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- Presents:Urinary (Frequency, Urgency, Burning, Dysuria)
- Ds: UA/UC (Elevated WBC's, Nitrates indicate G- infection, UC showing > 100,000 colonies per ml)
- Rx:Uncomplicated: Give 3 days trimethoprim/sulfamethoxazole (aka Bactrim) or quinolone (floxacin drugs)Diabetes: Treat for 7 days** Do not use quinolones in pregnancy**
- UTI Symptoms of frequency, urgency and dysuria plus flank pain and tenerness.
- Diagnosis: UA/UC
- Treatment: Outpatient treatment: Ciproloxacin
- Inpatient treatment : ampicillin/getamicin
Rare complication of pyelonephritis: Look for a patient who does not respond to tx after 5-7 days. Perform sonogram or CT to look for collection.Most accurate diagnostic test: BiopsyTx: quinolone (floxacin durgs) and add staph coverage with oxacillin of nafcillin
- Presentation: Frequency, Urgency, Dysuria and perineal or sacral pain.
- Exam: Tenderness and boginess of the prostate on DRE
- Tx: Ciprofloxacin for an extended period of time
- Duke's Criteria (Meeting 2 major, 1 major and 3 minor, 5 minor)Fever + New Murmur = Do Blood Cultures. If Blood Cultures Positive = Echo to look for vegitations.
- Diagnosis is made by 2 positive blood cultures and + Echo
- Treatment: vancomycin and getamicin for 4-6 weeks** If cultures grow Strep Bovis do Colonoscopy***
- Cardiac Defects That Need Prophylaxis:- Prosthetic valves;-Unrepaired cyanotic heart dz;-Previous endocarditis;-Transplant patients who develop valve dz
- Procedures that Need Prophylaxis- Dental procedures that cause bleeding (amoxicillin)- Respiratory Tract surgery- Surgery on infected skin
HIV/AIDS Management #1
When To Start HAART Therapy:- CD4 Count < 350- Symptomatic patients with any CD4 count or viral load- Pregnant Women (- If pt already on HAART continue therapy- If found to be HIV positive (1. CD4 <500 start HAART, 2. CD 4 > 500 and viral load low Use HAART 2nd and 3rd tri)- Needle stick scenario where patient is known to be HIV positive (HAART for a month)
HIV Med Side Effects: NRTI
Zidovudine - Luekopenia, anemia, GI side effectsDidanosine - Pancreatitis, peripheral neuropathyStavudine - Peripheral neuropathyLamivudine - NoneEmtricitabine - few side effectsAbacavir - Hypersentitivity that occurs in first 6 weeks (rash, fever, nausea/vomiting - stop medication and never restarted)Zalcitabine - Pancreatitis, peripheral neuropathy, lactic acidosis
HIV Med Side Effects: Protease Inhibitors
- Hyperlipidemia, hyperglycemia and elevated liver enzymes for all
- Nelfinavir - GI
- Indinavir - Nephrolithiasis,hyperbilirubinemia
- Ritonivir - Severe GI
- Saquinavir - GI
- Lopinavir/Ritonavir - Diarrhea
- Atazanavir - Diarrhea
HIV Med Side Effects: NNRTI
- Efavirenz**** Contraindicated in pregnancy
- Nevirapine - Rash, hetatotoxicity
- Delavirdine - Rash
- PCP Pneumonia (CD4 < 200)- TMP/SMX (Bactrim)
- -If rash with Bactrim switch to atovoquone or dapsone
- Mycobacterium Avium Intracellulare ( CD4 < 50)- Azithromycin once a week orally
HIV Infections: PCP Pneumonia
- Symptoms: Dyspnea, dry cough, hypoxia, increased LDH
- Get: Chest x-ray increased interstitial markings bilaterally
- Most Accurate Test: Bronchoalveolar lavage
- Treatment: IV TMP/SMX (Bactrim) or IV PentamidineIf severe then give steriods
HIV Infections: Toxoplasmosis
- Look for headache, nausea, and vomiting and focal neurologic findings
- - Best initial test: head CT with contrast showing "ring" or contrast enhancing lesions
- Tx: Pyrimethamine and sulfadiazine for 2 weeks and then repeat the CT scan. If lesions unchanged in size or bigger then do biopsy and is most likely lymphoma.
HIV Infections: Cytomegalovirus
- HIV with CD4 < 50 and blurry vision.
- Perform optho exam
- Tx: ganciclovir or foscarnetLifelong maintenance therapy with oral valganciclovir unless CD4 goes up with HAART
HIV Infections: Cryptococcus
- HIV and CD4 < 50 with fever and headache.
- Diagnosis: Perform LP looking for increased lymphocytes in CSF.
- Diagnosis: Best Initial is India Ink Stain, most specific is cryptococcal antigen test
- Tx: Amphotericin followed by fluconazole.
HIV Complication: Progressive Multifocal Leukoenchephalopthay
- HIV and CD4 < 50 cells and focal neurological abnormalities
- Best Initial Test: Head CT or MRI with lesions that do not show ring enhancement and no mass effect.
- Tx: No specific therapy, treat with HAART
HIV Infections: Mycobacterium Avium Intracellulare
- HIV and CD < 50. Weight loss, fever and fatigue. Anemia.
- Diagnostic testing: Bone marrow is more sensitive.
- Liver Biopsy is the most sensitive and blood culture is least sensitiive
- Tx: clarithromycin and ethambutol
Animal Borne Dz: Leptospirosis
- A spirochete (causes Animal + Jaundice + Renal)
- Symptoms: Fever, abdominal pain, muscle aches
- Diagnose with serology (looking for antibodies in the blood)
- Tx: Ceftriaxone or penicillin
Animal Borne Dz: Tularemia
- Transmission: Rabbits
- Ulcer at the site of contacts and enlarged lymph nodes. May also have conjunctivitis.
- Diagnosis: Serology
Animal Borne Dz: Cysticercosis
- Transmitted from infected pork (Mexico, South America, Eastern Europe, India)
- CT scan of the head will show thin-walled cysts which are most often calcified.
- Tx: Albendazole
Tick-Borne Disease: Lyme Dz
- Recent camper or hiker
- erythema migrans with bulls eye rash
- caused by Borrelia burgdorferi
- Tx with doxycycline history and rash is enough for treatment. A but rash must be 5 cm wide or bigger.
- Long Term Comlications- Joint, Cardiac, Nerulogical (Specifically 7th nerve palsy)
- Same tick vector as lyme dz- manifests with hemolytic anemia and is severe in asplenic individuals
- Dx: Peripheral smear looking for tetrads of intraerythrocytic rings or do PCR
- Same tick vector as lyme dz
- - Elevated LFT's, thrombocytopenia and leukopenia
- Dx: peripheral smear looking for "morulae"
- Tx: doxycycline
Look for a traveler who presents with hemolysis