Adult Infectious Disease Bulletpoints Handbook

Mycobacterium Tuberculosis- primary pneumonia is rare. Most cases are reactivation of old TB in upper lobes with cavities. Frequent- night sweats, weight loss, cough and hemoptysis. Initial Tx- isoniazid (lNH), rifampin, ethambutol, pyrazinamide (PZA)- 6 months, if extrapulmonary.-18 months. Dx- + AFB smear (Kinyoun or Auramine-Rhodamine stain) with culture. MTD for rapid identification. Quantiferon

Highly associated with ARDS. Use steroids here also.

Aspiration pneumonia- know the "Triple threat of aspiration". These are: 1) Aspiration of oral secretions- caused by mouth flora (especially anaerobes. These include peptostreptococcus, fusobacterium, prevotella and veillonella. Use clindamycin, amox/clav., pip/tazo. 2) Foreign body- post-obstructive pneumonia, also associated with tumors. Must remove obstruction. 3) Aspiration of gastric contents. "Chemical pneumonitis".

CAP protocol- use levofloxacin 750 mg daily, or moxifloxacin 400 mg daily, or Ceftriaxone 2 gms IV daily with Azithromycin 500 mg daily. Rx 4-10 days.

Antibiotic Prophyllaxis for endocarditic/ortho prostheses- only use prophylaxis for prosthetic heart valves or congenital heart defects. Use Amoxicllin 2 gms; 1 hour before procedure but not after. Penicillin allergic- use azithromycin 1 gm, or cefadroxil1 gm, or clinda 300 mg. If ortho prostheses < 2 years after implantation, then prophyllaxis is warranted.

Pneumonia in a normal host- start with doxycycline 100 mg bid or extended macrolide (azithro/clarithro) unless several co-morbidities. For failures, or in patients with co-morbidities like CHF or COPD, start with respiratory fluoroquinolones-Ievofloxacin 750 mg bid x 5 days (short course), or moxifloxacin 400 mg daily x 7 days. Avoid ciprofloxacin.

Encephalitis- delerium, fever, seizures. HSV-1- hemorrhagic temporal lobe changes on MRI. Acyclovir 10 mg/kg q 8 hours. Also arboviruses (like St.Louis), VZV, EBV, HIV, Rabies, JC virus

Use Ampicillin 2 gms q 4 hours for Listeria monocytogenes, and Vancomycin 15 mg/kg IV q 12 hrs for ceftriaxone-resistant Streptococcus pneumoniae. (add Rifampin if pneumococci).

Dexamethasone 10 mg q 6 hours X 4 days ASAP. Start before antibiotics. Use Ceftriaxone 2 gms q 12 hrs for Neisseria

CSF Profiles - Normal CSF- 0-8 lymphs, 10-40 protein, Glucose=2/3 serum. Bacterial- PMNs> 200. Protein >200, Glucose< 40. Viral/Brain abscess- Lymphs < 500, Protein <200, Glucose- normal. TB/Fungal- 50-100 Lymphs,. Protein - 200. Glucose- < 2/3 serum level