Infectious Disease In A Nutshell

Front 1

General principles of ID

Back 1

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Front 2

normally sterile body sites

Back 2

blood
urine
spinal fluid

Front 3

normally colonized areas

Back 3

skin
GI
fecal material

Front 4

MIC

Breakpoints

Back 4

lowest concentration of antimicrobial that prevents microbial growth after 18-24h

breakpoints
- susceptible
- intermediate
- resistant

Front 5

neutrophil

bands

shift to the left

Back 5

neutrophil
- first responder wbc
- count usually inc in infection

bands
- immature neutrophils

shift to the left
- marrow responding to infectious insult
resulting in more bands relative to
mature neutrophils

Front 6

inflammatory markers

Back 6

C-reactive protein
erythrocyte sedimentation rate
tumor necrosis factor

Front 7

leukopenia

leukocytosis

Back 7

penia - dec wbc count

cytosis - inc wbc count

Front 8

In general, latin suffixes for increased and decreased (deficiency of)

Back 8

increased
- cytosis

deficiency
- penia

Front 9

empiric therpay

vs

culture-guided tx

Back 9

empiric
usually broad-spectrum in nature

is therapy that is directed toward all common pathogens associated with a dz state

Front 10

meningitis

Back 10

inflammation of the meninges

abnormal # of wbc in cerebrospinal fluid

Front 11

meningitis

empiric treatment for newborn to 1 month

Back 11

ampicillin and aminoglycoside

or

cefotaxime

or

ceftriaxone

Front 12

meningitis

1 month to 60 years old

Back 12

cefotaxime or ceftriaxone

plus

vancomycin

Front 13

meningitis

> 60 yo

Back 13

ampicillin and aminoglycoside/vanc

or

cefotaxime

or

ceftriaxone

Front 14

endocarditis

Chapter 59 in Applied Txics
see tables for doing if want

Back 14

infection of the indocardium which is the membrane lining the heart chamber and valves

treatment depends on causative organism and presence of prosthetic devices (longer tx)

Front 15

endocarditis

streptococci
penicillin-susceptible

Back 15

penicillin G alone (4w)

or

penicillin G with gentamycin (2w)

or

ceftriaxone alone (4w)

or

vancomycin in allergic to penicillin (4w)

Front 16

endocarditis

streptococci
relatively resistant to penicillin

Back 16

penicillin G alone (4w)

or

penicillin G with gentamycin (2w)

or

vancomycin in allergic to penicillin (4w)

Front 17

endocarditis

staphylococcus (methicillin-sensitive)
w/out prosthetic materials
-pt not allerigic to penicillin

Back 17

nafcillin (4-6w)

or

oxacillin (4-6w)

w/optional gentamycin (3-5d)

Front 18

endocarditis

staphylococcus (methicillin-sensitive)
w/out prosthetic materials
-pt allergic to penicillin

Back 18

cefazolin (4-6w)

with optional gentamicin (3-5d)

or

vancomycin (4-6w)

Front 19

endocarditis

staphylococcus (methicillin-resistant)
w/out prosthetic materials

Back 19

vancomycin (4-6w)

Front 20

endocarditis

staphylococcus (methicillin-resistant)
WITH prosthetic materials

Back 20

vancomycin (>= 6w)

and

rifampin (>= 6w)

and

gentamycin (2w)

Front 21

endocarditis

staphylococcus (methicillin-suseptible)
WITH prosthetic materials

Back 21

nafcillin or oxacillin (>=6w)

and

rifampin (>=6w)

and

gentamicin (2w)

Front 22

endocarditis

epidemiology

Back 22

common in IV drug abusers

heart valve replacement

other IV access procedures
- hemodialysis
- central venous catheterizations
- IV catherterization

Front 23

Acute / chronic bronchitis

Back 23

inflammation of the bronchioles

chronic is largely associated with heavy smoking

virus responsible for half of causes

sputum cultures usually not helpful

Front 24

acute bronchitis treatment

symptom control

Back 24

treatment is controversial b/c primarily viral in origin

symptom control
-antitussive to control cough
-intermittant antipyretic (Ibup, APAP)
-adequate hydration

Front 25

acute bronchitis treatment

abx indicatation

Back 25

controlled trials say Abx not effective yet 6 million annual RXs for Abx (stupid)

if pertussis (whooping cough) suspected may treat w/Abx to prevent spread
- no clinical features...only suspected exposure

Front 26

acute exacerbation of chronic bronchitis
(AECB)

Back 26

treatment controversial...usually not necessary unless severe
- frequently caused by smoking

following have been adequately studied:
amoxicillin, tetracyclines (doxy, mino, tetra), TMP-SMX, chloramphenicol

fluoroquinolones and newer macrolides (clarithro, azithro) equally effective but not superior

Front 27

Common antibiotic macrolides

Back 27

* Azithromycin (Zithromax, Zitromax,
Sumamed) - Unique, does not inhibit
CYP3A4
* Clarithromycin (Biaxin)
* Dirithromycin (Dynabac)
* Erythromycin
* Roxithromycin (Rulid, Surlid,Roxid)
* Tulathromycin

Front 28

treatment of simple AECB

<4 exacerbations/year
no comorbidities
low rate of pen resistance

Back 28

macrolide
doxycycline
2nd, 3rd gen cephalosproin
amox/clav

Front 29

treatment of complicated AECB

>=4 exacerbations/year
comorbidities
inc risk of pen resistance

Back 29

amoxicillin/clavulanate

fluoroquinolone

Front 30

treatment severs AECB

recurrent abx or steroid TX

Back 30

based onculture

Front 31

Pneumonia

Back 31

inflammation of the lung parencyma

fills alveolar air spaces with exudates, inflammatory cells, and fibrin

sputum culture may be useful to id some pathogens but hard to get good deep culture

Front 32

Pneumonia

neonatal

1-3m

3m - 5y

5y-18y

Back 32

neonatal
ampicillin and gentamicin
or
cefotaxime and gentamicin

1-3months
erythromycin,clarithromycin,cefuroxime

3m-5y
clarithromycin,cefuroxime,cefotaxime

5-18y
clarithromycin,erythromycin,cefuroxime

Front 33

CAP treatment - adult

ambulatory

hospitalized

Back 33

anbulatory
- oral macrolide (azith, clarith, eryth)
or
- fluoroquinolone (levo, gati, moxi)

hospitalized
- cefotaxime or ceftriaxone
- w/ or w/out macrolide
or
- fluoroquinolone alone

Front 34

Hospital aquired pneumonia - adult

Back 34

aminoglycoside
(ie gentamycin, amikasin, tobramycin)

plus one of the following:

cefotaxime, ceftrizsone, cefepime, ticarcillin/clavulanic acid, pip-taz, meropenem, or imipenem

if MRSA suspected - add vancomycin

Front 35

aspiration pneumonia - definition

Back 35

Aspiration pneumonia is caused by aspirating foreign objects which are usually oral or gastric contents, either while eating, or after reflux or vomiting

Front 36

aspiration pneumonia - adult

Back 36

uncomplicated:
pen G, clindamycin

Hospital acquired:
ticarcillin-clavulanic acid, pip-taz

book didn't specify if AND or OR for above

Front 37

Hospital acquired pneomonia - definition

Back 37

also called nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission

Front 38

tuberculosis

Back 38

communicable infectious dz

can be silent, latent infection as well as active

usual site is pulmonary but can be any tissue or organ

Front 39

tuperculosis treatment

Back 39

latent (probably isoniazide sensitive)
- isoniazide 9 months

latent (prob isoniazide resistant)
- rifampin + pyrazinamide
- 2 months

active
- isoniazid + rifampin + pyrazinamide
- 2-4 months

Front 40

infectious diarrhea

treatable usually associated moderate to severe presentation w/fever, chills, cramping

Back 40

usually treat with supportive care except

e. coli in hospitalized pts
- fluoroquinolone or TMP-SMX

salmonella if febrile
- flurorquinolones or TMP-SMX

shigella
- TMP-SMX

Front 41

infectious diarrhea cont

treatable usually associated moderate to severe presentation w/fever, chills, cramping

Back 41

contaminated water (campylobacter)
- macrolides or fluoroquinolones

seafood ingestion:
- yersinia enterocolitica
- flurorquinolones
- vibrio parahaemolyticus
- tetracycine or fluoroquinolone

Front 42

infectious diarrhea supportive care

Back 42

- antimotility - discouraged


- antipyretics


- antiemetics

Front 43

skin and soft tissue infections

cellulitis

Back 43

skin infections:
1. cellulitis
2. secondary to wound or incision

cellulitis
- usually one organism
- direct infection of the skin

generally - treatment is empiric based on likely organisms

Front 44

cellulitis

Back 44

group A step; staph aureus

outpatient
- dicloxacillin, cefadroxil, cephalexin,
erythromycin

inpatient
- cefazolin, erythromycin

Front 45

diabetic foot infections

Back 45

clindamycin or cephalexin

severe infections:
ticaracillin-clavulanic acid or other B-lactamase inhibitor

vanconycin if MRSA

Front 46

Bacterial Venereal Dzs

name them

Back 46

gonorrhea and syphilis

Front 47

syphilis presentation

primary and secondary

Back 47

PRIMARY
- painless lesion or chancre appearing at the site of infection about 21d after exposure
- spontaneously goes away - 8wks

SECONDARY
- develops 2-6 weeks after onset of prim
- flu-like sx and rash
- sx disappear - 2-6 weeks

Front 48

syphilis

tertiary (messed up)

Back 48

Untreated patients will develop TERTIARY syphilis within 2-25 years

- general paresis (dementia, progressive
muscular weakness, and paralysis)
- nerve deafness
- progressive dementia
- aortic insufficiency

Front 49

gonorrhea presentation

Back 49

urethritis (an inflammation of the urethra) w/in 2-3 days

dysuria (painful or difficult urination) purulent discharge common

majority become asymptomatic w/out treatment in 6 months

15% will develop Pelvic inflammatory Dz
- can lead to infertility

Front 50

syphilis treatment

uncomplicated adult

infant born of untreated mother

Back 50

uncomplicated adult
- benzathine penicillin G
- 2.4 million units IM x 1

infant born of untreated mother
- penicillin G
- 50-70K U/kg q12h x 10-21d

secondary latent
-

Front 51

syphilis treatment (disseminated)

secondary latent

tertiary disease

Back 51

secondary latent
- benzathine penicillin G
- 2.4million units IM qw x 3

tertiary
- penicillin G
- 2-4 million units q4h for 10-14 days

Front 52

gonorrhea treatment

adult

child

disseminated (spread over a large area of body, tissue, or organ)

Back 52

adult
ceftriaxone 125mg IM x 1
or
spectinomycin 2g IM q12h x 2

newborn
- cefotaxime 25mg/kg q12h x 7d

disseminated
- ceftriaxone 1g qd x 10d

Front 53

gonorrhea

treatment considerations

Back 53

also receive tx against chlamydial infection
- usually doxycycline 100mg bid x 7d
or
- azithromycin 1g once

all sexual partners must also be treated

Front 54

sepsis

Back 54

systemic inflammatory response syndrome (SIRS)

requires two of the following:
- T>38 or < 36
- HR > 90
- RR > 20 or PaCo2 < 32
- WBS > 12,000 or < 4000, or >10%
bands

gram +, -, and fungi too

Front 55

sepsis

treatment

Back 55

initially broad until culture obtained

life-threatening
- cefotaxime, ceftriaxone, cefepime, ticarcillin-clavulanic acid, pip-tax, meropenem, or imipenem w/ and aminoglycoside (tobra, genta, amikacin)

Front 56

UTI - treatment

- acute uncomplicated cyctitis ( is
inflammation of the urinary bladder)

- acute pyelonephritis (inflammation of
the kidney and upper urinary tract)

- prostatitis (inflamm of the prostate)

Back 56

cyctitis
- TMP-SMX x 3d or quinolone x 3d

pyelonephritis
- quinolone x 14d or TMP-SMX x 14d
- if severe
- parenteral tx w/quinolone, extended -
spectrum penicillin, and aminoglyco

prostatitis
- quinolone x 4-6 weeks
- TMP-SMX x 4-6 weeks

Front 57

tick borne systemic febrile syndromes

primary treatments for:
lyme dz
rocky mountain spotted fever
ehrilichiosis
tularemia

Back 57

lyme dz
- doxycylcine

rocky mountain spotted fever
- doxycycline

ehrilichiosis
- doxycycline

tularemia
- gentamicin or tobramycin

Front 58

systemic fungal infections

define primary vs opportunistic

where do fungal infections like to go?

Back 58

primary
able to cause infection in both healthy and immoncomprised

opportunistic
only in immunocomprimised

pulmonary focus b/c aerosol spread of mold spores

Front 59

systemic fungal infections

treatment considerations

Back 59

empiric until organism isolated

pts response is to treatment is guiding since it takes so long to culture fungi

Front 60

systemic fungal infections

treatments (the players in general)

Back 60

amphotericin B

itroconazole

caspofungin

voriconazole

fluconazole

flucytosine

Front 61

viral infections

Back 61

treatment not curative

tx decreases level of virus so immune system can handle the infection

Front 62

hepatitis treatments

A, B, C, D, E

Back 62

A, D, E - standard tx not developed

B, chronic
- lamivudine + interferon alpha-2b

C, chronic
- interferon alpha 2b + ribavirin

C, acute
- interferon alpha-2b

Front 63

influenza

Back 63

acute respiratory viral infection

three viruses, A, B, C

therapy is prophylactic and determined by community patterns

no tx for C exist

Front 64

influenza A

prophylaxis and treatment

Back 64

prophylaxis
- oseltamivir

- rimantadine

- amantadine

treatment
- zanamivir
- oseltamivir
- ramantadine
- amantadine

Front 65

influenze B

prophylaxis and treatment

Back 65

prophylaxis
- oseltamivir

treatment
- oseltamivir
- zanamivir

Front 66

herpes simplex family

3 types

Back 66

herpes genetal

cytomegalovirus (CMV) in the immunocompromised

chickenpox/shingles (varicella-zoster)

Front 67

herpes genetal treatment

Back 67

initial episode - acyclovir

reoccurrence - famciclovir

chronic suppression - valacyclovir

immunocompromised - acyclovir

resistant to acyclovir - foscarnet

Front 68

cytomegalovirus

areas affected and treatment

Back 68

areas
- retinitis
- colitis
- esophagitis

treatment
- ganciclovir
- valganciclovir
flocarnet
cidofovir
fomivirsen

Front 69

varicella zoster

-shingles, chickepox

Back 69

acyclovir

resistant to acyclivir and in immunocompromised pts:
- foscarnet