Ipapburke Inf Dz Test 2- Strep

Front 1

causitive organisms in Strep throat

Back 1

Streptococcus pyogenes (Group A Beta-hemolytic strep)

Front 2

Peak season for strep

Back 2

late fall to early spring

Front 3

how many children are normally affected per season?

Back 3

40% Children (most commonly ages 5-12)

Front 4

What percentage of adults are normally affected?

Back 4

10% of adults

Front 5

How is strep throat transmitted?

Back 5

direct person to person (gets increased in crowded settings)

Front 6

Generalized sxs of strep throat

Back 6

Fever, Chills, Malaise, Headache

Front 7

How is strep throat diagnosed?

Back 7

Clinically by presentation OR Rapid-strep OR C&S)

Front 8

What is the normal tx for strep?

Back 8

Benzathin Penicillin (normally a 10 day course)

Front 9

What is the treatment for the non-compliant?

Back 9

IM medication

Front 10

What are alternative meds to Benzathin penicillin?

Back 10

ACE (amoxicillin Clavulanate/Augmentin), Clarithromycin, Erythromycin

Front 11

Complications of strep throat

Back 11

Rhem. Fever, Glomerulonephritis, Peritonsillar abscess, Otitis Media, Acute Sinusitis, Mastoiditis, Meningitis, Pneumonia

Front 12

What is the causitive agent of Scarlet Fever?

Back 12

Group A beta-hemolytic streptococcal infection (the Erythogenic toxin)

Front 13

Besides the common symptoms of any streptococcal fever, what other sxs are there that are unique to scarlet fever?

Back 13

Tongue dorsum with a white-exudate, and projecting edematous papillae

Front 14

There is a rash associated with scarlet fever. Describe the lesions.

Back 14

Fine papular or punctate lesions (texture of course sandpaper)

Front 15

Where does the rash begin?

Back 15

In the axillae, groin, and neck (it generalizes within 24 hours)

Front 16

What is the facial appearance of scarlet fever?

Back 16

Forehead and cheeks appear flushed and a Circumoral pallor

Front 17

What is the treatment for scarlet fever?

Back 17

Penicillin VK po, Pen G IM, Amoxycillin, Erythromycin

Front 18

What is the most common causitive agent in TSS?

Back 18

Secondary to trivial staph A infection. This is a toxin mediated multi-system dz (can occur with any staph infection)

Front 19

When was TSS first described?

Back 19

First described in children in 1978

Front 20

Where does TSS most commonly appear?

Back 20

In women associated with the use of tampons

Front 21

This dz has typical symptoms of fever.. What is the most common presenting symptom?

Back 21

Pain in 4-85% of patients

Front 22

What is classic about the fever related to TSS?

Back 22

>102 degrees

Front 23

Are there any physical exam findings unique to TSS?

Back 23

Bullae, Scarlet fever-like rash, petechiae or maculopapular rashes, Desquamation, Hypotension

Front 24

When does desquamation start to occur?

Back 24

1-2 weeks after onset of illness

Front 25

What else is unique to TSS?

Back 25

It involves the palms and soles.

Front 26

With hypotension, what is typical of the systolic pressure?

Back 26

It is normally less than 90 degrees, and causes orthostatic syncope, and dizziness

Front 27

Can TSS be diagnosed, clinically?

Back 27

Yes, based upon a sudden onset of fever, rash, hypotension, and systemic evidence of toxicity

Front 28

Systemic evidence of toxicity must involve 3 or more of these systems.

Back 28

GI (vomiting/diarrhea), Muscular (severe myalgia or CK increase), Muscous membranes (vaginal, oropharyngeal, conjunctival erythema), Renal (inceased BUN or SrCr), Hepatic (increased bili or transaminase), Hematological (platelets < 100,000), CNS (Disorientation without focal signs) (all increases are 2 x the upper limit)

Front 29

What is the direction of the labs and diagnostic procedures?

Back 29

Directed at finding the source (C & S)

Front 30

Treatment for TSS

Back 30

Aggressive supportive therapy; anti staph meds. Since it's toxin mediated, abx therapy is questioned (Clindamycin, Nafcillin), females d/c tampon use

Front 31

What is the most common complication?

Back 31

Prolonged, refractory hypovolemic shock (95%)

Front 32

What are the rest of the complications?

Back 32

ARDS (55%), Bacteremia (60%), ARF, Electrolyte and acid-base imbalance, cardiac dysrhythmias, DIC with thrombocytopenia, Mortality rate of 3%

Front 33

What are the two types of Group B strep infections found in neonates and what are they defined by?

Back 33

Early and Late onset. They are defined by age

Front 34

When does early onset normally occur?

Back 34

Within the 1st 20 hours of life (or within the first week)

Front 35

Are there signs present at birth?

Back 35

Yes, 50% have signs that are acquired during or shortly after birth

Front 36

What is the finding in the mother of a neonate who is infected with Group B strep?

Back 36

A colonized maternal tract

Front 37

What are the maternal risk factors/complications of Group B strep infections?

Back 37

Fever/prolonged labor/ prematurity

Front 38

What does this cause in neonates?

Back 38

It is the major cause of sepsis/meningitis in neonates

Front 39

What does this cause in pregnant women?

Back 39

It causes peripartum fever (most common presentation)

Front 40

What are the causitive agents of Group B Strep infections?

Back 40

Lancefield group B beta strep; strepococci agalactiae

Front 41

This infection is responsible for what percentage of non-neonatal streptococcal bacteremias

Back 41

8% of non-neonatal streptococcal bacteremias

Front 42

What are the main signs and sxs of early onset group B strep infections?

Back 42

Resp distress, Lethargy, Hypotension, 1/3 will have pneumonia, 1/3 will have meningitis (seizures, poor feeding)

Front 43

When does late onset occur?

Back 43

1 week to 3 months

Front 44

What is the etiology of late onset?

Back 44

It can occur at birth, or later from a colonized mother, or from Nursery personnel, or from other unknown sources

Front 45

What is the presentation of late onset Group B strep infections?

Back 45

Bacteremia without an identifiable source. Osteomylitis, Septic arthritis, Facial cellulitis

Front 46

What are the common labs and diagnostic procedures?

Back 46

CBC, C &S, urinalysis, CSF analysis, Chemistries, and blood cultures in addition for adults

Front 47

What is the tx for Group B strep infections?

Back 47

Penicillin- child (Pen G and Ancef-adults)

Front 48

What is the mortality rate of Group B

Back 48

10-40% mortality

Front 49

What are the complications and longterm affects with survivors with meningitis?

Back 49

Long-term neurological impairment, Uncontrolled seizures, profound mental retardation, mild language delay, hearing loss, blindness

Front 50

Who does this tend to affect in the adult population?

Back 50

Majority are the pregnant and parturition; the elderly; the chronically ill (DM, Malignancy, immunocompromised-case fatality is >40%)

Front 51

What are the remaining considerations with Group B strep infection in adults?

Back 51

UTI's, Pneumonia endocarditis, Septic arthritis, Cellulitis, and soft tissue infections, (less common- meningitis, Osteomylitis, Intra-abdominal/pelvic abscess)

Front 52

MRSA caustive agent

Back 52

Methicillin resistant staphy A.

Front 53

Where is MRSA typically acquired?

Back 53

IN hospitals/institutions

Front 54

Where does community acquired MRSA account for 60% of staph infections?

Back 54

California, Alaska, Georgia, and Texas (with recent outbreaks in the Midwest- Minnesota, North Dakota)

Front 55

What are the oral abx with efficacy against MRSA for outpatients?

Back 55

Septra, Minocycline or Doxycycline, Clindamycin, Rifampin

Front 56

What are the oral abx with efficacy against MRSA for inpatients?

Back 56

2 abx regimen: Vanco and Gent. (vanco should be tried after others fail to reduce resistance risk) For severe cases: Cubicin, Linezolid, Synercid

Front 57

How can you consider treating MRSA carriers (doctor's, care providers going from room to room)

Back 57

Bactroban applied to nares and wounds; chlorhexidine (Hibiclens) baths. Handwashing, Keep nails clean and short, proper handling of body secretions