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78 Cards in this Set
- Front
- Back
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Patient Predisposing factors for nosocomial infections
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Neonates
Immunocompromised Elderly |
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Common sites of nosocomial infection
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Bacteremia: IV or central line
Pneumonia: endotracheal tube UTI: Foley Catheter Surgical site infection Gastroenteritis: rotavirus or C. difficile |
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Three modes of transmission
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Contact
Droplet >5 micron Airborne <5 micron |
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Contact precautions
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Non-sterile gloves required
Gowns if there is likely substantial direct contact Hand hygiene Dedicate medical equipment to patient room Clean and disinfect equipment used for other pts |
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Droplet precautions
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Non-sterile gloves required
Face mask, but not respirator Door may remain open Gowns if there is likely substantial direct contact Hand hygiene Dedicate medical equipment to patient room Clean and disinfect equipment used for other pts |
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Airborne precautions
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Non-sterile gloves required
Airborne isolation infection room (AIIR) Requires negative air pressure w/ 6-12 changes/hr Respirator with 95% filtering capacity Gowns if there is likely substantial direct contact Hand hygiene Dedicate medical equipment to patient room Clean and disinfect equipment used for other pts |
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Name and shape of organism causing pertussis
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Bordetella pertussis
Gram negative coccobacillus |
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Transmission of pertussis
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Respiratory Droplets
Bacteria adhere to ciliated eipthelium and proliferat into lower respiratory airways |
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Three Stages of pertussis
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Catarrhal
Paroxysmal Convalescent |
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S/S during catarrhal stage of pertussis
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Rhinorrhea and occasional cough marked by a copious discharge
1-2 weeks duration |
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S/S during paroxysmal stage of pertussis
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on/off forceful continuous cough followed by whoop
1-6 weeks duration |
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S/S during convalescent stage of pertussis
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Gradual resolution with less and less whoop
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Diagnosis of pertussis
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Cough lasting at least 2 wks with one of the following:
paroxysms of coughing inspiratory "whoop" Post-tussive vomiting without cause Lab: positive PCR for B. pertussis from sputum |
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Treatment of pertussis
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Erythromycin Q4 x 7 days
Supportive care: fluid, nutrition management, avoid cough triggers |
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Name and shape of organism causing diphtheria
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Corynebacterium diphtheria
Gram positive bacillus |
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How does diphtheria manifest itself inside the body
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Toxin is released and causes progressive deterioration of myelin sheaths in the CNS and PNS
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Two types of transmission of diphtheria
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Respiratory diphtheria: toxin producing strains
incubation is 2-5 days after infection Contact diphtheria: toxin or non-toxin producing strain. Causes chronic, non-healing sores or shallow ulcers with dirty gray membranes |
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Clinical presentation of diphtheria
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Sore throat
Low grade fever ADHERANT GRAY MEMBRANE on tonsils, pharynx, and nose BULL NECK swelling in sever disease states |
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Complications of diphtheria
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Myocarditis
Polyneuritis Airway obstruction |
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Diagnosis of diphtheria
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Culture of gray membrane reveals C. diphtheriae
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Treatment for diphtheria
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Erythromycin Q4 x 14 days
Severe cases- antitoxin |
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Name of shape of organism causing Haemophilus Influenza Type B (HiB)
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Haemophilus Influenza Serotype-B
Gram negative coccobacillus (encapsulated) |
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Transmission of HiB
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Respiratory droplets
Invasion of nasopharynx that may eventually enter the bloodstream and seed in other organs |
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Presentation of HiB
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HiB presents depending on where is manifests. Before the vaccine these were the most common:
Meningitis Epiglottitis Pneumonia Septic Arthritis |
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Treatment of HiB
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Ceftriaxone WITH chloramphenicol
Rifampin can be used as preventative treatment if exposed to the bacterium |
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What is the organism causing Measles
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Parmyxovirus
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Transmission of Measles
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Respiratory droplets
Contagious 4 days before to for days after rash onset (incubation is 10-12 days) |
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Hallmark of measles
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Koplick Spots
"grains of salt on a wet background" |
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Clinical presentation of Measles
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Prodrome of increasing fever, cough, coryza, conjunc.
Koplick spots Rash: maculopapular, erythematous rash that starts on the scalp and descends. Lasts 5-6 days |
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Diagnostic findings of measles
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Leukopenia
Increased IgM ELISA testing |
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Complications of Measles
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Pneumonia
Otitis Media Diarrhea |
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Treatment of Measles
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Self-limiting
Treat symptoms with tylenol/ibu for fever |
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Define DTaP
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Diphtheria/ Tetanus Toxoids/ Acellular Pertussis
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Dosing of DTaP vaccine
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5 Doses
2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 years Adult booster ever 10 years |
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Hib Vaccine dosing
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4 Doses
2 mo, 4 mo, 6, mo 15-18 mo People >5 do not need boosters unless immunocompromised |
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MMR Vaccine dosing
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2 doses
12-15 mo, 4-6 years Most are immune after first vaccine, but second dose shows 99.7% lifelong immunity |
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What is the organism causing mumps
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Paramyxovirus
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Transmission of mumps
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Respiratory droplet
Saliva or mucus Contagious 1-7 days before onset and up to 9 after |
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Hallmark of mumps
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"Parotid tenderness with overlying facial edema"
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S/S of mumps
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Minimal fever
Headache Fatigue Parotid and salivary glands tender, painful, swollen Facial edema |
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Diagnosis of mumps
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Serology: IgM antibody w/in 5 days
PCR done from swab of effected glands Negative IgM does not R/O mumps, need to repeat test in two weeks |
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Treatment of mumps
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Self-limiting
Symptomatic treatment: tylenol/IBU for pain Cold and hot compresses for swelling |
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Define rubella
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Known as the "3 day measles" or "german measles"
Has been eliminated from the U.S. |
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Organism causing rubella
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Togavirus (an RNA virus)
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Transmission of rubella
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Direct contact with nasopharyngeal secretions
**Can cross the placental barrier Contagious a week before and a week after onset |
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Clinical presentation of rubella
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Prodrome of low grade fever
Lymphadenopathy in second week "Fine" maculopapular rash 2 weeks after exposure (rash is not always present!) Arthralgia is common in women |
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Congenital Rubella Syndrome
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Child may be born with one or more:
deafness, cataracts, heart defects, microencephaly, mental retardations Miscarriage is common |
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Treatment of Rubella
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Self-limiting
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What organism causes chicken pox
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Varicella-Zoster virus
Life-long immunity Resides dormant in dorsal root ganglia |
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Transmission of chicken pox
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Respiratory droplet
Contact with infectious lesions 2-3 week incubation period, infectious until all lesions are crusted over |
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Clinical presentation of chicken pox
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Hx of exposure to chicken pox or shingles
Minor constitutional symptoms followed by Eruption of clusters of red macules "dew on a rose petal" "vesicles on erythematous base" These become pustular, pruritic, encrust, and scab |
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Diagnosis of chicken pox
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Usually just history taking and recognition of rash
Tzanck Smear multinucleated giant cells w/ inclusions VZV antigent in skin lesions |
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Treatment of chicken pox
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Acyclovir
Supportive treatment for pain and itching |
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Vaccine for chicken pox
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Varivax- attenuated
2 doses 12-15 months, 4-6 years |
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Define Necrotizing Fasciitis
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Infection of deeper tissues resulting in progressive destruction of fascia and subcutaneous fat.
Muscle is typically spared |
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Two types of necrotizing fasciitis
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Type 1: Polymicrobial. Variety of gram+ and gram-
Often on legs and perineum Type 2: Monomicrobial. Usually GAS Often due to trauma |
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Who is affected by the two types of necrotizing fasciitis
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Type 1: pts with diabetes, peripheral vascular disease, immunocompromised
Type 2: healthy individuals with recent skin injury GAS can rarely/occasionally spread from throat inf. |
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Hallmark of necrotizing fasciitis
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Pain out of Proportion to physical exam findings
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S/S of necrotizing fasciitis
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Starts as minor contusion, burn, bite, etc...
Progresses rapidly Fever, toxicity common, crepitus Extremely painful, warm, swollen, and shiny After 3-5 days of onset: Skin breakdown with bullae, cutaneous gangrene, loss of sensation |
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Prophylactic treatment for high risk patients after surgery
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PCN for 24-48 hours
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Diagnosis of necrotizing fasciitis
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Surgical exploration is the only definitive diagnosis with culture!
Can perform CBC, serum creatine kinase, blood cultures, etc... |
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Treatment of necrotizing fasciitis
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SURGICAL EMERGENCY
Early and aggressive surgical exploration and debridement. Re-eval in 24 hours for more surgery. Emperical ABX before cultures return. Surgery is indicated with sever pain, toxicity, fever, with or without radiographic evidence |
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Complications of necrotizing fasciitis
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ABX with no surgery = 100% mortality
With optima therapy = 14-40% mortality Multi-organ failure, respiratory distress, limb loss |
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Define tetanus
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Generalized muscle weakness that starts with the face and descends.
Spasms and exaggerated reflexes to follow |
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Organism causing tetanus
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Clostridium tetani
"Tetanospasmin" Endospores living in environment for many years (rust ans feces) |
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Transmission of tetanus
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Any wound exposed to C. tetani
It is found in soil and may germinate once in wound Elderly, migrant workers, newborns, Injection drugs use |
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Clinical presentation of tetanus
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Early signs: pain and tingling at site followed by nearby spaciticiy. Stiffness of jaw and neck, dysphagia, and irritability
Later signs: hyperreflexia, spasms of jaw (trismus), rigidity with spasms of striate mm. Painful/tonic convulsions. Spasms of glottis and resp. muscles causing asphyxia |
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Diagnosis of tetanus
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Clinical diagnosis only
Patient remains awake and alert, sensory exam is normal, little to no temp. |
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Complications of tetanus
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Airway obstruction!!
Urinary retention and constipation Respiratory arrest and cardiac failure |
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Treatment for tetanus
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#1 Tetanus immunoglobulin (IM or IV)
Metronidazole IV for 10 days Muscle relaxers |
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Two categories of TB
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Latent Tuberculosis Infection (LTBI)
Tuberculosis Disease |
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Organism causing TB
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Mycobacterium tuberculosis
Acid Fast Bacilli |
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Transmission of TB
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Respiratory droplet
Smaller droplets can be inhaled and embedded in the alveoli. Tubercle bacilli multiply and enter blood stream to spead. |
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Risk factors for getting TB
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Close contacts
Foreign-born persons Homeless persons/low income groups Health care workers Racial and ethnic minorities Injection drug use |
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Clinical presentation of pulmonary TB
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Cough >3 weeks
Chest pain w/ breathing and coughing Coughing up sputum or blood Fever/chills Night sweats Appetite loss/weight loss/ fatigue |
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Clinical presentation of extra-pulmonary TB
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Usually not considered infectious
Can infect lymph nodes, pleura, brain, kidneys, bones |
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Testing for TB
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Mantoux Tuberculin Skin Test
PPD skin test (purified protein derivative) Measure area of induration, no erythema Chest X-ray: useful but not confirming Bacteriological: Acid Fast staining shows tubercle bacilli. Determine drug susceptibility at this time |
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Treatment for LTBI
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Isoniazid given daily for 9 months
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