GROUP A - Strep PYOGENES

"GASP due to pain in throat/skin due to burning"

Group B - STREP AGALACTAIE

"GBS Spaceship - Agalactaie"

1. Early 0-3 days of age
2. Late - 3 to 90 days of age
3. Types of infections   COP

Cellulitus

Osteomyleitis

Pneumonia

  4.  I:T Ratio > 0.2  TREAT

  5.  Screen 35-37 weeks; treat > 4hours before delivery

TETRACYCLINE

WHAT AGE CAN IT BE USED?

After age 8

EXCEPTION:  RMSF - first line at any age

FLUOROQUINOLONES

What age safe to use?

18+

Tendinitis and Tendon rupture risk before 18

PCN -

Treatment of choice for what infections

1. Strep Pharyngitis
2. Dental infections
3. Syphillis

ENTEROCOCCUS

1. ORGANISM?
2. TREATMENT?
3. AVOID WHAT ABX?

1. GRAM POSITIVE - Coag Neg, CHAINS
2. LAV(A) - Linezolid, Ampicillin (DOC), Vancomycin
3. Alternate - rifampin & quinolones
4. AVOID cephalosporins

1. CORYNEBACTERIUM DIPHTERIA
2. LISTERIA MONOCYTOGENES

1. Enterococcus Faecalis

CORYNEBACTERIUM DIPTHERIA

Type of organism

Symptoms

Complications

1. Gram POSITIVE ROD
2. Fever
   URI
3. Motor/Sensory Deficits with loss of reflexes
4. PSEUDOMEMBRANE - hard to intubate
5. RX.  Metronidazole / Erythromycin

STREPTOCOCCUS

-Appearance

- alpha hemolytic Strep

GRAM + Cocci in pairs and chains

Gram stain will show BLUE organisms

ALPHA Hemolytic Strep

Strep Viridans

Strep Pneumoniae

"GREEN (Verde=viridians) ALF with a newmoo = pneumonia"

POST STREP GN

Lab findings

Hematur

Hypertension

Edema

Low C3

Proteinuria

Normal C4

HELP 4 the kidneys

Biopsy:  Lumpy Bumpy IgG deposits

PERITONSILLAR ABSCESS

Physical findings

Organism

Treatment

Symptoms

Deviated uvula

Difficulty opening mouth

Hot potato voice

Drooling

Organism - GA Strep = Strep Pyogenes

IV treatment - Clindamycin + Amp/Sulbactam

Oral - Augmentin

STAPH AUREUS

-appearance on stain

- special testing

GRAM + Clusters

If in blood, IV ABX.  

ECHO

STAPH EPIDERMIS

- Coag + or -?

- Treatmen

1.  CONS - Coagulase Negative

2.  VANCOMYCIN

What organism likely causes

VPS Shunt infections or peritonitis through dialysis cather?

1.  STAPH EPIDERMIS!

2.  Treat with Vancomycin

RMSF

- Type of organism

- Lab findings

1.  M/C Tick borne illness

2.  Rickettsia Rickettsii

3.  Symptoms 

     Thrombocytopenia

      Petechiae

     Headache

     Lethargy

     Altered mentation

RMSF 

Describe Rash

Starts at palms, wrists and soles

Spreads to trunk within hours

Confirm dx with biopsy of lesion/ immunofluorescence

RMSF

Treatment 

DOXYCYCLINE

FOR ALL AGES

CAT SCRATCH DISEASE

Symptoms

Draining / tender LAN

Possible hx of cat exposure

RESOLVES ON OWN

(Only treat immunocompromised or severe symptoms)

RX:  NON PCN - macrolide/cephalosporin/TMP/Doxy

CITROBACTER FREUNDII

1.  BRAIN ABSCESS

2.  Can be hospital acquired

CHLAMYDIA TRACHOMATIS

- Type of organism

symptoms

1.  Obligate intracellular anaerobe

1.5 AFEBRILE!

2.  Symtoms 

Conjunctivitis ----Can lead to blindness

Urethritis

Pneumonia - cause staccato cough

PID

MNE:  CUPID causing LuV (Lymphamogranuloma Venerum)

Chlamydia Trachomatis

DX

PCR of cells, secretions, urine

INTRACYTOPLASMIC INCLUSIONS

TX:  Doxycycline x 7 days - STD

       Doxycycline x 14 days - PID

If fails treatment, Azithro - 1 gram 

LYMPHOGRANULOMA VENERUM

vs 

Lymphogranuloma Venerum Serovar

STD

Starts as small, non tender papules / shallow ulcers

Progress to unilateral inguinal LN and ruptures/drains

LVS

Same symptom

1.  Atypical Pneumoniae

2.  M/C < 2 months of age

3.  Tachypnea

     STACCATO cough

     Eye drainage +/-

GRAM - with intracytoplasmic inclusion bodies

4.  TREAT:  Macrolide azithro or erthrpmycin 

1.  Atypical pneumonia

2.  BULLOUS Myringitis

MNE:  MMMM = Mycoplasma - Get IgM, Macrolide, Myringitis, delayed M(N)eurologic

Pleomorphic Organism

Rx.  CEFTRIAXONE

--ELLA organisms are likely what type of

GRAM stain + or -

ie Brucella

Shigella

Salmonella

PSEUDOMONAS

- types of infections

Multiple

Skin

Pneumonia

Otitis

UTI

Osteomy

Sepsis

Pseudomonas

TREATMENT

CefTAZ

CefePIM(P)E

GENTamicin

CARbencillin

PIPEeracillin

TICKarcillin

ToBRAmycin

GENtle Taz (who is a) PIMP wearing only a PSUEDE BRA rides in a CAR with a TICking PIPE bomb.

1.  Pneumonia

2.  Skin Lesions

BROAD BASED YEAST NEAR water

Amphotericin B

Use Liposomal Amp B for pt with kidney issues

CRYPTOCOCCUS

- type of exposure

- location

1.  BIRD dropping - Pigeon

2.  Travel in NW US

3.  Symptoms - Meningitis

                      Pneumonia

IMMUNOCOMPROMISED

AMPHOTERICIN B + Fluconzaole for meningitis serious infx

FLuconazole (can use first for isolated pulmonary dz)

CRYing PT due to NECK pain as PIGEON on his shoulder pecked him and made him bleed red INDIA INK. 

Immunocompromised

BLASTOMYCOSIS

Treatment

COCCIDIOIDOMYCOSIS

Symptoms

Location

Treatment

1.  Pneumonia with pulmonary nodules

2.  Flu like symptom

3.  Az, California, Texas

4.  AMPHO or Fluconazole/Ketoconazole

HISTOPLASMOSIS

- Symptoms

1.  Most clear without intervention

2.  If doesn't clear, CALCIFICATIONS on XRAY can look like TB;  may get pulmonary fibrosis

3.  HSM

4.  Mediastinal / hilar calcifications

5.  Flu like symptoms with non pleuritic chest pain

HISTOPLASMOSIS

- Where likely to find?

RICKETTSIA

type of organism

transmission

diagnosis

1. Obligate intracellular 

2.  transmitted by tick bite of IXODES

3.  SEROLOGIC TESTS 

4.  Indirect Immunofluorescene Antibody

ENTEROCOCCUS

- most common genus

Enterococcus FAECALIS/ FAECIUM

ENTEROCOCCUS 

- should avoid what ABX?

1.  Avoid PCN

2.  RESISTANT TO CEPHALOSPORINS

3.  Can be resistant to Vanco and Amp

4.  LINEZOLID - can be used for vanco resistant Enter. infxn

5.  INVASIVE infxn - vanco or amp with Aminoglycoside (Gentamicin)

CAT SCRATCH

- Diagnosis

Immunofluroscence Antibody

CHLAMYDIA!

1.  Flu like symptoms

2.  RASH!!!

    erythematous maculopapular rash

erythema multiforme

erythema nodosum

3.  DISSEMINATION common in infants

HISTOPLASMOSIS

- when to treat

AMPHO B for disseminated / serious dz

consider itraconazole/fluconazole

HIV pts - itraconazole

Cryptococcus 

type of organism

Encapsulated yeast visualized with India ink or other stains of CSF

Chlamydia conjunctivits

How do you treat

ORAL erythromycin or ORAL sulfonamides

Enterovirus

Coxsackie

ADENOVIRUS 

- symptoms

- season

1.  Pharyngitis can look like STREP

2.  URI

3.  COnjunctivitis

4.  OM

5.  GASTRO!

SUMMER

1.  Encephalopathy - confusion, lethargy

2.  MOSQUITOes (California, St. Louis)

ARBOVIRUSES

- how to diagnosis

VIRUS specific Acute and Convalescent antibody titers

MNEMONIC:  Sitting under a tree(ARBO) grows NOW & LATER and a branch falls and hits HEAD - causing encephalitis

Hyperinflated 

Diffuse infiltrates

Human Herpes Virus 6

- what does it cause

Age group

Symptoms

ROSEOLA - rash after FEVER

6 months - 2 years

SUDDEN ONSET OF HIGH FEVER

Can have neuro symptoms

HSV

- symptoms

1.  PAIN before lesions

2.  Multiple lesions - ULCERS or VESICLES

3.  Clustered on erythematous base

4.  LAN

HSV

DiAGNSOSIS

Treatment

VIRAL CULTURE

HSV PCR

ORAL Acyclovir - 7 days 

IV ABX Acyclovir - Infants

HSV ENCEPHALITIS

CT findings

Symptoms

Treatment

EEG

Fever

Seizures

CT Of TEmporal LOBE of Brain

TREAT STAT IV ACYCLOVIR

Lumbar puncture for PCR testings

EEG - periodic lateralizing epliptiform discharge

SMALL POX

- rash location

- length of time

1.  LESIONS look same as chickenpox

2.  ALL APPEAR AT same time (unlike chickenpox) 

3.   ONLY on FACE/EXTREMITIES (not on trunk)

4.  Last 3-4 weeks

5.  SCAR!!!!!

WHICH viruses require

NEGATIVE PRESSURE isolation?

1.  Measles

2.  Mycobacterium TB

3.  Varicella

4.  ASpergillus

AS MTV 

RABIES

- what animals

RAccoons - most common in us

Bats

Skunks

Dogs

Foxes

Woodchucks

RABIES at DFW.  

1.  Human Rabies IG

2.  5 VACCINE doses

MEASLES

- most common symptoms

1.  Cough

2.  Coryza (rhinorrhea)

3.  Conjunctivitis

4.  Koplik SPOTS

5.  RASH

STARTS at HEAD and progresses DOWN

resolves in 5 days

Measles - 

MAIN CAUSE OF DEATH?

1.  Pneumonia

MEASLES

- transmission

-type of isolation

-length of contagious

1.  RESPIRATORY droplets

2.  NEGATIVE Pressure

3.  5 days before symptoms and 5 days after resolves

MEASLES

- how many days since exposure should you give vaccine

- what is minimum age for vaccine

1.  If less than 3 days since exposure, GIVE VACCINE

2.  Must be > 6 months

3.  If greater than 3 days since exposure, give Measles Immunoglobulin