Pearls from Dr. Will Greendyke
- Sensitivity for diagnosing PNA- 4-16%
- Specificity for diagnosing PNA- 96-99%
Posted 02/13/17 03:12:01 PM by Adam Faye
Light's Criteria Rule, if at least one of the three criteria is fulfilled, the fluid is defined as an exudate:
1) Pleural Protein : Serum Protein >0.5
2) Pleural fluid LDH > 2/3 ULN for serum LDH
3) Pleural fluid LDH/Serum LDH > 0.6
Pleural fluid glucose <60, pH <7.2 - think complicated parapneumonic effusion/empyema:
pH has to be run within an hour - can be falsely low if sits out for a long time. Glucose then becomes a better marker
A pleural fluid glucose level <60 mg/dL(3.33 mmol/L) is most commonly due to TB, parapneumonic effusion, malignant effusion, or rheumatoid disease.
- In parapneumonic effusions, a low glucose level implies the need for chest tube drainage.
- In malignant effusions, a low glucose level predicts a high yield on cytology, poor result of pleurodesis, and a poorer prognosis.
TB Effusions: Adenosine Deaminase <40 has almost a 100% negative predictive value for TB
Posted 02/13/17 03:16:21 PM by Adam Faye
- Patients with diabetes mellitus are at increased risk of empyema secondary to Klebsiella.
- MRSA can cause a necrotizing pneumonia; Group A Strep is also associated with a high rate of empyema.
- In patients with viral PNA, the major causes of bacterial superinfection and empyema have been S. aureus, S. pneumoniae, and S. pyogenes.
Posted 02/13/17 03:17:47 PM by Adam Faye
- tPA vs. Dnase vs. tPA + Dnasevs. placebo for 3 days; Outcome- improvement in radiography of effusion
- Placebo, tPA, Dnase – similar.
- Dnase + tPA improved fluid drainage and reduced surgical referral and hospital duration
Posted 02/13/17 03:19:59 PM by Adam Faye
DDx for fever in returning traveler (from DR) w/o localizing symptoms: Vector borne - Zika, Chikungunya, malaria (more likely in traveler from Asia or Africa), dengue. Others - TB, acute HIV, non-infectious causes.
Posted 07/11/17 09:23:05 AM by Emily Miller
Ixodes tick (deer tick) - vector for anaplasma, Lyme, Babesia. Very small tick, bites often missed by patients.
Posted 07/11/17 09:23:51 AM by Emily Miller
Doxycycline will treat most tick borne illnesses (Anaplasma, Lyme, RMSF), but NOT Babesia. Treatment options for Babesia are Clindamycin/quinine or Atovaqone/azithromycin.
Posted 07/11/17 09:25:24 AM by Emily Miller
Created by Christopher Kelly
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It is not meant to replace the advice of a health professional.