Infectious Disease #2

Front 1

impetigo presentation

Back 1

-thick crusted lesions
-superficial, rounded/irregular margins
-more in children
-associated with poor hygiene

Front 2

impetigo causes (bugs)

Back 2

staph aureus
strep pyogenes

Front 3

impetigo tx

Back 3

-topical mupirocin
-1st gen cephalo (cefazolin, cefalexin) oral

Front 4

erysipelas presentation

Back 4

-superficial fiery red lesions
-well marked edges
-more in older adults
-usually lower extremities

Front 5

erysipelas causes (bugs)

Back 5

-strep pyogenes (group A)
-can be group B, C, or D

Front 6

erysipelas tx

Back 6

-pen V or amoxicillin

Front 7

staphylococcal scalded skin syndrome presentation

Back 7

-lateral pressure on skin
-more common in <5yrs
-exotoxin, separation of skin

Front 8

staphylococcal scalded skin syndrome causes (bugs)

Back 8

staph aureus

Front 9

staphylococcal scalded skin syndrome tx

Back 9

-1st gen cephalo (cefalexin)
-dicloxacillin
-consider CA-MRSA

Front 10

folliculitis presentation

Back 10

-small pustules or abscesses adjuacent to hair follicles

Front 11

folliculitis causes (bugs)

Back 11

-staph (MSSA)
-unless hot tub folliculitis (consider MRSA)

Front 12

folliculitis tx

Back 12

-self limiting (unless hot tub folliculitis- tx MRSA)

Front 13

cellulitis presentation

Back 13

-localized pain, erythema, swelling, warmth, poor borders

Front 14

cellulitis causes (bugs)

Back 14

-strep pyogenes (more rapid spread and lymphangitis)
-staph aureus (localized infection- abscess, extends laterally)
-can have G- in immunocompromised, diabetics, or penetrating injuries

Front 15

cellulitis tx

Back 15

-1st gen cephalo + bactrim
-dicloxacillin
-clindamycin high dose

Front 16

folliculitis (with underlying skin problems) tx

Back 16

-if systemic signs of infection
-TMP/SMX, clindamycin- if -D test, linezolid, or vanco (HA-MRSA coverage)

Front 17

necrotizing fasciitis presentation

Back 17

-rapidly progressing, necrosis, pus, swelling, compartment syndrome

Front 18

necrotizing fasciitis bugs

Back 18

-group A strep pyogenes + toxic shock like toxin (exotoxin A)

Front 19

necrotizing fasciitis tx

Back 19

-pip/tazo or carbapenem (irta or mero) PLUS vanco or linezolid
-want broad specturm agents for aerobes and anaerobes
-pen + clindamycin once organism confirmed (clinda reduces toxin prod)

Front 20

necrotizing fasciitis tx with osteomyelitis risk

Back 20

-direct against S aureus, P aeruginosa
-vanco should be included until S aureus ruled out

Front 21

wound infection presentation

Back 21

-erythema, pain, tenderness, swelling
-bites, orthopedic prosthesis, heavy contamination with feces or saliva

Front 22

wound infection bugs

Back 22

-strep or staph
-may include anaerobes if near mucousal border
-more G- with trauma, feces contamination, and ulcers
-consider MRSA with bites

Front 23

wound infection tx

Back 23

?? (too many to list?)
-for diabetic foot infection could use nafcillin, dicloxacillin, or cefazolin

Front 24

hematogenous orthopedic infection bugs in children

Back 24

-95% by single organism
-staph aureus 50%
-group A streptococci

Front 25

hematogenous orthopedic infection bugs in neonates

Back 25

-95% by single organism
-staph aureus 50%
-group B strep, e coli

Front 26

hematogenous orthopedic infection bugs in elderly

Back 26

-95% by single organism
-staph aureus 50%
-e coli

Front 27

contigous orthopedic infection bugs

Back 27

-often polymicrobial
-staph, strep, enterobacteraciae, anaerobic
-staph involved usually

Front 28

length of tx for orthopedic infection

Back 28

-parenteral antibiotic 4 to 6 weeks, extend if still s/s
-can switch to oral midway

Front 29

prosthetic infection tx if staph MSSA

Back 29

-nafcillin + rifampin x 2 weeks
-rifampin + cipro/levo

Front 30

prosthetic infection tx if MRSA

Back 30

-vanco + rifampin x 2 weeks
-rifampin + cipro/levo

Front 31

prosthetic infection tx if streptococcus

Back 31

-pen G or ceftriaxone for 4 weeks
-amoxicillin

Front 32

prosthetic infection tx if enterococcus (pen-susc) or strep agalactiae

Back 32

pen G/amox/amp + aminoglycoside x 2-4 weeks
-then amox

Front 33

prosthetic infection tx if enterobacteriaceae

Back 33

-cipro

Front 34

prosthetic infection tx if nonfermenter

Back 34

-pseudomonas
-ceftazidime/cefepime IV + amino x 2 weeks
-then cipro

Front 35

prosthetic infection tx if anaerobes

Back 35

-clinda IV x 2-4 weeks, then clinca PO

Front 36

prosthetic infection tx if mixed infection (but not MRSA)

Back 36

-amox-clav/amp-sulb/carbapenem x 2-4 weeks
-then according to susc.

Front 37

grade I and II open fracture prophylactic tx

Back 37

-for G+
-for 24 hours
-cefazolin or vanco (if pen allergy)

Front 38

grade III open fracture prophylactic tx

Back 38

-G+ and G-
-d/c after 72 hours OR after coverage of wound achieved
-cefazolin + tobramycin?

Front 39

septic arthritis bugs (nongonococcal)

Back 39

-S aureus in adults
-streptococci
-gram (-) bacilli (e coli, pseudomonas, enterobacte, etc) less common, but in neonates, IVDU, elderly, immunosup.

Front 40

hematogenous osteomyelitis presentation

Back 40

-tenderness, pain, swelling, fever, chills
-high ESR, CRP, WBC
-50% have + blood culture
-bone changes lag 10-14 days

Front 41

septic arthritis presentation

Back 41

-single swollen and painful joint (80% only 1 joint)
-fever (elderly may be afebrile)
-synovial fluid G stain and culture

Front 42

septic arthritis tx if G+ cocci

Back 42

-staph - vanco
-at least 4 weeks

Front 43

septic arthritis tx if G- bacilli

Back 43

-3rd gen cephalo (ceftriaxone, cefotaxime)
-at least 4 weeks

Front 44

gonococcal arthritis presentation

Back 44

-50% have multiple joints affected
-skin lesions
-young, healthy, sex. active people

Front 45

gonococcal arthritis tx

Back 45

-ceftriaxone for 24-48 hrs after improvement, then oral (cefixime/cefpodoxime) for 1 week

Front 46

prosthetic joint infection presentation

Back 46

-purulence in synovial fluid or implant site

Front 47

prosthetic joint infection bugs

Back 47

-staph epi (40%)
-staph aureus (15%)
-strep (10%)

Front 48

prosthetic joint infection early presentation

Back 48

-<3 months after surgery
-acute onset pain, fever, warmth
-more virulent - staph, G- bacilli

Front 49

prosthetic joint infection delayed presentation

Back 49

-3-24 months after surgery
-low grade infection, subtle s/s
-less virulent - staph epi, p acnes

Front 50

prosthetic joint infection late presentation

Back 50

-more than 24 months later
-mostly hematogenous

Front 51

antimicrobial therapy for hip prosthesis

Back 51

-rifampin for biofilm
-plus other med (nafcillin or vanco if staph)
-3 months

Front 52

antimicrobial therapy for knee prosthesis

Back 52

-rifampin for biofilm
-plus other med (nafcillin or vanco if staph)
-6 months

Front 53

antimicrobial therapy for prosthesis if surgery unavailable

Back 53

-long term suppressive oral antibiotic

Front 54

osteomyelitis tx if staph (MSSA)

Back 54

nafcillin or oxacillin
-cefazolin, ceftriaxone, clinda

Front 55

osteomyelitis tx if MRSA

Back 55

vanco and rifampin
-clinda, linezolid, dapto

Front 56

osteomyelitis tx if strep

Back 56

penicillin G
-cefazolin, ceftriaxone, clinda

Front 57

osteomyelitis tx if G- bacilli

Back 57

-e coli, etc
-amp or cefazolin
-ceftriaxone, cipro

Front 58

osteomyelitis tx if pseudomonas

Back 58

-piperacillin or ceftazidime
PLUS tobramycin
-could use fluoro instead of B lactam or tobra

Front 59

osteomyelitis tx if enterobacter

Back 59

-piperacillin or ceftazidime PLUS cipro/levo

Front 60

osteomyelitis tx if mixed

Back 60

amp/sulbactam or pip/tazo
-carbapenem
-fluoro + clinda or flagyl

Front 61

endocarditis presentation

Back 61

-fever, anorexia, wt loss, malaise, heart murmur
-want >1 + blood culture

Front 62

endocarditis bugs (+)

Back 62

G+
-viridans strep (most common) from oral cavity
-high cure rate, low mortality

-staph aureus (2nd cause)
-common with IVDU
-high mortality

-staph epi
-common in prosthetic valve

-enterococci
-3rd most common cause
-high mortality - bc empiric coverage doesn't get this

Front 63

endocarditis bugs (-)

Back 63

HACEK
-haemophilus, actinobacillus, cardiobacterium, eikenella, kingella
-oropharynx flora, difficult to culture, large friable vegetations (emboli to brain)f

Front 64

endocarditis bugs (fungi)

Back 64

candida or aspergillus
-rare, mostly IVDU or prolonged IV antibiotics/TPN

Front 65

endocarditis empiric tx

Back 65

-mostly G+
-vanco, ceftriaxone, amp

Front 66

native valve endocarditis strep tx (PCN < .12)

Back 66

-pen G/ceftriaxone/vanco x 4 weeks
-pen G/ceftriaxone + gentamycin x 2 weeks

Front 67

native valve endocarditis strep tx (PCN .12-.5)

Back 67

-pen G/ceftriaxone x 4 weeks + gentamycin for 2 weeks or vanco x 4 weeks

Front 68

native valve endocarditis strep tx (PCN >.5)

Back 68

-penG/amp + gent 4-6 weeks
-vanco x 6 weeks

Front 69

native valve endocarditis staph tx

Back 69

-nafcillin/cefazolin x 6 weeks (+/- genta for 5 days)
-vanco x 6 weeks

Front 70

prosthetic valve endocarditis staph tx

Back 70

-nafcillin + rifampin > 6 weeks (genta for 1st 2 weeks)
-vanco and rifampin > 6 weeks (genta x 2 weeks)

Front 71

native/prosthetic valve endocarditis enterococci tx

Back 71

amp/pen/vanco + genta for 4-6 weeks

Front 72

native/prosthetic valve endocarditis enterococci tx (pen resistant)

Back 72

-amp/vanco + genta x 6 weeks

Front 73

native/prosthetic valve endocarditis enterococci tx (pen, genta, vanco resistant)
-E faecium

Back 73

-linezolid, quinupristin-dalfopristin x 8 weeks

Front 74

native/prosthetic valve endocarditis enterococci tx (pen, genta, vanco resistant)
-E faecalis

Back 74

-imipenem + amp x 8 weeks
-ceftriaxone + amp x 8 weeks

Front 75

native/prosthetic valve endocarditis HACEK tx

Back 75

-ceftriaxone/amp-sulb/cipro for 4 weeks

Front 76

vascular access infection bugs

Back 76

-staph aureus, staph epi, enterococci, candida, other

Front 77

vascular access infection staph aureus tx

Back 77

-remove catheter
-MSSA: nafcillin/cefazolin x 14 days
-MRSA: vanco x 14 days

Front 78

vascular access infection staph epi tx

Back 78

-remove catheter
-vanco 5-7 days

Front 79

vascular access infection enterococci tx

Back 79

-remove line if possible
-tx depends on susc
-amp + genta or vanco? x 14 days

Front 80

vascular access infection candida tx

Back 80

-remove line if possible
-tx depends on species
-fluconazole, amp B, echinocandin x 14 days after last positive blood culture

Front 81

PCP (pneumocystitis carinii pneumonia) prophylaxis

Back 81

-sulfamethoxazole/trimethoprim

Front 82

G+ infection prophylaxis

Back 82

-cefazolin and vanco unless known VRE
-worry about staph epi, MSSA/MRSA, viridans strep, enterococcus

Front 83

C diff treatment

Back 83

-flagyl PO or IV
-vanco PO
-probiotics, stool enema

Front 84

G- infection prophylaxis

Back 84

-carbapenems, fluoroquinolones, or aminoglycosides
-not cephalosporins or ESBL like pip/tazo

Front 85

MAC (mycobacterium avium complex) tx or prophylaxis

Back 85

-clarithro
-azithro
-rifabutin
-rifampin

Front 86

respiratory virus: influenza A and B tx and prophylaxis

Back 86

-immunization (non-live)
-oseltamivir (tamiflu)
-amantadine and rimantadine have high resistance rates
-IVIG
decrease immunosuppression

Front 87

respiratory virus: respiratory syncytial virus (RSV) tx and prophylaxis

Back 87

treatment:
-ribavirin inhaled (need to isolate because teratogenic)
-ribavirin oral or IV
-palivizumab
-RSV-IVIG
-decrease immunosuppression

Front 88

respiratory viruses: parainfluenza, rhinovirus, coronavirus txs

Back 88

-IVIG
-decrease immunosupporession

Front 89

adenovirus (common cold) tx

Back 89

-cidofovir- severe nephrotoxicity- give with probenacid
-ribavirin: PO, IV, inhaled
-decrease immunosuppression

Front 90

adenovirus presentation

Back 90

-kerato-conjunctivitis, pharyngitis, enteritis, D, cystitis, pancreatitis, hepatitis, viremia, GI bleed

Front 91

herpes tx

Back 91

-acyclovir, myelosuppression occurs
-famciclovir
-valacyclovir

Front 92

herpes simplex virus presentation

Back 92

-gingivostomatitis
-esophagitis
-pneumonia
-encephalitis
-ophthalmic infections

Front 93

cytomegalovirus (CMV) presentation

Back 93

-pneumonitis
-ophthalmic infections
-enteritis
-hepatitis
-viremia and disseminated infection

Front 94

CMV preemptive therapy

Back 94

-surveillance

Front 95

CMV prophylaxis therapy

Back 95

-acyclovir

Front 96

CMV treatment

Back 96

-ganciclovir
-valganciclovir
-foscarnet
-cidofovir
-NOT acyclovir

Front 97

varicella zoster virus presentation

Back 97

-cutaneous infections
-disseminated, superinfection or zoster
-pneumonitis
-hepatitis
-encephalitis

Front 98

varicella zoster virus treatment

Back 98

-acyclovir
-famciclovir
-valacyclovir

Front 99

epstein-barr virus treatment

Back 99

-decrease immunosuppression
-antivirals
-rituximab
-cytotoxic T cells

Front 100

human herpes virus 6 presentation

Back 100

-roseola
-rash
-graft failure if bone marrow transplant
-diffuse alveolar hemorrhage
-diffuse alveolar hemorrhage

Front 101

human herpes virus 6 treatment

Back 101

-foscarnet
-cidofovir
-ganciclovir

Front 102

polyomaviruses: BK virus presentation

Back 102

-with kidney transplant
-virus gets into urine
-asymptomatic viremia
-hemorrhagic cystitis
-nephritis

Front 103

polyomaviruses: BK virus tx

Back 103

-cidofovir

Front 104

polyomaviruses: JC virus presentation

Back 104

-with encephalitis, signs of meningitis
-progressive multifocal luekoencephalopathy

Front 105

zygomyces infection tx

Back 105

-up and coming mold infection, develops fast
-associated with diabetic pts and voriconazole use
-ampB first choice (high mortality)
-posaconazole

Front 106

pneumocystis jiroveci (carinii) prophylaxis or tx

Back 106

-SMX/TMP

Front 107

infection prophylaxis for allogenic stem cell transplant pts

Back 107

-antiviral: acyclovir or ganciclovir
-antifungal: fluconazole
-pt will be neutropenic for a long time

Front 108

colony stimulating factor for bacterial infection

Back 108

-filgrastim (G-CSF)
-concern with use in cancer pt
-causes bone pain

Front 109

colony stimulating factor for fungal infection

Back 109

-sargramostim (G-MCSF)
-concern with cancer
-causes bone pain