Most common pathogen of Necrotizing Fasciitis
Group A Strep (NOT staph aureus)
Disease that AIDS pts. can get from birds/pigeons
Dx
Tx
Cryptococcal meningitis (budding yeasts on India ink)
LP
Amphotericin B and Flucytosine
Describe erysipelas.
Causative pathogen
Tx
Raised, erythematous area with noted demarcation and painful to touch
Strep pyogenes (Group A strep)
PCN
Henoch Schonlein Purpura
Tx
Type 3 H.S. small vessel vasculitis in children d/t IgA complexes presenting as purpura in buttocks, hematuria, and proteinuria. Supportive care (hydration, rest, pain management)
Neutropenic Fever: What should you give if the fever doesn’t resolve with empiric antibiotics (Anti-pseudomonals)?
Amphotericin B anti-fungal
Post-Herpetic Neuralgia tx.
Nortriptyline is 1st line (Pregabalin is 2nd line)
Type I H.S. (anaphylaxis, asthma, urticaria/hives)
Mechanism
Ag cross links IgE on Mast and Basophils thereby releasing Histamine
Type II H.S. (Autoimmune Hemolytic Anemia, Erythroblastosis Fetalis, Goodpasture Syn, Rheumatic Fever)
Mechanism
Cy-2-toxic process where IgM and IgG bind to Ag on enemy cell to form Membrane Attack Complex or phagocytosis
Type III H.S. (Polyarteritis nodosa, SLE, Rheumatoid Arthritis, Serum sickness, Arthus rxn)
Mechanism
Ag-Ab complexes activate complement and attract Neutrophils which then kill with lysozymes
Type IV H.S. (Delayed type, Mantoux test, Transplant rejection, Contact dermatitis)
Mechanism
T lymph are sensitized and when triggered, release lymphokines to activate macrophages
Most common pathogen in nosocomial acquired G(-) bacteremias.
Tx?
Enterobacter
Ertapenem
Tetanus Management Clean minor wound:
Unknown vacc. hx or 10 yrs since last dose. Otherwise nothing.
Tetanus Management NON-minor wound:
Unknown vacc. hx or 10 yrs since last dose. Otherwise nothing.
Tx. of Mucor
Amphotericin B + Surgical debridement
Dx. Hydatid cyst (Echinoccocus)
US + serology
Tx. for Local Tetanus
Tetanus Ig
Metronidazole
Benzodiazepine (like Diazepam)
Tx. for Methicillin-Sensitive Staph Aureus (MSSA)
Cefazolin
Tx. of Coagulase-Negative Staph bacteria
Vancomycin empirically
Histoplasmosis
Ohio River Valley
Diffuse bilateral nodular densities
Hilar lymphadenopathy
Tx: IV Amphotericin B then Itraconazole x 12wks
Blastomycosis (Broad Based Budding)
South Central US
Flu-like illness
Violaceous papules with crusting
When is PCV13 (pneumococcal vaccine 13 valent given)?
for 65+ y.o. then do PPSV23
When is PPSV23 vaccine given?
1 time vaccine
Salmonella keywords
G(-) rod MOTILE (“salmon swim”) with flagella
Lactose Non-fermenter
H2S +
upregulates cAMP
Tx: Quinolone, TMP-SMX
Shigella keywords
G(-) rod NONMOTILE Lactose Non-fermenter H2S (-) protein synthesis inhibiting toxin daycare
Tx: Azithromycin, Ciprofloxacin
Tuberculosis keywords
Acid Fast
Non-calcified round opacities
Cavitation of upper lobe is “advanced TB”
What herbal remedy should be avoided in a pt. taking HAART?
St. John’s Wort. It increases metabolism of protease inhibitors.
Sarcoidosis pathophysiology
macro –> 1-a-hydroxylase (which converts Vit D to active 1,25…) thus increasing Ca absorption
AIDS Opportunistic Infections at 200-500 CD4
Prophylaxis?
Candidiasis HSV Kaposi TB (Ppx: Isoniazid x 9mo) Varicella
AIDS Opportunistic Infections at 100-200 CD4
Prophylaxis?
Pneumocystis Jirovecii pneumonia
Ppx: TMP-SMX single strength
AIDS Opportunistic Infections at 50-100 CD4
Prophylaxis?
Coccidioidomycosis
CryptoSPORIDIUM
Histoplasma
Toxoplasmosis (Ppx: TMP-SMX 2x strength)
AIDS Opportunistic Infections at
CMV retinitis
CNS Lymphoma
CryptoCOCCUS
MAC (Ppx: weekly Azithromycin or weekly Clarithromycin)
Rheumatic Fever Criteria
Dx?
Joints
Graft V. Host Disease (Type IV H.S.)
T cells from DONOR attack the HOST’s cells
Tx. Vibrio cholerae gastroenteritis
Azithromycin (macrolide), Tetracycline, or Fluoroquinolone + Oral rehydration
Cryptococcal Meningitis keywords
HIV pt.
budding yeasts on India ink
pigeons
Tx: Amphotericin B and Flucytosine
Primary Amyloidosis keywords
proteinuria
heavy lambda-light chains
apple green birefringence after K+-permanganate