See ICU Infections Chapter
Diphtheria
Pertussis (whooping cough)
Tetanus
Pharmacological Management in Tetanus
Toxin mediated (tetanospasmin)
Gram + rod, spores are heat and cold resistant. 3-14 day incubation
Trismus progressing to risus sardonicus
Opisthotonus-body bent concave forward, resting on head and heels
Diff: strychnine poisoning, dystonia, hypocalcemic tetany, rabies
Start c benzos, move to competitive NMJ blockade. Labetolol
Tetanus immunoglobin (eliminates circulating toxin not yet bound to nerve fibers) and tetanus toxoid, debride any infected wounds then PCN or Flagyl
Clean Minor Wounds
All Other Wounds
History of Tetanus Toxoid Td TIG Td TIG Unknown or <3 Doses Yes No Yes Yes 3 or More Doses No No No No
Botulism
Meningococcemia
Gram diplococci
Rashes-petechial or maculopapular
Rx Ceftriaxone, proph c rifampin
Pneumococcemia
Typhoid (Enteric Fever)
Salmonella typhi
Fever, HA, abd pn, possible organomegaly, later pea soup diarrhea.
Usually from contaminated food
Dx by blood, stool, or bone marrow cultures
Mimicked by plague, intestinal anthrax, melioidosis, bartonellosis, leptosirosis, typhus, tularemia, brucellosis
Mary Mallon=Typhoid Mary
Leptospirosis
From contaminated water (animal urine)
Can enter through intact waterlogged skin
5-30 days incubation
flu-like illness c aseptic meningitis
WBC 20-40
Rx c Pcn or tetracycline
Brucellosis
From livestock exposure
Treat c Abx
Enterobacter cloacae
think wooden foreign bodies
Sepsis
(2 or more):
- T>38 or <36
- HR>90
- RR>20 or CO2 <32
- WBC>12 or <4 or >10% bands
Antibiotic Selection
Cephalosporin use is contraindicated in penicillin-allergic patients only if an IgE-mediated reaction such as urticaria, angioedema, or anaphylaxis occurs. Estimates of cross-sensitivity of cephalosporins and penicillins vary widely, ranging between 2% and 16%.112 However, even in patients with a stated penicillin allergy, true anaphylaxis to cephalosporins is extremely rare (< 0.02%).113 In fact, cross-reactions appear limited to patients given first-generation cephalosporins. Studies of second- and third-generation cephalosporins show no increase in allergic reactions in patients who have a history of penicillin allergy (Ann Allergy Asthma Immunol 1995;74(2))