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Infectious Disease 2

Terms in this set (211)

Cephalosporins MOA
B-lactam drugs that inhibit cell wall synthesis by blocking PBPs to make transpeptidase. Bactericidal.
First generation cephalosporins
Cephlexin, Cefazolin.

Mostly gram positive organisms. (staph, strep), selective gram-negative (e.coli)

Cellulitis, abscesses, osteomyelitis, S. pyogenes, UTI (e.coli and Klebsiella), surgical prophylaxis.
Second generation cephalosporins
Cefuroxime, Cefaclor, Cefoxitin

extended gram negative treatment. (e.coli, H. flu, M. Catarrhalis)

CAP, otitis media, sinusitis, surgical prophylaxis
Third generation cephalosporins
Ceftriaxone (IV), cefotaxime (IV), ceftazidime, cefixime (PO Suprax), Ceftibuten (PO Cedax), Cefpodoxime (vantin), Cefdinir (omnicef)

Even more extended gram negative treatment (most have poor staph/strep coverage)

Pyelonephritis, intra-abdominal infections, ear infections (omnicef)

Ceftazidime ONLY: pseudomonas
Fourth generation cephalosporins
Cefepime (IV)

Broad spectrum-nosocomial pneumonia, empiric treatment of neutropenic fever. POST_CHEMO neutropenia

Pseudomonas
Cephalosporins side effects, special things
G.I. distress, rash, thrombocytopenia, Don't take with antacids (spread out)

Ceftriaxone has Renal AND hepatic elimination
Sulfamethoxalone and Trimethoprim MOA
SMZ/TMP
Bactrim
2-way inhibition of folic acid synthesis. Bactericidal combination
SMZ/TPM uses
Gram negative: e.coli, klebsiella, some H. flu, PCP (PJP)

UTI, prostatitis, MRSA, bacterial bronchitis
SMZ/TPM side effects
fever, rash, SJS, GI symptoms, thrombocytopenia, hyperkalemia, hyponatremia

Teratogen can cause neural tube defects.

Worry about kidney's and CC
Dosing of SMZ/TMP
always dosed in a combination. We only worry about the TMP dosage and take whatever the sulfa may be.
Tetracyclines MOA
Blocks translation through 30s subunit. bacterialstatic
Common tetracyclines
Doxycyline, minocycline, tetracycline
tetracycline uses
Tick borne illnesses (Rickettsia, Borrelia, yersenia)

Chlamydia, walking pneumonia (mycoplasma), acne, MRSA.

Malaria prophylaxis
Tetracycline side effects
decreases absorption of magnesium, iron, and calcium.

Tooth discoloration in young children and fetus'.

Fanconi syndrome with outdated TCNs (renal failure)

GI effects, photosensitivity, fatty liver necrosis.
How to take tetracyclines
avoid milk products and antacids or separate by 2hr.

avoid taking at bedtime (esophageal irritation)

Interacts with anti-convulsives and makes oral contraceptives less effective

don't take with food, use renal modification.
Macrolides MOA
Protein synthesis inhibition- translation of the 50s subunit. Bacteriostatic
Common macrolides
Azithromycin, clarithromycin (PO), erithromycin
Macrolides uses
Most respiratory: Legionella, S. Pneumo, S. pyogenes. H. Flu, M. Catarrhalis, bronchitis.

Sinusitis, otitis media

Skin infections, H. Pylori (with 3/4 other drugs), Chlamydia
Macrolide side effects
GI motility (loose stools)

jaundice (hepatic elimintation), prolonged QT interval, myopathy

metallic taste (Clarithromycin)
Considerations with Macroldies
interacts with antacids, monitor blood clotting
Common Quinilones
Levofloxacin, ciprofloxacin, moxifloxacin
Quinilones MOA
inhibit DNA gyrase and synthesis, bactericidal. Less resistance
Quinilones uses
Broad spectrum antibiotic

gram negative UTIs, Pyelonephritis, prostatitis, Gastroenteritis (shigella, e.coli, salmonella), strange pneumonias (walking and legionella)

Cipro: Pseudomonas (complicated UTIs)

Levo: better gram positive

Moxi: sinusitis
Quinilones side effects
GI side effects, headache, tendon and cartilage damage, photosensitivity, QT prolongation, CNS effects, muscle weakness, peripheral neuropathy

Hepatic toxicity, hypo/hyperglycemia

increased risk for bleeding
Quinilones dosing
interacts with calcium, iron, and magnesium

Bad with anticonvulsants, cyclosporine, caffeine, and warfarin
Vancomycin MOA
cell wall inhibitor, bactericidal
Vancomycin uses IV
MRSA, staph aureus, strep pneumo, penicillin resistant gram-positive strains, enterococcus
Vancomycin side effects
nephrotoxicity, ototoxicity, red man syndrome

Thrombocytopenia, thrombophlebitis
Oral vancomycin
C.diff
Daptomycin MOA
depolarizes the membrane bactericidal
Daptomycin uses
IV gram positive pathogens

MRSA, MSSA, strep pyogenes, enterococcus, Vanco resistant enterococcus, endocarditis
Daptomycin side effects
GI, phlebitis, headache, rhabdo/myopathy

Monitor CPK weekly
Linezolid (zyvox) MOA
protein synthesis inhibitor (50s unit)

bactericidal (S. pneumoniae) bacteriostatic (enterococcus, staphylococcus)

Oral (100% absorption) and IV

Not metabolized in the liver, not eliminated through kidneys
Linezolid uses
serious gram positive infections

MRSA, vancomycin resistant enterococcus (EW. faecium), nosocomial pneumonia/CAP (staph, S. Pneumo), skin infections (staph and strep)
Linezolid side effects
GI distress, thrombocytopenia
Linezolid interaction
SSRIs, Tyramine (cheese, beer, homemade bread), sudafed
Aminoglycosides MOA
inhibit protein synthesis (30s)

bactericidal
Aminoglycosides uses
serious gram negatives and psuedomonas

UTI, pyelonephritis, intra-abdominal infections, endocarditis, pneumonia
Aminoglycosides side effects
Ototoxicity, nephrotoxicity

avoid if cc <50ml/min
Monitor through serum
Common aminoglycosides
All IV (or eyedrops/creams)

gentamicin, tobramycin, amikacin
Monobactam MOA
PBPs inhibit cell wall
Common Carbapenems
Imipenem-cilastatin (primaxin)
Meropenem (merrem)
Ertapenem (invanz)
Monobactam uses
Similar to aminoglycosides, without renal/ototoxicity. (use instead)

Use with PCN allergies

Use for renal in sufficient patients

Gram-negatives including pseudomonas
Carbapenem uses
Gram positive and gram negative
IUTI, respiratory, intra-abdominal)
Serious infections only
Broad spectrum

No pseudomonas or enterococcus (ertapenem only)
Carbapenem MOA
Cell wall inhibition
carbapenem side effects
seizures
Glycylcyclines MOA
Protein synthesis

Bacteriostatic
Glycylcyclines uses
gram negative (not pseudomonas)
Gram positive (including MRSA)
Mycobacterium (except not tuberculosis)

Skin and intra-abdominal infections
Common glycycyclines
Tigecycline (tygacil) IV
Glycycyclines side effects
GI, photosensitivity.

AVOID in pregnancy

interacts with warfarin
Clyindamycin MOA
protein synthesis inhibition

Bacteriostatic
Common clindamycins
Clyindamycin!

PO and IV
Clindamycin uses
staph, strep and anaerobes
Clindamycin side effects
C. diff, GI distress
Metronidazole (Flagyl) MOA
Bactericidal

must be activated by certain anaerobes/parasites to disrupt bacterial DNA
Metronidazole (Flagyl) uses
Anaerobes and parasites

intra-abdominal, skin infections, pneumonia, brain abscesses, SOME c.diff
Metronidazole (flagyl) side effects
GI distress, Metallic taste, Neutropenia, neuropathy.

AVOID ALCOHOL "disulfiram reaction)
Increased bleeding with warfarin
Clostridium difficile
spore forming, produces two toxins

most common nosocomial infection
Most common cause of C. Diff
Clindamycin, cephalosporins, quinolones
Vancomycin PO dosing
125 mg 4x per day, for 10 days
Virus classification
DNA/RNA
Single strand or double strand
Shape
envelope
size
How viruses work
Enter into cell, releases contents, contents are replicated by host cell, particles are released (viral shedding), spread
Where does herpes and varicella lie dormant?
Dorsal root ganglion
How can a latent HS1 be triggered?
Fever, sunlight on face, menstruation, stress
Common Cold
Symptoms: nasal discharge and obstruction

Causes:
Infant: Rhino, Adeno

Children: Rhino, Adeno

Adults: Rhino, Corona
Pharyngitis
Symptoms: sore throat

Causes:
Infant: Adeno

Children: Adeno, Coxsackie

Adults: Adeno, Coxsackie
Laringitis/croup
Symptoms: hoarseness, "barking" cough

Causes:
Infant/children/adults: parainfluenza, influenza
Tracheobronchitis
Symptoms: Cough

Causes:
infants: parainfluenza, RSV

children: Parainfluenza, influenza

Adults: influenza, adeno
Bronchiolitis
Symptoms: cough, dyspnea

Causes:
Infants: RSV, parainfluenza

Children: Rare

Adults: Rare
Pneumonia
Symptoms: cough, chest pain

Causes:
Infants: RSV, Influenza

Children: parainfluenza, influenza

Adults: influenza, adeno
General treatment of viruses
Most resolve on their own. Supportive care and medicines.

Antivirals in some cases

Vaccines can prevent many of these
Human Herpes Virus family
HS1, HS2, Varicella Zoster, Epstein Barr, Cytomegaly
Herpes simplex 1 general
"oral herpes" "cold sores"
acquired early in life 6months-3 years (80-90% of adults)
Can spread without lesions
DNA
lays latent in ganglia
Herpes simplex 2 general
"genital herpes"
Infects neonates or young adults (sexual contact)
Can spread without lesions
DNA
lays latent in ganglia
HSV1 diseases
Most common cause of encephalitis.
1st episode is the worst, can last 2 weeks

Children: pharyngitis, gingivostomatitis, fever, sore throat. vesicular ulcerative lesions on mucosa

Adults: Herpes labialis (cold sores), pharyngitis, tonsilitis. Starting with numbness, tingling, and burning before the eruption. "cluster of vesicular lesions"

Keratoconjunctivitis: infection of the iris, dendritic lesion which can lead to blindness. Must do a corneal stain
HSV2 diseases
can cause viral meningitis

Genital herpes: vesicular, ulcerative lesions of genitalia. Very painful. recurrences are more mild.
Encephalitis
HSV1 is most common cause. affects adults and children. can be primary or reactivation

Infection of the brain.

Rapid onset fever, headache, seizures, confusion
Herpetic Whitlow
HSV-1 or HSV-2

painful, vesicular lesions on the hands/fingers
Herpetic Gladitorum
HSV-1
Head and neck regions, usually from wrestling
HSV1/2 diagnosis and treatment
lesions or history

PCR/NAAT

Use antivirals (Acycolvir, Valacyclovir, Famciclovir)
Varicella Zoster Virus (VZV) general
DNA virus
Replicates in upper respiratory tract then spreads through body. Spreads via respiratory route
VZV diseases
Children: chicken pox. rash, fever, malaise. Maculopapular rash with vesicles and erythema. Can develop into encephalitis

Adults: latent infection-shingles (herpes Zoster). vesicular rash that doesn't cross midline. Burning sensation then rash erupts 3-5 days later. Very painful!
VZV diagnosis and treatment
Diagnosis:
Clinical signs
NAAT

Treatment:
Chicken pox: self limited. supportive care

Shingles: antivirals (acyclovir, valacyclovir) first 72 hours, pain meds, keep rash covered.

Vaccine!
Cytomegaly virus general
DNA virus
Latency is in numerous cells
Transmission is usually through body fluids
Most infections are asymptomatic
Congenital CMV
growth retardation, jaundice, petechiae rash, hapatosplenomegaly, microcephaly, hearing loss.

20% mortality

neurological and mental deficits
Mononucleosis
CMV (more mild)
EBV (most common)

fever, lymphadenopathy (posterior cervical lymph nodes), pharyngitis (tonsillar exudates), profound fatigue, splenomegaly, rash(EBV after treated as strep)

No contact sports
Diseases caused by CMV
Congenital
Mono
CMV pneumonia: worry about immunocompromised
CMV retinitis: inflammation of the retina (frosted tree)
CMV diagnosis and treatment
Congenital: clinical diagnosis, noted infection in mother, or PCR-Ganciclovir

Mono: clinical-supportive

Retinitis: PCR, history (immunocomp)-Ganciclovir

Pneumonia: PCR, history (imunocomp)-Ganciclovir
Epstein-Barr virus (EBV) general
DNA virus
Main cause of infectious mononucleosis
Latent infections
Can cause lymphoma
Oral to oral (kissing) spread
Diseases EBV cause
Mononucleosis
B Lymphocytic lyphoma (non-hodgkin's)
Nasopharyngeal carcinoma
CNS lymphoma
EBV Diagnosis
Clinical presentation of mono or lymphoma
Monospot (only catches about 75%)

Serology
Acute: +IgM +IgG +/- Early Antigen - EBnuclear antigen
Past: -IgM +IgG -Early Antigen +EB nuclear antigen
EBV treatment
Supportive care, no contact sports.

If suspected lymphoma, refer to oncology.

No antivirals or vaccine.
Respiratory viruses
Rhinovirus, coronavirus, influenza, parainfluenza, RSV
Rhinovirus general
RNA
"common cold" "viral URI"
Peaks in fall and spring
Transmission through respiratory droplets
URI symptoms
sore throat (48 hrs)
congestion
rhinorrhea
headache
fever

Can last up to 10 days, cough can last up to 6 weeks
Rhinovirus diagnosis and treatment
Clinical diagnosis
rule out pneumonia and otitis media

supportive care
Coronavirus general
RNA
Responsible for SARS
Can affect animals as well (worst strains from bats)
Winter/spring months
Common cold
Rhinovirus or Coronavirus

IF needed can get NAAT (PCR) to distinguish, if mild they'll be similar
Coronavirus symptoms
Common cold: 15-30%
2-5 day incubation, URI 1 week, worse in those with lung disease

SARS:
6 day incubation, serious URI, respiratory distress, 15% mortality
Corona virus treatment
supportive care, hospitalization if SARS
Influenza virus general
RNA
Typed A, B, C. A and B are most virulent
Surface proteins H (hemagglutinin) and N (neuraminidase) to identify
Spread through the air (respiratory droplets)
Influenza symptoms
Incubation period 1-2 days
RAPID onset fever, chills, myalgia, headache, malaise, cough, nasal discharge, tachycardia

Fever for 3-5 days, cough 2-4 weeks
Influenza complications
Pneumonia, otitis media, death
Influenza diagnosis
Usually clinical (rapid onset of symptoms),

Rapid flu test with NAAT
Influenza treatment
Oseltamivir (Tamiflu) or zanamivir (relenza) within the first 48-hours post symptoms.

Usually for high risk patients

Supportive care

Vaccinations!
Parainfluenza general
RNA
"croup"
Respiratory droplet transmission
Mostly seen in young children
Parainfluenza diseases
Causes Croup (larygotrachiobronchitis):
Sudden onset fever, rhinitis, and congestion "Steeple sign", barking cough with stridor
Parainfluenza diagnosis and treatment
Clinical diagnosis (barking cough with stridor, rapid onset) IF needed, NAAT (PCR) test

No antiviral therapy or immunizations.
Supportive care
Dexamethason (steroid)
nebulizer if severe
RSV general
RNA
Most severe in infants, causes bronchiolitis
Infects columnar epithelial cells and pneumocytes of lower airway

Late fall/early spring (winter months)
Infections worse in early life
RSV diseases
Bronchiolitis (infants <2 yrs)
URI and fever then at days 2-3 progresses to wheezing, cough, respiratory distress (tachypnea, retractions, hypoxia)
RSV complications
Severe respiratory distress/failure
pneumonia
otitis media
death
RSV diagnosis and treatment
clinical diagnosis (season, symptoms), if needed NAAT to confirm

Supportive care only
Gastro intestinal viruses
Rotavirus, norovirus
Rotavirus general
RNA virus.
Double stranded
Most common cause of viral diarrhea.
Mainly affects children (daycare)
Winter seasons
Fecal-oral spread
Rotavirus symptoms
1-3 day incubation
Mucosal damage with secretory diarrhea (profusely watery)
Diarrhea with nausea and vomiting
Dehydration and hypovolemia can occur
Hypovolemia
decreased plasma volume.

Lethargy, dizziness, muscle cramps, thirst, confusion.

Tachycardia. low bp, dry skin, dry mucus membranes, low JVP, electrolyte disturbance, elevated serum creatinine
Rotavirus diagnosis and treatment
Clinical diagnosis (profuse diarrhea, known outbreak) can confirm with NAAT (PCR) from stool sample

Supportive care, IV resuscitation if necessary

VACCINATE! (live vaccine, don't give to immunocompromised patients)
Norovirus general
RNA
single stranded
"Norwalk virus"
Most important cause of viral gastroenteritis in adults
fecal oral, person to person, and food borne spread
Especially found in clams and oysters
Norovirus symptoms
1-2 day incubation
RAPID onset of diarrhea, nausea, vomiting, fever, abdominal cramping, and malaise
Norovirus complications
dehydration and hypovolemia
Norovirus diagnosis and treatment
Clinical diagnosis (rapid onset, closed quarters) NAAT (PCR) of stool samples if necessary

supportive care (fluids)

Clean areas with bleach
Hepatitis viruses
A, B, C.
Can be acute or chronic infections of the liver
Hepatitis A general
RNA
A=Acute (no chronic liver damage)
fecal-oral spread
can be infectious but asymptomatic for long periods of time
Hepatitis A symptoms
RUQ pain, jaundice, elevated liver enzymes, pale stools, fatigue
Hepatitis A diagnosis
elevated HAV-IgM
postive HAV antigen test
Postive HAV PCR test
Hepatitis A treatment
No antiviral treatment
supportive care (check liver enzymes)

VACCINATION
Hepatitis B general
DNA
can be acute and chronic
Surface and core antigens
transmitted via blood and sexual contact
(IV drug users, MSM, HIV at higher risk)
co-infection with Hep D
Hepatitis B symptoms
incubation for up to 4 months
Acute: flulike symptoms, jaundice, elevated liver enzymes
Chronic: asymptomatic, overtime leads to cirrhosis or hepatocarcinoma
Hepatitis B: Diagnosis
Positive B surface antigen, hepatitis core antigen, and hepatitis e antigen

Clinical signs or liver dysfunction
Hepatitis B treatment
Supportive care and anti-virals.

Vaccination!!
Hepatitis C general
RNA
Most common cause of chronic hepatitis
Transmission via blood, IV drug use, unsafe medical practice, sexual contact
Hepatitis C symptoms
Often asymptomatic
Overtime chronic liver disease develops (cirrhosis, hepatocarcinoma)
Hepatitis C diagnosis
Screen all patients born between 1945-1965
Positive hepatitis C antibody and positive PCR
May present with signs of cirrhosis or liver disease
Hepatitis C treatment
Start treatment ASAP, can be cured in 12 weeks. No vaccines. Use clean needles.
Measles general
RNA
Single strand
"rubeola"
highly infectious
transmitted via respiratory droplets
Major cause of child mortality worldwide
Measles symptoms
8-15 day incubation period
fever, croyza (rhinorrhea/conjestion), conjunctivitis, cough, koplik spots (white spots in mouth/tongue/palate)
Maculopapular pink rash starting at head and down trunk and limbs
Complications of Measles
pneumonia, otitis media, encephalitis
Measles diagnosis and treatment
Clinical diagnosis (koplik spots, vaccine status, rash) can confirm via NAAT (PCR) or serology (IgM)

VACCINATE!

Supportive care
Mumps general
RNA
Winter and spring
Highly contagious spread via airborne droplets
Mumps symptoms
incubation period about 14-days
Salivary gland inflammation (parotid) and orchitis
malaise, fever, anorexia.
Can be asymptomatic
Can cause meningitis
Mumps diagnosis
Clinical diagnosis. NAAT (PCR) test
consider other diagnosis as mumps isn't very common
Mumps treatment
supportive care

MMR VACCINATION
Rubella general
RNA
"German measles"
"3-day measles"
Major concern is congenital rubella syndrome
Eliminated in the US
Transmission via airborne droplets
Rubella symptoms
Malaise, fever, arthralgia, maculopapular rash on face, trunk and extremities. Usually mild.
Rubella diagnosis and treatment
Serum IgM or in-utero PCR if congenital rubella syndrome is suspected

Supportive care

MMR VACCINATION
Congenital Rubella Syndrome
Classic triad: congenital cataracts (white pupils), sensory-neural deafness, and patent ductus arteriosus (could be pulmonary artery stenosis as well)
Human Papillomavirus (HPV) general
DNA
usually infections of skin and genital region and that effects the mucosa.
Linked to cancer development
HPV diseases and diagnosis
plantar wart "varuca-like" (clinical)
genital wart (clinical)
Cervical cancer (pap and biopsy)
Laryngeal cancer (biopsy)
Anal cancer (pap and biopsy)
HPV treatment
Wart: cryotherapy
Genital wards: cryotherapy
Anal, cervical, laryngeal, esophageal CA: refer to oncology

HPV VACCINE
Rabies general
RNA
multiples in area of inoculation and spreads to nervous system
spreads to PNS and salivary glands
Rabies symptoms
weeks to 12 month incubation
Prodrome 2-12 days anorexia, headache, photophobia, nausea vomiting
Neuro phase: encephalitis, anxiety, bizarre behavior, fear so water or wind
Seizure, coma, cardiac arrest
Rabies treatment
Survival after onset of symptoms is rare
If exposed, clean area, administer rabies immunoglobulin and vaccine series.

Vaccinate dogs!
Parvovirus B-19 general
DNA
Single strand
"fifth's disease"
"erythema infectiosum"
Usually affects children
can be serious in immunocompromised patients
Spread via respiratory droplets
Parvovirus symptoms
1-2 week incubation
Fever, cold like symptoms, rash and joint pains (althralgias)
"slapped" cheek rash and rash of hand and feet (lace-like)

immunocompromised: aplastic crisis
Parvovirus diagnosis
Clinical diagnosis
PCR or IgM

Aplastic crisis: anemia, low reticulocytes
Parvovirus treatment
supportive care

aplastic crisis: hospitalization, blood transfusion, immunoglobulin.
Coxsackie (Human enterovirus) general
RNA
A= Human enterovirus A and C
B= human enterovirus B
Spreads through respiratory droplets
summer/fall time
Coxsackievirus symptoms
Herpangina: fever, pharingitis, pharyngeal vesicles (A)

Hand-Foot-Mouth disease: fever, oral ulcerations, rash of hands and feet (A, B)

Asceptic meningitis: fever, headache, nausea, weakness (A, B)

Myocarditis: A
Common cold: A, B, C
Coxsackie diagnosis
Clinical diagnosis, serum PCR if myocarditis, aseptic meningitis

Lumbar puncture: if aseptic meningitis
Coxsackie treatment
Supportive care. No antivirals or vaccines.

Treat the complications (myocarditis, meningitis, etc)
Ebola general
RNA
"African hemorrhagic fever"
Highly virulent and deadly (50% mortality)
Ebola symptoms
2-21 days incubation
fever, sore throat, abdominal pain, myalgia, internal and external bleeding-leads to death
Ebola treatment
Supportive care, electrolytes, blood transfusions
New cases of HIV
25-34 year olds mostly men who have sex with men
HIV general
RNA retrovirus
"lentivirus subfamily"
HIV 1 and HIV 2 (HIV 1 in the US=more pathogenic)
Myths about HIV
Cannot be spread through saliva
Ways to transmit HIV
body fluids (semen, breast milk, vaginal secretions)
IV drug use
Occupational exposure (needle stick)
In utero
During birth
Where does HIV replicate?
CD4 cells (T4)
Recommended screening for HIV
All health care settings for patients ages 15 (13) to 64

especially those with TB, seeking evaluation for an STI, all pregnant women
Acute HIV symptoms
80-90% have symptoms
Significant number seek medical attention during this syndrome
Average duration of symptoms is 22 days

Weight loss, sore throat, fever, sores, thrush, myalgia, liver/spleen enlargement, headache, malaise, lymphadenopathy, rash, nausea, vomiting

*Kaposi sarcoma (raised smooth purple color)
HIV vs. Acute EBV
HIV is more acute, no tonsillar hypertrophy, rash, diarrhea, opportunistic infections

EBV tonsillar hypertrophy, exudative pharyngitis, jaundice.
Mid to late HIV symptoms
Lymphadenopathy, weight loss, night sweats, diarrhea, fever, thrush, recurrent vaginal candidiasis, opportunistic infections, recurrent herpes

Anemia, -Penias (leuko, thrombo), hypocholesterol and protein. Hypogonad, Vit B12 deficiency. Co-infection with Hep B or C
Important lab values HIV
CD4 <200=AIDS
There is also a percentage that matters too
HIV testing
HIV RNA: early
Lab and POC 4th gen: 16-20 days
Lab and POC 3rd gen: 22-35 days
Western blot: 36 days
HIV treatment
All persons with acute or recent HIV infection should be on antiretroviral treatment (ART) regardless of CD4. Combination therapy-3 drugs.
NRTI + NRTI + other

entry inhibitors. transcriptase inhibitors. integrase inhibitors, protease inhibitors.
PREP uses
prevent HIV transmission.
MSM
Heterosexual women and men (HIV positive partner, high number of sex partners, recent STI, inconsistent condom use)
Injection drug users

Must have CC >60
PREP labs
HIV testing every 3 months along with other testing
Sepsis
life-threatening organ dysfunction caused by a dysregulated host response to infection

SIRS >/=2 PLUS infection
SOFA >/=2 PLUS infection
qSOFA >/=2 PLUS infection
SOFA
In an ICU
qSOFA
Not in the ICU
SIRS
systemic inflammatory response syndrome

Temp > 100.4 OR <96.8
HR >90
RR>20
WBC >12,000 <4,000 OR bands >10%
Risk factors for sepsis
in ICU
bacteremia
>/=65 yrs
immunosuppression
surgical, diabetic, CA patients
genetic factors
Warning signs of sepsis
fever, tachycardia, tachypnea, hypotension
altered mental status
mottled skin (slow capillary refill)
cold, clammy hands/feet
pale/cyanotic skin
significant edema
oliguria
Lab warnings of sepsis
high WBC
low platelets
high blood glucose and AFTs
AKI
First steps when you suspect sepsis
Lactate level (if >2, check again)
Cultures (X2 before ABX)
Procalcitonin
Imaging (look for infection, x-ray, UA, etc.)
Kill the bugs (broad spectrum)
Fill the tank (fluids-bolus)
Squeeze the tank (pressors)
Signs of infection
Red hot swollen (vasodilated area)
Pus, etc.
Septic shock
Hypotension (despite fluid resuscitation MAP >65mmHg)
Hyperlactatemia >2
tissue hypo-perfusion
MODS
multiple organ dysfunction syndrome.
3-5 days post untreated septic shock
Nitrofurantoin (Macrobid)
Class of it's own
broad-based nature
attacks multiple pathways
used mostly for UTIs
Avoid in renal impairment
Anti-herpes agents
Converted by virus
Acyclovir
Valacyclovir
Famciclovir
Acyclovir
HSV1, HSV2, VZV, EBV, CMV
must take 5-6 times daily
AEs: stinging, headache, rash
Valacyclovir
Drug of choice for HSV
Famciclovir
Alternative to acyclovir if it fails. HSV1 and HSV2
Anti-influenza agents
Amantadine, Rimantadine, Oseltamivir (tamiflu)
Amantadine
Treats influenza A, works for H5N1 and H1N1.
crosses BBB.
Can cause dizziness, hallucinations, orthostatic hypotension, and constipation.

treatment and prophylaxis
Oseltamivir (Tamiflu)
Very broad spectrum. Covers Influenza A and B.

can cause headache, nausea/vomiting, insomnia

Only give in the first 24 hours
Hepatitis B treatments
Tenofovir, entecavir, telbivudine, adefovir
Hepatitis C treatments
Ribavirin, interferon A
Adefovir Dipivoxil
Hepatitis B and other DNA viruses (HIV)

ADR: headache, sore throat, flu syndrome, nephrotoxicity
Tenofovir
HBV and HIV
Prodrug
Can cure HBV
Ribavirin
Broad spectrum
Influenza A and B
RSV
Measles
Herpes (need another drug)
Hepatitis C (need another drug)

ADRs: headache, fatigue, insomnia, alopecia, dermatitis, growth suppression, anorexia, teratogenicity
Interferon A
acts on multiple pathways
SC and IM
adjust for renal insufficiency
Very long half life

Treats Hep B and Hep C

ADRS: flu like symptoms, alopecia, fever, myalgia
Classes of antifungals
Poyenes, imidazoles, triazoles, others
Polynes
Amphotericin B and Nystatin
Bind to fungal cell wall
treats candida infections
Nystatin only topical (or mouth rinse)

ADR: "shake and bake" Amphotericin B: fever and rigors
Imidazoles and Triazoles
punches holes in cell wall

Clotrimazole, voriconazole, fluconazole

Wide range of fungi including candida (fluconazole), cryptococcal meningitis
RING WORM: Clotrimazole

ADRs: headache, increase heart failure, visual changes (voriconazole)
Clotrimazole
Ring worm
Fluconazole
Most common anti-fungal for yeast infection
Echindocandins
Caspofungin, micafungin
Target glucans

invasive aspergillosis and invasive candidiasis
Pyrimidine Analogue
Flucytosine
Only active against yeast infections
ADR: toxicity when given with Amp B
Allylamines
Terbinafine (lamisil), Naftifine
disrupt cell wall
infected nails, systemic ringworm infections
Tolnaftate and griseofulvin
Tolnaftate: Jock itch, athletes foot, ringworm

Griseofulvin: ringworm and nail fungus
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