On the Rise
At what stage of syphilis does neurosyphilis occur?
Any stage!
What are the two most common organisms associated with necrotizing fasciitis?
Staph aureus and GAS
Define what makes an organism an ESBL
Resistance to cephalosporins
List three clinically important fungi
Candida species (albicans, glabrata, tropicalis, parapsilosis, krusei)
Crytococcus spp (neoformans, gattii)
Dimorphic Fungi (B. dermatitidis, Coccidioides immitis, H. capsulatum)
Aspergillus species
Zygomycetes
Dermatophytes
PJP
Who was the founder of the first antibiotic (penicillin)?
Alexander Flemming
What is a blood test that can be useful to order if you suspect PJP?
LDH
List 5 things you would want to order on a patient with sepsis?
Blood cultures, VBG (lactate), IV antibiotics, IV fluids, oxygen, monitor urine output
This antifungal is known to cause AKI and infusion reactions
Amphotericin B
List 5 tests you would order on a patient with fever of unknown origin?
CBC, lytes, CRP, BCx, LDH, TST or IGRA, HIV, ANA, RF, TSH, SPEP, mono antibodies
CXR, CT CAP, echo
What is the susceptibility of MRSA to clindamycin based on our local antibiogram (non blood isolates)?
83%
What is an outpatient treatment option for ocular syphilis + duration?
ceftriaxone 2g IV daily x 2 weeks
What precautions are needed for patients with bacterial meningitis? How long should we continue precautions for?
droplet
continue for at least 24 hours after starting effective therapy
What 3 organisms have been shown to have clinically significant ampC production?
Kleb aerogenes
Enterobacter cloacae complex
Citrobacter freundii
List 4 common organisms associated with CAP. How does this compared to HAP and VAP?
Bacterial - strep pneumo, H flu, m catarrhalis, m pneumoniae, c pneumoniae, legionella, staph aureus (after flu)
Viral - flu, adenovirus, RSV, parainfluenza, human metapneumovirus, covid
Fungal - coccidioides, blasto, histo, crypto, PJP
HAP - tends to be more gram neg (E coli, kleb pneumoniae, enterobacter sp, pseudomonas aeruginosa) + staph aureus
VAP - similar to HAP, bure increased rates of pseudo and staph aureus, and also increased rates of MDR organisms (steno, acinetobacter)
How long (on average) does it take for HIV from the time of acquisition to progress to advanced HIV (ie CD4 < 200) if left untreated?
10-15 years
A patient presents fever, night sweats, weight loss of 60 lbs over the last 6 months and abdominal pain with a CD4 count of 35. What test would you like to order to confirm your diagnosis?
Blood cultures for disseminated MAC
What is the empiric antimicrobial therapy for a shunt infection?
Vancomycin + Anti pseudomonal coverage (cefepime, ceftazidime, meropenem)
When a patient is on voriconazole, list 2 things you want to monitor.
vision changes and neurotoxicity
liver function tests
therapeutic drug monitoring (trough concentrations)
QT prolongation
What is a categorical approach to classic FUO and give one example for each category?
Bacterial - TB, endocarditis, abscess, complicated UTI, OM, salmonellosis
Viral - herpes, acute HIV, hanta, west nile, dengue, chik, powassan
Fungal - endemic dimorphics (histo, blasto, coccidio, paracoccidio), aspergillosis, mucor, crypto
Parasitic - babesiosis, amoebiasis, strongyloidiasis
Neoplastic - renal cell carcinoma, lymphoma, HCC, ovarian cancer, atrial myxoma, castleman’s disease
Autoinflammatory - periodic fever syndromes (FMF, TRAPS, HIDS); GCA, PMR, adult onset still’s
This famous person was diagnosed with neurosyphilis while serving time in Alcatraz.
Al Capone
What stage of syphilis does this patient have: EIA positive, RPR non reactive, TPPA non reactive
early infection, prior syphilis (treated or untreated), false positive EIA
recommend repeat testing in 2 weeks
MASCC
>= 21 -> outpatient
< 21 -> inpatient
List 2 clues to help you differentiate Steno infection vs colonization and what is empiric treatment would you start for a mod-severe steno infection
Grow steno on cultures from sterile sites (blood, pleural fluid, peritoneal fluid)
Look for clinical evidence of pneumonia (fever, elevated WBC, decreased oxygenation, new pulmonary infiltrates)
Combo therapy with TMP SMX, mino, cefiderocol or levo OR ceftazidime-avibactam + aztreonam
List 4 risk factors for candidemia/disseminated candidiasis
broad spectrum antibacterial drugs (esp if including anti anaerobic activity)
central IV lines (lumnes: 3 >2>1)
abdominal surgery
TPN
severe burns
colonization (esp candiduria)
AKI, dialysis
immunosuppression
What is the name of a newly discovered antimicrobial in 2023 named after a famous actor due to its perceived deadliness to fungi?
Keanumycin