Infectology

Live attenuated vaccines

• oral polio

• yellow fever

• TBC

• MMR

Killed/inactivated vaccines

• hep A

• influensa

• polio

• Rabies

Toxoid vaccines

• diphteria

• tetanus

• pertussis

Hexa vaccine

• polio, HepB, H.influenza, DTP

• 2m, 4m, 10m

• DTP repeated again 5-12 year

MMR vaccine

• measles, mumps, rubella

• live attenuated

• 12m and 4-6years

Most common agents causing nosocomial UTI

• E.coli

• P.auerginosa

• Candida

Most common agents causing nosocomial RTI

• K.pneumonia

• S.Aureus

• Enterobacter

Most common agents causing surgical site infection

S.aureus

Most common agents causing nosocomial Blood infection

S.epidermidis

most common agents causing nosocomial GIT infections

C.difficile

ATB for ESBL organism

Carbapenems

ATB for MRSA

vancomycin

ATB for VRE (vancomycin resistant enterococci)

Linezolid

Pathogens causin nosocomial pneumonia

• MRSA

• Strep.pneumonia

• Pseudomonas

• Acinetobacter

ATB for nosocomial pneumonia

broadspectrum

• Vancomycin, linezolid + antipseudomonal agents (azithromycin?)

Nosocomial UTI tx

• mild fever: ciprofloxacin or fluoroquinolones

• severe fever: Ceftriaxone, Cefepime, Meropenem

Treatment for UTI

• TMP-SMX

• amoxicillin

• nitrofurantoin

• fosfomycin

Treatment for pyelonephritis

Ceftriaxone or Ciprofloxacin

Treatment for Urethritis

• Neisseria → Ceftriaxone

• Chlamydia → Azithromycin

Soft skin infections (types)

• impetigo

• erysipelas

• folliculitis → furuncle, carbuncle

• cellulitis

• fasciitis

• gas gangrene

CA of Impetigo

S.aureus

CA of erysipelas

GAS (S.pyogenes)

CA of folliculitis

• S.aureus

• Pseudomonas (hot tub)

CA of gas gangrene

• C.perfringens

CA of Fasciitis

S.pyogenes

Leptospirosis transmission

• through the urine of infected animals, usually rodents

Tularemia transmission

through rabbit bite or scratch

Bacterias causing infection in animal bites

• Pasteurella multicoda

• Capnocytophaga canimorsus

• S. aureus

• Strep. species

• Bartonella henselae

• Clostridium tetani

TORCH infections

• Toxoplasmosis

• Other (syphilis, parvovirus, VZV)

• Rubella

• CMV

• HSV

IgG Avidity test

• test for toxoplasma in pregnancy

• tells if infection is old or acute

• older Ab have stronger bond to Ag (high avidity 3-4 months)

Treatment for toxoplasmosis in pregnant mother

Spiramycin

Triad of Rubella

• cataract

• cardiac abnormality (patent ductus arteriosus)

• sensoryneural deafness

Signs of congenital CMV

• chorioretinitis

• periventricular calcification

• sensoneurinal deafness

• jaundice

• hepatomegaly

Treatment for Listeriosis

Ampicillin

Which immunization do pregnant women receive?

• Influenza

• DTP

• never live attenuated vaccines

Most common CA of community acquired pneumonia

Streptococcus pneumonia

CA of bacterial meningitis

• N.meningitides

• H.influenza B

• Strep.pneumonia

CA of viral meningitis

• VZV

• HSV

• mumps

Triad of tetanus

• Trismus (lockjaw)

• rises sardonicus (constant sardonic smile)

• opisthotonus

Treatment for HIV

cART:

2x NRTIs + 1 integrase inhibitor or 2x NRTIs + 1 NNRTI

Which toxins does Clostridium tetani have?

• Tetanospasmin

• Tetanolysin

Treatment for tetanus infection

• TIG (tetanus immune globulin) to neutralize toxin

• metronidazol or PNC to stop bacterial growth

• PrEP → DTP vaccine

Hydrophilic ATB

• Have low volume of distribution

• ex:

  • carbapenems

  • aminoglycosides

Lipophilic ATBs

• have a large volume on distribution

• ex:

  • macrolides

  • tetracyclins

Pharmacokinetics consists of….

ADME

• absorption

• distribution

• metabolism

• excretion

How are pharmacokinetics affected by sepsis

• increased volume of distribution

• increased clearance

  Both leading to low plasma concentration of ATB

which ATB needs a ”loading dose”

Vancomycin (hydrophilic)

“concentration dependent” ATBs

• aminoglycosides

• metronidazole

• glycopeptides

• fluroquinolones

“time dependent” ATBs

• beta-lactams

ATB for salmonella

• ciprofloxacin (fluoroquinonlone)

• ceftriaxone (cephalosporin)

VZV causes

• chickenpox

• herpes zoster/shingles

• post-herpetic neuralgia

• congenital varicella syndrome

treatment for VZV

acyclovir

what is congenital varicella syndrome?

• limb hypoplasia

• cutaneous dermatomal scarring

• blindness

Which influenza type causes epidemics

Influenza A

• B and C does not have antigenic drift

Influenza (type A) has subtypes:

H (16 subtypes) and N (9 subtypes)

Pandemics are caused by

antigenic shift (2 viruses infect the same cell and exchange genetic material)

Epidemics are caused by

antigenic drift (minor changes)

treatment for Influenza

Oseltamivir

EBV pathogenesis

• binds to CD21 → production of atypical reactive CD8+ T cells

  • aka Downey cells

    • larger and bean shaped

Complication of EBV

Burkitt’s lymphoma

Tick borne meningioencephalitis (TBM) is caused by

a virus of the flavivirus family

• trough tick bite

• through unpasteurized milk products

Japanese encephalitis is caused by

a flavivirus spread by mosquito

Treatment for TBE and JEV (encephalitis viruses)

supportive

CA of Q-fever

Coxiella burnetti

Q fever symptoms

febrile illness, pneumonia, endocarditis, and hepatitis

ATB for Q-fever

doxycycline

Pseudomembranous colitis is caused by

C.difficile

ATB for C.diff

Vancomycin or metronidazole

ELEK test is for

diphteria toxin

Malaria is caused by

the protozoa Plasmodium vivax/falciparum/ovale, transmitted by anopheles mosquito

Malaria life cycle

• sporozoites enter the blood and goes to hepatocytes

• merozoites leave liver and invades RBC → become trophozoites

• trophozoites mature into schizonts → digest RBC → lysis and then release more merozoites