已阅读5页,还剩29页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
,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,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,Oral, peri-rectal, vulvovaginal abscesses Amoxicillin-clavulanate 875/125 mg BID Clindamycin 150 mg QID PLUS Ciprofloxacin 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 Amantadine, 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 Cough Think,Postnasal drip syndrome Asthma Gastroesophageal reflux,Beatrice,28 YO otherwise healthy female who C/O: nasal congestion, purulent nasal discharge, maxillary tooth discomfort, hyposmia, and facial pain or pressure that is worse when bending forward, headache, fever (nonacute), halitosis, fatigue, cough, ear pain, and ear fullness,Acute Sinusitis,Almost all cases viral in etiology Rhinovirus, parainfluenza, and influenza virus Usually resolves in 7-10 days 2% complicated by acute bacterial sinusitis Streptococcus pneumoniae and Haemophilus influenzae Self-limited, 75% resolve without tx in 1 month Morbidity can include intracranial and orbital complications and of possibly developing chronic sinus disease,How many get it?,Average adult has from 2-3 colds and influenza-like illnesses per year Average child six to 10 Represents approximately one billion acute respiratory illnesses annually Approximately 0.5 to 2 percent of colds and influenza-like illnesses are complicated by acute bacterial sinusitis in adults Annual incidence of acute community-acquired bacterial sinusitis is approximately 20 million cases,Comparison of Contemporary Guidelines for the Diagnosis of Acute Community Acquired Bacterial Sinusitis,CDC Maxillary pain or tenderness in face or teeth + rhinorrhea, no improvement x 7 days Severe sxs Plain films not needed,Sinus ear sxs Plain films, CT, MRI not needed,Treatment of Viral Rhinosinusitis in Adults,At first sign of a cold Sustained release 1st generation antihistamine (chlorpheniramine, brompheniramine, clemastine), PLUS NSAID (ibuprofen, naproxen) Continue taking both q 12 hrs until sxs clear Add oral decongestant (pseudoephedrine) and/or a cough suppressant (dextromethrophan) If sxs persist and are no better or worse after 7-10 days, consider antibiotic therapy,Comparison Guidelines for the Treatment of ACA Bacterial
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2022-2023学年部编版六年级上册期末考试语文试卷
- 四年级上册数学教案- 4 三位数乘两位数 人教新课标
- 2024年3月黑龙江百春固废资源化利用工程技术研究有限公司引进人才笔试参考题库附带答案详解
- 2024年3月浙江省药品监督管理局所属3家事业单位招考聘用15人笔试参考题库附带答案详解
- 2024年3月山西吕梁市农林水利专项校园招考聘用笔试参考题库附带答案详解
- 2024年3月四川乐山沐川县事业单位招考聘用76人笔试参考题库附带答案详解
- 厨房小家电项目经营管理方案
- 三年级语文下册期末试卷【及参考答案】
- Module 10 A holiday journey 第1课时示范教案(七下)
- 2023-2024学年湖南省新课标高三压轴卷化学试卷含解析
- 媒体监督工作方案
- 2022广州数学中考试卷(含答案解析)
- 《世上最温暖的花》《棉花棉花》阅读练习
- 纳税人财务会计核算办法(通用3篇)
- 朗读者活动主题内容
- 2023年高考英语语法填空真题和答案解析
- 家庭财策规划技术知到章节答案智慧树2023年威海职业学院
- 2023年社区工作者必考试题库及答案(通用版)
- TD-T 1068-2022 国土空间生态保护修复工程实施方案编制规程
- 政务信息宣传写作培训
- 2023年上海崇明区区管企业招聘笔试参考题库附带答案详解
评论
0/150
提交评论