Download Infectious Disease Review for HMS III

Infectious Disease Review for HMS III
I.
Pneumonia
A. Community acquired pneumonia
1. Fever, cough, green sputum production x4days
a. Pathogens: S. pneumoniae, S. aureas, Klebsiella, H. influenza, mycoplasma,
chlamydia, viral (influenza, adenovirus), legionella, fungal (blastomycosis,
histomycosis)
b. Diagnosis: sputum - gram positive cocci pairs, gram negative rods
c. Treatment: levofloxacin or azithromycin + ceftriaxone
B. Chronic pneumonia
1. Low grade fever, cough, weight loss x2months
a. Pathogens: M. tuberculosis, histoplasmosis, coccidiomycosis, lung abscess
b. Diagnosis: sputum – AFB, fungal culture; serologies
c. Treatment: TB – four drugs, Fungal – itraconazole, Anaerobes –
metronidazole or clindamycin
C. Hospital Acquired/ICU pneumonia
1. Fever, cough, sputum production in hospitalized patient
a. Pathogens: MRSA, P. aeruginosa, K. pneumoniae, P. mirabilis
b. Diagnosis: sputum – gram positive cocci clusters, gram negative rods
c. Treatment: vancomycin + piperacillin/tazobactam, ceftazadime, imipenem
II.
Cellulitis
A. Cellulitis/ rule out DVT
1. Fever, erythema with leading edge, warmth and swelling of leg
a. Pathogens: S. aureas, S. pyogenes; neutropenic pt’s – pseudomonas
b. Treatment: vancomycin, oxacillin, cefazolin
III.
Neutropenic Fever
A. Infection likely
1. Breast cancer patient s/p 3 cycles chemotherapy via port-o-cath with fever
a. Pathogens: P. aeruginosa, E. coli, klebsiella, S. aureus, S. epidermidis
b. Diagnosis: blood, urine cultures, CXR
c. Treatment: “cover early and cover broadly;” ceftazadime, piperacillin +
tobramycin, vancomycin, imipenem, fungal coverage if fever persists –
caspofungin
IV.
Urinary tract infection
A. UTI
1. 32yr old sexually active woman with two days of increased urinary frequency
and dysuria
a. Pathogens: E. coli (UPEC), S. saprphyticus, GNRs – proteus, enterococcus
b. Diagnosis: urinalysis, urine culture
c. Treatment: ciprofloxacin, trimethoprim/sulfamethaxazole, nitrofurantoin
i.
Uncomplicated – 3 days; complicated (men, urinary tract structural
abnormality, foley catheter) – 10 to 14 days
V.
Bacteremia:
** Bacteremia = bacteria in the blood stream
** Sepsis = bacteremia associated with clinical toxicity
** Septic shock = syndrome of sepsis with hypotension
1. Fever, tachycardia, hypotension, tachypnea
a. Pathogens/Treatment:
i.
Gram positive cocci
- Sources: endocarditis, osteomyelitis, meningitis, pneumonia,
central venous catheters
- Streptococcus, Staphylococcus, Enterococcus – vancomycin,
oxacillin, ampicillin
- MRSA – vancomycin, linezolid
- VRE – linezolid
ii.
Gram negative rods
- Sources: urosepsis, pneumonia, meningitis, colitis
- E. coli, Pseudomonas – levofloxacin, *ceftazadime, ceftriaxone,
*ciprofloxacin, cefapime, gentamicin, piperacillin/tazobactam
(* activity against pseudomonas)