Disease

Organism

Presentation

Prevention

Pharyngitis

Group A Strep
(streptococcus
pyogenes)

Sudden onset of: Fever, sore

throat, nausea, malaise, tender
cervical lymphadenopathy

without
culture on single blood agar
treatment
plate (80-90% senstivie)
Rapid antigen test (<
Rheumatic Fever
sensitive)
may develop

Group A Strep
(streptococcus
pyogenes)

Diffuse red rash similar to sunburn

with superimposed fine red papules without
culture on single blood agar
treatment
most intense in groin and axilla,
plate (80-90% senstivie)
leaves fine desquamation. Flushed Rheumatic Fever
Rapid antigen test (<
face w/ circumoral pallor,
sensitive)
may develop
strawberry tongue

Scarlet Fever

Impetigo

Erysipelas
Arthritis
Necrotizing
Fasciitis
Streptococcal
Toxic Shock
Syndrome

Staphlycoccus
(temperate) or Group A
Streptococcus (tropical)
Gram +
Group A Strep
(streptococcus
pyogenes) or
Staphlycoccus
Group A Strep
(streptococcus
pyogenes)
Group A Strep
(streptococcus
pyogenes)
Pyogenic erythrotoxin
(Scarlet Fever) causes
massive release of
inflammatory cytokines

Diagnosis

Macules, vesicles, bullae,

and honey colored crusting
most often involving the
face

presentation/culture

Well demarcated superficial

cellulitis

presentation/culture

Occurs with cellulitis, fever,

joint pain
Severe cellulitis and pt is toxic,
may have little pain, usually
following skin trauma

presentation/culture

Invasion of skin, soft tissue,

contacts may be
ARDS, and renal failure with
reservoirs
mortality rates to 80%

Pneumococcal
Pneumonia

Streptococcal
Pneumoniae

Sudden onset of fever, chills,

rigors, productive cough w/pleuritic
chest pain, bronchial breath
sounds, slow onset

X-ray - lobar
consolidation/effusion,
Gram stain, Sputum
culture

Pneumococcal
Meningitis

Streptococcal
Pneumoniae

Rapid onset of fever, headache,

meningismus, AMS, absence of
rash/focal neuro deficits

Labs - CSF >1000 WBC w/

>60% PML, glucose <40 or
<50%, and protein >150
Culture**

Disease

Organism

Staph Skin/Soft
Staphlycoccus Aureus
Tissue Infection
MRSA

Presentation

Prevention

Diagnosis

Localized erythema with

induration, deep abscesses may
form, begins around in/around one
or two hair follicles

Culture

May develop into necrotizing

fascitis, presents same as
cellulitis

Culture

Deep soft tissue

Staphlycoccus Aureus
infection
Caused by direct innoculation,
long bones and vertebrae,
abrupt development of pain
Osteomyelitis
Staphlycoccus Aureus
over site of infection, abscess
formation is rare
C. perfringens
Trauma and IV drug use,
Gram positive
contaminated open fractures,
anaerobic spore producing,
sudden pain/edmea, brown foul
Gas Gangrene
found in soil, aquatic
discharge, gas in tissue, skin
sediment, and animal GI
changes to deeply discolored
tract
C. difficile
Gram positive
C. diff (diarrheal anaerobic spore producing,
found in soil, aquatic
disease)
sediment, and animal GI
tract
C. tetani
Anaerobic gram
Minor tingling at wound,
positive rod found in soil,
spasticity of muscles, rigidity
Tetanus
heat sensitive prior to
Tetnus
and spasm of neck, back,
forming spores, then
vaccination
becomes heat/antimicrobial and abdomen, alert, airway
obstruction
resistant, produces
neurotoxin tetanospasmin
C. botulinum
visual disturbances
Soil, anaerobic
(diplopia), ptosis, cranial
spore forming bacillus,
neurotoxin blocks release of nerve palsies, paralysis
Botulism
acetylcholine, Food born,
progressing to respiratory
infant (honey), and wound failure
(IV drugs)

Culture
Blood cultures positive,
bone biopsy, bone scan,
plain films normal in early
course
Gas in tissue found on
palpation or radiograph,
anaerobic culture
confirms, may have other
bacteria present in wound

Disease

Organism

Listeriosis

Listeria

Diptheria

Corynebacteriym
diptheriae, spread by
respiratory secretions

Cutaneous
Anthrax

Bacillus anthracis
Spread by
contact with animal,
hide, or terrorist

Inhalation
Anthrax

GI Anthrax

Whooping
Cough

Bacillus anthracis

Bacillus anthracis

Presentation
Infection during 3rd trimester,
granulomatosis infantisepticum
(high mortality), bacteremia
neonates or
immunocompromised,
meningitis <2 months/elderly,
focal infections
Usually repiratory tract but can
involve mucous membranes,
tenacious gray pharynx, sore
throat, nasal discharge,
hoarsness, malaise, fever,
myocarditis, neuropathy
2 weeks post exposure : initial
erythematous papule that
ulcerates and necroses to
purple/black eschar (painless)
self limiting
2 stages: 10 days non-specific
viral symptoms, progresses
rapidly to fulminatnt stage,
overwhelming sepsis, death
Fever, diffuse abdominal pain
w/rebound, vomiting,
diarrhea/constipation,
ulcerative process- bloody
diarrhea
emesis
Catarrhaland
stage:
insidious

onset, lacrimation, nasal d/c,

sneezing and coryza, malaise,
hacking night cough that
Bordetella Pertussis
becomes diurnal Paroxysmal
Gram negative
stage: bursts of rapid,
aerobic cocobacillus, binds consecutive coughs followed by
to cilia and produced
deep high pitched inspiration
trachael cytotoxin that
Convalescent: begins 4 weeks
prevents them from beating after onset of illness, decrease
in frequency and severity of
cough. 6 weeks of illness
mainly kids under 2

Prevention

Diagnosis

At risk : pregnant
women, infants,
immunoxomprom
ised, elderly

Clinical diagnosis, can

be cultured

DPT for all infants

TdaP for 11-18
as booster,
immunization as
a child does not
convey lasting
immunity

Disease

Organism

Presentation

Meningococcal
Meningitis

Neisseria meningitidis
foun in 40%
nasopharynx population
spread by droplet

fever, headache, back/neck

pain, abdominal pain, n/v,
petechial rash on
skin/mucous membranes,
+kernigs and brudzinski
signs

Legionnaire's
Disease

Legionella pneumophillia
gram negative Fever, toxicity, pleuritic
spread by moisture from chest pain, grossly purulent
shower heads and a/c
sputum
heating
units
Salmonella typhi

Typhoid Fever
(Enteric Fever)

Salmonella
Gastroenteritis

Shigellosis

Gram negative,
short, aerobic, flagellated
bacillus
enteric fever can
be caused by any
Salmonella species,
transmitted in
contaminated
Most
commonfood/milk
form of

salmonellosis contracted
from contaminated
food/liquid, dairy
products and eggs
Invasive organism, selflimiting

Prevention

MPSV4 indicated
for ages 2-10 and
>55 MCV4
indicated for those
11 to 55 years,
recommended
upon entry to high
school and for
college freshmen,
military, asplenic,
and known
exposure

at risk:
immunocomprom
ised, smokers,
COPD

Diagnosis

Gram stain, LP yields

cloudy/purulent CSF,
DIC is complication in
pt with septicemia,
Culture

Culture, urine antigen

assay, CXR shows
patchy infiltrates to
consolidation

Prodrome of malaise, headache,

cough, and sore throat,
abdominal pain/constipation, 710 days in pt appears acutely
ill, abdominal distension with
"pea soup" diarrhea,
splenomegaly, rose spot rash

Blood culture positive,

stool culture unreliable,
bradycardia and
leukopenia

Fever, nausea, vomiting,

crampy abdominal pain,
diarrhea which may be grossly
bloody, 3-5 days and usually
self limiting

Stool culture, must

differentiate from viral
AGE

Abrupt onset diarrhea w/low

abdominal cramps and
tenesmus, fever, malaise,
headache, abdominal
tenderness, sengorged sigmoid
mucosa w/ulcerations

Disease

Organism

E. Coli

Enterotoxigenic - travelers
diarrhea Enteroinvasive bloody diarrhea
Enterohemorrhagic
(O157:H7) - non-bloody
diarrhea, hemolytic uremic
syndrome and thrombotic
thrombocytopenic purpura,
transmitted via
undercooked hamburger

Cholera

Vibrio cholerae
Fecal-oral
transmission, releases
enterotoxin

Vibrio

Vibrio parahemolyticus from

oysters cause diarrheal
disease, Vibrio vulnificus
and alginolyticus cause skin
infection, all are marine
organisms

Presentation

Prevention

Diagnosis

voluminous diarrhea, liquid

gray, turbid, w/out odor,
mucous, or blood, rapid life
threatening dehydration and
hypotension

stool cultures positive

Brucellosis

Transmitted via animal

(cattle, hogs, goat)
exposure

insidious onset, cervical and

axillary lymphadenopathy,
lymphocytosis

positive blood culture

Tularemia
(Rabbit Fever)

Transmitted via contact

w/rabbits, rodents, and
biting arthropods

Fever, headache, nausea, and

prostration, papule progressing
to ulcer at site of innoculation,
enlarged regional lymph nodes

Disease

Organism

Presentation

Gonococcal
Infections

Local or disseminated
disease, sexually
transmitted

Males: Urethritis- profuse

purulent d/c, epididymitis,
prstatitis, proctitis, burning on
urination, 1-3 days later d/c
develops and increase in pain,
may be chronic and lead to
prostatitis and urethral
strictures

Chancroid

Haemophilus ducreyi

Painful ulcer

Mycobacterial
Infections

Tuberculosis

Prevention

Cervicitis: Purulent
cervical d/c, may
be asymptomatic,
salpigitis, proctitis,
vaginitis, becomes
symptomatic
during menses,
dysuria, frequency
and urgency,
chronic cervicitis,
can progress to
involve uterus and
tubes producing
sterility

Prophylaxis:
Clarithromycin or
Mycobacterium ayium
Azithromycin,
complex (MAC)
Rifabutin, Biaxin
persistent fever and weight
and Zithromax are
Disseminated dz seen in
loss
best tolerated. Can
HIV pt with CD4 cell
stop when CD4 cell
counts <50
count >100 x 3
months
TB skin test: does
not distinguish
between
active/latent
Primary (asymptomatic),
infection >5mm +
Latent (inactive dz,
malaise, anorexia, weight loss,
in HIV,
reactivation may occur if
fever, night sweats, chronic
immunocompromis
immune system is
cough which worsens and
ed, CXR suggestive
impaired), and Progressive develops purulent sputum,
of old dz
Primary (symptomatic,
malnourished and chronically
>10mm
atypical presentation in the ill, post tussive apical rales
+ IV drug, high
elderly)
risk, children <4
exposed
>15mm + no risk

Diagnosis

Blood culture

Definitive dx culture, 3
consecutive AM
specimens, bronchoscopy
with bronchial washings,
CXR shows small
homogenous infiltrates,
Hilar and peratrachial
lymph node enlargement,
pleural effusion

Treatment
Penicillin G injection
Penicillin VK PO QIDx10
Amoxicillin BID x 10
Macrolides (PCN allergy)

Tetracycline, Cephalosporin, Macrolide,

Penicillin, Vancomycin, anti-staph penicillin,
Licomycin, Sulfonamides, Linezolid,
Aminoglycosides, Fluoroquinolones, Rifampin

Penicillin G injection
Penicillin VK PO QIDx10
Amoxicillin BID x 10
Macrolides (PCN allergy)
Wash with soap and water and
use Topical agents: Mupriocin
(Bactroban) or Retapamulin
(Altabax)
or if systemic use
Cephalexin (Keflex) BID or
Doxycycline (Vibramycin) BID

Systemic/Face - Parenteral
Penicillin
if IV drug use/diabetes cover
strep as well

Parenteral Abx
Beta-lactams w/
surgical debridement
Beta-lactams
Treat Empirically:
Amoxicillin BID x 7-10
Penicillin allergic:
Azithromycin (Zithromax)
Clarithromycin (Biaxin)

Treat Empirically: IV
Ceftriaxone (Rocephin),
Vancomycin, and
Dexamethasone (antiinflammatory))

If penicillin resistance is high treat with Ceftriazone (Rocephin) or

oral plouroquinolones (Levaquin)

Treatment
I&D and penicillinaseresistant ABX like Keflex
or Diclox
Clindamycin, Doxycycline,
Trimethoprimsulfamethoxisole, NO
Macrolides
Nafcillin, Oxacillin,
Cefazolin (Ancef),
Vancomycin (if PCN
allergy), Linezolid (Zyvox)

4-6 weeks (long) of

parenteral Nafcilliin or
Oxacillin
IV Pencillin w/ surgical
debridement and HBO
therapy

Human tetanus
immune globulin (TIG)
within 24 hours of
presentation, sedation
and ventilation

Botulinus antitoxin,
ventilation, IV fluids,
notification of contacts

Treatment
IV Ampicillin divided
doses, Gentamycin
divided doses is
synergistic with ampicillin,
PCN allergic trimethoprim/sulfamethox
isole

Removal of membrane,
Antitoxin, PCN or
Erythromycin
Ciprofloxacin and
Doxycycline, second
line is Amoxicillin and
PCN G
Ciprofloxacin and
Doxycycline, second
line is Amoxicillin and
PCN G
Ciprofloxacin and
Doxycycline, second
line is Amoxicillin and
PCN G

Erythromycin or
Azithromycin may
shorten duration and
decrease severity

Treatment
Preventive by elimiation
of nasopharyngeal
carriage: Rifampin, PO
Cipro, Ceftriaxone
(Rocephin)
Treatment: Penicillin,
Ceftriaxone (Rocephin)
until afebrile x 5 days
Azithromycin (Zithromax),
Clairithromycin (Biaxin),
Levafloxacin (Levequin),
Duration 10-14 days or 21
for immunocompromised
pt
Ampicillin, Azythromycin,
Chloramphenacol,
Cephalosporins and
Bactrim all effective, treat
for 5-7 dayas if
uncomplicated, 10-14 if
complicated
severely ill, malnourished,
or sickle cell treat 3-5
days with Trimethoprimsulfamethoxazole,
Ampicillin, Ciprofloxacin
Rehydration and reversal
of HTN, Trimethoprinsulfamethsoxazole or a
Flouraquinolone, often
resistant to Ampicillin

Treatment

Fluid replacement, IV
Ringers Lactate, TCN,
Ampicillin,
Chloramphenicol, Bactrim,
and flouroquinolones will
shorten the course

Avoid single drug

regimens, Doxycycline
plus Rifampin or
Streptomycin or
Gentamycin
Streptomycin DOC

Treatment
Ceftriaxone (Rocephin)
AND Doxycycline or
Azithromycin, Cefixime,
No Flouroquinolones
(especially for men),
treat spreading dz w/
PCN G IV, treat PID with
Cefoxitin IV
Unilateral adenitis treat
with Ceftriaxone or
Azithromycin

Two drug therapy a must

Clarithromycin (or
Azithromycin) AND
Ethembutol with or w/out
Rifabutin. Treat
immunocompetent pt with
combo of Rifampin +
Ethembutol +
Streptomycin for 18-24
months
6 or 9 month course, first
2 months Isoniazid,
Rifampin, Pyrazinamide,
and ethambutol, once
determined isoniazid
senstive ethambutol can
be disc. Once sensitive to
isoniazid and rifampin
then at least additional 4
months of therapy