ETIOLOGY S&S Ix Tx

INFECTIOUS DISEASE
1. RESPIRATORY
- Pneumonia GBS Fever CXR : infiltrate Outpatient, ≤ 65 yrs : Macrolide/ Doxycycline
Strep. Pneumonia Cough < 65 yrs, comorbidity :
Chlamydia pneumonia Dyspnea Fluoroquinolone/ β-lactam + Macrolide
H.influenza Pleuritic chest pain Hospitalization : Fluoroquinolone/
S.aureus antipneumococcal β-lactam + Macrolide
Hospitalization : ICU : antipneumococcal β-lactam +
CURB-65 azithromycin/ fluoroquinolone
- C : Confusion Critically : add vancomycin/ linezolid
- U : Uremia (BUN > 19)
- R : RR > 30
- B : SBP < 90/ DBP < 60
- 65 : Age > 65 yrs
- Tuberculosis M.TB Respiratory : Sputum : RIPE 2 Mo  INH (+Vit.B6) & RIF 4 Mo
- Cough > 3 wks - Culture R: Rifampin
- Hemoptysis - Acid fast stain I : INH
- Dyspnea CXR : cavity infiltrate P : Pyrazynamide
(upper lobe) E : Etambutol
Systemic :
- Fever > 3 wks
- Night sweats
- Weight loss
- fatigue
- Sinusitis Viral Fever Symptomatic
Bacteria Facial pain/pressure - Decongestant
Headache - Antihistamine
Nasal congestion - Nasal saline lavage
Purulent nasal discharge - Pain relief
Acute : 10 d
- Amoxicillin/clavulanate
- Clarithromycin, Azythromycin
- TMP-SMX
- Fluoroquinolone
- 2nd cephalosporin
Chronic : 3-6 wks
 - Acute Pharyngitis Viral : Rhnovirus Fever Rapid GAS Antigen Penicillin 10 d
Bacterial : Sore throat detection Alternative :
GAS Pharyngeal erythema Throat culture Cephalosporin, Amoxicillin, Azythromycin
Tonsillar exudate
- Influenza Influenza A (H5N1, Fever, Chills Nasopharyngeal swab : Symptomatic
H1N1) Cough, coryza Rapid influenza test - Analgesic
Myalgia - Cough
Antiviral : 2 d
- Oseltamivir
- Zanamivir
Influenza vaccine
2. CNS
- Meningitis Bacterial Triad : Lumbar puncture for <1 Mo. : Ampicillin + Gentamicin/ Cefotaxime
Viral - Fever - CSF Gram stain 1-3 Mo. : Vancomycin IV + Ceftriaxone/
- Headache - CSF culture Cefotaxime
- Neck stiffness (Nuchal CT scan/ MRI 3 Mo - Adult.: Vancomycin IV + Ceftriaxone/
rigidity) Cefotaxime
60 yrs : Ampicillin + Vancomycin +
- Photophobia Ceftriaxone/ Cefotaxime
- N/V
Prophylaxis : Rifampin & Ciprofloxacin

- Encephalitis HSV, Arboviruses Triad : PCR HSV encephalitis : IV Acyclovir

CMV - Fever CT Scan/ MRI CMV encephalitis : IV Ganciclovir ± Foscarnet
Toxoplasmosis - Headache Lyme encephalitis : Ceftriaxone
- Altered conciousness Rocky Mountain spotted fever/ Ehrlichiosis :
Doxycycline
- Seizure

- Brain Abscess Bacteria (Staph. Triad : CT scan : ring enhancing Broad spectrum IV ATB (6-8 wks)
Step., Anaerobes) - Fever lesion - 3rd cephalosporin + Metronidazole ±
Toxoplasma - Headache Vancomycin
Candida - Focal neurologic deficit Dexamethasone (severe case)
Aspergillus (CN 3,6) IV Mannitol
Zygomycosis Sx drainage (aspiration/ exision)
- Seizure
3. SEXUALLY
TRANMITTED
DISEASE
- Chlamydia C.trachomatis Asymptomatic Culture Doxycycline (7d)/ Azithromycin SD
Urethritis Urine test (nucleic acid Pregnant : Azithromycin/ Amoxicillin
Mucopurulent cervicitis amplification test)
PID Gram stain
- Gonorrhea N.Gonorrhoeae Male : Gram stain Ceftriaxone IM + Azithromycin PO (SD)
- Purulent urethral Culture Prophylaxis :
discharge Nucleic acid - Treat the sexual partner
- Dysuria amplification test - Condoms
- Erythema of urethral - No fluoroquinolone (resistance)
meatus
Female :
- Greenish-yellow discharge
- Pelvic/ adnexal pain

- Syphilis T.Pallidum 1o(10-90 d) : Chancre (painless Dark field microscopy 1o/ 2o :

ulcer) VDRL/RPR - Benzathine penicillin IM SD
2o (4-8 wks) : systemic FTA-ABS, TP-PA - Allergies penicillin :
(maculopapular rash on the Tetracycline/Doxycycline (14d)
soles & palms, condyloma Latent :
lata - Early : Benzathine penicillin SD
Latent : - Late : weekly dose/3wks
- Early : no symptom, Neurosyphylis : Penicillin IV (10-14 d) -->X
serology (+) Desensitized
- Late : no symptom,
serology (+/-)
3o(1-20 yrs) : gummas
- AIDS HIV ELISA test ART
Watern blot Pregnant (HIV +) @ delivery : zidovudine
Rapid HIV test intrapartum & infant give zidovudine 6 wks
HIV RNA PCR
4. OPPORTUNISTIC
INFECTIONS
 - Oropharyngeal
Candidiasis
(Thrush)
- Cryptococcal
Meningitis
- Histoplasmosis
- Pneumocystic Pneumocystis carinii Dyspnea on exertion Silver stain High dose TMP-SMX (21 d)
Jirovecii Non productive cough Immunofluorescence Prednisone
Pneumonia Fever CXR : ground glass app.
Impaired oxygenation
- Cytomegalovirus CMV Infant : Virus isolation Ganciclovir
- Hearing loss Culture Valganciclovir
- Chorioretinitis Tissue histopathology Foscarnet
- Microcephaly PCR
- Petechiae purpura
- Jaundice
- Hepatosplenomegaly
- Toxoplasmosis Toxoplasma gondii Serology : PCR PO Pyrimethamine + Sulfadiazine & Leucovorin
(raw/undercooked CT Scan : (4-8 wks)
meat & changing cat - Multiple hypodense Prophylaxis (CD4+ <100/mm3 & IgG (+) Toxo) :
litter) ring enhancing mass - TMP-SMX (Bactrim DS)/
lesions Pyrimethamine + Dapsone
MRI
5. GENITOURINARY
- Urinary Tract SEEKS PP - Dysuria UA Uncomplicated UTI :
Infections - S : Serratia - Frequency Urine culture : - TMP-SMX/ Fluoroquinolone (3 d)/
- E : E.Coli - Urgency Microscopic analysis : Nitrofurantoin (5 d)
- E : Enterobacter - Suprapubic pain - Pyuria Complicated UTI : same (7-14 d)
- K : K.pneumoniae - hematuria - Bacteriuria - Urinary obstruction, men, renaal transplant,
- S : S.saprophyticus catheter
- P : Pseudomonas Pregnancy
- P : Proteus mirabilis - Nitrofurantoin, oral cephalosporin,
Risk factor : BPH, Amoxicillin (3-7 d)
DM, pregnancy, - **avoid : Fluoroquinolone, TMP-SMX,
previous UTIs, Tetracycline
immunosupression, st
- Pyelonephritis - Fever/ chills UA & Culture 1 line :
ATB use - Flank pain CBC : leukocytosis - Fluoroquinolone (7-14 d)
 - N/V Severe :
- Dysuria - Fluoroquinolone
- 3rd, 4th cephalosporins
- β-lacam, β-lactamase inhibitor
- carbapenem
6. HEMATOLOGIC
- Sepsis SIRS : WBC IV fluids
3TL Thrombocytopenia ATB
- T : Temperature (<36, CXR, CT Vasopressors
>38) *maintain BP & perfuse end organ
- T : Tachypnea (RR > 20)
- T : Tachycardia (HR >90)
- L : Leukocytosis
(>12,000)/ Leukopenia
(<4,000)
Septic shock :
- Warm --> cool skin &
extremities
- Hypotension
- Malaria Plasmodium Triad : Thick & thin blood films Chloroquine
(F, V, O, M) - Fever - Giemsa
- Chills - Wright stained
- Diaphoresis Rapid antigen detection
Fluorescent antibody
- Splenomegaly PCR
- Infectious EBV (body flids : Triad : - Heterophil antibody Supportive
Mononucleosis saliva) - Fever test (Monospot) - Analgesic : Acetaminophen/ Ibuprofen
(Kissing Disease) - Pharyngitis (sore throat) - EBV specific - Throat soothinf measures
- Lymphadenopathy antibodies Corticosteroid : severe

- Splenomegaly
- Bilateral upper eye lid
edema
7. TICK BORNE
- Lyme Disease Borrelia burgdorferi - Fever & Rash, malaise, On clinical (Bull’s eye + Early : Doxycycline/ Amoxicillin (<8 yr,
(Ixodes scapularis/ fatigue, headache, endemic area) pregnant)
เห็บ) myalgia, athralgia ELISA, IgM, IgG Advance : Ceftriaxone
 - 1st : Bull’s eye erythema Tissue culture/ PCR
migrans (รูปเป้ ายิงปื น)
- 2nd : migratory
polyarthropathies,
neurologic phenomena,
myocarditis
- 3rd : arthritis, encephalitis
- Rocky Moutain Rickettsia ricketsii - Fever Biopsy Doxycycline/ Chloramphenicol (pregnant)
Spotted Fever - Headache Indirect
- Rash (beginning @ wrist immunofluorescence
& ankles) --> spread
centrally
8. MISCELLANEOUS
INFECTIONS
- Infective S.aureus (history of FROM JANE DUKE Criteria Vancomycin + Gentamycin
Endocarditis IV drug abuse, - F : Fever BE FEVEER Prophylaxis : Amoxicillin-->X Azithromycin
prosthetic valves) - R : Roth spot (retinal Major
Viridans strep. (native hemorrhage) - B : Blood culture +
valve, dental - O : Osler nodes (จุดแดง - E : Endocardial
procedure) กดเจ็บบริเวณฝ่ ามือ involment from Echo
S.bovis (GI Minor
ฝ่ าเท้า)
malignancy) - F : Fever
- M : Murmur
Candida, Aspergillus - E : Echo finding (not
- J : Janeway lesions
(AIDS, organ fulfilling a major)
transplantation, IV (จุดแดง กดไม่เจ็บ - V : Vascular finding
drug use, IV catheter) มักพบทีฝ
่ ่ าเท้า) - EE : Evidence frome
- A : Anemia microbiological/
- N : Nail hemorrhage immunology (2
(Splinter hemorrhage) evidence)
- E : Emboli - R : Risk factor/
predisoding factor (
drug abuse, vulvular
disease)

*2 Major/
1 Major + 3 Minor/
5 Minor
- Anthrax Bacillus anthracis Cutaneous : Culture 1st line :
(เกียวกับสัตว์) Pruritic papule --> Black PCR, ELISA Ciprofloxacin/ Doxycycline +1-2 ATB
Eschar CXR : wide mediatinum, 14 d (face, head, neck), 7-10 d (other)
Inhalation : hemorrhagic pleural effusions Prophylaxis : Ciprofloxacin (60 d)
mediastinitis
GI : N/V, diarrhea,
abdominal pain
- Osteomylitis Bacterial : Staph., Localized bone pain & Lab : >> WBC, ESR, Surgical debridement
Pseudomonas, tenderness along with CRP IV ATB : 4-6 wks
Anaerobes warmth, swelling, erythema, X-Ray : Periosteal - Clindamycin + Ciprofloxacin
limit motion elevation - Ampicillin/Sulbactam
Purulent drainage MRI : >> signal in the - Vancomycin
Fever, chills bone marrow & - Cefriaxone/Ciprofloxacin
associated soft tissue *Penicillin & Cephalosporins -->X non-β-lactam
infection