Opportunistic Infections
Name 3 reasons a patient can be susceptible to opportunistic infection
uncontrolled diabetes, cancer, HIV, organ transplant patients, severely malnourished pt
What is the importance of monitoring vancomycin levels inpatient?
pharmacy measures the peaks and troughs to ensure the vancomycin levels are therapeutic and not nephrotoxic
Henry loves the hospital so much, he decides to build an entire wing so that he can live there. He remembers someone saying something about treatment for pneumonia. how does treatment differ from communiy acquired pneumonia to health care associated?
CAP: azithromycin /dozy
HCAP: multidrug resistant pathogens like Pseudomonas, klebsiella require cefepime, piperacillin/tazobactam, or respiratory fluoroquinolone
if MRSA, use vancomycin or linezolid
Raisa comes in with cough and muscle aches lasting 2 days. She denies any sick contacts. There are no exudates in her throat. What is the treatment and why
supportive care, likely viral
What is the treatment for recurrent C. Diff?
consider fecal transplant
Vancomycin orally 500mg QID for 10 days
consider cholestyramine
78 year old female with a BMI of 17 comes in from the nursing home with nonspecific fever, chills and FTT. Vitals 70/90, HR 100 and temp 96. After a few days of broad spectrum antibiotics, blood cultures are not back yet and patient remains on pressors. What is the next treatment?
Consider antifungals, get procal and fungitell.
Gus and Gul go on a trip to the caves in Mississippi. They both have a huge sweet tooth and refuse to listen to their endocrinologist, Dr. Jarugula. A few weeks later, they both notice red bumps on their shins. Name the sickness
Histoplasmosis!
Raad hasn't been feeling good the last few weeks. He goes to his favorite IM doctor Dr. Nathanson and is diagnosed with Pneumona. Name the first line treatment for pneumonia
Azithromycin, doxycycline, some may say moxifloxacin...
Arhum has been spending a lot of time working in the needle exchange program, trying to save the world. He's in line for the next nobel prize if you can name three opportunistic infections commonly associated with HIV/AIDS
PCP pneumonia, CMV, oral hairy leukoplakia, HSV encephalitis
Which organism commonly causes CLABSI?
Staph aureus / coagulase negative staph
Name two pathogens that can cause endocarditis and the valves they typically invade
Staph Aureus: mitral and aortic
Strep Viridans: mitral (dental procedures)
Enterococcus: mitral
Strep Bovis: tricuspid, can be from colonic tumors
Staph epi: Prosthetic valves
Outpatient treatment of cellulitis, when to hospitalize. include non-MRSA and MRSA
Staph: purulent, tx with cephalexan, dicloxacillin. Bactrim if allergy
MRSA: bactrim, amoxicillin, clindamycin, linezolid
pain out of proportion to exam findings, rapidly progressing, fever, chills, stiff muscle (compartment syndrome)
What is the primary antiretroviral class used in treatment of HIV?
Protease inhibitors and integrase inhibitors (emtricitabine, efavirenz, tenofovir, retrovir, epivir, doravirine)
Matt is a retired 99 year old man that has an infection that's being treated with cefepime. In his old, healthy age, what are the adverse effects of cefepime to look out for?
headache, dizziness, confusion
neutropenia, elevated BUN/Creatinine
Liver enzyme elevations
What are the types of necrotizing fascitis?
Type 1: Polymycrobial
Type 2:Group A strep
Type IV: fungal cases (rare)
40 year old Ronak presents with recurrent heartburn and has started having trouble swallowing. He takes omeprazole daily with no relief. What is the quadruple therapy he needs to be on? He is allergic to penicillin
PPI
Metronidazole
Clarithromycin
Bismuth Salicylate
Dr. Turfe, in his old age, is a 86 year old male with a recent A1C of 13 and undergoing systemic chemotherapy for colon cancer, diagnosed by his long time friend and colleague Dr. Dourra. He starts having black spots on his nose and face. What does he have and what is the treatment?
mucormycosis
tx: amphotericin B and RADICAL surgical debridement
40-50% mortality rate
Dr. Mansour is working on improving his 200 bed ICU. He asks, how can you prevent a CAUTI and CLABSI?
don't draw cultures on the line!
(just kidding)
22 year old female Henna presents in the springtime with heart palpitations lasting about a day. She went camping recently and has a rash on her ankles, wrists, palms and soles. Pt also has a low grade fever, muscle aches and joint pain. Upon further questioning, she states she went camping in Toronto over a week ago. Name the diagnosis and treatment.
Rocky mountain spotted fever
Doxycycline
Describe the difference between Bacterial vaginosis and vaginitis. Please include features, microscopic findings and treatment.
BV: overgrowth of bacteria, with thin grayish white discharge "fishy". pH of >4.5, clue cells on microscopy. Tx with metronidazole 500mg oral twice daily for 7 days
Vaginitis: thick white discharge, itching, redness. Pseudohyphae on microscopic exam, tx with fluconazole 150mg orally as single dose.