Fungi Among Us
Neutropenic pt w/ AML develops fever & hemoptysis. CT chest shows pulm nodules w/ halo signs. BAL grows Aspergillus fumigatus. 1st-line tx?
IV voriconazole
Pt w/ disseminated vesicular lesions involving multiple dermatomes & oral mucosa is admitted to ICU. Iso precautions?
Airborne + contact
Ventilated pt develops fever, purulent tracheal secretions, worsening O2, & new pulm infiltrate after 7 days on vent. Dx?
Vent-associated PNA (VAP)
Pt w/ ESBL-producing E. coli bacteremia has normal renal function & no drug allergies. Which abx should be used?
Carbapenem (e.g. mero, erta)
Pt w/ HIV & CD4 20 cells/mm³; p/w headache, photophobia, vomiting, fever, & neck stiffness. LP shows OP 45 cm H₂O. Dx? *bonus* Mgmt?
Diabetic pt p/w AMS, fever, foul-smelling nasal d/c, proptosis, & periorbital swelling. Invasive fungal sinusitis is suspected. Dx & mgmt?
Pt develops severe skin pain, mucosal involvement, & rapidly progressive epidermal injury after starting med. Dx?
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)
Pt w/ CVC develops septic shock, & bcx from both central & peripheral sites grow S aureus. Mgmt?
Remove CVC & start IV abx.
ESBL-producing bacteria are typically resistant to which classes of abx? Name 3
Kidney trx recipient develops fever, pulm cavitary nodules, brain ring-enhancing lesions, & painful skin nodules. Bx shows weakly acid-fast branching GPRs. Dx? *bonus* Mgmt?
Pt on chemo develops painful violaceous skin lesions. Bcx grow mold w/ characteristic banana-shaped macroconidia. Dx?
Disseminated fuseriosis
Pt w/ prostate ca found unconscious at home, developed status epilepticus, intubated, started AEDs. Family recently arrived from Central America. Suspected dx, classic imaging findings, & mgmt?
Pt w/ suspected IE develops multiple embolic cerebral infarcts. Tx w/ IV tPA as part of mgmt?
No; priority is IV abx targeting IE.
Name 3 adverse effects or toxicities associated w/ amphotericin B.
Pt on high-dose corticosteroids develops resp deterioration, abdo pain, sepsis, & diffuse maculopapular rash. Labs show eosinopenia. Suspected parasitic hyperinfection. Dx? *bonus* Mgmt?
Pt w/ suspected invasive fungal infection has +ve serum β-D-glucan, but clinical picture is not c/w fungal disease. 2 factors that can cause false +ve βDG?
During a smallpox outbreak, a Massachusetts physician refused mandatory vax & was fined under state law req vax. He challenged the law, arguing that it violated his individual liberty. Landmark Supreme Court case that established constitutional basis for states to enforce public-health measures during ID outbreaks?
Pt w/ septic shock has persistent hypotension despite initial fluid resuscitation. Suggested early predictor for initiating pressors?
Lack of fluid responsiveness on PLR (i.e. no significant increase in SV)
Pt on voriconazole is also taking tacro. Why bad?
Voriconazole inhibits CYP450 enzymes & can significantly increase tacro levels -> tox
Pt from Northeast develops fever, hemolytic anemia, elevated LDH, indirect hyperbilirubinemia, & low haptoglobin after hiking. PBS shows intraerythrocytic ring forms & Maltese crosses. Dx?
Babesiosis
Pt w/ candidemia develops blurred vision & eye pain. Ophthal exam shows chorioretinal lesions w/ vitreal involvement. Mgmt?
Poorly controlled diabetic pt p/w rapidly progressing, painful erythematous patch on skin over last 24 hrs; also fever, malaise, severe POP. Exam shows swollen, warm, tender, early blistering & dusky discoloration. 4 possible microbes?
Pt w/ persistent C albicans fungemia despite mica. CVC removed. CTAP & TTE clear. Suspicion?
Candida suppurative thrombophlebitis
Pt w/ ESBL E coli bacteremia that's sensitive to both mero & pip-tazo. Landmark RCT (name & outcome) that addressed whether pip-tazo was noninferior to mero for this infection?
Pt w/ suspected babesiosis has characteristic organisms on PBS. 3 labs to check?