Infectious Diseases

PCN AE

hypersensitvitiy, interstitial nephritis

ampicillin AE

maculopapular rash in pts with mono

cephalosporin AE

disulfiram rxn. interstitial nephritis

vanco AE

flushing/red man syn. ototoxic nephrotixic

macrolides AE

GI upset, prolonged QTi.

FQ AE

tendon rupture, CI in preg and kids. inc MG sx. QT prolongation

clinda AE

c diff

tetracyclines AE

teeth discoloration, hepatotoxic so CI in preg and kids. photosensitivity

sulfonamides AE

neonatal jaundice (CI in preg), CI in G6PD bc causes hemolysis

metro AE

disulfiram rxn when w alc, neurotoxic

if pt doens’t remember if they got tetanus vaccine what do oyu do

give them Tdap

pt has pain and tingles at inoculation site then spasti cparalysis. muscle rigidity, trismus, descending muscle spasms leading to stiff neck. later sx of gen muscle spasms, drooling, urinary incontinent. facial contractions w grimace and razised eyebrows (risus sardonicus)

tetanus

mcc of death in tetanus pt is

cardiac arrest

tx tetanus

mwtro, immune globulin, diazepam, magnesium

Tdap vaccine sched

0mol, 4-6 wk later, 6-12 mo later

DTaP vaccine sched

5 dose. 0mo, 2, 4 6, 15-18 mo, 4-6 yr

tx gas gangrene

surgical debridement + PCN + clinda

flaccid paralysis in baby. descending symmetric flaccid paralysis. 8 D’s : dysphagia diplopia dry mouth dilated pupils dysarthria dysphonia descending dec muscle strength dec DTR

botulism

how do babies get botulism

honey

how do adult gt botulism

canned fooda

tx botulism

<1 yr old give human derived antitoxin. if >1 give equine antitoxin. also debridement if wound

what type of microbe is resp diphtheria

gm + bacillus

how can diphtheria manifest besides the pseudomembrane.

sore throat, lo grade fever, myocarditis, neuropathy, cervical lymphadenoapthy (bull neck)

tx diphtheria

antitoxin + erythro or PCN

tx MRSA

bactrim, doxy, clinda, linezolid (oral)

vanco, ceftaroline, linezolid (IV)

gonorrhea is what type of org

gm- diplococci

gonorrhea can disseminate into what dz

purulent arthritis (esp on knee), dermatitis polyarthritis tenosynovitis

dx gonorrhea, chlamydia

NAAT best

mcc of bacterial STI

chlamydia

how does chlamydia present

PID, reactive arthritis, lymphogranuloma venereum

genital ulcer dz caused by variant of chlamydia

lymphogranuloma venereum

at first pt has shallow painless genital ulcer lasting 2 dyas. then pt has u/l painful inguinal/femoral lymphadenopathy with buboes.

LGV

tx LGV

doxy or z pak if preg

painless lesions

LGV, primary syphilis, condyloma acuminata

painful lesions

chancroid, genital herpes

STI leading to genital ulcers, painful enlarged inguinal lymphadenopathy that can become bubo formation. pt has 1 or more painful genital ulcers.

chancroid

tx chancroid

z pak or ceftriaxone

etiology of chancroid

h. ducreyi

cat scratch dz etiology

bartonella henselae

pt was scratched by animal and now has a red or brown ulcer at the site of inoculation. they then have fever, HA, malaise, lymphadenopathy (axillary and epitrochlear)

cat scratch dz

how to dx cat scratch dz

serology then bx

tx cat scratch dz

z pak first line. if serious + rifampin

scarlet fever is bc of

GAS

what type of hypersensitivity is sc arlet fever

type IV

pt had strep but it went away on own. they then have pharyngitis, dysphagia, diffuse erythema on body with sandpaper texture. flushed face with circumoral pallor and strawberry tongue

scarlet fever

tx scarlet fever

PCN V or PCN G first line.

tx scarlet fever if allergic to PCN

z pak or clarithro

acute rheum fever is bc fo what etiology

GAS

how do pts get rheum fever

pt has GAS infxn and it stims ab production to attack host tissues

how to dx rheum fever with jones criteria

need 2 major or 1 major 2 minor

JONES major criteria for rheum fever

Joint (migratory polyarthritis), Oh my heart (active carditis), Nodules (SQ), Erythema marginatum, Syndenham’s chorea

jones minor criteria for rheum fever

fever, arthralgia, inc ESR/CRP, prolonged QTi

tx rheum fever

ASA or NSAIDs. PCN G benzathine (abx of choice)

comps of rheum fever

valvular dz, mitral m/c. PANDAS (ped autoimmune neuropsych d/o assoc w strep infxn), kid gets OCD/tics

RMSF etiology

rickettsia rickettsii

vectors for RMSF

dog tick

pt was hiking in south east and had flu like sx at first. they now have fever, HA, and a petichial/maculopapular rash, myalgias. the rash is an erythematous blanchable rash that appeared on wrists and ankles first then spread to the trunk. its on their palms and soles too

RMSF

RMSF tx should begin in how much time

within 5 days

chloramphenicol SE

gray baby syn

tx RMSF

doxy or chloramphenicol

syphilis etiology

treponema pallidum

primary syphilis

chancre aka solitary painless punched out lesion on genitals

secondary syphilis

painless diffuse maculopapular rash on face, trunk, palms and soles. generalized lymphadenopathy,condyloma lata (warty lesions on mucous membranes)

tertiary syphilis

reactivation of latent syphilis, pt has aortitis, gumma, late neurosyphilis, areflexia, burning pain, weak, severe radicular pain, ataxia

screen for syphilis

RPR (rapid plasma antigen), treponemal testing showing + FTA-ABS (antibody absorption). darkfield microscopy sees the org from a chancre

tx syphilis

benzathine PCN G. if allergic desensitize

lyme dz etiology

borrelia burgdorferi

what transmits lyme

ixodes tick (deer tick) in NE states

after a bullseve rash goes away what are the next sx in lyme dz

b/l facial palsy, AV block, multiple erythema migrans lesions. later stages pt gets arthritis

dx lyme

ELISA first then western blot if ELISA is pos.

tx lyme

doxy. if preg amoxy or cefuroxime

pt found deer tick on leg what do you do

ppx with doxy to prevent lyme

who carries tularemia

rabbits

pt was in fields and got bit by animal. they have a single papule at inoculation site, then it ulcers and becomes an eschar. tender regional lymphadenopathy.

tularemia

dx tularemia

serology shows hi titers

tx tularemia

severe : gentamicin or streptomycin first line.

adult: cipro/doxy

kid: gentamicin

antifungal of choice for life threatening fungal infxns.

amphotericin B

AE amphotericin B

fever/chills, dec K, nephrotoxic

DoC for candida and cryptococcal infxn, esp in urine and CSF infxns

fluconazole

DoC for invasive aspergillus

voriconazole

DoC for noninvasive histoplasmosis, blastomycosis, coccidioidomycosis

itraconazole

fluconazole AE

hepatitis

ketoconazole AE

dec test and cortisol, inc LFTs

tx tinea infxns and onychomycosis

terbinafine

tx cryptococcal meningtiis

flucytosine + amphotericin B

pt was in mississippi and ohio river valleys. they work as construction worker. they have PNA lesions, verrucous lesions, osteomyelitis. histology shows round broad budding yeastr with double walls

blastomycosis

tx blastomycosis

mild itraconazole, severe amphotericin B

pt is immunocompromised. has HIV with CD4 <100. pt inhaled bird droppings and developed PNA. then pt develops meningitis sx. india ink stain shows budding encapsulated yeast. pos antigen test

cryptococcosis

tx cryptococcosis

amphotericin B plus fluconazole

pt in SW US reports a mild flu illness at first, then sx of fever, arthralgias, and erythema nodosum. can become meningitis

coccidioidomycosis

tx coccidioidomycosis

CNS sx fluconazole, severe amphotericin B

pt was in the mississippi and ohio river valley. they are spelunker. they have PNA with hilar lymphadenopathy. histology shows narrow ovoid budding yeast

histoplasmosis

tx istoplasmosis

itraconazole or amphotericin B if bad

this dz can present in those with asthma, bronchiectasis, or CF as asthma sx with brown mucus production in sputum. can also present as a mass in the pulmonary cavity with sx of cough and hemoptysis.

aspergillosis

tx aspergillosis

if pulm infxn then GCC (prednisone) + itraconazole. severe vori. resect aspergilloma

tx candida esophagitis

fluconazole

tx vulvovaginal candidiasis

topical azole miconazole or clotrimazole, or one dose fluconazole

dx croptococcosis

CSF shows a fungal pattern of inc WBC, dec glucose, and inc protein. antigen seen on CSF. you see budding encapsulated yeast on india ink

dx histoplasmosis

PCR antigen test, histology showing narrow based ovoid budding yeast, cx most specific