The not so Fun Guy
I am often a colonizer of sputum and urine, especially in an ICU patient who has been on broad spectrum antibiotics, but I am never a colonizer or contaminate when I am found in the blood.
What is candida?
I am the infectious agent that has lead to vomiting and diarrhea in over 100 people on a cruise ship over the course of 5 days. Symptoms last from 1-3 days.
What is norovirus?
24 yr male on PrEP to prevent HIV presents to the ED with a diffuse macular papular rash. He is afebrile, A/O x 3. He denies any associated headache but on ROS he admits to some blurry vision. A stat ophtahlmolgic exam shows posterior uveitis. LP is normal. I am the treatment.
What is IV penicillin?
The syndergistic combination of Ceftriaxone + Ampicillin
What is the treatment for PCN sensitive enterococcal endocarditis?
65 yr male with underlying HIV infection, not compliant with his HIV medication, last known CD4 52, presents with this rash. No other rash found. You will prevent the spread of this infection with this order.
What are Airborne and Contact Precautions?
I have emerged as a new multi-drug resistant candida species, often causing invasive infections in health care facilities and sometimes outbreaks in healthcare facilities. I am pretty much always resistant to fluconazole and other azoles with varying resistance. Better check surveillance blood cx and monitor closely after starting antifungal treatment b/c I can develop resistance quickly.
What is candida auris?
I am the infectious agent in this 34 yr female with underlying IgA deficiency who presents with chronic diarrhea described as watery, “greasy”, floating, with abdominal cramping, nausea, steatorrhea, flatulence, and weight loss.
What is giardia?
A 70 yr male with underlying alcoholic cirrhosis presents to the ED with 1 day high fever, headache, stiff neck, photophobia. On exam he has a temp 102.5, pulse 112, BP stable. He is mentating fine. While awaiting the results of a lumbar puncture, you start treatment with .....
What is dexamethasone, vancomycin, ceftriaxone, ampicillin?
If you are bacteremic with me you should check an echo to look for endocarditis but also a colonoscopy to look for colon cancer.
What is strep gallolyticus?
25 yr female presents with vaginal discharge. She is sexually active with 3 male partners, all of whom are known to her. A chlamydia trachomatis test is positive. She is treated with doxycycline x 7 days and her symptoms improve. In addition to expedited partner treatment, review of her vaccines, testing for other STIs and discussion PrEP, this is when and why you should repeat a chlamydia test on this patient if she remains asymptomatic.
What is 3 months to look for reinfection?
Test of cure is not indicated except in pregnancy, when treatment nonadherence is a concern, with persistent symptoms, and when alternative regimens are used.
54 yr male with prolonged neutropenia from chemotherapy presents with fevers and cough. No response to community acquired pneumonia treatment. CT of chest shown.
Note: also need to name 2 other syndromes I cause
What is invasive aspergillosis?
2 other syndromes: ABPA (allergic bronchopulmonary aspergillosis) and aspergilloma (often in an old persistent TB cavity)
I love to cause diarrhea outbreaks in community swimming pools or other recreational water facilities because I am resistant to chlorine.
What is cryptosporidium?
23 yr old male with HIV living in New York presents to the ED with high fevers, headache, nucal rigidity. LP shows this gram stain. I am the treatment.
What is Ceftriaxone 2gm BID?
23 yr female presents with fevers. On exam she has a temp of 101, BP 90/40, HR 112 and a new heart mumer - grade 2/6 diastolic murmer along the LLSB. Echo shows severe aortic regurg, valvular vegetation, and an echolucency around the aortic annulus. Blood cultures reveal MSSA. In addition to IV nafcillin, I am the most appropriate additional management.
What is consult cardiothoracic surgery?
I am the reason to treat asymptomatic bacteriuria in this clinical scenario. (name all that apply)
72 yr male is undergoing a pre-procedural w/u for a cystoscopy with a biopsy for invasive bladder cancer and an elective total hip arthroplasty for osteoarthritis. He has DM with hgba1c 10 and had a kidney transplant 6 yrs ago.
Medications include metformin and tacrolimus.
UA : 0 WBC, 0 squamous cells, 100,000 cfu/ml proteus mirabilis.
Cystoscopy and bladder biopsy
Screening for and treating ASB is supported by only two indications: during pregnancy and risk mitigation before an invasive urologic procedure
56 yr female with poorly controlled DM, hgba1c 16, presents with 2 weeks right maxillary sinus pain and now pain and swelling around right eye. She is febrile and ill appearing. Exam shows black eschar on right nasal mucosa. CT sinus shows boney erosion of the right maxillary sinus. See picture.
What is mucormycosis?
54 yr female with underlying alcoholic liver cirrhosis is admitted with a cough and SOB. CXR shows RLL infiltrate. She is started on ceftriaxone for CAP. Her other medications include carvedilol, lactulose, lasix and spironolactone. On HD#2 she has one soft stool overnight. A stool Cdiff PCR is sent and returns positive. I am the treatment.
What is none?
32yr female with no PMHx presents with 2 days fevers and mental status change. On presentation to the ED she is drowsy and not oriented, mumbling and not able to carry on a conversation. Head CT is negative and LP shows an elevated WBC, lymph predominate, elevated protein and nrl glucose. She is started on IV acyclovir for possible HSV encephalitis. MRI brain shows temporal enhancement. CSF HSV PCR returns negative. I am the treatment (if any) and next step.
Continue IV acyclovir!
Repeat LP and HSV PCR
You want to add me into the regimen along with an anti-staph agent + gentamicin to treat staph aureus prosthetic valve endocarditis, but not until blood cultures are clear!
What is rifampin?
42 yr female traveled home to Haiti to visit family. Three days after returning she developed fevers, HA, and altered MS.
Labs show leukopenia, anemia, thrombocytopenia, elevated HFTs, AKI
Blood smear is shown.
You will want to treat with me ASAP!
What is IV artesunate?
36 yr male presented with multiple episodes of sudden onset hemoptysis. No associated fevers or chills or other systemic symptoms. He recalls being diagnosed with pneumonia a few years ago when he was living in Arizona but recovered without event. CXR and CT chest are shown.
What is coccidioidomycosis?
46 yr male with underlying hemochromatosis is admitted with fevers, chills, crampy abd pain, diarrhea. He attended a wedding in Florida 2 days prior where he consumed raw oysters. He is ill appearing with a BP 90/45 and HR 110. Blood cx show a curved shaped GNR.
What is Vibrio vulnificus?
A 68-year-old man presents to the emergency department in late August with a 4-day history of high fever, severe headache, and confusion. His wife notes that he has been disoriented and lethargic for the past 24 hours. On physical examination, he is febrile (102.2), confused, and has neck stiffness. Neurological exam shows coarse tremors and flaccid weakness in the right arm. Lumbar puncture reveals a CSF WBC of 150 cells/μLmu L (predominantly lymphocytes), elevated protein, and normal glucose. I am your best diagnostic test.
CSF West Nile IgM
I am a coagulase negative staphylococcus but I act more like the more virulent coagulase positive staphylococcus aureus. When I am present in 2 or more blood cultures, you better check an echo even for native valves.
What is staphylococcus lugdunensis?
65 yr male is admitted with a post viral CAP. CXR shows evidence of a RLL infiltrate. Sputum for bacterial, fungal, and mycobacterial cx are sent. He is treated for a CAP and clinically improves. He is discharged 3 days later feeling much better. You see him in clinic 1 week after discharge and he is feeling well. Three weeks later you receive a call from the micro lab that one of the three sputa collected is growing mycobacterium avium complex (MAC).
I am the treatment you will offer.
What is nothing?