Infectious Diseases (12%) Flashcards
Management of influenza?
Mostly supportive
Antivirals (Oseltamivir) if w/in 48 hours of onset of sx
Side effects: N/V
What are the rashes that can affect the palm and soles? (x8)
Coxsackie (Hand Foot & Mouth)
RMSF (especially if wrist/ankles involved)
Syphilis (secondary)
Janeway lesions (cutaneous finding of endocarditis, along with osler nodes)
Kawasaki
Measles
Toxic Shock Syndrome
Reactive Arthritis (Keratoderma Blenorrhagica)
Meningococcemia
When will the prodrome of HSV first appear?
What are common sx of the prodrome?
Prodromal sx 24 hours prior
Burning, paresthesias, tingling
How does rubella typically present?
Compared to rubeola, rubella does/does not do what?
What may be present in young women with rubella, especially?
- Low-grade fever, cough, anorexia, lymphadenopathy (posterior cervical and posterior auricular)
Pink, light-red spotted maculopapular rash on face that spreads to the extremities (lasts 3 days).
Compared to rubeola, rubella spreads more rapidly & does NOT darken or coalesce.
- Transient photosensitivity & joint pains may be seen (especially in young women)
How is influenza spread?
What time of year is it most prevalent?
Airborne respiratory secretions
Fall/winter
Herpes zoster ophthalmicus: shingles involving the____ division of the _____ nerve
What is Hutchinson’s sign?
_______ lesions will be seen on slit lamp exam if _________ is present
1st
Trigeminal (CN V)
lesions on nose usually heralding ocular involvement
Dendritic
keratoconjunctivitis
How to diagnose pinworms?
Scotch tape test
performed early in the morning to look for eggs under a microscope
EBV infects ___ cells and is associated mostly with what lymphoma?
It may cause _______ lymphoma, too, and also ____ lymphoma in pts with AIDS.
B cells
Hodgkin Lymphoma
Burkitt’s lymphoma
CNS lymphoma
How do you dx a pt with HSV?
What is the most sensitive and specific test?
What will be seen on Tzacnk smear?
PCR = most sensitive and specific test for HSV
Clinical diagnosis
Tzanck smear: multinucleated giant cells and intranuclear inclusion bodies
POST HERPETIC NEURALGIA: pain ____ months, hyperesthesias or decreased sensation
>3 months
What is the mainstay of tx for pertussis?
Indication for abx?
Potential complications?
Supportive care
Abx for decreasing contagiousness, Macrolides are drug of choice (Erythromycin)
PNA, encephalopathy, otitis media, sinusitis, sz
Human Herpesvirus Family:
- _____
- _____
- _____
- _____
- _____
- _____
- _____
- _____
Human Herpesvirus Family:
- Oropharyngeal
- Genital
- Varicella Zoster
- Epstein Barr
- CMV
- Roseola
- Pityriasis Rosea
- Kaposi Sarcoma
The scientific name for pinworms is _____ ______
Enterobius vermicularis
What are the three kinds of oral lesions caused by HSV?
Acute herpetic gingivostomatitis
Acute herpetic pharyngotonsillitis
Herpes labialis
Pertussis is MC seen in what age group of pts?
<2 y/o
What can both types of coxsackie virus cause in a patient?
Aseptic meningitis, rashes, common cold sx, or no sx at all
HSV espohagitis presents as small deep ____ on EGD, and is seen primarily in ______ pts
small deep ulcers
immunocompromised
Secondary (Reactivation) TB infections:
Pts (are/are not) contagious
__-__% lifetime incidence of reactivation
Most commonly localized in the ___/___ lobes of the lungs with _____ lesions. Why there?
ARE CONTAGIOUS
5-10%
Apex/upper lobes (more O2 content)
cavitary
What is another name for measles?
Rubeola
Which influenza is associated with more severe, extensive outbreaks, A or B?
A
Mortality from TB is (low/high) when (treated/not treated)
High not treated
low when treated! (<5%)
Chronic/latent TB infections:
Pts (are/are not) contagious
____% of the population will control TB infeciton with _____ formation, which may become caseating. Caseating means: ____
ARE NOT
90%
granuloma
Caseating: central necrosis, acidic with low oxygen, making a hostile envr. for TB to grow
What is pleurodynia? How does it present?
Fever, severe pleuritic chest pain, and paroxysmal spasms of the chest/abdominal muscles including the diaphragm (may have swelling over the diaphragm), headache
Where are myalgias most commonly in a pt with influenza?
Legs and lumbosacral area
Influenza vaccines are given annually, usually in ___(months of the year)___
Contraindicated in pts with?
October-November
Egg, gelatin, or thimerosal allergies, or if severely ill
How do you dx rubella?
What assay is most commonly used?
Clinically
Rubella-specific IgM antibody via enzyme immunoassay
What is the incubation period of varicella zoster?
10-20 days
Usually, pts will become PPD + how many weeks after infection with TB?
2-4 weeks
In what ages is sixth’s disease most commonly diagnosed?
What is the incubation period?
<5 y/o
~10 day incubation period
What are the three phases of whooping cough?
Describe them (how long they last for, when is the pt most contagious, what are the presentations of each stage)
- Catarrhal phase: URI symptoms lasting 1-2 weeks. Most contagious during this phase.
- Paroxysmal phase: severe paroxysmal coughing fits with inspiratory whooping sound after cough fits. ± Post coughing emesis. Often lasts 2-4 weeks. ±Scattered rhonchi.
- Convalescent phase: resolution of the cough (coughing stage may last for up to 6 weeks)
Mononucleosis, otherwise known as the “kissing disease”, is caused by what herpes family virus?
How is it transmitted?
In what age group is it most commonly diagnosed in?
_____% of adults are seropositive
Epstein Barr virus (HHV 4)
Saliva
15-25 y/o
80%
Will a patient with mono have anterior or posterior cervical lymphadenopathy? Could it also be general?
What organs many be enlarged?
What kind of rash can present, especially if given ampicillin?
Posterior, yes
Spleen and possibly liver too
Petechial (~5%)
Describe the presentation of hand foot and mouth disease.
Mild fever, URI sx, decreased appetite starting 3-5 days after exposure
Oral enanthem: vesicular lesions with erythematous halos in the oral cavity (especially buccal mucosa & tongue)
Exanthem: 1-2 days afterwards: vesicular, macular or maculolapular lesions on the distal extremities (often includes the palms & soles)
Influenza has a (abrupt/gradual) onset.
Associated sx?
Abrupt
HA, fever, chills, malaise, URI sx
Enterobiasis is otherwise referred to as _______
Pinworms
How to treat active TB?
Common side effects of each?
After starting therapy, how long until patient is considered non-infectious?
“RIPE” or “RIPS”:
Rifampin – orange colored secretions
lsoniazid – hepatitis, peripheral neuropathy (which can be prevented by pyridoxine B6)
Pyrazinamide – photosensitive rash, hepatitis
Ethambutol – optic neuritis, peripheral neuropahty
(or Streptomycin) – ototoxicity (CN VIII), nephrotoxicity
2 weeks
When is a CXR indicated in pts with TB or possible TB?
- indicated to exclude active TB (ex. newly +PPD)
- used as yearly screening in pts w/ known + PPD to r/o active TB
The rubella virus belongs to what viral family?
Togavirus family
What is gold standard for dx of pertussis?
PCR of nasopharyngeal swab
Tuberculosis is caused by what infective agent?
Mycobacterium tuberculosis
What is the recommended management for 5th disease/ erythema infectiosum?
Supportive, anti-inflammatories
What is the recommended management of measles/rubeola?
What are possible complications of measles/rubeola?
Supportive, anti-inflammatories (no specific tx)
Vitamin A reduces mortality in all children with measles (decreased morbidity & mortality)
COMPLICATIONS: Diarrhea, otitis media, PNA, conjunctivitis, encephalitis
What is herpes whitlow?
Herpes infection of the finger or fingernail
How are pinworms transmitted?
Feco-oral
Complications of Chicken Pox include…
Which complication is most common?
Most common: Bacterial infection
PNA, Encephalitis, Guillain Barre syndrome
What is the recommended management of sixth’s disease?
Supportive
Can administer antipyretics to prevent febrile sz
How does measles/rubeola typically present?
Prodrome?
What are the “3 C’s”?
- URI prodrome: high fever
“3 C’s”: Cough, Coryza (rhinitis), Conjunctivitis
Koplik Spots: small red spots in buccal mucosa with pale blue/white center) precedes rash by 24-48h, lasts 2-3 days
Morbiliform (maculopapular) brick-red rash on face beginning @ hairline then spreading down to extremities (palms & soles involvement usually seen last if it occurs) that darkens & coalesces.
- Rash usually lasts 7 days fading from top to bottom. Fever often concurrent with the rash
What medication to use for pinworms?
Albendazole, Mebendazole
What is the incubation period for pertussis?
7-10 days
Genital HSV lesions are most often HSV (1/2), which is seen in __% of population
2
25%
How does mumps usually present?
How do you dx mumps?
Low grade fever, myalgias, headache
Parotid gland pain & swelling
Dx clinically, or with serologies, look for elevated amylase
Acute herpetic gingivostomatitis: primary infection in (children/adults) with a sudden onset of fever, ______, ______, and ______ in the mouth,
Tongue and lips will have ____(color)____ lesions.
____% ofUS population is infected with HSV 1
children
anorexia
gingivitis
vesicles
grey-yellow
>90%
What does chronic TB cause in the lungs?
Granuloma formation
What are sx of having pinworms?
When are sx of pinworms especially noticeable? Why?
Perianal itching
At night, because that is when the eggs are laid
Describe sixth’s disease presentation, including prodrome, rash, how long it lasts for, and what the child feels like.
- Prodrome of HIGH FEVER 3-5 days (fever resolves before the onset of a rose, pink maculopapular, blanchable rash on the trunk/back that then spreads to the face.
Rash lasts hours (up to 1-2 days).
ONLY CHILDHOOD VIRAL EXANTHEM THAT STARTS ON TRUNK and then spreads to face
- Child appears “well” and alert during the febrile phase.
May be irritable during febrile phase.
What are possible complications of mumps?
What is mumps the most common cause of in children?
In what age group are complications of mumps most commonly seen in?
- Orchitis in males* (usually unilateral), oophoritis (inflammed ovary), encephalitis, aseptic meningitis
- Mumps MC cause of acute pancreatitis in children. Deafness, arthritis, infertility.
MC seen in older patients
What is the recommended management of mumps?
Supportive, antiinflammatories
What is the infectious agent that causes 5th disease/ erythema infectiosum?
Parovirus B19
Rubella is otherwise known as?
German Measles
How is rubella transmitted?
What is the rash of rubella commonly referred to as, due to its length of presentation?
Respiratory droplets
“3 day rash”
Has a 2-3 week incubation period
To be diagnosed with latent TB, one must meet x3 criteria:
- patient must be _____
- have a (positive/negative) PPD
- have NO evidence of ______ infxn on CXR/CT
- asymptomatic
- positive PPD
- Active infxn
What is considered gold standard for diagnosing active TB?
AFB cx (acid fast smear and sputum cx x3 days)
HERPES ZOSTER OTICUS, otherwise known as _________, follows the ____ nerve. It can cause sx such as …
Ramsey Hunt Syndrome
facial nerve (CN VII)
otalgia, lesions on the ear, auditory canal & tympanic membrane, facial palsy, auditory sx: tinnitus; vertigo, deafness, ataxia.
How is TB transmitted?
Airborne droplets
In patients with TB and HIV infection, there is a ___-___% yearly chance of reactivation of latent infection
7-10%
How do you tx a pt with rubella?
What do patients with rubella typically NOT have compared to patients dx’d with rubeola?
Supportive, antiinflammatories
Generally, there are NO complications in pts with rubella, compared to those with rubeola.
What can be done to prevent mumps in patients?
MMR vaccine
Given at 12-15 months, with a second dose at 4-6 y/o
What does 5th disease/ erythema infectiosum present like?
What can it cause in older children and adults?
What can it cause in pregnant women?
- Coryza, fever –> “slapped cheek” rash on face with circumoral pallor 2-4 days –> lacy reticular rash on extremities (especially upper).
* Spares the palms & soles*
Resolves in 2-3 weeks
- Arthropathy/arthralgias: older children & adults
- Associated with fetal loss in pregnancy (fetal hydrops, CHF, spontaneous abortion)
What are sx that a patient with pulmonary TB may present with?
PE findings?
Pulmonary TB: chronic, productive cough, chest pain (often pleuritic), hemoptysis if advanced, night sweats, fever /chills, fatigue, anorexia, weight loss
PE: signs of consolidation, rales or rhonchi near apices/involved areas, dullness.
May have normal exam
Varicella (chicken pox) is the primary infection of HSV ____.
Sx include fever and malaise, and a rash that is described as … with all lesions at (the same stage/different stages), beginning on the ___ & ___ and spreading to the ____.
(Never/Sometimes/Usually) pruritic
More severe presentation may occur in (children/adults)
3
“dew drops on a rose petal” (clusters of vesicles on an erythematous base)
Different stages (macules, papules, vesivcles, pustules, and crusted lesions)
Face & trunk
extremities
Usually
adults
What is the recommended course of tx for the following:
- Chicken Pox: _______
- Shingles: _______
- Herpes Zoster Ophthalmicus: _______
- Ramsay Hunt syndrome: _______
- Post Herpetic Neuralgia: _______
- Chicken Pox: symptomatic treatment
- Shingles: Acyclovir, Va/acyclovir, Famciclovir (given w/in 72 hours to prevent PHN)
- HZO: PO antivirals; May add Trifluridine, Acyclovir or Vidarabine ophthalmic
- Ramsay Hunt syndrome: oral Acyclovir + corticosteroids
- PHN: Gabapentin or Tricyclic antidepressants, Topical (Lidocaine gel, Capsaicin)
What would classic miliary TB look like on CXR?
Diffuse millet seed size infiltrates throughout the lung fields
How is varicella zoster spread?
respiratory droplets and direct contact
High risk populations for TB include those with:
high risk of exposure (health care workers)
high risk of infection (immigrants, homeless)
high risk of active TB once infected (immunocompromised)
How do you dx a pt with mono?
Within what timeframe will this test be positive?
What will be seen on a peripheral smear?
Heterophile (Mono) Ab Test {monospot}
Postive within 4 weeks
Peripheral smear: Atypical lymphocytes
What is the recommended management for HSV?
Acyclovir (IV for encephalitis)
Valacyclovir, Famciclovir
What two conditions are caused primarily by coxsackie A?
Coxsackie B?
A: Hand foot and mouth disease, Herpangina
B: Pericarditis and myocarditis, pleurodynia
What are Forcheimer spots? What other exanthem are they typically present in?
Forchheimer spots: small red macules or petechiae on soft palate –> also seen in Scarlet fever)
What time of year and in what age group does coxsackie virus usually occur in?
How is coxsackie virus transmitted?
What are the different types of coxsackie virus?
Late summer/early fall
children <5 y/o
Feco-oral and oral-orally
Coxsackie A and B
Pertussis, or whooping cough, is caused by what infectious agent?
Bordetella pertussis
Describe the potential complications that could occur if a pt is pregnant and contracts rubella.
Teratogenic esp 1st trimester
Congenital syndrome –> sensorineural deafness, cataracts, TTP (“blueberry muffin rash”), mental retardation, heart defects
(part of the TORCH syndrome)
(T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
What is the recommended management of coxsackie A?
Supportive
How to tx a pt with mono?
When to use corticosteroids?
What to recommend if +splenomegaly?
Supportive!
Corticosteroids only used if there is airway obstruction from lymphadenopathy
Avoid contact sports x1+ month if splenomegaly is present
Bell palsy is associated with HSV (1/2)
1
What infectious organism is mumps caused by?
How is it transmitted? What is the incubation period?
What time of year is mumps most commonly diagnosed?
Paramyxovirus
Transmission: respiratory droplets
12-14d IP
Increased incidence in the spring
Patients are usually infectious 48 hours prior to and 9 days after the onset of parotid swelling
What family is influenza virus a part of?
Orthomyxovirus
Herpes labialis is a secondary infection caused most often by HSV (1/2). It results in a ____ ____, usually following a periord of _____ or illness
1
cold sore
stress
How is rubeola/measles transmitted?
What infectious agent is it caused by?
Transmission: respiratory droplets, person-person, airborne
Paramyxovirus
Extra-pulmonary TB can affect what organ systems?
If a patient has vertebral TB, it is called ____ disease.
If TB presents in the lymph nodes it is called _____.
ANY ORGAN SYSTEM
Pott’s disease
Scrofula
TB meningitis, pericarditis, peritonitis, joints, kidney, adrenal or cutaneous involvement
What is the most common cause of encephalitis?
HSV
What is the clinical presentation of HSV?
Can HSV 1 and HSV 2 interchange?
Painful, grouped vesicles on an erythematous base
YES, oral (HHV 1) and genital (HHV 2) can be interchanged
What are the infectious dz that are associated with arthropathy?
Erythema Infectiosum (in older adults)
Rubella (especially in young women)
Coccidiomycosis (Valley fever also associated with erythema nodosum)
Herpes keratitis is usually (unilateral/bilaterl)
Upon examination with a slit lamp, one will see ____ _____
Management?
unilateral
dendritic ulcers
Antiviral eye drops (ex. Trijluridine, Vidarabine, Ganciclovir) and/or oral Acyclovir
Coxsackie virus is a part of the _____ family
enterovirus
Describe the presentation of herpangina.
Who is herpangina most commonly diagnosed in?
Sudden onset of high fevers, stomatitis: small vesicles on the soft palate, uvula & tonsillar pillars that ulcerate before healing, sore throat 3-5 days.
Most commonly seen in children 3-l0 y/o
Diagnosis of influenza?
Clinical
Rapid influenza test (nasal swab)
What is the most common viral cause of pericarditis and myocarditis?
Coxsackie (B>A)
What would classic reactivation TB look like on CXR?
Infiltrates and cavitation in the upper lobe/apices
Acute herpetic pharyngotonsillitis is a primary infeciton in (children/adults) with vesicles that (do/do not) rupture, with ulcerative lesions with __(color)__ exudates in the (anterior/posterior) pharyngeal mucosa
adults
do rupture
grayish
posterior
What would classic primary TB look like on CXR?
Lower lobe consolidation, right sided hilar consolidation also seen here:
PVB19 may cause ______ in patients with sickle cell disease or with ____ deficiency
Aplastic crisis (a temporary cessation of RBC production; b/c of markedly shortened RBC survival time in patients with sickle cell dz, a precipitous drop in hgb occurs in the absence of adequate reticulocytosis)
G6PD
T/F: Treatment of latent TB infection reduces risk of reactivation TB in the future
True!
On CBC with Diff, what is the finding in a patient with pertussis?
Lymphocytosis (60-80%)
Elevated WBC count (50,000)
What is another name for Sixth’s Disease?
What is it caused by?
How is it transmitted?
Roseola Infantum
Human herpes virus 6 or 7
Respiratory droplets
What is 5th disease otherwise known as?
Erythema infectiosum
PPD testing for TB:
Is + vs - based off of erythema or induration?
In what kinds of pts would >=5mm be considered a + test?
In what kinds of pts would >=10mm be considered a + test?
In what kinds of pts would >=15mm be considered a + test?
INDURATION
5: Immunosuppressed/HIV
10: High risk/prevalence populations
15: Everyone else
Primary TB infections:
Pts (are/are not) contagious
Common in (children/teens/adults) in endemic areas
ARE CONTAGIOUS
children <4 y/o
How do you dx a pt with 5th disease/ erythema infectiosum?
serologies
How is 5th disease/ erythema infectiosum transmitted?
In what age group is 5th disease/ erythema infectiosum most commonly seen in?
What is 5th disease/ erythema infectiosum’s incubation period?
Respiratory droplets
<10 y/o
4-14 day incubation period
HERPES ZOSTER (aka _______) is the VZV reactivation along one _______ of the dormant virus in the spinal root & _____ _____ ganglia
± Disseminated in pts with _____
Shingles
dermatome
cranial nerve
HIV
