTI + G+ve) Ciprofloxacin (GIT) NB: newer Nor-&Moxifloxacin also for G+ve!! |
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Tetracycline
-not for... -e.g. -for... |
-PC: pregnancy/children
-e.g. doxycycline -for intraC bacteria (chlamydia), chronic RTI |
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Name an antibiotic for anaerobes
-mechanism of action? |
metronidazole
-admin'd as prodrug, anaerobes reduce it to activate it (i.e. specificity) |
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Main disadv's of using antibiotics?
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A LARS:
-Allergy -Liberation of pro-inflam cell wall fragments [can make it temporarily worse in patients] -incr'ing Resistance -Side effects -Antibiotic assoc'd diarrhea/colitis (esp. after clindamycin/chemotx for neoplasm) -->due to Clostridium difficile overgrowth |
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Antibiotics for MRSA are...
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Vancomycin
Linezolid |
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TORCH
- what are they? - which organs do each affect? - which ones cross the placenta? - |
Congenital infections:
Toxoplasma gondii - BELS: brain (mental retardation), eyes, liver, spleen Other: e.g. Listeria Rubella -HEEB: heart, eyes, ear, brain CMV -BELS: brain (hearing, mental retardation), eyes, liver, spleen HSV -disseminated infection via blood -> meningitis All crosses placenta except HSV which is via genital lesion [during passage of birth canal] |
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What is not effective in containing Norovirus transmission and why is that?
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Alcohol-based soap&water
-because it lacks lipid viral envelope (non-enveloped) |
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What are the signs of TORCH infection in neonates?
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FRFSH ("fresh") Jaundice
Fever Rash poor Feeding SGA (small for gestational age) Hepatosplenomegaly often Jaundice |
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What are latent signs of TORCH infection?
Typically occurs in which organism? |
CMV, toxoplasmosis
-hearing loss, mental retardation picked up in later of child |
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Lab tests for TORCH infection are...
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detection of microbe
or raised IgM [doesn't crosses placenta, neonate & infant make their own] |
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Ways of preventing TORCH infection are...
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HPVC:
-Hygiene: uncooked meat, cat feces (Toxoplasmosis) -avoid Preserved food (Listeria) -Vaccination (rubella) -Caesarean section (HSV) - prevents disseminated herpes infection |
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Bacterial rash result from...
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Bacteria releasing exotoxin or endotoxin -> DIC
e.g. Scarlet fever -Strep pygogenes have superantigens that cause exaggerated immune response |
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Viral rash results from...
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Multiplication of virus or immune interactions
e.g. -Measle rash: T cell-infected cell interaction in small vessels [cytotoxic T-cell attacking endoth cells] -Chickenpox rash: replication in epithelium |
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Tx for Scarlet fever is...
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penicillin
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Tx for Chickenpox is...
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?Acyclovir
-decr symptom by 1d -BUT no reduction in complications |
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Of the childhood diseases that cause rash, which of those do not have antivirals?
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MR FHM:
measles rubella fifth disease hand, food & mouth disease molluscum contagiosum |
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Scabies
-caused by... -risk for ... -safest tx is... |
-caused by mite: Sarcoptes scabiei
-risk for impetigo->glomerulonephritis: --skin break leads to strep pyogenes infection ->impetigo->glomerulonephritis -safest tx is Permethrin |
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Pathogenesis of Otitis media
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1) Blockage of eustachian tube due: (AUA)
-allergy -anatomical abnormality esp in children [narrow tube] [grows wider in adult]/ -URT infection: Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis 2) Absorption of air into tissue 3) Middle ear effusion (MEE) - i.e. effusion of fluid into middle ear |
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Describe OM with effusion
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ear drum begins bulging out due:
-inflammation in middle ear with - accumulation of fluid |
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Describe suppurative OM
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accumulation of pus behind ear drum
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Tx for chronic & recurrent OM patient is...
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Tympanostomy tube (Gromet)
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Symptoms of OM are...
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fever
pain diarrhea, vomiting |
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What are the problems with recurrent/chronic OM?
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Biofilm formation
-Escapes immune surveillance -Greater antibiotic resistance -Difficult to eradicate -Difficult to culture |
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Which URT causing organisms can cause OM?
- Current vaccines have ... |
Streptococcus pneumoniae
Haemophilus influenzae Moraxella catarrhalis - Current vaccines have little effect |
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Complications & consequences of OM are...
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Complications:
- Infection of mastoid space/bone - meningitis (rare) Consequences: -bilateral, chronic/recurrent disease, hearing-loss, delay language devm in 2-5yo |
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Tx for:
i) Acute OM ii) Glue ear iii) Chronic/persistent effusion |
i) AOM
antimicrobial not routinely given [withold 1-3d] - viral (50%): no tx - resolves by itself - bacterial (50%): amoxycillin, co-amoxyclav or azithromycin ii) glue ear = gromet iii) chronic/persistent effusion = gromet |
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Giardia duodenalis
- infects... -type of microbe -appropriate specimen |
-infects wild&domestic animals, human
-protozoa -"intermittent" thus need at least 3 fecal specimen; fecal specimen must also be warm |
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Giardia duodenalis Pathogenesis causing Acute Symptoms
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- Impairs absorption of electrolytes (Na, Cl, K)
Symptoms watery diarrhea abd cramps malaise nausea (2-4wk) NB: resolves w/o tx |
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Giardia duodenalis Pathogenesis causing Chronic Symptoms
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CBD:
-Crypt hyperplasia -Blunting of Microvilli -Digestive enz inhibition Leads to malabsorption of: -carbohydrates -fat -vitamins -folate |
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Cryptosporidium h & p
- hominis vs parvum - life cycle of Cryptosporidium |
hominis = infects human only
parvum = infects animal & human Life cycle: 1) new infection undergoes asexual reproduction [binary fission] 2) sexual reproduction: - forms 2 types of oocyst: -- thin walled oocyst = reinfects host -- thick oocyst exit via feces, survive in the environment to re-infect host or infect new host |
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- Symptoms of Acute Cryptosporidium infection
- Occurs in what kind of patients? |
immunocompetent patients
Acute (1-2wk): -acute watery diarrhea (5-10 frothy bowel motions) -abd cramps -slight fever (vomiting) |
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- Symptoms of Chronic Cryptosporidium infection
- Occurs in what kind of patients? |
immunocompromised patients
Chronic: -chronic diarrhea -may involve: --bile duct --respiratory tract [unusual cause of pneumonia] --intestinal wall --pancreas |
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Giardiasis is esp. prevalent in immunocomromised patient who have...
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hypogammaglobulinemia
-because need humoral response for removal of Giardia |
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Cryptosporidiosis is esp. prevalent in immunocomromised patient who have...
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HIV
-because need cell-mediated response for removal of Cryptosporidium |
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Method of transmission of Giardia & Cryptosporidium is...
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-Cysts excreted in human/animal feces (esp. calves)
--main source is contaminated water (chlorine resistant) --direct (fecal-oral) --food-borne |
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Tx for Giardiasis is...
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MAQ
-metronidazole (also for anerobic infection) -albendizole -quinacrine |
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Tx for Cryptosporidiosis is...
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-self-limiting (2wks)
-nitazoxanide (others) |
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Legionella pneumophila
-Lab test for diagnosis -mode of transmission |
Lab diagnosis
-PCR -G-ve but difficult to gram stain, difficult to culture, ?silver stain used instead. Transmission -contaminated water aerosols (shower, whirlpool spas, air-conditioning) |
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Pathogenesis of Legionella pneumophila
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Upon ingestion by macrophage
1) inhibit lysosome-phagosome fusion 2) recruit ER, modulate host gene expression [via producing host cell type proteins] -> cascade for cell proliferation 3) Multiply in phagosome 4) Regain motility and released from phagocyte via lipase&protease NB: virulence of ameba is similar to that of macrophage |
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Legionella pneumophila
-clinical syndromes are... -other indicators are... |
Clinical presentation:
-pontiac fever (hypersensitvity rxn = less severe outcome) -atypical pneumonia (Legionnaire's disease) --esp in: "rices" renal/cardiac disease immunocompromised COPD elderly smokers Other indicators: NURFDc -hypoNatremia -upper lobe infiltration -renal impairment -fever & diarrhea -raised Cr kinase |
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Tx for Legionella
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Azythromycin (usually not for G-ve)
Levofloxacin Rationale: because it is intraC life-styled (macrophage, lung fibroblasts) - need to penetrate host cell |
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Bacterial causes of STI's are...
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Neisseria gonorrhea
Chlamydia trochomatis Treponema pallidum ss pallidum NB: strictly sexually transmitted |
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Viral causes of STI's are...
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3H sip virus:
HSV2 HIV HPV NB: strictly sexually transmitted |
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STI-causing Microbes which may be transmitted by sexual contact (ie. not strictly sexual transmission) are ...
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genital Mycoplasma
Trichomonas vaginalis (protozoa) Candida albicans (yeast) |
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Chlamydia trachomatis
--prevalence in NZ -lifestyle -replicate in what cell type -EM shows... -Tx |
-2nd most common STI in NZ (1st: HPV)
-obligate intraC bacteria -trophism for non-ciliated epithelial cell EM: Inclusion body contains ER -Elementary body (small, survival mode) -Reticulate body (large, multiplying form) Tx = azythromycin (intraC) |
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Neisseria gonorrhea
-lifestyle -cellular trophism for... -Gram stain -Tx |
-free living
-trophism for non-ciliated columnar and transitional epithelial cells -G-ve diplococci Tx = ceftriaxone |
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Pathogenesis of Gonorrhea
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1) protease against IgA
2) attach to epithelial cell via pili 3) cell endocytose bacteria 4) prevents fusion with phagosome & lysosome 5) multiply and released 6) binds to macrophage, releasing TNFa 7) inflammations damages the host |
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C. trachomatis infects which part of female urinary tract?
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urethra, cervix, vagina
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N. gonorrheae infects which part of female urinary tract?
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Primarily infects endocervix:
cervix (post-puerty) vagina (pre-puberty) urethra - not usual |
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Discharge of C. trachomatis & N. gonorrheae are...
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C. trachomatis = muco-purulent
N. gonorrheae = purulent |
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Apart from urinary tract, C. trachomatis & N. gonorrhea affect which body part?
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C. trachomatis = eye (trachoma)
N. gonorrheae: -pharynx -rectum --disseminated: -eye -skin lesion |
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Neonatal infection of C. trachomatis & N. gonorrhea are...
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C. trachomatis
-pneumonia -conjunctivitis N. gonorrhea -Ophthalmia neonatorum |
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Types of Arthritis caused by C. trachomatis & N. gonorrhea are...
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C. trachomatis = Reiter's (reactive arthritis)
-- due cross-rxn: chlamydia has similar antigen to knee joint antigen N. gonorrhea = septic arthritis (purulent) |
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Ascending infection of C. trachomatis & N. gonorrhea:
-what is it? - e.g.'s |
inflammation causing:
- stricture (of tubular structure) - scarring - adhesion (e.g. side of fallopian tubes sticking together) E.g.'s "peu pies" Male ("peu"): prostatitis, epididymitis, urethral stricture Female ("pies"): PID, infertility, ectopic pregnancy, salpingitis |
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Treponema pallidum ss pallidum
-causes... -type of microbe -has ability to... |
- causes syphilis
- spirochaete, so can't be cultured - has enz that allows tissue penetration |
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Describe the stages of treponema pallidum ss pallidum
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Primary stage:
- initial lesion (chancre) --in genital tract or other site NB: often go unnoticed due minor single lesion Secondary stage (2-24wk): -disseminated from untreated primary via blood -reappears in lesions (skin =maculopapular rash/mucous membrane) -heals then relapse -can cross placenta: 50% die, 50% symptom = congenital syphilis Tertiary stage (latency period up to 20yrs) - about 1/3 of patients - extensive tissue dmg due cell-mediated immunity ->forms "gumma" in soft tissue and bone -> ulceration may flow -variable symptoms, dep on where it is e.g. brain - deafness, blindness |
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Lab dx of syphilis is..
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Serum for RPR
-detects antibody against lipoidal antigen that is released from damaged tissue Microscopy -although unable to culture, microscopy can detect characteristic morphology of the bacterium |
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Tx for Syphilis is ...
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Penicillin (7-10d)
-extremely sensitive to it -no effect on tertiary stage or Tetracycline (if penicllin allergy) |
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Genital herpes
-causal microbe is... -affects which body part? -Tx |
- HSV2 (HSV1 10%)
-affects genital tract/region Tx = Acyclovir |
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Anogenital warts
-causal microbe is... -also associated with ... -Tx |
- HPV6&11
- also assoc'd with cervical neoplasia & cancer (HPV16&18) Tx = no tx currently exist - immune system can clear infection within 2yrs in 90% of case |
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Vaginal thrush
-causal microbe is... -Tx |
Candida albicans (yeast)
Tx = fluconazole |
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Tx for Trichomonas vaginalis is...
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metronidazole
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Bacterial vaginosis
-overgrowth with... -assoc'd with incr'd... -Tx |
-mixed anerobic bacteria with biofilm infection
incr'd: -susceptibility to STI -doubles risk of pre-term labor -serious infection e.g. sepsis post-partum Tx = clindamycin [currently funded is metronidazole] |
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Vaginal thrush, bacterial vaginosis and trichomoniasis are STI - T/F
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False - they are caused by overgrowth of vaginal microflora components
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Describe the virulence factors of Staphylococcus aureus
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Cell wall assoc'd molecules:
-binds Fc portion of antibody -binds fibronectin (Techoic acid) Capsule = inhibits phagocytosis Exoenzymes: CSCHL -coagulase -staphylokinase -collagenase -hyaluronidase -lipase Exotoxins: -Panton Valentine leukocidin -Epidermolytic (exfoliative) |
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Describe the virulence factors of Streptococcus pyogenes
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Cell wall assoc'd molecules: (PIC FIn)
-Invade host cell (F protein) -binds Fibronectin (Lipotechoic acid) -Ig-binding -degrade C3b (M protein) -inhibits Phagocytosis Capsule = inhibits phagocytosis Exoenzymes: (CHDSS) -C5a peptidase -Hyaluronidase -DNAse -Streptolysins -Streptokinase Exotoxin -Erythrogenic toxin (superantigen) |
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Diseases only caused by Staphylococcus aureus virulence are...
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Epidermolytic exotoxin
->Staphylococcus scalded skin syndrome (SSSS) Bullous impetigo (localized SSSS) "PCP->C" Peptidoglycan, coagulase, Panton Valentine leucocidin esp. CA-MRSA ->Carbuncles |
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Diseases only caused by Streptococcus pyogenes virulence are...
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"HDS->EnF"
Hyaluronidase, DNase, Streptokinase ->Erysipelas & Necrotising Fasciitis Erythrogenic toxin (superantigen) ->Scarlet fever [usually follows pharyngitis] |
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Disease caused by Staph aureus &/or Strep pyogenes are...
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Techoic/lipotechoic acid
-> Impetigo/pyoderma "school sores" [Staph aureus alone, Staph aureus + Strep pyogene; other streps] Staphylokinase/Streptokinase ->Preseptal cellulitis [Staph aureus or Strep pyogenes; others: e.g. anaerobes] |
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Tx for uncomplicated Impetigo/pyoderma
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Tx = topical antibiotics
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Tx for skin/soft tissue abscesses
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antibiotics + surgical drainage
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Tx for Cellulitis
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Because it progresses rapidly,
Tx = empiric antibiotic therapy |
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Tx for Necrotising fasciitis
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25% mortality & rapid progression
Tx = surgery + antibiotic |
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Tx for Erysipelas
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Tx = Penicillin
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Acute bronchitis
-features -antibiotics? |
WNcs
-previously well, no chest signs or features of severity -virus (some bacteria) -usually no antibiotic tx |
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Tx for exacerbation of chronic bronchitis
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Bacteria may be involved (often low virulence) so antibiotics may be helpful
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Whooping cough
-causal organism -vaccination period & rationale -why vaccinate? |
Bordetella pertussis
-vaccinate at 3mo, 5mo, 4yr & 11yr rationale: short lived antibody response from vaccine -we vaccinate because significant mortality in <1yo |
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Modes of transmission of Pneumonia are..
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"ABA":
-Aerosols -Blood-borne -Aspiration of normal microflora |
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Symptoms of Pneumonia are...
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FC CDR
-fever -cough (sputum) -chest pain -dyspnea -difficulty/pain on breathing rales (crepitation) ronchi Elderly: -confusion -hypothermia |
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CXR of pneumonia may show...
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Lobar (consolidation)
Bronchopneumonia (pathcy, spreading) Interstitial Lung abscess (cavitation) |
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Prevalence of microbe causing pneumonia in different age-grp are:
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Children:
-mainly viral, secondary bacterial Adults: -bacterial more common Neonate -Chlamydia trachomatis |
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Typical CA Pneumonia
-features -causal microbe |
RWL
-Rapid onset -previously Well -Lobar distribution: R upper lobe -Streptococcus pneumoniae =G+ dipplococci |
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Atypical CA Pneumonia
-features -causal organisms |
-Adolescent
-Flu-like -Minimal chest signs: -moderate mucus -moderate incr in WBC (no leukocytosis) MCL: Caused by microbes that don't gram stain ... -Mycoplasma pneumoniae (no cell wall) -Chlamydia pneumoniae (intraC) -Legionella pneumophila |
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Bronchopneumonia
-features -causal organism |
SEuP
-Smoker -Elderly -underlying chest disease -Patchy, diffuse Haemophilus influenzae =gram -ve rod |
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Necrotising pneumonia
-features -Causal organism |
LETA:
Lobar Empyema Tissue destruction ->Abscess Early stg: resembles viral pneumonia (influenza) Caused by Staph aureus =G+ve coccus, cluster -Panton Valentine leukocidin -absent Neutrophilia |
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HA Pneumonia
-causal organisms |
-Haemophilus influenzae
-Staphylococcus aureus Intubated/ventilator: G-ve rods -Pseudomonas -Klebsiella pneumoniae |
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Aspiration pneumonia
-caused by... -feature |
-aspiration of URT microflora & food particles
-often polymicrobial: mixed aerobes & anaerobes -may be cavitation |
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Primary pneumonia
-occurs in... -causal organisms |
immunocompromised
- transplant, HIV CMV fungi: Aspergillus, Pneumocystis jiroveci TB & other mycobacteria |
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Beta lactams
|
penicillin, cephalosporins, combo (+clavulanic a)
-oral -not for intraC or mycoplasma |
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Aminoglycoside
|
TAG-cin
Gentamicin Tobramycin (anti-pseudomona) Amikacin (gentamicin resisitant) Good for serious G-ve + Staph aureus |
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Macrolide
|
RACE-thormycin
-Erythromycin (original) -Clarithromycin -Azithromycin -Roxithromycin Alt to B-lactam esp G+ve -good for mycoplasma, intraC |
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MRSA antibiotic
|
linezolid
vancomycin |
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Tx for TB
|
isoniazid, rifampicin
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Tetracycline is for...
|
intraC bacteria
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Metronidazole is for...
|
anerobes, Giardia
|
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Empiric tx of RTI
|
broad spectrum:
-ceftriaxone + other -Tazocin: tazobactem + piperacillin |
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Tx for Whooping cough
|
Pertussis bordetella
-Erythromycin |
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Tx for CA pneumonia
|
CAm
for no features of severity = amoxycilin / co-amoxyclav for severe = macrolide |
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Tx for Atypical pneumonia
|
Macrolide or Tetracycline
[intraC or mycoplasma] |
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Tx for Haemophilus influenzae
|
CC
-cefaclor -cefuroxime |
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Tx for Severe pneumonia
|
iv combo within 4h
e.g. co-amoxyclav/cefuroxime [2nd gen cephalosporins] + macrolide/fluoroquinolone Also adjunct therapy = oxygen, fluid |
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Tx for Necrotising pneumonia
|
iv flucloxacilin
COLOR: co-amoxyclav, cefaclor MRSA = iv vancomycin VRE (vancomycin-resistant enterococci) = iv linezolid |
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Tx for HA pneumonia
|
no previous antibiotics:
-co-amoxyclav or cefuroxime previous: either qCT -cefotaxime -fluoroquinolone -tazocin (tazobactam + piperacillin) |
