EMCrit.org

Bacterial and Toxin Infections

Diphtheria

Pertussis (whooping cough)

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):

  1. T>38 or <36

  2. HR>90

  3. RR>20 or CO2 <32

  4. 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))