Sandbox: Fatima

Sputum Analysis

Sputum Analysis

Acid Fast Stain

Culture on Sabourad's medium

Direct Microscopic Examination

Gentain Voilet Stain

Aerobic Culture

Tuberculosis

Yeast and Fungi

Actinomyces and other mycelia of Fungi

Fusiform Bacteria and Spirochetes

Pyogenic organsims

DD

Rhinitis

Positive Skin Prick or RAST

Negative Skin Prick or RAST

Allergic Rhinitis

Non Allergic

Infectious

Vasomotor

Gustatory

Nonallergic eosinophilic rhinitis syndrome (NARES)

Acute Rhinosinisitis

Chronic Rhinosinusitis

Approach

Diagnostic Paracentesis ❑ Perform ascitic fluid cell count and differential ❑ Perform ascitic fluid culture (Inoculated at bedside)

PMN ≥ 250cells/mm³

If YES ❑ Presumptive SBP ❑ Begin empiric antibiotic therapy(eg:Cefotaxime 2g IV q8H and ❑ IV Albumin on day 1 & day 3 IF serum creatinine 1mg/dl, BUN > 30mg/dl or total albumin > 4mg/dl

IF NO ❑ Look for the signs/symptoms of Infection

Is Culture Positive ?

Absent Symptoms ❑ Is Culture Positive?

Symptoms Present ❑ Begin Empiric Antibiotic Therapy for SBP

Negative Culture ❑ Complete 5 day Antibiotic Course

Confirmed SBP ❑ Narrow the spectrum based on the susceptibility to complete the 5 day course

Culture Negative ❑ No Antibiotics indicated

Culture Positive ❑ Bacterascites: Repeat diagnostic paracentesis when the culture growth is discovered

Diagnostic Paracentesis

Classification of acute abdomen based on etiology	Disease		Diagnosis		Mother to Child Transmission		Most Serious Complications
			Laboratory studies	Clinical Diagnosis	Vertical Transmission	Trans-vaginal transmission
Primarily sexually transmitted	Genital Dermatological Manifestation (e.g., ulcers, chancre, vesicles, warts, balanitis etc.)	HPV	✔	✔			Cervical Cancer
		Herpes simplex-2	✔	✔	✔	✔	Severe pruritis/discomfort
		Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
		Scabies	✔	✔			Moderate to Severe pruritis/discomfort
		Pubic lice	✔	✔			Moderate to Severe pruritis/discomfort
		Candidiasis (in males)		✔			Mild to moderate pruritis/discomfort
	Generalized Symptoms (e.g. constitutional symptoms	HIV	✔		✔		Primary CNS Lymphoma Immunosuppression (AIDS)
		Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
	Urogenital infections (e.g.,Vaginitis, Urethritis, Cervicitis, and PID)	Gonorrhea	✔	✔		✔	PID
		Chlamydia	✔	✔		✔	PID
		Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
		Mycoplasma genitalium	✔	✔	unknown	unknown	PID
		Trichomonas vaginalis	✔	✔			PID
Less frequently sexually transmitted	Generalized Symptoms (e.g. constitutional symptoms)	Zika Virus	✔		✔		Vertical transmission and congenital abnormalities
		Hepatitis B	✔	✔	✔		Hepatocellular Carcinoma
		Hepatitis C	✔	✔	✔		Liver cirrhosis
	Urogenital Infections (e.g.,Vaginitis, Urethritis, Cervicitis, and PID)	Gardnerella vaginalis	✔	✔			Moderate to severe discomfort
		Candidiasis (in females)		✔			Moderate to severe pruritis/discomfort
		Ureaplasma urealyticum	✔	✔			Moderate to severe pruritis/discomfort