Infectious Disease, Antibiotics and Sepsis

Diagnosis and management of malaria

Fungal sepsis

Management of biliary sepsis

Necrotising fasciitis and streptococcal toxic shock syndrome

Leptospirosis, a little bit about malaria, DIC and citrate toxicity

A 54-year-old man with type 2 diabetes mellitus and psoriatic arthritis on monoclonal antibody therapy presents with a two week history of progressive headache, nausea and vomiting, fever and an unsteady gait. He has had a recent episode of sinusitis which was treated with oral antibiotics.

Resuscitation of the septic shock patient

A previously well, 19 year old man has been referred to you by the Emergency Department. He sustained a finger laceration that required debridement and suturing 3 days previously.

Central line cultures, CLAB and infective endocarditis

You are asked to admit a 48-year-old lady who received ablative chemotherapy and an allogeneic bone marrow transplant two weeks ago for acute myeloid leukaemia. She has become progressively more dyspnoeic in the ward. A chest XRay demonstrates  a diffuse pulmonary infiltrate.

You are reviewing an intubated and ventilated 35 year old 4 days following traumatic subarachnoid haemorrhage.

A 58 year old man is admitted to the Intensive Care Unit, intubated and ventilated. Haemodynamic monitors have been inserted and the following haemodynamic measurements have been recorded:

Mean arterial pressure          53 mmHg

A 63 year old woman was admitted to the Intensive Care Unit 4 days ago. She has suffered a cardiac arrest in the community, was resuscitated by Ambulance Officers and was treated with urgent cardiac angiography and stenting of a significant left main coronary artery lesion.

Microbiology OSCE
Data sets provided for interpretation included
a)  a Gram positive bacilli bacteremia with neurological symptoms and signs - Listeriosis
b)  an antibiogram of a multiresistant Gram negative bacillus in a patient on meropenem

A 72 year old diabetic male is admitted to the Intensive Care Unit with a history of loin pain. He is febrile, tachycardic, hypotensive and tachypnoeic but stabilizes after fluid resuscitation and vasopressor infusion.
 

Clinical Case history 1 

This focussed on principles of antibiotic management of staph aureus bacteremia and Gram negative sepsis.

A previously well 27 year old woman has been admitted to ICU following an appendectomy for a perforated appendix. Her Pulse is 130/min, BP 65/30 despite six litres of crystalloid resuscitation. Her SpO2 is 90% on FIO2 of 0.7, PEEP 10 cm H2O, SIMV.

An 18-year-old man presents to hospital two days following completion of induction chemotherapy for acute myeloid leukaemia.  His main complaint is central abdominal pain.  He is tachycardic at 120/min and his systolic blood pressure is 70mmHg.  His temperature is 38.7 C.

Clinical case.
Case presented regarding severely ill patient with meningitis and discussion of intubation, and drug concentration time curves.

Haemato-oncology 
Scenario: 
“You have been called to the haematology ward to review a 55 year old man, who is 2 months post

Sepsis

Clinical case: Material presented regarding management of a man with a past history of diabetes, ischaemic heart disease and chronic lymphatic leukemia who presented with hours of severe abdominal and back pain and hypotension: biochemistry (pseudohyperkalaemia), microbiology (oxidase positive no

Microbiology: Material presented included questions about gentamicin, Legionella pneumonia, VRE, synergistic drug combinations and Activated Protein C.

Twenty-one out of twenty-two candidates passed this section.

Microbiology. Material presented included central venous catheters (some with anti- bacterial impregnation), anti-bacterial and anti-fungal therapeutic agents, and activated protein C.

Management of sepsis due to a fungal infection.   Ten out of twelve candidates passed this section.

Management of 14 year old girl with septic shock

Management of a young man with overwhelming post-splenectomy sepsis syndrome.

Management of a 32 week pregnant woman with staph. Pneumonia and infective endocarditis