Integrated Case-Based Learning 2: Infectious Diseases

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Questions and Answers

What is one of the overall course objectives of Integrated Case-Based Learning 2?

To develop pharmaceutical sales techniques

To study the chemistry of antibiotics

To implement clinical pharmacy tools in real case scenarios (correct)

To learn about historical cases of infectious diseases

Which day of the week are lectures for the course scheduled?

Friday

Monday (correct)

Wednesday

Sunday

What is not allowed in the lecture hall according to the general rules?

Eating food (correct)

Using laptops

Taking notes

Participating in discussions

Which of the following topics is included in the weekly schedule of the course?

Prophylaxis of SSI Signup and view all the answers

What skills are students expected to advance in through this course?

Managing complicated cases of infectious diseases Signup and view all the answers

What grading component carries the highest weight in the overall grades for the course?

Final Signup and view all the answers

What is required from students during lectures as part of the course rules?

To engage in interaction Signup and view all the answers

What method is encouraged for implementing evidence-based medicine in the course?

SOAP notes and clinical scores Signup and view all the answers

What temperature is considered a fever in the context of infection?

≥ 38°C Signup and view all the answers

Which white blood cell count range is generally considered normal?

4000 - 10000/mm3 Signup and view all the answers

What does a shift to the left in a WBC differential indicate?

Increased bone marrow response to infection Signup and view all the answers

In which of the following scenarios might a patient be afebrile?

Localized uncomplicated urinary tract infection Signup and view all the answers

What is the significance of inflammatory markers in the context of infections?

They help in establishing the presence and severity of infection Signup and view all the answers

What is a common presentation of a patient with overwhelming infection?

Hypothermia with temperatures less than 36°C Signup and view all the answers

Which of these symptoms would be categorized as subjective signs of an infection?

Patient-reported pain Signup and view all the answers

What is NOT a primary goal when managing an infection?

Enhancing the patient's pain experience Signup and view all the answers

What can be associated with overwhelming sepsis regarding white blood cell count?

A markedly decreased WBC count Signup and view all the answers

What is the definition of neutrophilia?

Absolute neutrophilic count more than 8000/µL Signup and view all the answers

What virus is NOT typically associated with lymphocytosis?

Clostridium difficile Signup and view all the answers

Which of the following infections is commonly linked to eosinophilia?

Parasitic infections Signup and view all the answers

What white blood cell type is most likely increased in response to bacterial infections?

Neutrophils Signup and view all the answers

Which condition is defined as a WBC count greater than 50,000/µL with a pronounced left shift?

Leukemoid reaction Signup and view all the answers

What absolute count defines eosinophilia in adult patients?

More than 400/µL Signup and view all the answers

Which of the following statements about lymphocytosis is false?

It is commonly associated with neutrophilia Signup and view all the answers

Which sign is NOT typically associated with severe infection or sepsis?

Hyperthermia Signup and view all the answers

How do corticosteroids affect the diagnosis of an infection?

They can mask infection symptoms by reducing the febrile response. Signup and view all the answers

Which of the following is a possible result of using NSAIDs in patients?

Aseptic meningitis. Signup and view all the answers

What is a key factor in determining the likely pathogen causing an infection?

Comorbidities and recent hospital admission. Signup and view all the answers

What technique is used for confirming the identity of an organism in cases of suspected infection?

Isolation of the organism and susceptibility testing. Signup and view all the answers

Which of these types of bacteria is NOT classified under typical gram-positive or gram-negative categories?

Atypical bacteria Signup and view all the answers

In immunocompromised patients, how may the signs of infection present?

They may be masked and only detectable by cultures. Signup and view all the answers

Which of the following methods is least likely to help in determining the site of infection?

Blood glucose levels. Signup and view all the answers

What is the primary purpose of prophylactic therapy?

To prevent infections in high-risk groups. Signup and view all the answers

In which situation is empirical therapy typically used?

Symptomatic patients with unidentified causative agents. Signup and view all the answers

What type of therapy is considered as secondary prophylaxis?

Suppressive therapy Signup and view all the answers

What should be the preferred duration of definitive therapy?

The shortest possible duration. Signup and view all the answers

What indicates the need for antibiotic de-escalation based on monitoring?

Procalcitonin levels below 0.25–0.5 ng/mL. Signup and view all the answers

What is a common characteristic of pre-emptive therapy?

It targets patients with laboratory evidence of infection. Signup and view all the answers

Which antibiotics are commonly used for post-exposure prophylaxis for meningitis?

Rifampin or ciprofloxacin. Signup and view all the answers

What condition was diagnosed in the 64-year-old woman admitted to the ICU?

Community-acquired pneumonia. Signup and view all the answers

Study Notes

General Course Information

Course: Integrated Case-Based Learning 2 (Infectious Diseases)
Instructor: Amany El-Bassiouny, Pharm-D, PhD
Lecture Schedule: Mondays, 10:30-12:00 and 1:30-3:00
Mobile phones must be silenced.
Entry after 10 minutes late is not permitted.
Eating is prohibited in the lecture hall.
Active class participation is required.
Recording lectures is not allowed.

Course Objectives

Apply clinical pharmacy tools to real case scenarios.
Identify drug-related problems and screen for potential drug interactions.
Develop skills in managing complex infectious disease cases using evidence-based medicine, SOAP notes, and relevant clinical scores.
Participate in team-based collaborations using patient cases and drug information.

Course Structure and Grading

Midterm Exam: 30% of final grade.
Practical Assessment: 30% of final grade.
Final Exam: 40% of final grade.
Bonus Points: Possible additional points based on correct answers in quizzes (1 point per correct answer; bonus grade awarded based on total points: <10 points: no bonus, 10-15: 1 grade, 15-20: 1.5 grades, etc.)

Course Content Outline (Weekly Topics)

Week 1: Establishing the presence of an infection; Tutorial: Reviewing information resources.
Week 2: Prophylaxis of surgical site infection (SSI).
Week 3: Special populations; Upper respiratory tract infections.
Week 4: Practical pearls in managing infections; Pneumonia.
Week 5: Antimicrobial stewardship; Meningitis.
Week 6: Home parenteral therapy and PICC lines; Practical quiz.
Week 7: Infective endocarditis; Midterm Exam.
Week 8: Viral and fungal infections; Urinary tract infections.
Week 9: Management of antimicrobial-resistant Gram-negative infections; Sepsis and septic shock.
Week 10: Management of bed sores; Skin and soft tissue infections.
Week 11: Vaccination (types, precautions, adverse effects); Tuberculosis (TB).
Week 12: Midterm Exam 2; Human immunodeficiency virus (HIV).
Week 13: Opportunistic infections; Final practical.

Lecture 1: Establishing the Presence of an Infection

Signs and Symptoms of Infection

General: General condition, temperature, white blood cell (WBC) count, inflammatory markers.
Specific: Dependent on the infection site.

Temperature

Fever: Oral temperature ≥ 38°C.
Hypothermia: Oral temperature ≤ 36°C (may occur in overwhelming infections).
Afebrile: No fever; may occur in localized infections.

White Blood Cells (WBCs)

Normal range: 4,000-10,000/mm³.
Increased WBC count: Common in infections, especially bacterial. "Shift to the left" in bacterial infections due to bone marrow response.
Decreased WBC count: Can occur in overwhelming sepsis.
Normal WBC count: Possible in less acute or localized infections.

Differential White Blood Cell Count

Neutrophils: 2,500-8,000 per mm³ (55-70%)
Lymphocytes: 1,000-4,000 per mm³ (20-40%)
Monocytes: 100-700 per mm³ (2-8%)
Eosinophils: 50-500 per mm³ (1-4%)
Basophils: 25-100 per mm³ (0.5-1%)

Neutrophilia

Defined as >8,000 neutrophils/µL.
Caused by infection, inflammation, stress, or medications.
Elevations >30,000/µL, and leukemoid reaction (>50,000/µL with left shift) may indicate severe infections like Clostridium difficile or tuberculosis.

Lymphocytosis

Defined as >4,000 lymphocytes/µL.
Associated with viral infections (EBV, CMV, HIV, influenza, etc.) and some bacterial infections (e.g., Bordetella pertussis, Mycobacterial tuberculosis).

Eosinophilia

Defined as >400 eosinophils/µL.
Elevated in drug reactions, allergies, asthma, parasitic infections, and some fungal infections.

Severe Infection (Sepsis)

Hypotension, tachycardia, hypoperfusion, oliguria, and organ dysfunction.

Drugs Interfering with Infection Diagnosis

Corticosteroids: Can mask fever and may cause increased WBCs, potentially leading to misdiagnosis.
Some drugs (NSAIDs, sulfonamides, some antiepileptics, corticosteroids): Can cause aseptic meningitis.

Establishing the Site of Infection

Often apparent from signs and symptoms.
May be masked in immunocompromised patients, requiring cultures for detection.

Determining the Likely Pathogen

Patient history and comorbidities.
Infection site.
Age.
Recent hospitalizations.
Immune status.
Travel history.
Culture and susceptibility testing (Gram stain, acid-fast stain).
Empirical therapy (treatment before identification of pathogen).

Antimicrobial Therapy

Prophylactic: Preventative treatment in high-risk groups (immunocompromised, pre-surgical procedures, post-exposure). (Examples: amoxicillin for infective endocarditis prophylaxis, rifampin or ciprofloxacin for meningitis prophylaxis).
Pre-emptive: Treatment in high-risk patients with lab evidence but no symptoms.
Empirical: Treatment of symptomatic patients before pathogen identification (cultures still needed).
Definitive: Treatment based on susceptibility testing; monotherapy preferred (exceptions exist).
Suppressive: Secondary prophylaxis to prevent relapse in conditions like HIV or post-transplant with lower dose.

Monitoring Infection Progression

Clinical symptoms, temperature, WBCs, CRP, procalcitonin (PCT; reduction below 0.25-0.5 ng/mL or 80-90% decline from baseline may indicate success of antibiotic de-escalation), repeated cultures.

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Description

This course focuses on applying clinical pharmacy tools to real-world infectious disease cases. Students will learn to identify drug-related issues, manage complex cases, and collaborate in teams. Participation and adherence to guidelines are essential for success.