Clin Med - ID > Bacterial > Flashcards

Bacterial Flashcards

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1
Q

pertussis etiology

A
  • Bordatella pertussis
  • highly contagious infection
  • transmitted via resp droplets
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2
Q

Who is at risk from a pt with pertussis?

A
  • elderly

- pregnant

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3
Q

What is the clinical case definition of pertussis?

A
  • acute cough lasting at least 14d with one of paroxysmal cough, posttussive emesis, or inspiratory whoop
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4
Q

How is pertussis confirmed?

A
  • culture
  • PCR
  • leukocytosis with absolute/strikingly increased lymphocytosis
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5
Q

What is the pathogenesis of pertussis?

A
  • 2ndary bacterial infx

- primarily a toxin mediated dz

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6
Q

complications of pertussis in infants

A
  • hospitilazation
  • PNA
  • seizures
  • encephalopathy
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7
Q

What is the MC patient population for pertussis?

A
  • children
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8
Q

Define catarrhal phase

A
  • 1st stage of pertussis
  • URI sx x1w
    (congestion, rhinorrhea, sneezing, low-grade fever, tearing, coryza)
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9
Q

Define paroxysmal phase

A
  • 2nd stage of pertussis

- severe paroxysmal coughing fits (older infants/toddlers w/ or w/o cough; infants

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10
Q

Define convalescent phase

A
  • 3rd stage of pertussis

- chronic cough lasting weeks to months (resolving sx p ~1m of onset)

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11
Q

pertussis treatment

A
  • older than 1mo = macrolide abx (erythromycin, clarithromycin, aythromycin)
  • older than 2mo w/ macrolide allergy = bactrim (TMP-SMZ)
  • under 1 mo = azythromycin
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12
Q

Why are erythromycin and clarithromycin not recommended in infants?

A
  • increased risk for infantile hypertrophic pyloric stenosis (IHPS)
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13
Q

pertussis presentation

A
  • 3-12d incubation period
  • 3 stages
  • petechiae above nipple line
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14
Q

pt education about pertussis tx

A
  • tx generally ineffective @ changing clinical course but decreases contagiousness
  • abx given in paroxysmal stage doe not affect duration and severity
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15
Q

define acute rheumatic fever

A
  • systemic immune (autoimmune-like) process occurring 15-20d after group A streptococcal pharyngitis
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16
Q

acute rheumatic fever symptoms

A
  • Sydenham chorea
  • carditis
  • subQ nodules
  • erythema marginatum
  • migratory polyarthritis
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17
Q

acute rheumatic fever pathophysiology

A
  • migratory arthritis
  • Sydenham chorea (St. Vitus’ Dance)
  • carditis
  • genetics
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18
Q

When should you consider carditis in acute rheumatic fever?

A
  • new/changing valvula murmurs
  • cardiomegaly
  • CHF
  • pericarditits
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19
Q

What are the labs/EKG for acute rheumatic fever?

A
  • elevated ESR and CRP

- prolonged PR interval

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20
Q

How is acute rheumatic fever dx’d?

A
  • T. Ducket Jones criteria

- except chorea or possibly indolent carditis means you win the dx regardless of having the other sxs

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21
Q

What is the work-up for acute rheumatic fever?

A
  • throat culture
  • ASO
  • antistrep antibodies
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22
Q

images for acute rheumatic fever?

A
  • EKG
  • CXR
  • Echo
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23
Q

acute rheumatic fever treatment

A
  • PCN

- PCN allergy = oral cephalosporins

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24
Q

T/F: Abx will lessen the course/frequency/severity of cardiac dz from acute rheumatic fever.

A
  • false, no change
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25
What is the treatment of severe carditis 2ndary to acute rheumatic fever?
- corticosteroids - rest - digoxin
26
What is the tx for Sydenham chorea?
- haloperidol | - antimicrobial prophylaxis
27
botulism etiology/epidemieology
- Clostridium botulinum - gram (+), spore forming rod - neurotoxin inhibits ACh release @ neuromuscular jxn --> weakness, flaccid paralysis, respiratory arrest
28
When does the cure for botulism occur?
- only after sprouting new n. terminals
29
types of botulism
- infant (IB) - foodborne (FBB) - wound (WB)
30
infant botulism transmission
- bee honey
31
foodborne botulism transmission
- improper canning or home-prep of food
32
wound botulism transmission
- s/p traumatic injury
33
botulism presentation
- sudden onset 7 D's leading to paralysis - GI sx (N/V) - CN palsies - ANS (opposite of SLUDGE)
34
What are the 7 D's of botulism presentation?
- diplopia - dry mouth - dysphagia - dysarthria - dysphonia - decreased muscle strength - dilated, fixed pupils
35
botulism workup
- wound cultures - EMG - mouse neutralization bioassay
36
botulism tx
- antitoxin - supportive care - PCN only for WB
37
What are the 3 species of chlamydia and the diseases that can result from each?
- C. pneumoniae = PNA - C. psittaci = psittacosis or ornithosis - C. trachomatis = STDs and PNA
38
S and S of C. pneumoniae PNA
- 3-4w incubation period - gradual, biphasic onset - follows URI - prolonged cough and malaise - hoarseness - H/A - pharyngeal erythema w/o exudate - TTP sinus - rhonchi and rales
39
S and S of C. psittaci PNA
- incubation period of 5-14d + - sudden onset constitutional sx - nonproductive cough, initially absent - chest pain - high fever - pulse-temp dissociation - sleepy - splenomegaly - maculopapular rash - meningitis or encephalitis
40
S and S of C. trachomatis PNA
- 2-3mo old - staccato cough - tachypnea - afebrile - scattered crackles w/o wheezing
41
Describe chlamydia
- small - gram (-) - obligate intracellular
42
What do the 15 immunotypes of C. trachomatis cause?
- A-C = chronic conjunctivitis - D-K = genital tract infx - L1-L3 = genital ulcer dz
43
What is the MC cause of STDs in US?
- chlamydia
44
diagnostic tests for C. pneumoniae PNA
- IgM titer - PCR - cell culture
45
diagnostic tests for C. psittaci PNA
- paired acute/convalescent sera | - seriologic tests
46
diagnostic tests for C. trachomatis PNA
- CBC = eosinohilia in kids | - screen parents
47
general chlamydia PNA tx
- tetracyclines (bacteriostatic) | - macrolides (inhibit bacterial growth)
48
abx tx for all 3 types of chlamydia PNA
- C. pneumoniae = doxycycline (except in kids) - C. psittaci = tetracycline/doxycyline - C. trachomatis = erythromycin
49
Who is most at risk for chlamydial GU infx?
- adolescent female (squamocolumna jxn)
50
What are the S&S of chlamydial GU infx in females?
- mucopurulent cervicitis - PID -->Fitz-Hugh-Curtis syndrome - dyspareunia - hx of sexual activity w/o condoms - most asymptomatic
51
What are the sx's of chlamydial GU infx in males?
- urethritis - epididymitits - hx or sexual activity w/o condom - fever
52
What other infx are often associated with chlamydial GU infx?
- gonorrhea - HIV - syphillis
53
What is one of the leading causes of infertility in women?
- C. trachoma
54
C. trachomatis GU tx
- 1st: azythromycin and doxycycline | - 2nd: erythromycin, PCN, and sulfisoxazole
55
What are the complications of chlamydial GU infx?
- HIV - reactive arthritis syndrome - miscarriage - preterm delivery - urethral scarring
56
How do you work up chlamydial GU infx?
- urine sample - CBC for eosinophilia - HIV - HCG
57
presentation of C. trachomatis trachoma
- chronic follicular or intese conjunctival inflam - tarsal conjunctiva scarring - entropion and trichiasis - corneal abrasions, scarring, opacifications leading to blindness
58
Who else, besides the patient must be tested in chlamydial GU infx?
- sexual partners
59
What is a contraindication to using doxycycline or ofloxacin?
- pregnancy
60
Who should be regularly screened for C. trachoma?
- all sexually active, nonpreg women 24y/o | - NO routine screenings women > 25 y/o
61
What imaging can be done for C. trachoma?
- US - CT - CXR
62
Who should be admitted with C. trachomatis?
- adolescents with PID
63
What is the post therapy instructions?
- no sex until all partners have been cured | - no sex for 1 week or until end of longer abx regimen
64
Define C. trachomatis trachoma
- chronic keratoconjunctivitis | - repeated reinfection
65
What are the metabolic derangements of cholera?
- hypoglycemia - acidosis - hyponatremia - hypokalemia - hypocalcemia (Chvostek, Trousseau signs)
66
C. trachomatis trachoma tx
- oral azythromycin + tetracycline eye ointment | - facial cleanliness
67
types of C. trachomatis trachoma
- follicular (TF) - inflam ( TI) - conjunctival scarring (TS) - trichiasis (TT)
68
cholera etiology
- Vibrio cholerae
69
What is the hallmark sign of cholera?
- profuse secretory diarrhea (rice water stool)
70
What is the priority of cholera tx?
- hydration with electolytes
71
describe the diphtheria toxin
- A and B fragments
72
cholera pathophys
- comma, shaped, gram (-) aerobic or facultative anaerobic bacillus - not acid- resistant (cant survive in the stomach ==> high infectious dose) - overwhelms large intestine with excessive fluid loss from small intestine
73
cholera presentation
- sudden onset - rice water stool - dehydration
74
diphtheria presentation
- 2-5d incubation period - non-specific, general URI sx - *localized or coalescing pseudomembrane* - cervical adenopathy = bull neck - fever and nasopharyngeal sx - cardiac and neuro toxicity
75
cutaneous diphtheria presentation
- indolent, non-healing ulcers covered with grey membrane | often co-infx w/ S. aureus and strep
76
What is the work up for cholera?
- stool culture - serologic testing - chem 7
77
non pharm cholera tx
- cholera cots (dont pee in the bucket or else ovehydration will kill pt)
78
pharm cholera tx
- doxy - TCN - TMP-SMZ (bactrim) - ciprofloxacin
79
What does chlamydia PNA look like?
- mycoplasma PNA
80
What is the tx for chlamydia PNA?
- macrolide
81
What is the etiology of diphtheria?
- Coynebacterium diphtheriae | - aerobic gram (+) rod
82
How does diphtheria manifest?
- URI | - cutaneous infx
83
diphtheria pathophys
- adheres to mucosal epithelial cells - endosomes release endotoxin causing localized inflam rxn - causes tissue destruction & necrosis
84
describe the diphtheria toxin
- A and B fragments
85
How is the diphtheria toxin moved in the body?
- lymph | - blood
86
What is the MC cause of death of diphtheria?
- airway obstruction/suffocation s/p psuedomembrane aspiration
87
cutaneous diphtheria presentation
- indolent, non-healing ulcers covered with grey membrane | often co-infx w/ S. aureus & strep
88
diphtheria workup
- culture - gram stain - toxigenicity (detection of toxin) - CBC - serum troponin - EKG
89
diphtheria tx
- erythromycin or PCN for 14d | - horse serum antitoxin
90
Define gonorrhea
- purulent infx of mucuous membrane caused by Neisseria gonorrhea
91
Besides gonorrhea, what else does N. gonorrhea cause?
- opthalmia neonatorum | - systemic neonatal infx
92
What is the most common site of gonorrhea infx in women and what does it result in?
- cervix | - endocervicitis & urethritis, complicated by PID
93
What is the most common site of gonorrhea infx in men?
- anterior urethritis
94
What are gonococcal complications?
- ectopic pregnancy - high risk for HIV - having gonorrhea is a risk factor for getting other STIs - conjunctivitis
95
How is gonorrhea transmitted?
- male to female
96
gonorrhea S+S
- anal, vaginal, penile, or pharyngeal d/c | - PID
97
PID sx
- lower abd pain - dysuria - cervical motion tenderness - adnexal tenderness - bleeding - perihepatitis
98
Define disseminated gonococcal infx (DGI)
- gonorrhea that has spread
99
DGI S+S
- arthritits/dermatitis syndrome (joint and tendon pain with rash) (Lover's Heels) - 2nd stage = septic arthritis
100
gonococcal work up
- culture - seriologic tests - STD panel - NAAT, PCR, LCR
101
gonorrhea tx
``` - ceftriaxone IM OR - cefixime + azythromycin or doxy (also tx for chlamydia) - eval and tx sex partners ```
102
What is not recommended in the tx of gonorrhea?
- fluoroquinolones | - TCN
103
PID tx
- cefalosporins
104
salmonella epidemiology
- consumption of contaminated foods | - large inoculum unless in low acidic stomach (requires fewer) or postvaccine (requires more)
105
salmonella pathophysiology
- selectively attaches to specialized epithelial cells of the Peyer patches
106
nontyphoidal enterocolitis presentation
- loose, bloodless stools - smaller vol stool than cholera - resolves w/in 3-7d
107
typhoid fever presentation
- nonspecific features - 10-14d incubation period - H/A, malaise, myalgia, lethargy - dry cough - *stepwise, low grade fever progression* - *bradycardia @ fever peak* - *rose spots* - coated tongue - change in BM
108
salmonella work up
- blood cultures | - stool cultures
109
T/F: Abx do not shorten salmonella duration of sx and may prolong duration of convalescent carriage.
- true
110
T/F: Abx are often used for uncomplicated nontyphoidal Salmonella gastroenteritis.
- false
111
What is the treatment for Salmonella bacteremia?
- single bactericidal drug for 10-14d
112
What are the surgical interventions for typhoid fever?
- cholecystectomy - splenectomy - endarterectomy
113
Shigella pathophys
- fecal-oral route - ingestion of contaminated food or water - fomites - sexual contact - vectors (housefly) - low infectious dose - can withstand low pH
114
Shigella symptoms
- sudden onset severe abd cramping - high fever - emesis - anorexia - large vol. watery diarrhea - seizures - tenesmus
115
Shigella signs
- elevated T - tachycardia and tachypnea - dehydration - abd tenderness - CNS sx - anemia - renal failure
116
Shigella work-up
- CBC - blood culture - stool exam and culture - enzyme immunoassay for toxin
117
Shigella tx
- fluid + electrolytes - antipyretics - *VIt A* - Zn - beta lactams, quinolones, macrolides
118
What do you not give for Shigella?
- antidiarrheals
119
tx of travelers diarrhea
- doxy
120
What are the types of tetanus?
- neonatal - cephalic - local - generalized
121
What causes tetanus?
- Clostridium tetani
122
What is formed by the C. tetani spores?
- 2 toxins: tetanolysin & tetanospamin
123
local tetanus presentation
- muscle rigidity near site of injury
124
general tetanus presentation (early)
- local muscle spasms - neck/jaw stiffness - dysphagia - hyperirritability
125
general tetanus presentation (late)
- trismus - drooling - risus sardonicus - descending muscle rigidity
126
tetanus tx
- immunizations - ICU admit & supportive care - benzodiazepines - vecurnonium - magnesium sulfate - metronidazole NOT PCN
Clin Med - ID
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