SYSTEM EYE PROBLEM Conjunctivitis PATHOGEN Adenoviris Herpes 1 & 2 Chlamydia trachomatis Neonatal conjunctivitis Neisseria Gonorrhea Retinitis SINUS/NOSE Sinusitis THROAT Bacterial Pharyngitis Viral Pharyngitis (Cold) Mononucleosis Acute Bronchitis TREATEMENT No Tx Acyclovir Azithromycin / tetracycline CMV CLASSIFICATION Picornavirus Acyclovir bacteria (obligate intracellular) Bacteria – diplococci (G-) Herpes virus Strep. Pneumoniae H. Influenza B G+ diplococci G- Rod M. Catarrhalis G- Kidney bean S. Aureus G+ cocci clusters Rhinovirus RSV Picornovirus Paramyxovirus doxycyclin / amoxicillin doxycyclin / amoxicillin (+ Blactamase inhib) doxycyclin / amoxicillin (+ B-lactamase inhib) Non-resistant = PCN MRSA = Vanco, Clindamycin No Tx Ribavirin Strep. Pyogenes (Group A) N. Gonorrhea M. catarrhalis G+ cocci G- Diplococci G- Kidney bean C. diptheriae G+ Rhinovirus Coronavirus Influenza Coxsackievirus A / B Parainfluenza - CROUP Adenovirus RSV EBV, CMV HIV “Usually Viral” S. pneumoniae H. influenza M. catarrhalis Picornavirus Coronavirus Ceftriaxone (3 cephalosporin) Valgancyclovir (gancyclovir) PCN, Clindomaycin, Azithromycin 3 Ceflosporin Doxy, ampicillin (+ B-lactamase inhib) Vancomycin Oseltamivir (if Risk) Picornavirus Adenovirus Paramyxovirus Herpesvirus Retrovirus G+ diplococci G- rod G- kidneybean Ribivirin (if Risk) Symptomatic Tx Amoxicillin Amoxocillin Amoxocillin Pneumonia (viral) Pneumonia (bacterial) Chronic/Severe pneumonia (immuno-compromised) GI Acute gastritis Gastroenteritis (Preformed toxins) Gastroenteritis RSV, Parainfluenza Hantavirus Measles paramyxovirus bunyavirus parmyxovirus Influenza CMV Legionella Chlamydia (neonatal) Klebsiella (alcoholics) Mycoplasma (“Walking”) Strep. pneumoniae (**1**) Nocardia Staph H. influenza B orthomyxovirus herpesvirus G- rod (tiny) obligate intracellular Enteric Gobligate intracellular G+ diplococci Mycobacterium Tuberculosis Acid-fast bacteria Histoplasma capstulatum Cocidioides immitis Blastomyces Cryptococcus Dimorphic fungi H. pylori Staph aureus (entrotoxin A,B,C) G- bacteria Bacillus cereus (“rice” – heat stable) C. botulinum (canned goods, honey) C. perfringes (gravy, uncooked meat) Cigatera (neuro toxin, shell fish, reverses hot and cold sensation) Demoic Acid (“red tide”) Short term memory loss Scrombroid (histamine release: flush, NV, red) Pfiesteria (long term memory deficit) Campylobacter (chicken) G+ G+ G+ Produced in fish Produced in mussels and clams Produced in shellfish Produced via contact w/fish feces G- ECMO (extra corporial memb. O2) Prevention = vaccine, ribavirin and +/- Vit. A Oseltamivir, zanamivir acyclovir Antifungals Self resolves Self limited. Fluid therapy(bacteremia in immunocomp) Salmonella (chicken, eggs) Shigella (produce) (“bacillary dysentery”) Yersinia enterocolitica Vibrio Cholerae (fecal oral) ETEC (travelers) EIEC (similar to shigella) EPEC (infantile) EHEC (Shiga toxin) Gasteroenteritis (Parasitic) G+ bacillus Plasmodium falciparum Sporozoite (vector) Giardia lamblia Trophozoite (cyst ingestion) Trophozoite (cyst ingestion) Trophozoite (cyst ingestion) Sporulated oocyst (cyst ingestion) Cryptosporidium Parvum Cyclospora Ascaris lumbricoides Enterobius (pinworm) Strongyloides T. trichuria T. solium Gastroenteritis (Viral) GGGGGG- C. difficile (pseudomembranous colitis=green, mucousy diarrhea Listeria monocytogenes (deli meat) E. histolytica Gastroenteritis (helminthic) G-, intracellular G- Rotavirus (most common cause of diarrhea in kids worldwide) Norwalk (explosive diarrhea) eggs ingested (fecaloral) eggs ingested (fecal – oral) Filariform larvae, penetrate intact skin (soil) Ingest eggs Ingest ova or cyst (pork) Reovirus Fecal-oral Calicivirus Cipro and antimotility DO NOT TREAT! ( risk of HUS due to of mass release of toxin) Metronidazole Chloroquine, mefloquine, malarone, doxycycline Metronidazole Metronidazole + Paromomycin Fluid Support Bactrim Albendazole/mebendazole, Pyrantel pomoate Pyrantel pomoate Ivermectin, Thiabendazole Mebendazole/ Albendazole Fluid support Vaccine Available Fluids, Antiemetics LIVER Liver abscess Mixed enterobacteriaceae Anaerobic (peptostreococcus) E. histolytica (See gastroenteritis – parasitic) Viral Hepatitides (A, B, C, D, E) (“vowels” = Fecal oral ) (“consonants” = serum blood, maybe sex) Acute = Flu-like symptoms, jaundice, LFT Hepatitis A (Acute, may be asymptomatic) Picornavirus, Get it once and establish immunity. Vaccine available by IgM, immunity lifelong Hep B (Acute or chronic, may be asymptomatic) Hepadnovirus Unique b/c makes RNA template Vaccine available Acute = HBsAg+ / IgM-core + Chonic = HBsAg+ / IgG-core + Vaccinated = HBsAG + only Hep C Flavivirus 80-85% become chronic, 15% clear infection, rarely acute #1 cause liver transplants #1 cause of chronic liver disease in US Chronic = hepatomegaly, LFT, risk hepatocellular carcinoma, cirrhosis STDs NASH non-alcoholic fatty liver disease Vaginitis C. albicans (White cheesy discharge, itch) Trichomoniasis (Yellow discharge, itch) Gardnerella vaginalis (white-grey malodorous discharge) C. trichomatis N. gonorrhea HSV N. gonorrhea Dimorphic, germ tubes protozoa Fluconazole (anti-fungal), caspofungin, imidazole Metronidazol and tinidazle G- Metronidazole Obligate intracellular G- diplococci Herpes G- diplococci Azithromycin 3 cephalosporin acyclovir 3 cephalosporin C. trachomatis E. coli S. saprophyticus E. faecalis P. aeruginosa Obligate intracellular G- rod G+ cocci cluster G+ cocci G- azithromycin cipro, bactrum PCN Urethritis Pelvic Inflammatory Disease (PID) UTI aminoglycosides + Ex spec pen Glomerulonephritis Other STDs GU/SKIN SKIN Lesions Viral Rash Bacterial rash Impetigo Erysipelas Cellulitis Fungal (superficial) Fungal (cutaneous) Fungal (Subcaneous) K. pneumonia G- P. mirabilis Uropathogenic E. coli (fimbrae) Strep. pyogenes HIV GG- HSV 1/ 2 T. pallideum (syphilis) H. ducreyi HPV Molluscum contagiosum Herpes virus spirochete Gpapillomavirus pox virus Measles Pox viruses (small poxk molluscum contagiosum) Rubella Parvovirus – 5ths disease Roseola (HHV-6) Varicella zoster (chicken pox, shingles) 3 syphilis – treponema pallidum vibrio vulnificus (raw shellfish, rampant skin inf) S. Aureus Strep. pyogenes (scarlet fever: red rash on body) S. Pyogenes S. aureus / S. Pyogenes (small, non-purulent) MRSA (purulent) Malassezia furfur (Pityriasis versicolor) Dematophytes/ringworm (microsporin, trichophyton, epidermophyton) Sporothry schenkii (Rose bushes, sporotrichiosis) aminoglycosides and chephalosporin fluorquinolones (cipro, Bactrim) PCN, azitrhomycin, clindamycin retrovirus acyclovir PCN (single large dose) risk of cervical cancer herpes virus 1 gen. cephalosporins, cephazolin NO ABX! Vancomycin Topical imidazoles Lyme Disease Rocky Mnt. Spotted Fever Bubonic Plague Leishmoniasis Trypanosomiasis (African Sleeping Sickness) Trypanosomiasis (Chaga’s disease) BRAIN Meningitis Encephalitis Eumycoti mycetoma (pus, lesions, commonly on foot) Borriella burgdoferi (deer ticks) (target-colored lesions) Rickettsia (tick) Yersinia pestis (flea) Leishmania tropica + L. Major (sandfly) African: Trypanosoma brucei (tsetse fly) periorbital edema, lymphodema= “Romana’s sign”, ulcer at bite site American: T. cruzi (kissing bug) doxycycline and ceftriaxone (acute) N. meningitis S. pneumonia H. Influenza Listeria (elderly, infants, pregnant women, immunocomp) S. agalactica Enterovirus HSV II GG+ G- diplococci G+ rod (tumbling) Steriods First, 3 cephalosporins Ampicillin, vancomycin 3 cephalosporins ampicillin G+ Picornavirus Herpesvirus ampicillin HSV I West Nile Virus Rabies Herpesvirus Flavirirus Rhabdovirus Trypanosoma “African Sleeping Sickness” (Tsetse fly) T. Brucei acyclovir antibody + CTL’s Post exposure Prophylaxis Anti-rabies Ig Melasporol, Suramin, Eflornithine acyclovir