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Snapshot
  • A 55-year-old woman presents to the emergency department with fatigue and abdominal pain. Her symptoms are associated with dysuria, hematuria, and increased urinary frequency. Physical examination is remarkable for bilateral flank pain, suprapubic tenderness, and costovertebral angle tenderness. Urine studies are obtained and she is started on empiric antibiotics. Urine cultures grows Pseudomonas aeruginosa. (Pyelonephritis secondary to Pseudomonas infection)
Introduction
  • Aerobic, non-lactose fermenting, oxidase-positive, gram-negative bacillus
  • Pathogenesis
    • phospholipase C
      • produced to degrade cell membranes
    • endotoxin, which leads to
      • fever
      • hypotension
      • disseminated intravascular coagulation
    • exotoxin A
      • this inactivates elongation factor 2 (EF-2), which stops protein synthesis via ADP ribosylation
    • pyoverdine and pyocyanin pigment
      • leads to a blue-green pigment

Associated Conditions
Conditions
Comments
Pneumonia
-
Sepsis
-
Ecythma gangrenosum 
  • Seen in severely ill and immunocompromised patients
Urinary tract infections -
Diabetes -
Osteomyelitis
  • Can be seen in patients with puncture wounds
Nosocomial infections
  • Such as catheter-associated and ventilator-associated infections
Skin infections
  • Hot tub folliculitis
  • Wound infections in burn victims
Cystic fibrosis (CF)
  • Its mucoid polysaccharide capsule may play a role in chronic pneumonia seen in CF patients
    • most common microbe isolated in adults with cystic fibrosis 
 
Treatment
  • Prompt antibiotic administration is associated with improved mortality
  • In addition to antibiotic treatment, source control is important (e.g., abscess drainage and removal of the catheter)
  • Treatment options include
    • carbapenems
    • aminoglycosides
    • monobactams
    • polymyxins
    • fluoroquinolones
    • third and fourth generation cephalosporins
    • piperacillin

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Questions (4)

(M1.MC.17.4754) A 45-year-old male presents to his primary care physician complaining of drainage from his left great toe. He has had an ulcer on his left great toe for over eight months. He noticed increasing drainage from the ulcer over the past week. His past medical history is notable for diabetes mellitus on insulin complicated by peripheral neuropathy and retinopathy. His most recent hemoglobin A1c was 9.4%. He has a 25 pack-year smoking history. He has multiple sexual partners and does not use condoms. His temperature is 100.8°F (38.2°C), blood pressure is 150/70 mmHg, pulse is 100/min, and respirations are 18/min. Physical examination reveals a 1 cm ulcer on the plantar aspect of the left great toe surrounded by an edematous and erythematous ring. Exposed bone can be palpated with a probe. There are multiple small cuts and bruises on both feet. A bone biopsy reveals abundant gram-negative rods that do not ferment lactose. The pathogen most likely responsible for this patient’s current condition is also strongly associated with which of the following conditions?

QID: 108951
1

Otitis externa

67%

(96/143)

2

Gastroenteritis

10%

(14/143)

3

Waterhouse-Friedrichsen syndrome

10%

(15/143)

4

Rheumatic fever

4%

(6/143)

5

Toxic shock syndrome

7%

(10/143)

M 2 C

Select Answer to see Preferred Response

(M1.MC.17.4723) A 37-year-old woman presents to her primary care physician after returning from her honeymoon in Cancun. A few days ago, she began to notice an eruption of small red bumps that cover her torso, back, and buttocks. The patient first thought she had acne, but became worried when the rash continued to itch. The patient denies other symptoms. Vital signs are within normal limits. Physical exam is notable for red papules and pustules scattered across the trunk, abdomen, back, and buttocks, while sparing the limbs. Closer examination indicates inflammation of the hair follicles. Culture yields motile, gram-negative rods that are non-lactose fermenting and oxidase positive. What other finding is commonly observed in the culture of the most likely organism?

QID: 108525
1

Pink colonies

8%

(23/290)

2

Blue-green pigment

64%

(185/290)

3

Alpha-hemolysis

9%

(27/290)

4

Yellow sulfur granules

11%

(33/290)

5

Red pigment

5%

(14/290)

M 1 D

Select Answer to see Preferred Response

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Evidence (4)
EXPERT COMMENTS (7)
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