Bacterial Major Clinical Syndromes

Streptococcus group A (streptococcus pyogenes)

pharyngitis, URI, skin

tx: penicillins

Streptococcus group B - strep agalactiae

neonate meningitis, neonate sepsis

tx: penicillins

Viridans streptococci

dental related, can lead to endocarditis

tx: penicillins

Streptococcus pneumoniae

CAP, otitis media, meningitis

tx: penicillins

Streptococcus group D/ enterococcus

UTI, infective endocarditis

tx: penicillins

Folliculitis

s.aureus(MSSA) , ingrown hair from shaving

tx: topical mupirocin

Hot tub folliculitis

pseudomonas aeruginosa

tx: selflimited 5 to 10 days

Furuncle (boil)

s.aureus (MSSA or MRSA), deep follicle infection, nodule with abscess

tx: I&D plus warm compress

Think wrestler

Carbuncle

s.aureus (MRSA), cluster of furuncles

tx: I&D then bactrim if needed

Think wrestler

Cellulitis

GAS + s.aureus (MSSA), poorly demarcated border

tx: cephalexin

Erysipelas

GAS, clear border

tx: penicillin

Nec fasc

GAS/ polymicrobial, severe pain out of proportion, rapid progression

tx: emergent surgery and broad spectrum abx

Gas gangrene

clostridium perfringens, common after trauma, severe pain, crepitus

tx:emergent surgery and IV abx

Osteomyelitis

s.aureus (MSSA>MRSA), bone pain and systemic sick symptoms

tx: IV penicillin 4 to 6wks

Septic arthritis

s.aureus (MSSA>MRSA), N.gonherrea if sexually active, joint pain

tx: IV penicillin 3 to 4 wks

Peripheral manifestations of infective endocarditis

janeway lesions, splinter hemorrhages, roth spots, osler nodes

Janeway lesion

painless, erythematous macules on palms and soles

Splinter hemorrhages

proximal nail bed lesions

Roth spots

retinal hemorrhages with pale center

Osler nodes

painful nodules on fingers and toes

DUKE criteria

BE (major: pos blood cx, endocardial involvement) TIMER (minor: temp, predisposition, immune response or micro evidence)

Infective endocarditis

MC s.aureus , could be HACEK dx:blood culture and TTE (transesophageal echo)

tx: IV abx (penicillins)

Toxic shock syndrome

s.aureus, tampon or nasal packing, diffuse sunburn like rash and fever

tx: clindamycin and vancomycin

Scarlet fever

GAS, sandpaper rash

tx: penicillin

Staphylococcal scalded skin syndrome

s.aureus, diffuse red rash that turns to blisters, positive nikolsky sign (skin breaks away with touch), mucous membranes are ok!

Tx: penicillin

Diphtheria

C.diptheriae, gray pseudo-membrane on throat

tx: diphtheria antitoxin and penicillin

Tetanus

C.tetani, rigid muscle spasms and lock jaw (trismus)

tx: tetanus IG and supportive care

Cholera

vibrio cholerae, rice water diarrhea

tx: doxycycline and rehydration

Staphylococcal food poisoning

s.aureus, foods left at room temp (dairy, meat, salads)

tx: supportive

botulism

c.botulinum , descending paralysis, canned foods and honey for infants

tx: antitoxin and supportive care

Bacillus cereus

food poisoning , rice and pasta at room temp (even after microwaving)

tx: supportive

C.perfringens

food poisoning, meat/gravy/stew at room temp , profuse watery diarrhea

tx: supportive

Vibrio parahaemolyticus

food poisoning, seafood

tx: supportive

Pharyngitis

GAS, use CENTOR score (white exudate, ant. Cervical lymphadenopathy, no cough)

tx: penicillins

Otitis media

strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

tx: HIGH DOSE penicillins

Otitis externa

pseudomonas aeruoginosa or s.aureus

tx: topical fluoroquinolone

Epiglottitis

H.flu type B (Hib), tripod position, severe sore throat and trouble breathing

tx: ceftriaxone

Sinusitis

strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

tx: amoxicillin-clav

Typical CAP

strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis , crackles on exam

tx: penicillin

Atypical CAP (walking)

mycoplasma/ klebsiella/ legionella/ viral , milder fever and SOB than typical

tx: azithromycin

Aspiration pneumonia (community onset)

history of aspiration

HAP

gram negatives and pseudomonas , must be in hospital for 48 hrs

tx: piperocillin-tazobactam

VAP

gram negatives and pseudomonas, must be on ventilator for 48 hrs

tx:piperocillin-tazobactam or cefepime

Neonatal meningitis

group B strep

Dx: blood cultures, LP with CSF culture tx: ampicillin and cefotaxime

infant/child meningitis

strep pneumoniae, H.flu, Neisseria meningitidis tx: blood cultures, LP with CSF culture

tx: ceftriaxone and vancomycin

Adult meningitis

strep pneumoniae, neisseria meningitidis (petichiae) tx: blood cultures, LP with CSF culture

tx: ceftriaxone and vancomycin

Older adult/immunocompromised meningitis

strep pneumoniae, neisseria pneumoniae, listeria monocytogenes

tx: ceftriaxone and vancomycin and ampicillin

ETEC

watery diarrhea, no blood, travelers diarrhea

tx: azithromycin

C.diff

watery diarrhea, hospitalization or recent antibiotic use

tx: vancomycin or fidaxomicin

Shigella

bloody diarrhea, fecal oral transmission

tx: azithromycin

Salmonella

bloody diarrhea, reptiles and undercooked poultry/eggs

tx: supportive care

Campylobacter jejuni

bloody diarrhea , undercooked food or contaminated water

tx: azithromycin

STEC/EHEC

shiga toxin producing e.coli, undercooked beef or raw milk, bloody diarrhea

tx: supportive care

Yersinia enterocolitica

bloody diarrhea, pork products or raw milk tx: supportive care

Entamoaeba histolytica

bloody diarrhea, travel hx

tx: metronidazole and paromomycin

Tularemia

francisella tularensis, rabbits and ticks

tx: gentamicin

Pertussis

Whooping cough, vomit after coughing , lasts longer than croup

Bordetella pertussis

Brucellosis

brucessa spp, fever, night sweats, muscle aches, unpasteurized dairy or contact with farm animals

tx: doxycycline and rifampin

Plague

yersinia pestis, fleas and rodents

tx: gentamicin

Cat scratch disease

bartonella henselae

tx: azithromycin

Pasteurellosis

pasteurella multocida , cat or dog bite causing rapidly developing cellulitis

tx: amox-clav

Psittacosis

chlamydia psittaci, atypical pneumonia from birds or inhalation of bird droppings

tx: doxycycline

Anthrax

bacillus anthrax, cutaneous MC (inhalation and GI also exist), from contact with animal, inhaling spores, occupational exposure (animal exposure or war)

"Black eschar" , think animal exposure!

tx: ciprofloxacin or doxycycline

E.coli

MC cause of uncomplicated UTI

tx: nitrofurantoin

Proteus mirabilis

UTI with struvite stone

tx: TMP SMX

Enterococcus faecalis

complicated UTI

tx: amoxicillin

Kliebsiella pneuominae

complicated UTI due to healthcare exposure

tx: ceftriaxone

Staphylococcus saprophyticus

uncomplicated UTI

tx: nitrofurantoin

Pseudomonas aeruginosa

complicated or catheter related UTI

tx: piperacillin tazobactam

Serratia marcescens

healthcare associated UTI

tx: cefepime