![Picture](/uploads/2/4/7/7/24774519/9431370.jpg)
MENINGITIS
Head Trauma or neurosurgery: Vanco + Ceftazidime
>60 yo: Ampicillin + Vanco+ Ceftriaxone
>15yo Ceftriaxone
2months: Ceftriaxone + Ampicillin
Head Trauma or neurosurgery: Vanco + Ceftazidime
>60 yo: Ampicillin + Vanco+ Ceftriaxone
>15yo Ceftriaxone
2months: Ceftriaxone + Ampicillin
![Picture](/uploads/2/4/7/7/24774519/5993776.jpg?136)
TRICHOMONIASIS
Anaerobic, Flagellated protozoa
Treatment: Single dose Metronidazole or Tinidazole for patient and partner
Anaerobic, Flagellated protozoa
Treatment: Single dose Metronidazole or Tinidazole for patient and partner
![Picture](/uploads/2/4/7/7/24774519/4359644.jpg)
Capnocytophaga canimorsus
Member of the normal oral flora of dogs.
Seen in patients with splenectomy (impaired ability to clear intravascular bacteria and impaired antibody production) and those who abuse alcohol or have cirrhosis.
Treatment: β-lactam/β-lactamase inhibitor combination, supportive care, and possible surgical debridement.
Suspect this infection on asplenic patient after dog bite
Image is from blood journal
Member of the normal oral flora of dogs.
Seen in patients with splenectomy (impaired ability to clear intravascular bacteria and impaired antibody production) and those who abuse alcohol or have cirrhosis.
Treatment: β-lactam/β-lactamase inhibitor combination, supportive care, and possible surgical debridement.
Suspect this infection on asplenic patient after dog bite
Image is from blood journal
![Picture](/uploads/2/4/7/7/24774519/3364371.jpg?350)
WEST NILE VIRUS ENCEPHALITIS (Flaviviruses)
Flaccid paralysis that may be irreversible.
Vector : mosquito ( bites in the late summer and early fall)
Host: Bird
Detection of cerebrospinal fluid (CSF) IgM antibodies is considered diagnostic of neuroinvasive disease.
First time reported in USA was August 1999, 7 deaths in NYC
Flaccid paralysis that may be irreversible.
Vector : mosquito ( bites in the late summer and early fall)
Host: Bird
Detection of cerebrospinal fluid (CSF) IgM antibodies is considered diagnostic of neuroinvasive disease.
First time reported in USA was August 1999, 7 deaths in NYC
![Picture](/uploads/2/4/7/7/24774519/2741662.jpg?524)
CLOSTRIDIUM DIFFICILE COLITIS
- Mild to Moderate
WBC < 15 000
Cr < 1.5
Treatment: Metronidazole
- Severe
* WBC > 15 000 /Cr >1.5
Treatment : Oral Vanco
If Ileus add Vanco IV or switch to rectal Vanco
* WBC >20 000 / Lactate >2.2 / Toxic Megacolon / Severe Ileus
Treatment: subtotal colectomy or diverting loop ileostomy with colonic lavage
BEST WAY TO PREVENT WASH HAND WITH SOAP AND WATER AND BARRIER CONTACT (ALCOHOL SANITIZER DOES NOT WORK!!)
- Mild to Moderate
WBC < 15 000
Cr < 1.5
Treatment: Metronidazole
- Severe
* WBC > 15 000 /Cr >1.5
Treatment : Oral Vanco
If Ileus add Vanco IV or switch to rectal Vanco
* WBC >20 000 / Lactate >2.2 / Toxic Megacolon / Severe Ileus
Treatment: subtotal colectomy or diverting loop ileostomy with colonic lavage
BEST WAY TO PREVENT WASH HAND WITH SOAP AND WATER AND BARRIER CONTACT (ALCOHOL SANITIZER DOES NOT WORK!!)
![Picture](/uploads/2/4/7/7/24774519/6197552.jpg)
SPIROTRICHOSIS
Sporothrix schenckii (dimorphic fungus).
Gardeners "prick by a thorn"
Tx:
- Cutaneous and lymphangitic with oral potassium or itraconazole.
- Pulmonary or disseminated: Itraconazole or Amphotericin B
Sporothrix schenckii (dimorphic fungus).
Gardeners "prick by a thorn"
Tx:
- Cutaneous and lymphangitic with oral potassium or itraconazole.
- Pulmonary or disseminated: Itraconazole or Amphotericin B
![Picture](/uploads/2/4/7/7/24774519/330661.jpg?228)
CYCLOSPORIDIASIS
Cyclospora cayetanensis. Spread through contaminated food and water with feces.
Affects small intestine giving watery diarrhea.
Rasberries from Guatemala/ Basil from Missouri/ Snow peas from Philadelphia
Tx: TMP-SMX
Cyclospora cayetanensis. Spread through contaminated food and water with feces.
Affects small intestine giving watery diarrhea.
Rasberries from Guatemala/ Basil from Missouri/ Snow peas from Philadelphia
Tx: TMP-SMX
![Picture](/uploads/2/4/7/7/24774519/9654194.jpg)
PLASMODIA-MALARIA
Africa or Asia (chloroquine resistant area)
P.falciparum: Banana gametocyte, multiple parasites in RBC. Worst type
P. Vivax: Duffy RBC antigen is site of attachment
P.malarie : Nephrotic syndrome
Tx
- Chloroquine: P.vivax, P.ovale, P.malariae
- Primaquine P.vivax P.ovale (hypnozoites in liver, they relapse)
Prophylaxis:
- Mefloquine 1/week 2 weeks before until 4 weeks after
- doxycycline Start 1 day before, until 4 weeks after travel
- Malarone 1d before until 7 days after
- Primaquine 2 weeks after travel in area with ovale or vivax (careful in pt with G6PD def)
Africa or Asia (chloroquine resistant area)
P.falciparum: Banana gametocyte, multiple parasites in RBC. Worst type
P. Vivax: Duffy RBC antigen is site of attachment
P.malarie : Nephrotic syndrome
Tx
- Chloroquine: P.vivax, P.ovale, P.malariae
- Primaquine P.vivax P.ovale (hypnozoites in liver, they relapse)
Prophylaxis:
- Mefloquine 1/week 2 weeks before until 4 weeks after
- doxycycline Start 1 day before, until 4 weeks after travel
- Malarone 1d before until 7 days after
- Primaquine 2 weeks after travel in area with ovale or vivax (careful in pt with G6PD def)
![Picture](/uploads/2/4/7/7/24774519/4862991.png)
BABESIA MICROTI
Intra RBC protozoan (Maltese Cross Pattern)
Febrile hemolytic anemia, sweats, myalgias
TX :Clindamycin+quinine
Intra RBC protozoan (Maltese Cross Pattern)
Febrile hemolytic anemia, sweats, myalgias
TX :Clindamycin+quinine
TB
Side Effects of medication:
Ethambutol: color blindness
Streptomycin: Ototoxicity
Isoniazid: Hepatotoxicity and Peripheral neuropathy
Rifampin: Red orange body fluids
Pyrazinamide: Hepatotoxicity
Side Effects of medication:
Ethambutol: color blindness
Streptomycin: Ototoxicity
Isoniazid: Hepatotoxicity and Peripheral neuropathy
Rifampin: Red orange body fluids
Pyrazinamide: Hepatotoxicity
![Picture](http://www.editmysite.com/editor/images/na.png)
PNEUMOCYSTIS JIROVECI PNEUMONIA (PCP)
Sx: fever, dyspnea, dry cough, chest pain, malaise, weight loss, headaches, weoght loss
Labs: LDH>450
CXR diffuse interstitial infiltrates. Can be normal.
Spontaneous pneumothorax in 5%
Sx: fever, dyspnea, dry cough, chest pain, malaise, weight loss, headaches, weoght loss
Labs: LDH>450
CXR diffuse interstitial infiltrates. Can be normal.
Spontaneous pneumothorax in 5%
STREPTOCOCCUS PHARYNGITIS
CENTOR Criteria
- no cough
- tonsillar exudates
- fever
- cervical Lymph nodes
If 2-3 criteria do rapid strep tes
If 4 criteria treat empirically
http://www.aafp.org/afp/2009/0301/p383.html
CENTOR Criteria
- no cough
- tonsillar exudates
- fever
- cervical Lymph nodes
If 2-3 criteria do rapid strep tes
If 4 criteria treat empirically
http://www.aafp.org/afp/2009/0301/p383.html
EPIGLOTITIS
Clinical Features:
- Sore throat
- Fever
- Odynophagia or dysphagia
- Dysphonia
- Stridor
-Drooling
Dx lateral neck xray : abn if epiglottis>8mm (thumbprint sign)
Tx Vanco+Ceftriaxone
Clinical Features:
- Sore throat
- Fever
- Odynophagia or dysphagia
- Dysphonia
- Stridor
-Drooling
Dx lateral neck xray : abn if epiglottis>8mm (thumbprint sign)
Tx Vanco+Ceftriaxone