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67 Cards in this Set
- Front
- Back
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== TRAVEL MED=== |
=== TRAVEL MED=== |
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complicated malaria? |
- hyperparasitemia, defined as 5% to 10% or more of parasitized erythrocytes - Falciparum usually - seizures, DIC, AKI, hypoglycemia |
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Malaria species with i. high risk severity ii. Chloroquine resistance |
i. falciparum, knowlesi
ii. vivax, falciparum |
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malaria ppx if pregnant |
Avoid travel if possible. Chloroquine is the only safe med Mefloquine OK in 2nd-3rd trim |
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malaria ppx, chloroquine-resistant falciparum? |
Mefloquine, atovaquone/proguanil, doxycycline give before departure and after return |
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malaria TX, chloroquine-resistant falciparum? |
quinine sulfate + doxy OR atovaquone / proguanil (malarone) OR quinidine gluc + clinda OR artemisinin-amodiaquine |
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malaria ppx, chloroquine-sensitive falciparum? where found? |
(hydroxy) chloroquine mefloquine doxy primaquine found in Carib, cent america, near/mid east |
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malaria tx, chloroquine-sensitive falciparum? |
chloroquine + primaquine |
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malaria med conraindicated in G6PD def |
primaquine |
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malaria ppx, vivax |
(hydroxy) chloroquine mefloquine doxy primaquine Atovaquone/proguanil |
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malaria ppx for relapse d/t vivax or ovale |
Primaquine ASAP |
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most sensitive malaria test |
Antigen-based malaria rapid diagnostic test |
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Cerebral Malaria tx? |
IV doxy Quinidine Gluconate Arsenic |
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mefloquine contraindications |
pt with cardiac conduction defects |
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Classic “banana-shaped” gametocytes seen in |
falciparum malaria |
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Typhoid fever tx and ppx
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tx: 3rd gen cephalosporin > fluroquinolone ppx: vaccine oral live att or IM cell-free polysacc |
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When to use antimotility agents in traveler's diarrhea?
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- should be given only with antibiotic diarrhea treatment. - should not be used when dysenteric disease or bloody diarrhea is present |
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tx, rickettsial dz? |
doxy |
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Brucellosis i. risk factors ii. tx |
i. consuming unpasteurized milk, other dairy products, or undercooked meat ii. doxycycline, rifampin, and streptomycin (or gentamicin). |
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Fungal infection in HIV / immunocomp persons traveling to SE asia?
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Penicillium marneffei
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=== INFECTIOUS GI ===
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=== INFECTIOUS GI ===
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Diarrhea in an otherwise healthy person lasting for more than 7 days suggests
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parasitic / noninfectious origin
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stool cx indicated for
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symptoms lasting longer than 72 hours, particularly in patients with associated fever, tenesmus, or bloody or mucoid stools
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campylobacter, when is treatment indicated and what tx to give? |
- severe symptoms (high fever, frequent or bloody stools), or symptoms lasting longer than 7 days - azithromycin or erythromycin |
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Shigella, when to treat? what tx? |
Treat all positive cultures or suspected (decreases duration of sx and shedding) fluroquinolone x 5 d |
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Salmonella, when to treat and with what? |
(1) < 6 months or > 50 years of age; (2) presence of prosthetic heart valves or joints; (3) comorbidities (malignancy, uremia, SCD); (4) significant atherosclerotic disease (because of risk of infectious arteritis); and (5) impaired cellular immunity. - 5-7 d fluoroquinolone (14 d if immune defect) |
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E. coli O157:H7 i. culture grown on ii. tx |
i. sorbitol-MacConkey ii. no Abx (can induce HUS) |
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yersinia GI infection, tx? |
generally none if limited, fluroquinolone if severe or prolonged. |
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Vibrio diarrhea, when to treat? |
tx with doxy or fluoroquinolone if severe or pt has liver dz. |
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The presence of visible blood in the stool is diagnostic of hemorrhagic colitis, which in the United States is most often caused by |
Shiga toxin–producing Escherichia coli. |
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tx of c. Diff infection? |
Init: mild - flagyl 500 tid x 10-14d severe - oral vanco severe + organ failure - oral vanco (rectal if megacolon or ileus) + flagyl recurr 1 - as above recurr 2 - vanco taper up to 12 wk [fidaxomycin also approved by FDA] |
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giardia tx? |
flagyl 7-10d (also nitazoxanide, *bendazole) Lactose free diet after |
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crypto tx in HIV pt? |
nitazoxanide - optimized ART tx |
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amebiasis, tx? |
metronidazole, followed by a luminally active agent such as paromomycin or iodoquinol to eradicate intestinal reservoirs - also treat asymptomatic pt |
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==== TRANSPLANT MED ==== |
==== TRANSPLANT MED ==== |
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General immune suppressive regimen for transplant pt? |
Most transplant centers use a three-drug regimen consisting of prednisone, a calcineurin inhibitor, and an antimetabolite (usually mycophenolate mofetil). |
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Immunosuppression prior to allogeneic hematopoietic stem cell transplantation (HSCT) involves |
conditioning regimen of whole-body irradiation and myeloablative high-dose chemotherapy |
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In the early period (first month after solid-organ transplantation), patients are at risk for? |
-surgical site and wound infections (bact) - central line - PNA, C. diff |
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In the middle period (after 1 month) after transplant pt at risk for? |
- CMV reactivation and infection - EBV, polyoma BK virus, and hepatitis B and C viruses. - legionella, PCP, fungal |
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In the late period (more than a few months posttransplantation), pt at risk for? |
- less opportunist infections (CMV may still occur) - EBV-associated PTLD may develop. - Polyomavirus infections - Listeria and Nocardia and fungal infections also become relatively more frequent, as do severe episodes of community-acquired infections. |
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bone marrow |
bm infection |
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fever and an extranodal mass or lymphadenopathy after solid organ transplant? |
EBV infection with B-lymphocyte proliferation leading to PTLD, |
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nephropathy and ureteral strictures in kidney transplant recipients and may cause hemorrhagic cystitis in HSCT recipients caused by? |
Polyoma BK |
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== HOSPITAL-ACQUIRED INFECTION == |
== HOSPITAL-ACQUIRED INFECTION == |
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Hospital-acquired infections are defined as |
infections that develop after 48 hours of hospitalization, with no evidence that the infection was present or incubating at the time of admission |
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Ventilator-associated pneumonia is defined as |
pneumonia that develops more than 48 to 72 hours after beginning mechanical ventilation. |
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The four important components of treating HAP and VAP are to |
(1) treat early, (2) administer empiric broad-spectrum antimicrobial agents, (3) de-escalate antimicrobial coverage when appropriate, and (4) consider short-duration therapy (8 days) whenever feasible. |
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ways to reduce VAP? |
- HOB elevation - daily weaning assessment - chlorhexidine mouth care - continuous intermittent subglottic suctioning |
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treatment of CAUTI Prevention? |
- remove catheter, place new one if needed - get culture - treat 7-14d Prevention: avoid foley / use texas - hand hygeine, aseptic placement - smaller catheter - secure, below bladder, unobstructed |
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Surgical Site infections, risk factors? |
Pre-op: obesity, smoking, age, DM peri-op: surgery length, shaving, hypoxia post-op: hyperglycemia, poor wound care, blood transfusion |
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Surgical site infections, prevention? |
- control risk factors (smoking, glucose, length of hospital stay) - abx ppx 30-120 mins before - avoid shaving hair - chlorhexidine prep - minimize OR traffic - post-op glucose control |
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CLABSI prevention? |
- Bundles - avoid femoral vein (subclavian preferred) - chlorhexidine - hand hygeine - remove line ASAP |
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Therapeutic options for infections caused by carbapenem-resistant Enterobacteriaceae?
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- limited.
- Polymyxins, tigecycline (never as monotherapy), and sometimes, aminoglycosides |
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How to prevent c. diff in pt on antibiotics? |
Probiotics |
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=== INFECTIVE ENDOCARDITIS PREVENTION == |
== INFECTIVE ENDOCARDITITIS PREVENTION == |
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Infective endocarditis prophylaxis is recommended forpatients with |
(1) a prosthetic cardiac valve; (2) a previous episode of infective endocarditis; (3) unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; a completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure; and repaired congenital heart disease with residual defects; or (4) for cardiac transplantation recipients in whom cardiac valvulopathy develops. |
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recommended agents for endocardititis ppx? What procedures? |
amox/ampicillin, cefaz, clinda / azithro if allergic 30-60 min before, up to 2 hrs after - dental procedure, possibly respiratory - NOT for GI/GU or endoscopy |
