Following influenza infection high-incidence of Staph aureus, if CAP staph. suspected in IV drug users
Mycoplasma pneumoniae, atypical affecting younger patients. Dry cough, bilateral consolidation, erythema multiforme with complications of haemolytic anaemia/thrombocytopenia, encephalitis. Diagnose with serology. Tx Erythomycin or Clarithromycin
Strep. pneumoniae is most common agent of CAP, with rapid onset, high fever, pleurisy and reactivation of HSV- cold sores. Tx oral Amoxicillin + a Macrolide if admitted if considered low/moderate.
CURB 65 (3 + = severe pneumonia) confusion, urea >7mmol/L, RR >30, BP <90 or diastolic <60 and age >65
High severity CAP Tx = IV Co-Amoxiclav (Cefuroxime/Cefotaxime/BenPen) + Clarithromycin. Legionella/Mycoplasma pneumonia Tx with Macrolide e.g. Erythromycin, Clarithromycin
Klebsiella in alcohols/immunosuppressed typically following aspiration or UTI. Often affects upper lobes and can progress to cavitation
As a result of broad-spectrum Abx e.g. Clindamycin, Cephalosporins, peniciliins. Tx Metronidazole and Vancomycin.
Perform stool microbiological investigations if you suspect septicaemia, a child is immunocompromised or there is blood/mucus
Campylobacter (gram -ve) presents with flu-like prodrome. Tx Clarithromycin
Salmonella e.g. dodgy chicken/eggs or Shigella e.g. bloody diarrhoea, abdo pain. Tx both with Ciprofloxacin
E. Coli (gram -ve rod) associated with hemorrhagic, watery diarrhoea, spread by ground beef. Also causative organism of neonatal meningitis. O157:H7 associated with haemolytic uraemic syndrome with severe hemorrhagic diarrhoea
Weil's disease/ Leptospirosis seen in sewage workers, farmers, abbatoir. Spread by rat urine, and presents with fever, flu-like, renal failure, jaundice, subconjunctival hemorrhage and headache,
Infectious mononucleosis (EBV) presents with sore throat, lymphadenopathy, pyrexia, palatal petechiae, splenomegaly with risk of rupture. Supportive management. Taking Amoxicillin/ampicillin will result in maculopapular, pruritic rash
Cytomegalovirus, one of the herpes viruses. Often in immunocompromised e.g. HIV or organ transplants.
Lyme disease, caused by spirochaete Borrelia burgdorferi. Spread by ticks. Fever, arthralgia and erythema chronicum nigrans (target rash), facial palsy and can complicate . Ix serology, tx Doxycycline if early, Cetriaxone if disseminated.
SIRS: 2 or more of the following: temp <36 or >38.3. HR >90, RR >20, glucose >7.7mmol/L, WBC <4 or >12.
:red_flag: systolic <90 or >40 fall, mean arterial pressure <65, HR >131 or RR >25 or AVPU score of V, P or U :check:Sepsis 6
Sepsis 6: 1. Oxygen 2. Blood cultures 3. Broad-spec Abx 4. IV fluids 5. Serum lactate and Hb 6. Measure urine output