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24 Cards in this Set
- Front
- Back
MRSA -
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-humans are a natural reservior of staph aureus
-50% of all healthy adults are colonized -historically a nosocomial infx |
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CA-MRSa
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-skin and soft tissue infxs mostly
-can progress to serious, perhaps fatal necrotizing conditions |
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CA-MRSA whos at risk
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-younger pops:dermatologic conditions, attendance in day care and the presence of infection in another family member
-older pops:IVDU, prison inmates, low socioeconomic status/crowded living conditions or chronic disease (HIV, diabetes, chronic steroid use) |
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presentation CA-MRSA
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-often present with boils or pruritic papules
-may progress to form abscesses or cellulitis -may also progress to necrotizing -pneumonias, necrotizing fasciitis, scalded skin syndrome and TSS |
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CA-MRSA dx
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-inc index of suspicion
-wound cx -nasal swab |
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CA-MRSA tx
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-TMP/SMZ, tetracyclines, clindamycin
-quinolones -rifampin -linezolid (stop SSRIs) -mupirocin ointment intranasally -anti-bacterial soaps -household contacts: should be tx with mupirocin |
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C. Diff
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-causative agent in pseudomembranous colitis
-leading to severe diarrhea and colitis -Initially thought to affect hospitalized patients or those on antibiotics or in long-term facilities -C. diff is now affecting healthy patients |
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C. diff etiology
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-may occur when broad-spectrum abx eradicate nml GI flora
-C. diff infxs have been known to occur most often with pts taking clindamycin and second-and third generation cephalosporins |
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C. diff transmission
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-person-to-person
-spores are resistant to alcohol or other antiseptic wipes |
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C. diff a new strain
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-resistant to quinolones
-showing up more frequently in pts taking H2blockers and PPIs -affecting patients in the community and those who have not taken antibiotics or recently hospitalized |
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C.diff dx and tx
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-check stools for C.diff toxin
-tx: PO metronidazole or vanco |
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multi drug-resistant S.pneumoniae
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-causative agnet: meningitis, PNA, OM, bacterial RS, bacteremia
-patterns of resistance: PCN resistance may be as high as 30% in US -prevention: pneumovax |
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S. pyogenes
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-the causative agent of: strep throat, impetigo
-all isolates of S.pyogenes were PCN susceptible -the rate of resistance to the macrolide erythromycin was 5.5% -the majority of erythromycin-resistant strains were also resistant to clarithromycin and azithromycin..but susceptible to clindamycin |
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Pertussis
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-bordatella pertussis
-childhood vaccination does not provide immunity into adulthood -a sig proportion of infx occurs in adults and adolescent whose levels of ABs have declined |
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pertussis clinical presentation
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-cough lasting >2wks
-paroxysms of coughing -inspiratory whooping -posttussive emesis |
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pertussis sequelae
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-in infants, the disease may result in apnea, pneumonia, encephalopathy and death
-severe coughing may produce conjunctival and scleral hemorrhages, subcutaneous emphysema, PTX, rib fractures, hernias, seizures |
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pertussis transmission
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-highly contagious, can develop in up to 90% of family contacts
-spread by resp droplets -very contagious during the first week of illness |
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pertussis dx
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-CBC with diff: leukocytosis with lymphocytosis may be present
-preferred test is the nasal swab for PCR and culture confirmation |
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pertussis tx
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-erythromycin x 14 days
-macrolide-allergic: use TMP/SMZ -cough may persist beyond tx with abx -goal of therapy is to reduce transmission to others |
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pertussis prophylaxis
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-household contact should be treated, regardless of immunization status
-new vaccines are avail: Tdap -reportable disease |
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Respiratory synctial virus
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-pediatric illness on the rise inthe elderly
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RSV in elderly
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-accounted for 11% of hospitalizations for pneumonia, 11% for COPD, 5% for heart failure and 7% for asthma
-death rate was 8% for hospitalized patients and 7% for influenza patients -more dangerous in the elderly |
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RSV sx
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1. nasal congestion
2. sore throat 3. hoarsness 4. new or worsening cough 5. sputum production 6. +/- fever |
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RSV dx and tx
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-reverse-trascriptase PCR
-tx: largely supportive, ?Ribaviron, no vaccine |