Bacteria and conditions

Question 1

Anthrax

Answer 1

Bacillus anthracis, gram pos rod
1) inoculated through skin
- single lesion, black eschar, doesn’t hurt, starts as blister
2) Inhaled “woolster’s, most severe
- flu like, severe dyspnea/shock, pleural effusions, mediastinal widening
3) GI, from eating tainted meat fever, ulcer, leads to hematemesis and or melena, NVD
TX: Cipro, doxycycline second

Question 2

Dengue

Answer 2

Flavivirus transmitted by Aedes mosquito

• 3-15 days incubation period, history of travel south
• ranges from aymptomatic to hemorrhagic fever, fatal shock (in people previously exposed)
• high fever, chills, “bone breaking fever”
• skin rash sparing palms and soles
• usually self limited, symptom management

Question 3

Cat scratch disease

Answer 3

Sub acute regional lymphadenitis Bartonella henselae
-Ulcer at site of entry, followed by fever, headache, solitary/regional lymphadenopathy, malaise

Pasteurella multocida: from puncture, localized cellulitis, treat with Abx

Question 4

Toxoplasmosis

Answer 4

Obligate intracellular protozoan. Toxoplasma gondii
- Under cooked meats, bad H2O, fecal oral, cat box, ingestion of cysts
- Primary infection: maybe Asymp; or fever, HepMeg
- can become reactivated in ImComp, encephalitis, necrolizing brain lesions
Tx: ImComp: pyrimethamine and sulfadiazine, folic A

Question 5

Plague

Answer 5

Yersinia pestis, from rodents carrying infected fleas
- Fever, malaise, HA, arthralgia/myalgia
-Bubonic: lymphadenitis resulting in buboes, cough, hemoptysis, tachypnea and meningitis
-Pneumonic: infects lungs, spread person to person
-Septicemic: endoctoxins invade blood resulting in rapid death
Prophylaxis: Doxy
Tx: Streptomycin, gentamycin, doxy

Question 6

Malaria

Answer 6

Four species of plasmodium, trans: anopheline mosquito
- incubation 7-30 days
classic attack: 6-10 hrs, cold stage: rigors, hot stage: fevers, HA, vomiting); sweating stage
Dx: think and thin blood smears
Tx: Chloroquine and quinine
Prevent: avoid bites, travelers prophylaxis

Question 7

Tularemia

Answer 7

Francisella tularensis, contact with animal tissues, bad H2O
- Incub: 1-14 days, papule at site of inoculation
- S&S: fever anorexia, lethargy, reg lymphadenopathy.
- pneumonia with inhalation
- GI sx, splenomegaly
Tx: streptomycin or tetracycline

Question 8

Syphilis “The great pretender”

Answer 8

Treponema pallidum: trans direct contact with infected lesion or vertical transmission
-Primary: painless chancre where entered body 3-6wk
-Secondary: nonpruritic rash on palms and soles, condyloma lata (wart like) in intertriginous areas, mucous patches, malaise, lymphadenopathy
-Latent asymptomatic
-Tertiary: CV, gumma lesion, neurosyphilis
Dx: dark field microscopy, serology
Tx: benzathine penicillin

Question 9

Gonorrhea

Answer 9

Neisseria gonorrhea; 2nd most common communicable disease
- symp 1-14 days after exposure, women screened every year
- More purulent discharge than chlamydia
- Women sx: vaginal discharge, and pain, fever, cervical motion tenderness, dysuria
- Males: urethritis, dysuria, penile discharge
Dx: swab or first catch urine
Tx: Ceftriaxone 250mg IM plus Azithromcin 1 gram PO
Retest in 3 months

Question 10

Chlamydia

Answer 10

Chlamydia trachomatis, gram neg
(most freq reported infectious disease)
- often Asymp, or symp may occur 1-2 wks after exp
- women: cervical discharge, low abdom pain, fever chills, adnexal tenderness
- men: urethritis, penil discharge, dysuria
Dx: swab or first catch urine
Tx: Doxy 100mg PO BID x7 days or AZ 1 gram PO single dose
-Retest in 3 months

Question 11

HPV

Answer 11

Most Asymp, genital wart (esp. in friction zones0
can be pruritic rarely painful
Dx: visual inspection, biopsy if uncertain, abnormal pap leading to HPV testing
Tx: no cure, to clear warts acid or cryotherapy

Question 12

Genital herpes

Answer 12

HSV 1 or 2
Symp: most Asymp (up to 90%), exquisitely painful lesions, prodrome burning/tingling. 1st exposure usually most severe
Dx: clinical, culture, PCR, serology, could be false neg.
Tx: acyclovir, valacyclovir, famiciclovir

Question 13

chancroid

Answer 13

Haemophilus ducreyi: gram neg coccobacillus
- vesicopustule develops which breaks down to form painful soft ulcer with necrotic base, erythema and undermined edges.
- Lymphadenitis follow, lymph nodes may rupture
Dx: culture
Tx: single dose Az 1g, or ceftriaxone 250 mg IM

Question 14

granuloma inguinale: Donovanosis

Answer 14

Blebsiella granulomatis
S&S: 1 -12 wks
- half pt. have sores in the anal area
- small,beefy-red bumps appear on genitals or anus
- skin wears away, bumps become raised, velvety nodules called granulation tissue, usually painless, but bleed easily
- Slowly spreads and destroys genital tissue
Dx: culture, skin biopsy
Tx: Az 1 g per week, or doxy 100 mg bid, treatment should last 3 weeks or until lesions healed

Question 15

lymphogranuloma venerum

Answer 15

three serotypes of chlamydia trachomatis
- S/S in men: genital lesion, tender lymphadenopathy, lymph nodes often fuse, soften and break down to form multiple draining sinuses, proctitis, tenesmus (recurrent inclination to evacuate bowels)
- S/S women: lymph drain to perirectal glands, proctitis
Dx: complement fixation test, nucleic acid detection test
Tx: Doxy 100 mg po BID for 21 days, erythromycin 500mg qid for 21 days