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Infectious disease > Bacterial infections III - atypicals > Flashcards

Bacterial infections III - atypicals Flashcards

1
Q

3 atypical causes of pneumonia

A
  1. mycoplasma
  2. legionella
  3. chlamydia
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2
Q

mycoplasma are small bacteria lacking ____

A

a cell wall

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3
Q

mycoplasma are commonly found where?

A

lining mucous membrane of:
1. rsp tract (especially)
2. genitourinary tract

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4
Q

___ is most associated with acute pneumonia

A

M. pneumoniae

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5
Q

mycoplasma causes ___ (2)

A

epithelial injury
activates immune response

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6
Q

what causes the milder form of “pneumonia” and is often associated with bullous myringitis and referred to as “walking pneumonia”

A

M. pneumoniae

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7
Q

presentations of M. pneumoniae

A
  1. clear auscultation
  2. no lobar consolidated
  3. diagnosed by NP swab**
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8
Q

clinical suspicion of M. pneumoniae in CAP what should be initiated?

A

empiric tx
azithromycin (z pack)

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9
Q

what is an obligate intracellular bacteria that does not contain a peptidoglycan cell wall

A

chlamydia

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10
Q

what is the second most common cause of “atypical” pneumonia

A

chlamydia pneumoniae

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11
Q

what causes an “atypical” pneumonia with fever, chills, cough, HA and comes from contact with birds?

A

chlamydia psittaci

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12
Q

tx to chlamydia psittaci

A

tetracycline
erythromycin

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13
Q

what is the most common STD

A

chlamydia trachomatis

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14
Q

clinical manifestations of chlamydia

A

female:
- cervicitis
- urethritis
- PID
male:
- urethritis
- epididymitis
- prostatitis
BOTH:
- conjunctivitis
- lymphogranuloma venereum*

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15
Q

typical presentation of chlamydia

A

pain, tenderness, inflamed
mucopurulent/mucoid/watery discharge

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16
Q

is gram stain helpful for chlamydia trachomatis?

A

no! they have no cell wall

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17
Q

screening for chlamydia is recommended for:

A
  1. pregnancy
  2. sexually active females +25 y/o
  3. positive risk factors
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18
Q

DDX of cervicitis

A
  1. chlamydia
  2. gonorrhea
  3. trichomoniasis
  4. BV
  5. candidiasis
  6. HSV
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19
Q

tx for urogenital chlamydia

A

azithromycin PLUS ceftriaxone (for gonorrhea)

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20
Q

complications with chlamydia trachomatis

A
  1. periphepatitis (fitz Hugh-curtis syndrome)
  2. pregnancy complications - PROM (premature rupture of membranes)
  3. infertility (from PID)
  4. transmission to newborn
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21
Q

3 spirochetes

A
  1. treponema pallidum - syphilis
  2. borrelia - lyme disease
  3. leptospira - leptospirosis
22
Q

clinical stages of syphilis

A
  1. primary
  2. secondary
  3. tertiary/late
  4. neurosyphilis
  5. latent
23
Q

clinical manifestations of primary syphilis

A

appears 2-4 wks after contact
chancre* - painless ulcer
spontaneous healing

24
Q

steps into diagnosing primary syphilis

A
  1. culture ulcer via dark field microscopy
  2. non-treponemal antibody test
  3. treponemal antibody tests - after #2 is positive
25
Q

tx for primary syphilis

A

benzathine PCN G single dose

26
Q

when is syphilis considered secondary

A

begins several weeks to 6 months after chancre - disseminates of T. pallidum through body (systemic infection!)
*still infectious

27
Q

work-up and tx for secondary syphilis is the same as ____

A

primary syphilis

28
Q

2 types of latent syphilis

A
  1. early - within 1st year after primary infection - STILL INFECTIOUS
  2. late - after 1st year of latent infection - NONINFECTIOUS
29
Q

how does tertiary/late syphilis occur?

A

occurs any time after UNTREATED secondary syphilis (rare)

30
Q

presence of gummas is indicative of ?

A

tertiary/late syphilis
infiltrative tumors that can go to the skin, bones, internal organs

31
Q

neurosyphilis is most common in what stage?

A

late syphilis
can still occur in any stage of disease

32
Q

disease course of neurosyphilis

A
  1. asx
  2. meningovascular syphilis - meningeal symptoms
  3. tabes dorsalis - progressive degeneration of posterior columns of spinal cord
  4. general paresis - involvement of cerebral cortex
    - personality change
    - memory loss
    - psychosis
    - slurred speech
    - dysarthria
    - tremors
33
Q

diagnosis/tx for neurosyphilis

A
  1. LP (diagnose)
  2. PCN
34
Q

risk factors of neurosyphilis

A
  1. HIV
  2. Non-HIV
    - males
    - +45 y/o
35
Q

what is the most common mode of transmission of borrelia burgdorferi

A

ticks

36
Q

stage 1 of lyme disease

A
  1. erythema migrans* - flat “bulls’ eye” lesion with central clearing
    - occurs 1 wk after tick bite
  2. flu-like

(resolves 3-4 wks w/o tx)

37
Q

stage 2 of lyme disease

A

early disseminated infection
1. bacteremia
2. secondary lesions and rash
3. worsening flu symptoms
4. cardiac involvement - arrhythmias and HB (4-10% of pts)
5. neurologic manifestations - aseptic meningitis, facial palsy (10-15% of pts)

38
Q

stage 3 of late persistent infection of syphilis

A
  1. MSK (60%)
  2. neurologic
  3. skin
39
Q

criteria for lyme disease diagnosis

A

exposure to tick bite who:
- developed erythema migrans
or
- at least one late manifestation
AND
- lab confirmation

40
Q

to have lab confirmation of lyme disease, you order

A

ELISA - detects antibodies to B. burgdorferi
Western Blot

41
Q

tx for lyme disease

A

doxy for 2-4 wks

42
Q

leptospirosis is transmitted by ?

A

ingestion of food/drink contaminated by urine of infected animal (rat)

43
Q

tx for leptospirosis

A

doxycycline

44
Q

rocky mountain spotted fever is transmitted via

A

ticks! tick bourne illness

45
Q

what is the most serious rickettsia disease

A

rocky mountain spotted fever

46
Q

presentation of rocky mountain spotted fever

A

Rash*
- faint macules progressing to papules, then to petechiae
- appears first on wrists and ankles and spreads from distal to proximal

47
Q

what is the tx for rocky mountain spotted fever

A

doxy! within 5 days
NO AMOXICILLIN

48
Q

what is the rickettsia disease that is commonly seen with tick vectors in tropical settings

A

typhus

49
Q

what is the rickettsia disease that is commonly seen with tick vectors in southern US

A

ehrlichiosis

50
Q

what is the rickettsia disease that is commonly seen with flea and body lice vectors throughout the US

A

anaplasma

51
Q

what is the general tx for rickettsia diseases?

A

doxy

Infectious disease (15 decks)

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