普通感染性疾病的诊断与治疗课件.ppt

Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Diagnosis and Treatment of,Common Infectious Diseases,Angela,Heithaus,MD,PS,Internal Medicine,Seattle Healing Arts Center,Gioconda,20 YO non-pregnant UW female student sexually active 3 x week with 1 partner over past 6 months(he is asymptomatic),no prior medical history including STD,C/O:pain on urination x 3 days with increased frequency and urgency,some,suprapubic,pain,no:blood,back pain,vaginal,d/c,fever,Epidemiology,First 10 years of life:,Girls 3%Boys 1.1%,Teen girls 0.5 episodes/year,Adult women 50-60%at least 1 episode/life time,Young,sexually active women 0.5 episodes/person year,Post-menopausal women 0.07%episodes per person per year,UTI,UNCOMPLICATED,Healthy,young,non-pregnant female,COMPLICATED,Everything else:men,recurrent UTI,pyelo,in-dwelling catheters,pregnant,diabetic,Increased risk of failing therapy,Microbiology,80-85%Escherichia coli,Staphylococcus,saprophyticus,Proteus mirabilis,enterococci,Chlamydia-(acute urethral syndrome),Negative standard culture,Diagnosis in Uncomplicated UTI,PEx,Nl,temp,No,costovertebral,angle tenderness,Clinical Criteria,Dipstick:leukocyte esterase(,pyuria,)and nitrite(,Enterobacteriaceae,),75-96%sensitivity;94-98%specificity for detecting 10 leukocytes per HPF,Evaluation of mid stream urine(,unspun,)for,pyuria,is most valuable laboratory diagnostic test,(,abnl,:10 or more leukocytes per,microL,),Selected Oral AB Regimens for Use in Uncomplicated UTI,Drug,Dose,Intervals,Duration,Ciprofloxacin,100-250 mg q12 hrs(500 mg q24),3 days,Levofloxacin,250 mg q24 hrs,3 days,Trimethoprim-sulfamethoxazole,160/800 mg,q12 hrs,3 days,Trimethoprim,100 mg q12 hrs,3 days,Amoxicillin/,Clavulanate,500 mg q 12 hrs,7 days,Giovanni Battista,Morgagni,22 YO M C/O(not:homeless,recently incarcerated,IDU,in military,on athletic team or have family member with infection):,Local pain,swelling,redness,?Drainage,?Hit something a while ago,Denies:fever,chills,Skin and Soft Tissue Infections,Cellulitis,Most common skin infection leading to hospitalization,Superficial,spreading infection involving subcutaneous tissue,Other Common Skin Infections,Impetigo,Folliculitis,Furuncles,and Carbuncles,Abscess,Impetigo,Folliculitis,Furuncle,Carbuncle,Impetigo:superficial,vesiculopustular,skin infection occurring prominently on exposed areas of the face and extremities,FFC:arise from hair follicle,Staph,Aureus,Rarely require hospitalization,Respond to local measures,Recurrence may be prevented by decreasing,staph,aureus,skin carriage,Abscess,Localized accumulation of,polymorphonuclear,leukocytes with tissue necrosis involving the dermis and subcutaneous tissue,Large numbers of microorganisms are typically present in the purulent material,Infection begins from tracking in from the skin surface,Microbiology,Most common,microorgansim,:,Staph,Aureus,Increased incidence of community-associated infections due to:,methicillin,-resistant S.,Aureus,(CA-MRSA),Urban ER:61/119 MRSA isolated,An average of more than 3 organisms;anaerobic in 1/3 of cases(1/2 IDU),Management,Incision,Drainage and culture,Fluctuant or has pointed,Culture?MRSA,Bacteremia,and Antibiotic Prophylaxis,AHA guidelines for those high risk for EC and who have hardware(,oxacillin,cefazolin,vanco,),Oral Antibiotic Therapy,Not ready for I&D,cellulitis,fever,high-risk features,Community Associated MRSA,Awareness of the local antimicrobial susceptibility patterns of community S.,aureus,isolates,Oral Antibiotic Therapy,Drug,Dosage,interval,Dicloxacillin,500 mg,qid,Cephalexin,250 mg,qid,Clindamycin,150-450 mg,qid,Azithromycin,500 mg x 1,250 mg,qd,Oral,peri,-rectal,vulvovaginal,abscesses,A,moxicillin-,clavulanate,875/125 mg BID,C,lindamycin,150 mg QID,PLUS C,iprofloxacin,500 mg BID,Galileo,Galilei,40 YO otherwise healthy,non-smoker C M presents C/O:,dry cough x 2 weeks,clear sputum production and fatigue,Denies:,pharyngitis,fever,chills,Vitals:,Nl,temp,RR,P,Acute Bronchitis,Over 90%are viral,Approximately 60%of patients seeking medical care are given antibiotics,One of the most common causes of antibiotic abuse,ACP and CDC state,Pertussis,is only form that should be treated,Usual Suspects,Coronavirus,(types 1-3),Rhinovirus,Influenza A and B,Parainfluenza,Respiratory,syncytial,virus,Human,metapneumovirus,Influenza,Cough,purulent sputum,fever,and constitutional complaints during the influenza season,A,mantadine,rimantadine,or neuraminidase inhibitors,Must be given within 48 hours of symptom onset for demonstrable benefit,Other Suspects,Mycoplasma,pneumoniae,Chlamydophila,(formerly Chlamydia),pneumoniae,Bordetella,pertussis,(severe paroxysmal cough),To Shoot or Not to Shoot,Pneumonitis,vs,Acute Bronchitis,Abnl,vital signs:,temp 38 C(100.4 F),Pulse 100/min,RR 24,Crackles on exam,Chronic CoughThink,Postnasal drip syndrome,Asthma,Gastroesophageal,reflux,Beatrice,28 YO otherwise healthy female who C/O:,nasal congestion,purulent nasal discharge,maxil。