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CLASS 22010 INFECTIOUS DISEASE > CLINICAL CARE OF INFECTIOUS DISEASE > Flashcards

CLINICAL CARE OF INFECTIOUS DISEASE Flashcards

1
Q

What is a person or animal that harbors the infectious agent/disease an can transmit it to others but does not demonstrate signs of the disease?

A

Carrier

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1
Q

What is a person or animal that harbors the infectious agent/disease an can transmit it to others but does not demonstrate signs of the disease?

A

Carrier

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2
Q

What is an exposure to a source of infection; a person who has been exposed, this does not imply infection; it implies possibility of infection?

A

Contact

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3
Q

What does it mean for something to be capable of being transmitted from person to person by contact or proximity, does not need or utilize a vector?

A

Contagious

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4
Q

What is an organism that harbors a parasitic, mutualistic, or commensalism guest?

A

Host

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5
Q

What is an organism that lives on or in a host organism and gets its food from or at the expense of its host?

A

Parasite

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6
Q

What are the three main classes of human parasites?

A
  1. Protozoa
  2. Helminths
  3. Ectoparasites
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7
Q

What is an infectious agent or organism that can produce disease?

A

Pathogen

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8
Q

What is an invasion of the body tissues of a host by an infectious agent, regardless if it causes disease or not?

A

Infection

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9
Q

What is a pathway into the host that gives an agent access to tissue that will allow it to multiply or act?

A

Portal of entry

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10
Q

What is a population of organisms or the specific environment in which an infectious pathogen naturally lives and reproduces; usually a living host of a certain species?

A

Reservoir

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11
Q

What is a pathogen that is transmissible from non-human animals (typically vertebrates) to humans?

A

Zoonosis

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12
Q

An increase, often sudden, in the number of cases of a disease above what is normally expected in that population and area?

A

Epidemic

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13
Q

What carries the same definition of epidemic but is often used for a more limited geographic area?

A

Outbreak

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14
Q

What is the constant presence of an agent or health condition within a given geographic area or population?

A

Endemic

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15
Q

What is an epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial portion of the population?

A

Pandemic

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16
Q

What is any group of viruses that are transmitted between hosts by mosquitos, ticks, and other arthropods?

A

Arbovirus (arthropod-borne virus)

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17
Q

What is a resistance developed in response to an antigen (pathogen or vaccine) characterized by the presence of antibody produced by the host?

A

Immunity, active

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18
Q

What is it when the majority of a given group is resistant/immune to a pathogen, they achieve this; this confers protection to unvaccinated or susceptible individuals/groups by reducing the likelihood of infection or spread?

A

Immunity, herd

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19
Q

What is the transfer of active humoral immunity of ready-made antibodies produced by another host or is synthesized?

A

Immunity, passive

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20
Q

What form of immunization is used where there is a high risk of infection and insufficient time for the body to develop its own immune response? (short term)

A

Passive immunization

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21
Q

What describes any illness, impairment, degradation of health, chronic, or age related disease?

A

Morbidity

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22
Q

True or False

A high morbidity equals a low lifespan and high mortality when infected with any pathogen

A

True

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23
Q

What is the time interval from a person being infected to the onset of symptoms of an infectious disease?

A

Incubation period

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24
Q

What is the time interval from a person being infected to the time of infectiousness of an infectious disease?

A

Latency period

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25
Q

What is an infection that is nearly or completely asymptomatic, a person with this infection is an asymptomatic carrier of the infection?

A

Subclinical infection

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26
Q

What is a combination of symptoms, characteristics of a disease or health condition; sometimes refers to a health condition without a clear cause; Greek for “concurrence”?

A

Syndrome

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27
Q

What is the measure of death in a defined population during a specified time interval, from a defined cause?

A

Mortality rate

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28
Q

What is transmission that occurs between an infected person and a susceptible person via direct physical contact with blood or body fluids? (person to person)

A

Direct contact (infection)

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29
Q

What is transmission that occurs when there is no direct human-to-human contact?

A

Indirect Contact (infection)

  1. Vehicle borne: person to contaminated surface/object to person
  2. Vector borne: person to vector to person
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30
Q

True or False

A prodrome (or prodromal symptoms) often indicate the “onset of a disease” before more diagnostically signs and symptoms develops

A

True

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31
Q

What is an organism that lives on or in a host organism and gets its food from or at the expense of its host?

A

Parasites

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32
Q

What are the three main classes of human parasites?

A
  1. Protozoa
  2. Helminths
  3. Ectoparasites
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33
Q

What can be transmitted through the consumption of contaminated food or water, bite of an infected arthropod, certain practices, fecal-oral-route, person-to-person, and between animals and people?

A

Parasitic Infection

REPORTABLE

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34
Q

What are some parasitic diseases in the US that are public health priorities?

A
  1. Chagas disease
  2. Cyclosporiasis
  3. Cysticerosis
  4. Toxocariasis
  5. Toxoplasmosis
  6. Trichomoniasis
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35
Q

What are one-celled organisms that are free living or harbors on a host; capable of multiplying in humans, contributing to its survival and permitting further serious infections to develop?

A

Protozoa

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36
Q

What form of parasites that harbor in the GI track are transmitted via fecal-oral route through contaminated food or water, or person-to-person contact; these in the blood or tissue are transmitted to another human by the bite of an infected arthropod vector?

A

Protozoa

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37
Q

Protozoa are classified into what further groups based on the modes of transmission?

A
  1. Sarcodina: the ameba (Entamoeba)
  2. Mastigophora: the flagellates (Giardia, Leishmania)
  3. Ciliophora: the cilates (Balantidium)
  4. Sporozoa: Non motile adult stage organisms (Plasmodium, Cryptosporidium)
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38
Q

What is the only cilates protozoan to affect humans?

A

Balantidium

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39
Q

What protozoa is the leading cause of waterborne disease in the US?

A

Cryptosporidium

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40
Q

What parasites are large multicellular organisms that are visible to the naked eye in the adult stage, they are free-living or harbors on a host; they invade the GI tract but are unable to multiply in humans?

A

Helminths

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41
Q

What has its name derived from the Greek word for worms?

A

Helminths

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42
Q

What are the three main groups of soil-transmitted helminths human parasite infection?

A
  1. Flatworms (platyhelminths)
    a. Blood flukes (trematodes (shisthosomiasis)) and tapeworms (cestodes)
  2. Thorny-headed worms (acanthocephalins)
  3. Roundworms (nematodes)
    a. reside in GI tract, blood, lymph system or subcutaneous tissues (ascarids, hookworms, pinworms)
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43
Q

What form of parasites are ticks, fleas, lice, and mites that burrow into the skin and remain there for weeks to months; this category broadly includes blood-sucking arthropods such as mosquitos?

A

Ectoparasites

*function as vectors or transmitters of many different pathogens that causes morbidity and mortality

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44
Q

What is the disposition of a patient with a parasitic infection?

A

Based on the infectious agent and severity of illness

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45
Q

What is known as a single-stranded RNA virus of the family Flaviviridae?

A

West Nile Virus

REPORTABLE

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46
Q

What is the leading cause of domestically acquired arboviral disease in the US?

A

West Nile Virus

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47
Q

What is the primary mode of transmission for West Nile Virus?

A

Culex mosquito

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48
Q

Is West Nile Virus vaccine preventable?

A

No

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49
Q

True or False

West Nile Virus that is non-neuroinvasive is lethal

A

False

Neuroinvasive WNV is lethal

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50
Q

Outbreaks of West Nile Virus tend to occur between what months?

A

Mid-July and Early September

Elevated temps and rainfall correlate with increased West Nile Virus transmission and infection

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51
Q

What is the most prevalent mosquito borne disease in the US?

A

West Nile Virus

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52
Q

True or False

West Nile Virus should be considered in any febrile patient or acute neurologic illness with recent exposure to mosquitoes during the summer months in West Nile Virus endemic areas

A

True

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53
Q

___% to ___% of human West Nile Virus infections are subclinical or asymptomatic

A

70% to 80%

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54
Q

An acute systemic febrile illness may be accompanied by the following in what virus?

  1. Headache, weakness, myalgia, or arthralgia
  2. GI symptoms
  3. Transient maculopapular rash
A

West Nile Virus

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55
Q

What percentage of patients infected with West Nile Virus develop neuroinvasive West Nile Virus, which typically manifests as meningitis, encephalitis, or acute flaccid paralysis?

A

<1%

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56
Q

True or False

West Nile Virus Meningitis is easily distinguishable from viral meningitis

A

False

Clinically indistinguishable from viral meningitis due to other etiologies & typically presents with fever, headache, and nuchal rigidity

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57
Q

What is a more severe clinical syndrome associated with West Nile Virus that usually manifests with fever and altered mental status, seizures, focal neurologic deficits, or movement disorders such as tremor or Parkinsonism?

A

West Nile Virus Encephalitis

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58
Q

What is typically, clinical and pathologically identical to poliovirus associated poliomyelitis and may progress to respiratory paralysis requiring mechanical ventilation; often presents as isolated limb paresis or paralysis and can occur without fever or apparent viral prodrome?

A

West Nile Virus Acute Flaccid Paralysis

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59
Q

How is the diagnosis of West Nile Virus made?

A
  1. Identifying IgM in serum
    a. ELISA used to detect IgM antibody
  2. CSF
    a. If CNS symptoms are present, lumbar puncture is needed
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60
Q

True or False

CBC is a reliable indicator for West Nile Virus

A

False

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61
Q

What is the treatment of West Nile Virus?

A

No specific treatment, treat according to symptoms presenting

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62
Q

What is warranted for patients with West Nile Virus if there are signs of encephalitis, meningitis, or paralysis?

A

MEDEVAC MEDEVAC MEDEVAC

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63
Q

In the absence of a vaccine, prevention of West Nile Virus depends on what?

A
  1. Community-level mosquito control programs to reduce vector densities
  2. Personal protective measures to decrease exposure to infected mosquitoes
  3. Screening of blood and organ donors
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64
Q

Most patients with what form of West Nile Virus recover completely, however the fatigue, malaise, and weakness can linger for weeks or months?

A

Non-neuroinvasive West Nile Virus

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65
Q

True or False

Patients who recover form West Nile Virus encephalitis o poliomyelitis often have residual neurological deficits

A

True

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66
Q

Among patients with Neuroinvasive WNV, the over all case fatality ration is approximately ___%, and case-rate fatality is significantly higher for patients with WNV encephalitis and poliomyelitis than _____

A
  1. 10%

2. WNV Meningitis

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67
Q

Protozoan parasites of the genus Plasmodium transmit what?

A

Malaria

REPORTABLE

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68
Q

What are the subtypes of malaria?

A
  1. P. Falciprum
  2. P. Vivax
  3. P. Ovale
  4. P. Malariae
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69
Q

Malaria is transmitted via what mosquito?

A

Female anopheles mosquito

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70
Q

Lethal or Not Lethal?

  1. P. Falciprum
A

Lethal

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71
Q

Lethal or Non Lethal?

  1. P. Vivax
  2. P. Ovale
  3. P. Malariae
A

Maybe

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72
Q

What is the sporogony phase in the malaria lifecycle?

A

Sexual cycle in the female anopheles mosquito

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73
Q

What is the exoerythrocytic phase in the malaria lifecycle?

A

Asexual cycle in the human liver

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74
Q

What phase of the malaria lifecycle is the asexual reproduction in RBCs?

A

Erythrocytic Phase

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75
Q

In what phase of the malaria lifecycle is the patient symptomatic?

A

Erythrocytic Phase

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76
Q

True or False

Malaria Presentation

Symptoms can develop as early as 7 days after mosquito bite and as late as several months or more after exposure

A

TRUUUEEE

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77
Q

The presentation of Malaria can be broken down into what two broad categories ?

A
  1. Uncomplicated Malaria

2. Severe Malaria

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78
Q

What category of malaria is characterized by the following?

  1. Paroxysmal (cyclical) fever
  2. Influenza-like symptoms including chills, headaches, myalgias, and malaise
  3. Jaundice and mild anemia secondary to hemolysis
A

Uncomplicated Malaria

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79
Q

What category of malaria is characterized by the following?

  1. Small blood vessels infarction, capillary leakage and organ dysfunction
  2. Altered consciousness
  3. Hepatic failure and renal failure
  4. Acute respiratory distress syndrome
  5. Severe anemia
A

Severe Malaria

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80
Q

What kind of fevers are typical of Malaria and considered a clinical hallmark of the infection?

A

Paroxysmal fevers

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81
Q

How long does the Cold stage of paroxysmal fevers last?

A

approximately 1 hour

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82
Q

How long does the Febrile stage of paroxysmal fevers last?

A

2-6 hours

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83
Q

How long does the Diaphoretic stage where the fever drops of paroxysmal fevers last?

A

2-4 hours

patient then returns to normal

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84
Q

The cycle of paroxysmal fevers repeats itself in ___ to ___ hours depending on the species of malaria infection

A

48-72 hours

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85
Q

True or False

Consider malaria in any febrile patient returning from a malaria endemic country

A

True

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86
Q

True or False

Rapid Malaria Testing

Both positive and negative Rapid Diagnostic Test results must always be confirmed by microscopy

A

True

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87
Q

The treatment options for malaria are dependent on multiple factors but what are the two reliable-supply treatment regimens available in the US?

A
  1. Atovaquone-proguanil (Malarone)

2. Artemether-lumefantrine (Coartem)

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88
Q

True or False

You should use the same or related drug to treat Malaria as was sued for chemoprophylaxis

A

False

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89
Q

What is the treatment of Uncomplicated Malaria?

A
  1. Chloroquine Phosphate 1g (600mg base) PO
  2. THEN 0.5g in 6 hours
  3. THEN 0.5g daily for 2 days
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90
Q

What is the treatment for malaria in areas with chloroquine resistance?

A
  1. Malarone (Atovaquone 250mg/Proguanil 100mg) 4 tabs PO QD for 3 days
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91
Q

What is the treatment of Severe Malaria?

A
  1. Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours

2. Followed by Doxy 100mg BID x 7 days after parenteral therapy

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92
Q

What is the treatment of P. Ovale?

A
  1. ADD primaquine 52.6mg (30mg base = 2 tabs) PO QD x 14 days
  2. Added to regiment for hypnozoites
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93
Q

Administration of prophylactic medication should begin ___ to ___ weeks prior (except for Malarone, Primaquine, & Doxycycline) to the expected embarkation to an endemic area and continued for _____weeks after leaving the endemic area.

A
  1. 1-2 weeks

2. 4 weeks

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94
Q

What is the disposition for a patient with malaria?

A

Even patients presenting with signs and symptoms of the mild form of the disease should be evacuated to definitive medical care facility as soon as possible.

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95
Q

Complications of what can include the following?

  1. Neurologic abnormalities
  2. Acute renal failure
  3. Anemia
  4. Metabolic acidosis
  5. Hypovolemia
  6. Acute Respiratory Distress Syndrome
A

Malaria

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96
Q

What is caused by single-stranded RNA viruses of the genus Flavivirus?

A

Dengue Fever

REPORTABLE

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97
Q

What are the four subtypes of Dengue Fever and is it possible to be infected four times?

A
  1. DENV-1
  2. DENV-2
  3. DENV-3
  4. DENV-4

Possible to be infected four times

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98
Q

What is a common name for Dengue Fever?

A

Break bone fever

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99
Q

What disease is endemic in the tropics and subtropics and >100 countries world wide plus Puerto Rico, Virgin Islands, US-affiliated Pacific Islands; outbreaks have also occurred in Florida, Hawaii, and Texas ?

A

Dengue Fever

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100
Q

How is Dengue Fever transmitted?

A
  1. Aedes Aegypti mosquito
  2. Mother to child
  3. Blood transfusion/organ donation (rarely)
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101
Q

Approximately ___% of DENV infections present asymptomatically and the person doesn’t realize they were infected

A

75%

Remaining 25% of infections present with mild to moderate,
nonspecific, acute febrile illness, characterized by fatigue & malaise.

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102
Q

Dengue Fever follows what 3 phases?

A
  1. Febrile Phase
  2. Critical Phase
  3. Convalescent Phase
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103
Q

Dengue Fever is classified as either Dengue or Severe Dengue; approximately ___% of people infected with DENV progress to threatening severe damage.

A

5%

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104
Q

What phase of Dengue Fever lasts 2-7 days and can be biphasic including signs and symptoms such as the following?

  1. Severe headache
  2. Retroorbital Pain
  3. Muscle, bone, and joint pain
  4. Transient maculopapular rash
  5. Minor hemorrhagic manifestations
    a. petechiae
    b. ecchymosis
    c. purpura
    d. epistaxis
    e. bleeding gums
    f. hematuria
    g. positive TQ test result
A

Febrile Phase

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105
Q

What phase of Dengue begins at defervescence and typically lasts 24-48 hours?

A

Critical Phase

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106
Q

In what phase of Dengue Fever will most patients clinically improve and move on to recovery and convalescence phase?

A

Critical Phase

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107
Q

Initially, physiologic compensatory mechanisms maintain adequate
circulation, which narrows pulse pressure as diastolic blood pressure
increases; patients with severe plasma leakage will have pleural effusions or ascites, hypoproteinemia and hemoconcentration in what phase of Dengue Fever?

A

Critical Phase - Severe Dengue Fever

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108
Q

Once hypotension develops in the critical phase of severe dengue fever, systolic blood pressure rapidly declines and irreversible shock and death may ensure despite resuscitation efforts and this is known as what?

A

Dengue Shock Syndrome

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109
Q

As the plasma leakage of Dengue Fever subsides patients enter what phase?

A

Convalescent Phase

  1. Patient begins to reabsorb extravasated IV fluids, pleural, and abdominal effusions
  2. As patient continues to improve, hemodynamic status stabilizes and diuresis ensues
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110
Q

What are the two hallmarks of Severe Dengue Fever?

A
  1. Infection-induced capillary permeability (leaky capillaries)
  2. Disordered/diminished blood clotting
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111
Q

What is a fairly effective test used to further justify a presumptive Dengue diagnosis without the ability or access to confirmatory laboratory testing?

A

Tourniquet test

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112
Q

Should you consider Dengue in a patient who was in an endemic area within 2 weeks of symptoms onset?

A

Yes

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113
Q

What is the treatment for Dengue Fever?

A
  1. ensure patient stays hydrated
  2. avoid aspirin, aspirin containing drugs, and NSAIDS
  3. treat fever with acetaminophen
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114
Q

What is the treatment of Severe Dengue?

A
  1. ICU level monitoring

2. Maintenance of patients body fluid volume is critical for severe dengue care

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115
Q

What is the disposition for a patient with Dengue?

A

MEDEVAC, MEDADVICE while waiting for MEDEVAC

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116
Q

What disease is caused by a gram-negative, intracellular, coccobacillus bacterium?

A

Rocky Mountain Spotted Fever (R. Rickettsia)

REPORTABLE

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117
Q

What disease is endemic in Central South America; occurs throughout the US, but most commonly reported from North Carolina, Tennessee, Missouri, Arkansas, and Oklahoma?

A

Rocky Mountain Spotted Fever

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118
Q

What disease is transmitted via the American dog tick east of the Rockies and the Pacific Coast, and the Rock Mountain wood tick in the Rocky mountain region, and the brown dog dick worldwide?

A

Rocky Mountain Spotted Fever

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119
Q

True or False

Rocky Mountain Spotted Fever is one of several diseases reported under the category “spotted fever rickettsiosis (SFR)” and are reported in all lower 48 states, but >50% of the cases are reported in 5 states (NC, AR, MO, TN, and VA)

A

True

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120
Q

The early onset (days 1-4) of what disease will present with the following symptoms?

  1. Fevers, HA, myalgias, GI symptoms, Edema around eyes and back of hands
  2. A rash typically presents 2-4 days after fever onset
    a. small flat pink macules on wrists, forearms and ankles that spread to trunk
    b. can also involve palms of hands and soles of feet
A

Rocky Mountain Spotted Fever

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121
Q

The late illness (days 5 or later) of what disease will it infect the endothelial cells that line blood vessels, causing vasculitis and bleeding or clotting in the brain or other vital organs; this may also call permanent complications from things such as:

  1. Neuro deficits
  2. Damage to internal organs
  3. Vascular damage requiring amputation
A

Rocky Mountain Spotted Fever

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122
Q

Most (__%) of people with RMSF have some type of rash during the course of the illness, however <___% of patients have a rash in the first 3 days of the illness.

A
  1. 90%

2. <50%

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123
Q

The petechial rash of RMSF does not typically appear until day ___ to ___ of the illness with this being a sign of severe disease

A

Day 5-6

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124
Q

What are some crucial findings to rule in or rule out RMSF?

A
  1. Recent tick bites
  2. Exposure to areas where ticks are common
  3. Domestic and International travel history to endemic areas
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125
Q

What is the treatment of Rocky Mountain Spotted Fever?

A

Doxycycline 100mg PO BID for 5 to 7 Days

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126
Q

What is the disposition of RMSF?

A

MEDEVAC

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127
Q

What disease is caused by spirochetes belonging to the Borrelia Burgdorferi complex?

A

Lyme Disease (B. Burgdorferi)

REPORTABLE

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128
Q

What are the subtypes of Lyme Disease?

A
  1. B. Afzelii
  2. B. Burgdorferi
  3. B. Garinii
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129
Q

What tickborne disease has a prevalence in Europe (central and eastern), Asia (western Russia, Mongolia, northeastern China, and into Japan), Northeaster and North-central United States?

A

Lyme Disease

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130
Q

How is Lyme Disease transmitted?

A

bite of Lyme-infected Ixodes (blacklegged) ticks

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131
Q

What are the main reservoirs for Lyme Disease?

A

Rodents (white foot deer mice, chipmunks, squirrels)

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132
Q

What ticks spread Lyme Disease in the northeastern, mid Atlantic, and north-central US?

A

Blacklegged ticks (Ixodes Scapularis)

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133
Q

What ticks spread Lyme Disease on the Pacific Coast?

A

Western Blacklegged Tick (Ixodes Pacificus)

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134
Q

How long must the tick be attached to the host before Lyme Disease (B. Burgdorferi) can be transmitted?

A

36-48 hours (can occur in as little as 24)

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135
Q

The following are common early manifestations of what disease?

  1. Malaise, headache, fever, myalgia, arthralgia, lymphadenopathy
  2. Erythema Migrans (EM)
    a. red ring-like or homogenous expanding rash
    1. appears 1 weeks after initial infection
    2. “bulls-eye/target” lesion
A

Lyme Disease

Early Localized Stage

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136
Q

During what stage of Lyme Disease may you see the following?

  1. Constitutional
    a. multiple secondary annular rashes
    b. flu-like symptoms
    c. lymphadenopathy
  2. Cardiac manifestations
    a. conduction abnormalities
    b. pericarditis, myocarditis
  3. Neuro manifestations
    a. Bell’s palsy or other cranial neuropathy
    b. meningitis
    c. encephalitis
A

Acute/Early Disseminated Stage

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137
Q

What stage of Lyme Disease has the same symptoms as the Acute Disseminated stage except with Rheumatologic Manifestations such as:

  1. Transient, migratory arthritis and effusion in one or multiple joints
  2. Migratory pain in tendons, bursae, muscle, and bones
A

Late Disseminated Stage

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138
Q

What is the treatment of Early Lyme disease (erythema migrans) and Early Disseminated Lyme Disease (bell’s palsy)?

A

Doxycycline 100mg PO BID x14 days

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139
Q

What is the treatment for Late Disseminated Lyme Disease (arthritis)?

A

Doxycycline 100mg PO BID x 28 days

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140
Q

What medication can be used at post-exposure prophylaxis of Lyme Disease?

A

Doxycycline 200mg PO 1 dose

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141
Q

What is the disposition for a patient with Lyme Disease?

A

Clinical suspicion of Lyme Disease will necessitate MEDADVICE and treatment at the IDC level

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142
Q

What is the small percentage of cases of Lyme Disease that include lingering fatigue, myalgia, and arthritis that can persist for months to years?

A

Post-treatment Lyme Disease Syndrome (PTLDS) also called Chronic Lyme Disease

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143
Q

What disease is caused by obligate intracellular protozoan parasites and is also called L. Tropica?

A

Leishmaniasis

REPORTABLE

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144
Q

What are the subtypes of Leishmaniasis?

A
  1. Old World Leishmaniasis (eastern hemisphere)

2. New World Leishmaniasis (western hemisphere)

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145
Q

How is leishmaniasis transmitted?

A

Bites of an infected female phlebotomine sand flies

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146
Q

What is the most common manifestation of leishmaniasis?

A

Cutaneous Leishmaniasis

Characterized by gradual-onset cutaneous lesions

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147
Q

What presents with the following?

  1. Begins with pink colored papule that enlarges to a nodule or plaque like lesion
  2. Lesion becomes ulcerated with an indurated border and may have a thick white-yellow fibrous material
  3. Lesion is often painless
  4. Lesions gradually heal over months to years with noticeable scarring at the site
A

Cutaneous Leishmaniasis

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148
Q

True or False

Clinicians should maintain a high suspicion for CL in any patient with
chronic (nonhealing) skin lesions that has been to an area where CL is
endemic & the patient reports a history of sandfly bites.

A

True

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149
Q

If an IDC encounters a patient with possible Cutaneous Leishmaniasis where should the patient be referred?

A

Medical officer and/or MTF Infectious Disease

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150
Q

What is the FDA approved treatment for CL, MCL, and VL?

A

oral Miltefosine

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151
Q

What are some medications that might have merit for treating selected cases of leishmaniasis are commercially available in the United States, but the FDA-approved indications do not include leishmaniasis?

A
  1. Treatment of choice for visceral leishmaniasis: Amphotericin B deoxycholate.
  2. Pentavalent antimonials remain the most commonly used drug to treat leishmaniasis in most areas.
  3. Orally administered “azoles” (ketoconazole, itraconazole, & fluconazole), & topical formulations of paromomycin for CL.
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152
Q

What is caused by a gram-positive genetically distinct strain of Staphylococcus aureus?

A

Methicillin-resistant Staphylococcus Aureus (MRSA)

Reportable: state dependent

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153
Q

What are the subtypes of MRSA?

A
  1. Community Associated (CA-MRSA)

2. Healthcare Associated (HA-MRSA)

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154
Q

What is any strain of S. aureus that has developed multiple drug resistances to beta-lactam antibiotics?

A

MRSA

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155
Q

What are the most frequently reported clinical manifestations of MRSA?

A

Skin and Soft Tissue Infections (SSTIs)

  1. Furuncles
  2. Carbuncles
  3. Abscesses

Patients may complain of “spider bite”

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156
Q

What antibiotics are used to treat a MRSA infection?

A
  1. TMP-SMX (160mg/800mg) PO BID x 5-10 days
  2. Clindamycin 300-600mg PO BID x 5-10 days
  3. Doxy 100mg PO BID x 10 days
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157
Q

True or False

Unless complications develop, most cases of MRSA should be retained on board and treated by the IDC

A

True

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158
Q

What is the third most common bite wound pattern after dogs and cats?

A

Human bites

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159
Q

What are the two basic categories of human bites?

A
  1. Occlusive wounds

2. Clenched fist or “fight bites”

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160
Q

What are the typical human oral and skin flora that cause infection from human bites?

A
  1. Eikenella
  2. Group A Strep
  3. Fusobacterium
  4. Staph
  5. Prevotella
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161
Q

How do you manage a human bite with no signs or symptoms of infection?

A
  1. Initial wound care is the primary factor in preventing infection
  2. Control bleeding, clean wound, dress/bandage wound
  3. Follow up in 24 hrs
  4. Assess TDAP/HBV/HIV immz/test status
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162
Q

True or False

Human Bites aren’t considered tetanus prone wounds

A

False

Human bites are considered tetanus prone wounds

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163
Q

True or False

In general, human bites should be closed due to the high risk for the development of infection

A

False

Human bite wounds SHOULD NOT be closed due to the high risk for the development of infection.

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164
Q

Human Bites

Patients with clinically uninfected wounds plus infection risk factors may require prophylactic antibiotics in what cases?

A
  1. Wounds in partial closure or those needing surgery
  2. wounds on hands, face, or genitals
  3. wounds near bones or joints
  4. wounds near underlying venous and/or lymphatic comprise
  5. immunocompromised hosts
  6. wounds associated with crush injuries
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165
Q

Prophylactic antibiotics used for Human bites require empiric coverage of human oral/skin flora as well as reasonable MRSA meaning you cant use which antibiotics because they do not cover Eikenella Corrodens?

A
  1. Cephalexin (keflex)
  2. Penicillinase-resistant penicillins PRPs (dicloxacillin)
  3. Macrolides (erythromycin & azithromycin)
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166
Q

Human Bite

What antibiotic is used for early prophylaxis (wound not yet infected)?

A

Amoxicillin clavulanate 875/125mg PO BID x 5 days

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167
Q

Human Bites

MEDADVICE is warranted in what situations?

A
  1. Clenched fist wounds
  2. Complex facial laceration
  3. Deep wounds, especially if significant avulsion or amputation present (likely MEDEVAC)
  4. Wounds associated with neuro compromise (likely MEDEVAC)
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168
Q

What is an acute or chronic inflammatory process involving bone and structures secondary to infection with pyogenic organisms, including bacteria, fungi, and myobacteria?

A

Osteomyelitis

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169
Q

Osteomyelitis occurs most commonly in younger adults in what settings?

A
  1. Trauma

2. Related surgery

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170
Q

Osteomyelitis occurs most commonly as a result of contiguous spread of infection to the bone from adjacent soft tissues and joints in who?

A

Older adults

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171
Q

True or False

In adults, OM most often affects the vertebrae of the spine and/or the hips. However, extremities are frequently involved due to skin wounds, trauma and surgeries.

A

True

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172
Q

These are all risk factors for what?

  1. Bacteremia
  2. Endocarditis
  3. IV drug use
  4. Trauma
  5. Open fractures
A

Osteomyelitis

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173
Q

True or False

Patients with osteomyelitis involving the hip, vertebrae, or pelvis tend to manifest many comorbid signs besides just pain

A

False

Patients with osteomyelitis involving the hip, vertebrae,
or pelvis tend to manifest few signs or symptoms other
than pain.

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174
Q

Are labs helpful in diagnosing osteomyelitis?

A

Nope

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175
Q

What are the most useful imaging studies used in the evaluation of Osteomyelitis?

A
  1. Plain radiographs
  2. MRI
  3. Technetium-99 Bone Scintigraphy
176
Q

What are the most common causes of acute OM in adults and children?

A

S. aureus (MSSA and MRSA strains)

177
Q

What are the two pillars of osteomyelitis treatment?

A
  1. Surgical containment

2. Prolonged antibiotic therapy

178
Q

What antibiotics are used in the treatment of osteomyelitis?

A

IV Vancomycin and Ceftriaxone

179
Q

What is the disposition for a patient with suspected Osteomyelitis?

A

MEDEVAC

180
Q

What is caused by a spore forming, anaerobic, gram-positive bacterium that is referred to scientifically as Clostridium Tetani?

A

Tetanus

REPORTABLE

181
Q

What is an acute, often fatal, exotoxin-mediated disease produced by gram positive, spore forming anaerobic rod, Clostridium tetani?

A

Tetanus

182
Q

What causes the symptoms of tetanus and is one of the most potent toxins known?

A

Tetanus Toxins

  1. Minimum lethal dose in humans is approximately 2.5ng per kg.
  2. 227.5 nanograms of tetanus toxin drops (kills) a 200pound man.
183
Q

Generalized tetanus compromises ___% of reported tetanus infections

A

80%

184
Q

Typically the first sign of what is trismus or lockjaw, followed by nuchal rigidity, dysphagia, and rigidity of abdominal muscles, frequent muscle spasms may occur (q 10-15 min) and last several minutes?

A

Tetanus

185
Q

These are all common late symptoms of what?

  1. Periods of apnea due to contraction of thoracic muscles or pharyngeal muscle contraction
  2. Fracture of long bones/ vertebrae during muscle spasms
  3. Nosocomial infections secondary to long-term hospitalization, aspiration pneumonia
  4. Death typically occurs secondary to respiratory arrest.
A

Tetanus

186
Q

What wounds are particularly conducive for the proliferation of C. Tetani?

A

Burns

187
Q

What should you do if you suspect tetanus in a patient?

A
  1. Urgent MEDEVAC
  2. Clean/debride wounds as best as possible
  3. Supportive therapy and airway protection
188
Q

What medications are used in the treatment of Tetanus?

A
  1. Metronidazole 500mg IV Q6-8 hrs x7-10 days
  2. Pen G 2-4Mil Units IV Q4-6hrs (alternate)
  3. Tetanus Immune Globulin (TIG, HTIG): 500 units IM at different sites from the Tetanus Toxoid, part of the dose should be infiltrated around the wound.
189
Q

What is defined as inflammation of the meninges (dura mater, arachnoid mater, and pia mater) that line the vertebral canal/skull enclosing the spinal cord/brain?

A

Meningitis

190
Q

What is known as inflammation of the brain itself?

A

Encephalitis

191
Q

What are the bacterial etiologies of meningitis/encephalitis?

A
  1. Streptococcus Pneumonia
  2. Group B Strep
  3. N. Meningitides
  4. H. Influenza
  5. E. Coli
  6. Listeria Monocytogenes
192
Q

What is the most common viral etiology of meningitis/encephalitis?

A
  1. Enteroviruses

Also includes:

  1. Coxsackieviruses
  2. Echoviruses
  3. WNV
  4. Influenza
  5. VZV
  6. EBV
  7. Arboviruses
193
Q

Meningitis typically occurs through what two routes of inoculation?

A
  1. Hematogenous seeding

2. Direct contiguous spread

194
Q

Meningococcal meningitis patients may have what characteristic signs?

A

Petechiae and Purpura

195
Q

Meningitis/Encephalitis

Cranial nerve abnormalities are seen in ___% to ___% of patients

A

10%-20%

196
Q

What is the classic meningeal tetrad?

A
  1. Fever
  2. Nuchal rigidity
  3. Altered mental status
  4. Severe headache
197
Q

What is the confirmatory lab for meningitis?

A

Lumbar puncture

198
Q

What is the preferred imaging modality of meningitis?

A

CT

Should be done prior to lumbar puncture and CF collection

199
Q

What is the antibiotic treatment for meningitis?

A
  1. Ceftriaxone 2g IV q 12hrs x 7 days

2. Pen-G 4 million units IV q 4hrs x 7 days

200
Q

Meningitis

Administration of _____ is associated with reduction in the rate of hearing loss, neuro complications, and decreased mortality rates

A

Dexamethasone 4mg IV

201
Q

What is the Meningitis chemoprophylaxis regimen for close contacts?

A
  1. Ceftriaxone 250mg IM one time

2. Ciprofloxacin 500mg PO one time

202
Q

What is caused by one of the 9 known human herpesviruses and is often referred to as the following?

  1. Epstein-Barr Virus
  2. Formerly called gammaherpesvirus 4
  3. The kissing disease
  4. Glandular fever
A

Mononucleosis

NOT REPORTABLE

203
Q

Mononucleosis

Extremely common; approximately ___% of five year old children and ___% of adult have evidence of previous infection

A
  1. 50%

2. 90%

204
Q

How is mononucleosis spread?

A

bodily fluids, mainly saliva

205
Q

EBV is one of the most common human viruses and found globally. Most people get infected with EBV at some point in their lives. ____% of people ages 15-24 who are infected with EBV will develop infectious mononucleosis.

A

25 %

206
Q 
EBV causes \_\_\_% cases of IM, but IM-like illnesses can also be caused
by Cytomegalovirus (CMV), Toxoplasma, Adenoviruses, and primary
HIV infection.
A

90%

207
Q

What may present with the following symptoms?

  1. This presentation can be consistent with erythematous or exudative pharyngitis or tonsillitis
  2. Malaise
  3. Fever
  4. Cervical lymphadenopathy (typically posterior)
  5. Splenomegaly (typically post infection)
  6. Generalized maculopapular rash may occur in patients treated
    with cillin-class antibiotics for strep pharyngitis.
A

Infectious Mononucleosis

208
Q

True or False

Diagnosis of Infectious mononucleosis can be made clinically and confirmed with a monospot test, patients will typically be positive within 4 weeks after symptoms onset

A

True

209
Q

How is Infectious Mononucleosis treated?

A

Symptomatically

  1. Best rest, tylenol, NSAIDS
  2. Saline gargles 3-4 times a day
  3. Avoid use of antivirals
  4. Steroids should only be used in cases where airway obstruction is possible due to tonsillar enlargement
210
Q

What are some complications of EBV?

A
  1. Peritonsillar Abscess
  2. Suppurative lymph nodes
  3. Mastoiditis, Sialadenitis
  4. Blockage of the air passages in the nose and throat
211
Q

What is the disposition for Mono?

A

Patient should be placed SIQ until acute symptoms subside

212
Q

Mononucleosis

Fever resolves within ____ days, but the lymphadenopathy and splenomegaly may persist upwards of ___ to __ weeks

A
  1. 10 days

2. 3 to 4 weeks

213
Q

True or False

Patients with mono should be LLD with no contact sports for 3-4 weeks due to the risk of splenomegaly and splenic rupture

A

True

214
Q

What is caused by neurotropic viruses in the family Rhabdoviridae and is also called lyssavirus?

A

Rabies

REPORTABLE

215
Q

What accounts for 99% of all rabies transmissions to humans?

A

Dogs

216
Q

What is a fatal, acute, progressive encephalitis caused by neurotropic viruses in the family Rhabdoviridae, genus Lyssavirus?

A

Rabies

217
Q

Transmission if what occurs secondary to the inoculation of saliva from the bite of a rabid animal?

A

Rabies

218
Q

Where does viral replication of Rabies occur?

A

CNS

219
Q

All mammals are believed to be susceptible to infection, but major rabies reservoirs are what?

A
  1. Terrestrial Carnivores

2. Bats

220
Q

What disease progresses rapidly from a nonspecific, prodromal phase with fever and vague symptoms to an acute, progressive encephalitis?

A

Rabies

221
Q

The neurologic phase of what disease may be characterized by anxiety,
paresis, paralysis, and other signs of encephalitis; Spasms of swallowing muscles can be stimulated by the sight, sound, or perception of water (hydrophobia); and delirium and convulsions can develop, followed rapidly by coma and death?

A

Rabies

222
Q

Clinical rabies typically manifest as what 1 of 2 major forms?

A
  1. Encephalitic “furious”

2. Paralytic “dumb”

223
Q

What form of rabies is characterized by the following?

  1. Fever, hydrophobia, pharyngeal spasms, hyperactivity subsiding to paralysis, coma
  2. ANS instability: hypersalivation, lacrimation, diaphoretic, “goose flesh”, dilated pupils.
A

Encephalitic “furious”

224
Q

What form of rabies is characterized by the following?

  1. Ascending paralysis that is similar to Guillain-Barre
  2. Lost of DTR & plantar reflex
A

Paralytic “dumb”

225
Q

What is the most characteristic feature of rabies; patient becomes afraid of water due to involuntary pharyngeal muscle spasms when they attempt to drink?

A

Hydrophobia

226
Q

What is the pathognomonic pharyngeal muscle spasms triggered by the feeling of a draft of air seen in rabies that leads to aspiration, coughing, choking, and if severe, asphyxiation and respiratory arrest?

A

Aerophobia

227
Q

Fever and chills with paresthesia(s) surrounding an animal bite site is suggestive of what?

A

Rabies

228
Q

How is rabies diagnostically confirmed?

A

Post Mortem evaluation of tissue samples of the brain

229
Q

True or False

Any animals overseas that have bitten/scratched a service member will be assumed rabid until proven otherwise

A

True

230
Q

Can an IDC Manage a potential rabies infection?

A

No, requires immediate referral (routine MEDEVAC) whether they have symptoms or not

231
Q

What is defined as 3 or more watery stools within a 24 hour period?

A

Diarrhea

232
Q

How long does acute diarrhea last?

A

less than 14 days

233
Q

How long does persistent diarrhea last?

A

more than 14-30 days

234
Q

How long does chronic diarrhea last?

A

more than 30 days

235
Q

What form of diarrhea presents with blood in loose-watery stools and fever; secondary to tissue damage to the lining of the colon from certain bacteria and/or toxins?

A

Inflammatory Diarrhea

236
Q

What form of diarrhea is just watery stools with NO blood and absence of fever?

A

Non-inflammatory Diarrhea

237
Q

Community outbreaks of infectious diarrhea are highly suggestive of what?

A
  1. Common food source

2. Viral etiology

238
Q

True or False

Infectious Diarrhea does tend to be more common in older travelers than in young adult travelers

A

False

More common in younger adult travelers

239
Q

What are the viral etiologies of Infectious Diarrhea?

A
  1. Norovirus

2. Rotavirus (primarily children)

240
Q

What are the bacterial etiologies of Infectious Diarrhea?

A
  1. Enterotoxigenic Escherichia coli (ETEC)
  2. Campylobacter jejuni
  3. Shigella spp.
  4. Salmonella spp.
  5. Bacterial toxin-releasing
241
Q

What are the protozoal etiologies of Infectious Diarrhea ?

A
  1. Giardia

2. Entamoeba Histolytica

242
Q

What is caused by nonenveloped, single stranded RNA virus in the genus Norovirus?

A

Viral Infectious Diarrhea

REPORTABLE

243
Q

How is Viral Infectious Diarrhea transmitted?

A
  1. Primarily Fecal-oral route
  2. Direct person-to-person contact
  3. Indirectly via contaminated food and water
  4. Also spread through aerosols of vomitus and contaminated environmental surfaces and objects
244
Q

These are all symptoms of what virus?

  1. Acute onset of abdominal cramps, nausea, vomiting, and non-bloody diarrhea
  2. other symptoms like body aches, headaches, and sometimes a low-grade fever
  3. Generally self limited, full recovery in 1-3 days for most patients
A

Norovirus (Norwalk virus)

245
Q

What is caused by, Escherichia Coli (E. Coli), a gram-negative bacteria that inhibit the GI tract, normal part of GI flora but can be pathogenic under certain circumstances, most strains do not cause illness?

A

Bacterial Infectious Diarrhea - E. Coli

246
Q

What is also known as Traveler’s Diarrhea?

A

Enterotoxigenic E. Coli (ETEC)

247
Q

True or False

Enterohemorrhagic E. Coli (EHEC) is also called Shigatoxigenic Escherichia Coli (STEC)

A

True

248
Q

What are the main reservoirs for non-STEC pathotypes?

A

Humans

249
Q

How is E. Coli transmitted?

A
  1. Fecal-Oral Route (contaminated food or water)
  2. Person to person
  3. Contact with animals/environment
  4. Swimming in untreated water
250
Q

What is the most common bacterial infectious diarrhea worldwide and among travelers returning from most regions?

A

ETEC

251
Q

What does treatment consideration for Bacterial Infectious Diarrhea - E. Coli?

A
  1. Oral rehydration
  2. Antimotility agents
  3. Antiemetics

Depends on severity level

252
Q

What specific bacterial pathogen associated with Bacterial Infectious Diarrhea should NOT be treated with antibiotics?

A

Shiga Toxin-producing E. Coli (STEC)

253
Q

What form of bacterial infectious diarrhea is transmitted via food or water contaminated with animal feces, direct contact with infected animals or their environment and directly between humans; caused by a gram negative, rod shaped bacillus?

A

Salmonella (salmonella enterica)

254
Q

What is one of the leading causes of Bacterial Infectious Diarrhea, causes about 153 million cases of gastroenteritis and 57,000 deaths each year?

A

Salmonella

255
Q

Salmonella

Gastroenteritis is the most common clinical manifestations, typically presents with acute diarrhea, abdominal pain, fever, and vomiting for ___ to __ days.

A

4 to 7 days

256
Q

Salmonella

Generally antibiotics are not recommended, but are warranted in patients with severe disease, what should be used?

A

Ciprofloxacin 500mg BID (fluoroquinolones)

257
Q

What is a cause of Bacterial Infectious Diarrhea that is a gram negative spiral shaped microaerophilic bacteria that is normally carried in the intestinal tracts of domestic and wild animals?

A

Campylobacter (campylobacter jejuni)

258
Q

What Bacterial Infectious Diarrhea is characterized by diarrhea (frequently bloody), abdominal pain, fever, and occasionally nausea and vomiting; severe infections of this can include dehydration, blood striatum infection, and mimic acute appendicitis or ulcerative colitis?

A

Campylobacter

259
Q

True or False

Bacterial Infectious Diarrhea - Campylobacter

Generally self-limiting & lasting < 1 week; ABx therapy decreases duration of symptoms & bacterial shedding if administered early in the course of disease.

A

True

260
Q

Bacterial Infectious Diarrhea - Campylobacter

Severe disease with bloody stools, high fever, extraintestinal infection, worsening or relapsing symptoms, or symptoms lasting longer than one week, suggest the use of what antibiotic?

A

Azithromycin 500mg PO daily x 3days

261
Q

Is Protozoal Infectious Diarrhea caused by Giardia (Giardia Duodenalis) a reportable disease?

A

YES REPORTABLE

262
Q

Giardia Life Cycle

What is the infectious form of the parasite, excreted in the stool and can survive in wet environments, after ingestion of this, excystation occurs in the proximal small bowel releasing trophozoites?

A

Cyst Form

263
Q

Giardia Life Cycle

What part of the life cycle is where flagellated parasites adhere to the proximal small bowel, these that pass into the large intestine revert to cysts and are excreted into the environment?

A

Trophozoite Form

264
Q

Acute Giardiasis

Symptoms typically develop __ to __ weeks after exposure and generally resolve within __ to __ weeks afterwards. Symptoms include the following:

  1. Diarrhea (foul smelling and greasy)
  2. Abdominal cramps
  3. Bloating
  4. Flatulence
  5. Fatigue
  6. Anorexia
  7. Nausea
A
  1. 1 to 2 weeks

2. 2 to 4 weeks

265
Q

The primary treatment of Giardiasis consists of drug regimen with activity against bacteria and protozoa such as what?

A
  1. Tinidazole 2g PO single dose Non-AMAL

2. Metronidazole (Flagyl) 250mg PO TID x 5-7 days AMAL

266
Q

Patients with Giardiasis need to be excluded from going into water until asymptomatic for ___hours

A

48 hours

267
Q

What does diarrhea within 6 hours of food consumption suggest?

A

Possible toxin from S. aureus or B cereus

268
Q

What does diarrhea between 8-16 hours after food consumption suggest?

A

C. perfringens

269
Q

What does diarrhea more than 16 hours after food consumption suggest?

A

viral or other bacterial etiology

270
Q

Diarrhea of the ____bowel origin tend to be larger volume, watery and more abdominal cramping bloating and gas

A

Small bowel

271
Q

Diarrhea of ____ bowel tend to be more frequent, smaller volume and are often more painful; fever, bloody stool, or mucus tends to be more common.

A

Large Bowel

272
Q

What labs can be helpful in ruling in or ruling out Non-Infectious Diarrhea Etiologies ?

A

CBC and UA

273
Q

What are some general treatment guidelines for Infectious Diarrhea?

A
  1. Rule out more serious stuff
  2. Oral rehydration/IV rehydration if patient is dehydrated
  3. BRAT Diet
  4. Patient Education
274
Q

What is some conservative treatment for Infectious Diarrhea?

A
  1. Loperamide (Imodium) 4mg PO initially, then 2mg PO after each loos stool (16mg a day max)
  2. Bismuth Subsalicylate (Pepto-Bismol/Kaopectate) 525 mg Q30-60 min PRN for up to 2 days; not to exceed 4,200mg/day.
275
Q

True or False

In healthy adults, severe dehydration secondary to Infectious Diarrhea is unusual unless the patient cannot tolerate oral hydration due to prolonged nausea & vomiting.

A

True

276
Q

What is the fluid replacement level of Lactated Ringers for a patient with severe fluid loss?

A

1-2 L of LR

Pre and Post orthostatic hypotension tests should be utilized as a metric for improvement

277
Q

Are prophylactic antibiotics recommended for Infectious Diarrhea?

A

No, not recommended for viral or unknown diarrhea suspicion since they afford no protection against non-bacterial/protozoa pathogens and can remove protective microflora from the bowel, increasing the risk of infection with resistant bacterial pathogens

278
Q

What is the empiric PO antibiotic therapies for Infectious Diarrhea?

A 
1. Azithromycin 500mg QD x 3 days 
OR 
2. Ciprofloxacin 500mg BID x 3 days 
OR 
3. Levofloxacin 500mg QD x 3 days

Protozoa suspected:
1. Metronidazole 250mg TID x 5-7 days

279
Q

When should you consider antibiotics for a patient with Infectious Diarrhea?

A
  1. Severe disease
    a. Fever plus,
    b. > 10 stools/day with signs/symptoms of dehydration
    c. Significant or complete loss of operational effectiveness
  2. Blood or mucoid stools with no clinical suspicion of E. Coli O157:H7
280
Q

The STEC E. Coli O157:H7: specific strain of E. Coli is associated with what?

A

Undercooked fast-food hamburger meat

281
Q

Antibiotic treatment has no clinical benefit in a patient with O157:H7 and can significantly worsen outcomes by causing what?

A

Hemolytic Uremic Syndrome (HUS)

-associated with anemia, thrombocytopenia and renal failure

282
Q

Most cases on non-inflammatory diarrhea are self-limiting and resolve within ___ to ___ hours

A

48-72 hours

283
Q

Any patient suspected of having infectious diarrhea shall be removed from food handling & food preparation duties until symptom free for _____ hours

A

24 hours

284
Q

When should you consider MEDADVICE or MEDEVAC for a patient with Infectious Diarrhea?

A
  1. Fever >101.3
  2. Bloody diarrhea with positive Hemocult
  3. Severe dehydration (inability to hydrate the patient)
  4. Multiple patients presenting at once with similar symptoms
  5. Inability to control nausea and vomiting w/ antiemetics and Pepto
285
Q

What is caused by RNA viruses but the Orthomyxovirus genus?

A

Influenza

REPORTABLE

286
Q

What are the subtypes of Influenza and what are the only ones to cause illness in humans?

A
  1. A (humans only)
  2. B (humans only)
  3. C
  4. D
287
Q

Influenza affects ___% of the world population annually and is a major historic and contemporary cause of mortality and morbidity

A

9%

288
Q

Influenza

Adults shed the virus in the upper respiratory tract and are infectious from 1 day prior to symptom onset to __ to __ days after symptom onset; infectiousness if highest within __days of onset and correlated with fever

A
  1. 5 to 7 days

2. 3 days

289
Q

Influenza

Children and immunocompromised/severely ill may shed the virus for ___days after the onset of symptoms

A

10 days

290
Q

Influenza - Virion Structure

Surrounding the viral membrane, what are the 2 distinct glycoproteins which is necessary for viruses to enter cells and are also how influenza undergoes periodic changes?

A
  1. Hemagglutinin (H1, H2, H3)

2. Neuraminidase (N1, N2)

291
Q

What is the most common presentation of influenza?

A

Uncomplicated Influenza

292
Q

A patient presents with the following symptoms, what is the most likely diagnosis?

  1. Fevers/chills (>100.8f), Myalgias, headaches, malaise, occasional nausea, sometimes vomiting
  2. Nonproductive cough, sore throat, rhinitis, substernal soreness, nasal congestion
A

Influenza

293
Q

What disease will you see it predominantly localized to the respiratory tract; including nasal discharge, pharyngeal inflammation without exudates, and occasionally rales on chest auscultation?

A

Influenza

294
Q

True or False

Rapid Influenza tests distinguish between influenza A and B but not subtypes

A

True

295
Q

Influenza typically resolves within ___ to ___ days, however cough and malaise can persist for up to ___ weeks in some cases

A
  1. 1-7 days

2. >2 weeks

296
Q

What is the treatment goal of Influenza?

A

Alleviate and control symptoms while preventing spread to other personnel

297
Q

What treatment can shorten the duration of fever and other symptoms and reduce the risk of complications from influenza?

A

Antiviral Treatment

298
Q

What is the antiviral treatment for Influenza?

A

Oseltamivir 75mg POBID x 5 Days

Healthy people within 48hr of symptoms onset
High risk can still get it even if >48hr has elapsed

299
Q

True or False

Hepatitis A Virus is transmitted through consumption of contaminated water or food, and fecal-oral route to include certain sex practices

A

True

300
Q

True Or False

Hepatitis A

Infections are typically mild and acute, with most making a full recovery but gaining no immunity

A

False

Infections are typically mild and acute, with most making a full recovery and gaining life long immunity

301
Q

What hepatitis virus poses a large risk to healthcare workers because of needle stick injuries?

A

Hepatitis B

Transmitted through exposure to infective blood, semen, body fluids, contaminated blood products, and IV drug use

302
Q

What hepatitis virus is transmitted through exposure to infective blood, HCV contaminated blood and blood products, and IV drugs use; sexual transmission with this form is possible but less common and there is no vaccine available?

A

Hepatitis C

303
Q

What hepatitis virus only occurs in combination with Hepatitis B?

A

Hepatitis D

Dual infection of HCV and HBV results in a more serious disease and worse outcome

304
Q

What Hepatitis virus is a common cause of hepatitis outbreaks in developing nations and vaccines for this exist but are not widely available?

A

Hepatitis E

305
Q

What is inflammation of the liver from infection, toxins, autoimmune diseases, and metabolic disorders?

A

Hepatitis

306
Q

What form of Hepatitis is typically an acute illness that many children in developing nations are infected by and remain asymptomatic, chronic infection with this form does not occur?

A

Hepatitis A

307
Q

What forms of Hepatitis can remain dormant in the liver and cause chronic hepatitis and hepatocellular carcinoma?

A

Hepatitis B and C

308
Q

What virus initially presents with non-specific flu like symptoms (fatigue, fever, muscle/joint pains, runny nose, pharyngitis, abdominal pain, nausea, vomiting, anorexia) and within 1-3 weeks, jaundice and RUQ pain develops?

A

Hepatitis

309
Q

These are all common physical findings in a patient with what?

  1. Low-grade fever
  2. Hepatomegaly with liver tenderness
  3. Jaundice and Scleral icterus
  4. RUQ abdominal pain
  5. Dark or brown colored urine
  6. Gray/clay colored stool
A

Hepatitis

310
Q

What does the IDC level of management for a patient with Hepatitis consist of?

A

Supportive and palliative interventions and patient monitoring

MEDADVICE for further recommendations

Patient will require MEDEVAC as soon as operational conditions allow

311
Q

What disease is caused by a rod-shaped, nonmotile, slow-growing, acid-fast bacterium?

A

Tuberculosis

REPORTABLE

312
Q

What are the subtypes of tuberculosis?

A
  1. Multi-drug resistant TB (MDR-TB)

2. Extensively Drug resistant TB (XDR-TB)

313
Q

How is tuberculosis transmitted?

A

Transmission occurs when a contagious patient coughs, spreading bacilli through the air

314
Q

How many deaths are related to TB annually?

A

1.7 million

315
Q

What disease is found in every country on earth and is the leading infectious cause of death worldwide?

A

Tuberculosis

316
Q

Approximately __ to __ billion people in the world are LTBI, & 5-15%
of these people will suffer from reactivation of TB during their
lifetime.

A

2 to 3 billion

317
Q

True or False

Tuberculosis

High-endemic areas, primary infection occurs usually in adulthood, but in less-endemic areas can occur in children. Characterized by local granulomatous inflammation in periphery of the lung (GHON focus) may be accompanied by ipsilateral lymph node involvement (GHON complex).

A

False

High-endemic areas, primary infection occurs usually in CHILDHOOD, but in less-endemic areas can occur in ADULTS. Characterized by local granulomatous inflammation in periphery of the lung (GHON focus) may be accompanied by ipsilateral lymph node involvement (GHON complex).

318
Q

What is a vaccine given against tuberculosis, routinely given to children in countries with high prevalence of TB to prevent childhood TB, however, not used in the US because of low risk of TB infection?

A

Bacille Calmette-Guerin (BCG)

319
Q

Can prior BCG vaccination cause a false positive reaction to a TB skin test?

A

Yes, difficult to determine if a positive TST/PPD result is secondary to the BCG vaccine or due to latent TB infection

320
Q

What TB blood tests are not affected by prior BCG vaccination and doesn’t give a false positive result in people who have received BCG?

A

Interferon-Gamma Release Assays (IGRAs)

321
Q

What instructions states “ TST results in persons vaccinated with BCG immunization will be interpreted and treated using the same criteria for those not BCG vaccinated” ?

A

BUMEDINST 6224.8C

322
Q

Latent Tuberculosis Infection (LTBI) is defined as a positive result on what labs?

A
  1. TST
  2. PPD
  3. Positive QuantiFERON Gold blood test
  4. Positive IGRA-TB blood test
323
Q

True or False

In LTBI the patient is infected with M. Tuberculosis but does not have active TB disease

A

True

324
Q

What instruction governs LTBI?

A

BUMEDINST 6224.8C

325
Q

All newly identified IGRA/TST must be evaluated by who to rule out Active TB disease ?

A
  1. MO, NO, PA, or IDC
326
Q

On what form must positive TB tests be documented on?

A

NAVMED 6224/7 Initial Exposure Risk Assessment

327
Q

Regardless of chest x-ray results what kind of sputum examination must be performed for a patient with LTBI?

A

Acid Fast Bacilli (AFB) smear microscopy

add diagnostic NAAT and culture if suspicious for active TB

328
Q

Are baseline LFTs routinely indicated for patients beginning treatment for LTBI?

A

No, but they are indicated for patients who may be at elevated risk for liver disorder (drinkers)

329
Q

True or False

The provider must rule-out active TB via labs and CXR before LTBI treatment can be initiated

A

True

330
Q

CDC and the National Tuberculosis Controllers Association (NTCA) preferentially recommend short-course, rifamycin-based, __ or __ month latent TB infection treatment regimens over __ or __month isoniazid monotherapy.

A
  1. 3 to 4 month

2. 6 to 9 month

331
Q

What is the current US LTBI treatment regimens listed in CDC’s Core Curriculum on TB?

A
  1. Isoniazid & rifapentine (3HP) PO once a week x 12 weeks.
  2. Rifampin (4R) 1 PO QD x 16 weeks (4 months)
  3. Isoniazid & Rifampin (3HR) 1 PO daily x 12wks (3 months).
    • Not part of CDC preferred treatment: Isoniazid PO QD for 6-9 months, plus Pyridoxine PO QD for 6-9 months to mitigate peripheral neuropathy.
332
Q

True or False

LTBI

Monthly follow ups are required until treatment is completed

A

True

333
Q

LTBI

The idc will evaluate compliance, possible side effects, and indication of active TB and document monthly evaluations on what form?

A

NAVMED 6224/9

334
Q

Active TB disease can affect any organ, but the vast majority of TB infections occur where?

A

Lungs (70%-80%)

335
Q

Active TB infections are typically denoted by one of what three terms?

A
  1. Post-primary Tb
  2. Reactivation TB
  3. Active TB
336
Q

What form of TB includes symptoms such as prolonged and productive cough with or without hemoptysis, chest discomfort and pain, low-grade fever, decreased appetite and anorexia, unexplained weight loss, and night sweats?

A

Typical Pulmonary-TB symptoms

337
Q

What form of TB includes site such as the following?

  1. Lymph nodes
  2. Pleura
  3. Bones and joints
  4. Brain and spinal cord linings (meningitis)
  5. Kidneys
  6. Bladder
  7. Genitalia
A

Extrapulmonary TB

338
Q

True or False

Extrapulmonary TB is extremely hard to diagnose without advanced imaging & laboratory capabilities.

A

True

339
Q

What form of TB is most common in adults (60%-80%) and can occur years to decades after the primary infection after immunological impairment?

A

Post-primary TB (Re-activation TB)

340
Q

Hemoptysis associated with TB is usually the result of what that causes erosion of pulmonary blood vessels?

A

Cavitating Lung Disease

341
Q

What lab measure the immune response to TB antigens?

A

IGRA-TB

does not differentiate LTBI and ATB

342
Q

TB can be identified via TST/IGRA-TB within __ to __ weeks after exposure

A

8 to 10 weeks

343
Q

What test is the gold standard for confirmatory diagnosis and can differentiate between LTBI and Active TB?

A

Sputum Test - Acid-Fast Bacillus (AFB) with NAAT

344
Q

Medical Event Reports need to be submitted with __ hours for all known or suspected cases of active TB

A

24 hours

345
Q

Who should be notified of all suspected or confirmed case of active TB at a Navy MTF or at USN/USMC operational forces?

A

cognizant NEPMU

346
Q

Routine testing and screening guidelines are laid out in what instruction?

A

BUMEDINST 6224.8C

347
Q

What is caused by an aerobic, gram-positive, spore-forming, nonmotile rod-shaped bacterium known as bacillus anthracis?

A

Anthrax

REPORTABLE

348
Q

What are some common predisposing factors of anthrax?

A
  1. Working with unvaccinated animals (common anthrax reservoir)
  2. Common in ranchers, leather workers, veterinarians, and wildlife researchers
349
Q

What is a zoonotic disease primarily affecting ruminant herbivores such as cattle, sheep, goats, antelope, and deer that become infected by ingesting contaminated vegetation, water or soil?

A

Anthrax

350
Q

True or False

The primary mode of transmission for anthrax spore is direct contact with the tissues/hides of infected animal, or contact with the soil in which the spores have been deposited

A

True

351
Q

True or False

Anthrax in humans generally is not considered contagious; person-to-person transmission of cutaneous anthrax has been reported only rarely

A

True

352
Q

What are the 4 main clinical presentations of anthrax?

A
  1. Cutaneous
  2. Ingestion
  3. Injection
  4. Inhalation
353
Q

What is the most common form of anthrax in humans?

A

Cutaneous anthrax (95% to 99%)

354
Q

What is the hallmark of cutaneous anthrax?

A

Eschar with extensive surrounding edema

355
Q

The following is the common clinical presentation of what?

  1. Small, painless, pruritic papules emerge anywhere from 1-12 days after exposure
  2. Papules enlarge rapidly to vesicles or bulla (blisters)
  3. Vesicle or bulla start to erode and leave painless black necrotic ulcer
A

Cutaneous anthrax

356
Q

Where should suspected cases of anthrax be referred to?

A

Infectious Disease Specialist

357
Q

What antibiotics have activity against Anthrax?

A
  1. Ciprofloxacin 500mg PO bid x 7-10 days.
  2. Levofloxacin 750mg PO qd x 7-10 days.
  3. Doxycycline 100mg po bid x 7-10 days.
358
Q

What is the disposition for a patient with suspected anthrax?

A

GET EM OFF DA SHIP

359
Q

If untreated, cutaneous anthrax may result in what?

A

Sepsis or meningitis

360
Q

What is the most frequently reported bacterial STI and nationally notifiable disease in the US; 2.6 million new cases are diagnosed annually?

A

Chlamydia trachomatis

REPORTABLE

361
Q

Chlamydia

__% of new infections occur among people aged 15-24 y/o

A

66%

362
Q

__ in ___ sexually active young women aged 14-24 y/o have chlamydia

A

1 in 20

363
Q

What sexual disease is commonly known as a “silent” infection because most infected people are symptomatic and lack abnormal physical exam findings?

A

Chlamydia

Estimated that 10% of men and 5-30% of women with laboratory confirmed chlamydial infection develop symptoms

364
Q

What is the common female presentation of Chlamydia?

A
  1. Urethritis
    a. dysuria
    b. pyuria
    c. increased urinary frequency
  2. Cervicitis (most frequent clinical manifestation in females)
    a. increased vaginal discharge
    b. intermenstrual vaginal bleeding
    c. dyspareunia
365
Q

What is the common male presentation of Chlamydia?

A
  1. Urethritis (most frequent clinical manifestation in males)
    a. mucoid or clear water discharge
    b. dysuria is most common complaint
    c. scant discharge on underwear usually presents in the morning
  2. Epididymitis
    a. unilateral testicular pain and tenderness with palpable swelling of epididymis
  3. Prostatitis
    a. pelvic pain
    b. pain with ejaculation
    c. dysuria
  4. Proctitis MSM
    a. anorectal pain
    b. discharge
    c. rectal bleeding
366
Q

What is the gold standard for laboratory diagnosis of Chlamydia?

A

Nucleic Acid Amplification Testing (NAAT)

  • Usually obtained with UA, vaginal, or urethral discharge
  • Females: endocervical swab specimen as part of annual screening or if symptomatic
367
Q

What is the preferred treatment for chlamydia?

A

Doxycycline 100mg PO BID for 7 days

368
Q

What is the alternative treatment for chlamydia?

A

Azithromycin 1g single dose (must observe patient taking med)

369
Q

If untreated what can chlamydia cause in women?

A

Pelvic Inflammatory Disease (PID)

370
Q

True or False

Reactive arthritis can occur in men and women following symptomatic or asymptomatic chlamydial infection, sometimes as part of a triad of symptoms (with urethritis and conjunctivitis) formerly referred to as Reiter’s Syndrome.

A

True

371
Q

It is recommended that patients with laboratory-confirmed chlamydia
be retested __ months after treatment of an initial infection, regardless
of whether they believe that their sex partners were successfully
treated.

A

3 months

372
Q

What is caused by a gram-negative diplococci bacteria called Neisseria Gonnorrhoeae?

A

Gonorrhea

REPORTABLE

373
Q

What is the male presentation of gonorrhea?

A
  1. Most males are symptomatic
  2. Urethral symptoms
    a. Dysuria
    b. white/yellow/green urethral discharge
  3. Testicular symptoms
    a. epididymitis, manifesting as testicular or scrotal pain
  4. Rectal infection
    a. discharge, anal itching, bleeding, or painful bowel movements or may be asymptomatic
  5. Throat
    a. sore throat, typically asymptomatic
374
Q

What is the female presentation of gonorrhea?

A

Most women ae asymptomatic but may have:

  1. Urethral
    a. dysuria, increased discharge, or vaginal bleeding between periods
    b. lower abdominal discomfort
    c. dyspareunia may be present
    d. can be mistaken for bladder or vaginal infection
  2. Rectal infection
    a. discharge, anal itching, bleeding, or painful bowel movements or may be asymptomatic
  3. Throat
    a. sore throat, typically asymptomatic
375
Q

True or False

Chlamydia trachomatis; 50% of patients will test positive for both
Chlamydia & Gonorrhea.

A

True

376
Q

__% of gonorrhea infection are resistant to at least one antibiotic

A

50%

377
Q

What is the CDC recommended treatment regimens for gonorrhea?

A
  1. Ceftriaxone 500 mg IM in a single dose
    AND
  2. Doxycycline 100mg PO BID x 7 days.
    **3. Alternative to Doxycycline: Azithromycin 1g orally in a
    single dose
378
Q

Individuals who are seeking an STI evaluation often do so because of a
specific exposure, therefore, we screen for what infections?

A
  1. Gonorrhea
  2. Chlamydia
  3. HIV
  4. RPR for syphilis
  5. HPV vaccination counseling
379
Q

What is caused by a spirochete bacterium that is also called Treponema Pallidum?

A

Syphilis

REPORTABLE

380
Q

What are the subtypes of syphilis?

A
  1. T. P. Pallidum (causes syphilis)
  2. T. P. Endemicum (causes bejel)
  3. T. P. Pertenue (causes yaws)
  4. T. Carateum (causes pinta)
381
Q

What disease is historically called “the great pretender” as its symptoms can look like many other diseases ?

A

syphilis

382
Q

What are the three distinct phases and one “break” of infection with syphilis?

A
  1. Primary
  2. Secondary
  3. Tertiary
383
Q

What phase of syphilis begins as a painless papule that proceeds to ulcerate into a 1-2cm painless ulcer with raised margins (chancre)?

A

Primary syphilis

384
Q

Syphilis

Chancres last ___ to ___ weeks and heals regardless of whether a person is treated or not, however, active lesions are infectious

A

3 to 6 weeks

385
Q

Skin rashes and/or mucus membranes lesions (sores in the mouth, vagina, or anus) mark what phase of syphilis?

A

Secondary Syphilis

-may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

386
Q

What is characterized by a diffused non-pruritic maculopapular eruption on the trunk and extremities that includes the palms and soles?

A

Syphilitic Rash

387
Q

What stage of syphilis will there be a period of no visible signs or symptoms?

A

Latent Stage

388
Q

What is latent syphilis where the infection occurred within the past 12 months?

A

Early Latent Syphilis

389
Q

What is latent syphilis where the infection occurred more than 12 months ago, can last for years?

A

Late Latent Syphilis

390
Q

What phase of syphilis is rare and develops in a subset of untreated syphilis infections that appear 10-30 years after infection and can be fatal?

A

Tertiary Syphilis

391
Q

What is the symptom/form of syphilis that affects the heart; the dilated ascending aorta leads to aortic valve regurgitation which can lead to heart failure?

A

Cardiovascular syphilis - aortitis

392
Q

What is the symptom/form of syphilis that involves general paresis (early signs of cognitive changes and confusion that progresses to dementia) and Tabes Dorsalis (sensory ataxia and sudden bouts of brief stabbing pain that can affect the limbs, back and face, may also have abnormal pupillary responses (Argyll-Robertson pupil))?

A

Neurosyphilis

393
Q

What is a very uncommon symptoms/form of tertiary syphilis that presents with granulomatous lesions with round or irregular shape that can appear on the skin, bones, or internal organs?

A

Gummatous Syphilis

394
Q

What is the standard lab used to diagnose syphilis?

A

Serologic test

395
Q

What test is used to confirm syphilis because an RPR can be non-specific and be falsely positive?

A

Treponemal Test (FTA-ABS)

396
Q

What is the standard treatment for all stages of syphilis?

A

Parental Penicillin G

397
Q

What is the treatment for primary and secondary syphilis?

A
  1. Penicillin G benzathine 2.4 million U IM once.

2. PCN allergy: Doxycycline 100mg PO BID x 14 days

398
Q

What is the treatment for tertiary syphilis?

A
  1. Penicillin G benzathine 2.4 million U IM once weekly for 3
    weeks
  2. Doxycycline 100mg PO BID x 4 weeks
399
Q

Syphilis

What is an acute febrile reaction frequently accompanied by headache, myalgia, fever, rigors, diaphoresis, hypotension, and worsening rash if initially present, it can occur within 24 hours after initial treatment for syphilis and most frequently occurs among persons who have early syphilis?

A

Jarisch-Herxheimer reaction

400
Q

What disease is caused by an anaerobic flagellated protozoan parasite referred to as Trichomonas vaginalis?

A

Trichomoniasis

NOT REPORTABLE

401
Q

What is the most common curable STI?

A

Trichomoniasis

402
Q

Trichomoniasis

Most infected persons, __% to __% have minimal or no symptoms, and untreated infections can last for months to years

A

70% - 85%

403
Q

T. Vaginalis principally infects the ___________ in the urogential tract

A

squamous epithelium

404
Q

What can trichomoniasis present with in women?

A
  1. purulent, malodorous discharge, burning, pruritis, dysuria, dyspareunia
  2. erythematous vulva, erythematic petechial rash on cervix “strawberry cervix” and green malodorous frothy discharge
405
Q

Upwards of ___% of men infected with T. Vaginalis are asymptomatic and can serve as carriers

A

75%

406
Q

What lab is recommended due to high sensitivity/specificity; detecting three to five times more T. Vaginalis infections than wet-mount microscopy?

A

NAAT

407
Q

What is the treatment of trichomoniasis?

A

Metronidazole 2 g orally in a single dose, or Metronidazole 500 mg orally twice a day for 7 days

408
Q

Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women within
____ months following initial treatment regardless of whether they believe their sex partners were treated.

A

three months

409
Q

What is caused by a double stranded DNA virus known as Human alphaherpesvirus 1 & Human alphaherpesvirus 2?

A

HSV

NOT REPORTABLE

410
Q

The primary infection of what presents with the following?

  1. Severe, painful genital ulcers
  2. Dysuria
  3. Fever
  4. Local inguinal lymphadenopathy
A

HSV

411
Q

Recurrent infections of what will present with the following?

  1. Unilateral small vesicular lesion on erythematous base or ulcerative lesions
  2. May have mild tingling or shooting pains in buttocks and legs prior to recurrent episodes
A

HSV

412
Q

What are the preferred HSV tests for genital ulcers or other mucocutaneous lesions?

A

Cell culture and PCR

Negative tests does not indicate an absence of infection

413
Q

What is the acute treatment for Primary HSV Infection?

A
  1. Acyclovir 400mg orally TID for 7-10 days
  2. Acyclovir 200 mg orally five times a day for 7–10 days
  3. Valacyclovir 1 g orally BID for 7–10 days
  4. Famciclovir 250 mg orally TID for 7–10 days
414
Q

True or False

Almost 100% of patients with symptomatic primary infection will experience recurrent episodes of genital lesions

A

True

Less frequent after initial genital HSV-1 infection

415
Q

What is the treatment for a recurrent HSV infection?

A
  1. Acyclovir 800 mg orally twice a day for 5 days

2. Valacyclovir 1 g orally once a day for 5 days

416
Q

True or False

Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis

A

True

417
Q

HPV

Types __ and ___ are low risk subtypes, but the most common strains causing anogenital warts (condyloma acuminata)

A

types 6 and 11

418
Q

HPV

Types ___ and ___ are high-risk subtypes for developing malignancy such as cervical cancer

A

Types 16 and 18

419
Q

What is the most common STI world wide with 9-13% of the global population being infected?

A

HPV

NOT REPORTABLE

420
Q

True or False

Condyloma acuminatum is usually found incidentally during routine female gynecologic exams

A

True

421
Q

What are some topical therapies available for HPV?

A
  1. Imiquimod cream 5%
    a. applied 3x per week every other day
    b. resolution typically seen in 16 weeks
  2. Podophyllotoxin Solution (0.5% & 0.15%)
    a. used to treat the fleshy papules, applied BID x 3 days with a 4 day break
    b. lesions can resolve after 4 weeks
422
Q

What are some clinician applied therapies for HPV?

A
  1. Cryotherapy

2. Surgical Excision (Derm)

423
Q

The efficacy rate for the HPV vaccine, Gardasil, shows an ___% reduction in infections that cause HPV-related cancers in teen girls and a ___% reduction in young adult women

A
  1. 86%

2. 71%

424
Q

___ out of 10 cases of cervical cancer are caused by HPV

A

9 out of 10

425
Q

Is HIV reportable?

A

DUH

426
Q

What disease can be lethal if untreated and is an enveloped positive strand RNA virus in the Retroviridae family?

A

HIV

427
Q

What are some common routes of transmission with HIV?

A
  1. Sexual contact
  2. Needle/syringe sharing
  3. Unsafe Medical Injection
  4. Blood transfusion
  5. Mother to child during pregnancy
428
Q

True or False

HIV

There is an increased HIV risk in Sub-Saharan Africa, Eastern Europe, Central and Southeast Asia

A

True

429
Q

HIV

The average time from infection to the development of symptoms is __ to __ weeks with a median of __ days

A
  1. 2 to 4 weeks

2. 10 days

430
Q

The acute phase of HIV infection (symptomatic) is called what and can present similarly to Mono or Influenza but the clinical features can be highly variable including things like:

  1. Fever
  2. Maculopapular rash
  3. Arthralgia
  4. Myalgia
  5. Malaise
  6. Lymphadenopathy
  7. Oral ulcers
  8. Pharyngitis
  9. Weight loss
A

Acute Retroviral Syndrome (ARS)

431
Q

What is the screening test for HIV ?

A

OraQuick ADVANCE Rapid HIV-1/2 Antibody Test

432
Q

HIV confirmatory testing is performed via 4th Gen HIV immunoassay and detects HIV type 1 and 2 antibodies and the p24 antigen, being reactive approximately __ to __ weeks after HIV infection.

A

2-3 weeks

approximately 99% develop a reactive result within 6 weeks of infection

433
Q

What instructions covers the Guidance for HIV (PrEP) for Persons at High Risk ?

A

DHA IPM 18-020

434
Q

HIV

When should you reach out for MEDADVICE and/or a Routine MEDEVAC ?

A
  1. Positive screening with Oraquick rapid HIV test
  2. Positive confirmatory testing utilizing 4th generation HIV
    Ab/Ag
  3. High clinical suspicion of ARS
  4. Needle Stick/bloodborne exposure to high-risk individual
435
Q

A DOD member with HIV will be managed by who?

A

Infectious Disease and Internal Medicine

436
Q

What is DoDI 6485.01?

A

HIV in Military Service Members

437
Q

HIV

Clinical evaluations are required by military infectious disease physicians at least every __ to __ months after diagnosis

A

6 to 12 months

CLASS 22010 INFECTIOUS DISEASE (2 decks)

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