Infectious Disease Study Guide
The Sanford Guide to Antimicrobial Therapy is a handy place to start studying infectious diseases. Because the knowledge
base is changing it is definitely a good habit to look up antibiotic choices frequently. There is also a lot of great information
available on the internet which is updated frequently by world leaders in infectious disease.
Immunizations: http://www.cdc.gov/vaccines/vpd-vac/default.htm
SEE
SANFORD
GUIDE!
Viral
Empiric Treatment
Meningitis
(Fever, headache, neck
stiffness, photophobia)
Ceftriaxone
Dexametasone
EV
HH2
LCM
Ac Sinusitis
Occ fever, purulent
discharge, localized
pressure
AM/CL TMP/SMZ
(treat only if indicated,
95% resolvs
spontaneously. Pain
control is important
15%
Upper respiratory
infection (mild fever,
malaise, cough, runny
nse)
StaphAureus
Strep Pneumo
GBS
Mycoplasma
H. Influenza
Pseudomonas
Vanc
Vanc
amp/gent
ery/tet
Cef3
Cef3/Imip
tmp/smz
(VP shunt)
?/30
49/5*
rare/10
trauma
18/eld
31%
E Coli
Other
Meningococcus 60%
Listeria 7%/5%
(ampicilin)
21%
Almost
always
Acute Otitis
Rare fever, deep ear
pain, no drainage
Amoxicillin?
48%
31-45%
Pharyngitis1
fever, sore throat, cold
symptoms point
towards viral
(etiology)
EBV2
Pneumonia
FEver, cough chills
Ceftriaxone+azith
RSV
Children,
bronchiolitis
Influenza3
SEVERE
cold
symptoms
Diarrhea
Hydrate
EV/Norwalk +
/Rota
UTI
TMP/SMZ
Cellulitis
Clinda**/TMP/SMZ
bullous
22-56%
MOE in DM
MCat 12%
+
+
?/60
Productive
cough, onset
<48 hours
+
+/20
(duration>2
weeks with
dry cough)
GAS (pcn/ery)
+
inhaled
tobramycin for
CF
cath
+
Legionella <5%
O157=HUS!
campyllobacter,
Shighella, salmonella
80%
Klebsiella, proteus
+++
*numbers separated by slash indicate approximate incidence in infants/adults.
abbreviations:
EV=enterovirus
GAS= group A Streptococcus
GBS= group B Streptococcus
HH2= human herpes virus type 2
HUS=hemolytic uremic syndrome in E Coli serotype O157
MCat=moraxella catarrhalis
MOE=malignant otitis externa
RSV= respiratory syncitial virus
Clinda**=Beware of erythromycin induced clindamycin resistance....perform the D-test
Other syndromes have fairly specific etiologies and require specific treatment
Syndrome
Infection
Prevention
Treatment (consult JP Sanford Guide for more
options4)
Hepatitis5
A fecal-oral
Handwashing; Varivax
Symtomatic
B
Safe Sex, universal precautions; Engerix, Recombivax
Chronic infection if:
HBSAg+> 6 months
viral load > 10,000
persistent ALT elevation
liver biopsy Knodell score >4
HBe positive, more likely to progress
inf-a2B 5mu qd or 10mu tw X1648W;adefovir;entecavir; telbivudine*
Annual CT
alpha feto protein Q6m
1 A fairly recent article with a reasonable algorithm is AFP 3/15/04 http://www.aafp.org/afp/20040315/1465.html
2 CDC overview or mononucleosis: http://www.cdc.gov/ncidod/diseases/ebv.htm non-EBV entities that cause a
prolonged exanthem referred to as the Gianni-Crosti syndrome: Echo, Coxsackie, HBV, RSV
3 Influenza is caused by type A or B (and rarely C). http://www.cdc.gov/flu/professionals/acip/index.htm
4 The Sanford Guide is an excellent study guide, particularly for common infections. Table 1 is organized according to
clinical scenarios and is quite useful in helping you pin down empiric treatment.
5 The US Board of Prisons has a great summary of hepatitis at http://www.bop.gov/news/PDFs/hepatitis.pdf (Who knew?)
C
Safe Sex, universal precautions
Annual CT
alpha feto protein Q6m
Viral load
Genotype:
I 40-50% response
II , III 76-82% response (no biopsy needed)
IV , V, VI ?
peg inf-a2B 1 mcg/kg/w or 1.5 mcg/kg/w + riavinX
1 year
Autoimmune
?
conult rheumatology
Medication
medication selection
stop medication /switch to less injurious agent
Alcohol
Ask about alcohol use at every visit
Stop drinking; ?milk thistle?
*Guidelines for the prevention and treatment of Viral hepatitis; Federal Bureau of Prisons, October 2005
Genital6
Discharge: DO WET PREP (see urogyn)
WBC: Gonococcus
Safe sex
Ceftriaxone 250mg IM X i
"
Doxycycline 100 mg i po bid
Green: Trichomoniasis
"
Metronidazole Oral (i gm po X i or 250 tid X 5
days) Vaginal qhs X 5
Non STD: Candida
Improve underlying immune dysfunction (DM, HIV)
Fluconazole 150mg X i repeat if necessary
No douching;
Clinda? possibly aidophilus
Chlamydia
Bacterial Vaginosis
Ulcer:
Painless: Primary Syphilis
Safe sex
Painful: Chancroid (H. ducrei)
"
Ceftriaxone 250mg IM X i
Abstinence! Infective even if no active lesions
Acyclovir 400 mg po bid X 10 days
Gardasil protective only against 6, 11, 16, 18 (other serotypes can still cause
disease
freeze
Blister/vessicle:(see HHV section below)
HSV
Wart:
HPV (different serotypes cause Cervical
Cancer)
HIV7
Any CD4 level
More frequent infections (see above)
Frequent candidiasis
CD4<2008
6 CDC Website: http://www.cdc.gov/std/treatment/2006/toc.htm
7 The US Department of Health and Human Services has an excellent website with new updates as of December 2007 at
http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf . The document has only about 40pp of information
most of which can be skimmed. General practitioners should focus on initial diagnosis and management. Johns
Hopkins has a new website at www.hopkins-hivguide.org which has a handy resistance checker!
8 AIDS is defined as having CD4<200 or any of the following AIDS-defining illnesses:
Candidiasis of bronchi, trachea, or lungs
Candidiasis esophageal
Cervical cancer (invasive)
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal for longer than 1 month
Cytomegalovirus disease (other than liver, spleen or lymph nodes
SOB: PJP
CD4<100
Meningitis: Toxo
DM
Yeast infections
Pseudomonas in ears
Polymicrobial feet
Glycemic control
Aggressive treatment of OE
Intensive foot protection/surveillance
Splenectomy
Pneumococcal infection
Vaccination
Exanthems9
Diseases of Childhood:
Incubation
Prodrome
Start
Spread
1st Measles (Rubeola) Paramyxovirus
C, C, C
face
body
2nd Scarlet Fever Group A Strep
pharyngitis
3rd German Measles (Rubella) Rubivirus
pharyngitis
face
body (mild)
5th Ery Infectiosum (Slap Cheeks) PVB19
fever
cheeks
6th Roseola HHV 6 /7
High fever
trunk
outwards
trunk
outwards
Infectious
4th Dukes (?)
Others:
HHV-1,2 HSV
HHV-3 HZV (vaccine for both children and
adults)
pain
HHV-4 EBV
HHV-5 CMV
HHV-6,7 (see above)
HHV-8 Kaposi Sarcoma
Tuberculosis
opportunis
tic
http://www.cdc.gov/tb/pubs/mmwr/Maj_guide/Testing.htm
Autoimmunity
Principles of active and passive immunity
Vaccine-preventable diseases
emerging antimicrobial resistance
the judicious use of antibiotics
worms
ob
Encephalopathy (HIV-related)
Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
Histoplasmosis, disseminated or extrapulmonary
Isosporiasis, chronic intestinal (for more than 1 month)
Kaposi's sarcoma
Lymphoma Burkitt's, immunoblastic or primary brain
Mycobacterium avium complex
Mycobacterium, other species, disseminated or extrapulmonary
Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii)
Pneumonia (recurrent)
Progressive multifocal leukoencephalopathy
Salmonella septicemia (recurrent)
Toxoplasmosis of the brain
Tuberculosis
Wasting syndrome due to HIV
9 Great website from New Zealand! http://dermnetnz.org/viral/viral-exanthem.html
Resolve