COVID, polio, TB, atypical diseases Flashcards
What are general prodromal symptoms of COVID?
fever, chills, myalgias, fatigue, anorexia
What are common upper resp infections of COVID?
pharyngitis, congestion, rhinorrhea, conjunctivitis
What are some cardiopulm symptoms of COVID?
cough (dry or wet), SOB, hypoxia
What are some cardio symptoms of COVID?
chest tightness, pain, pressure; palpitations
What are some GI symptoms of COVID?
decreased appetite, diarrhea, N/V
What are some neuro symptoms of COVID?
headache, confusion, dizziness, altered taste/smell
What are some skin symptoms of COVID?
rash, covid toes, acrocyanosis
What are some allergic symptoms of COVID?
urticaria, angioedema
How do children differ with COVID symptoms?
mixture of these symptoms, generally with pharyngeal erythema and less severity
Who are at risk for COVID?
- pregnancy
- young/middle aged adults
- mortality >50 years
- exposure to children=lowers elderly risk
- unvaccinated
Who are at risk for severe COVID?
- BMI>35
- CKD
- DM
- immunocompromised
- immunosuppressant use
- pregnancy
- > 65
- > 55 and comorbidities
Is COVID transmitted through breast milk?
No
What is it called: 24 hour risk of critical respiratory disease after hospital admission, taking into consideration their pulse, O2, and RRR?
quick COVID-19 severity index
What’s a way to score the risk of COVID severity?
COVID-GRAM critical illness risk score
What are some labs that can help diagnose COVID?
- CBC: lymphophenia, leukocytosis, thrombocytopenia
- LFTs: elevated AST, ALT
- CRP, d-dimer (acute phase)
- PCR, rapid antigen detection, antibody tests
What imaging can help diagnose COVID?
CXR, CT, lung ultrasound
What are markers of increased mortality in COVID?
serum troponin, IL-6, LFTs, serum CR, CK, ferritin, procalcitonin
What O2 sat = mild-moderate COVID?
> 94%
What O2 sat = severe COVID?
<94% on room air
What signifies critical COVID?
respiratory failure
What can COVID cause that you need to be on the lookout for?
multi-system inflammatory syndrome
In what population are COVID complications the most common?
Blacks, men, obesity, and with pre-existing conditions
What characterizes long COVID?
- fatigue
- smell/taste disorder
- dyspnea
- headache
- memory impairment
- hair loss
- sleep disorder
- female sex + overweight
When should you consider treatment in mild/moderate COVID?
With risk factors – start ASAP and within 5-7 days of onset to decrease severity
Paxlovid
What symptom is most common in polio?
asymptomatic
What type of polio involves: fever, headache, vomiting, diarrhea, constipation, and sore throat?
abortive poliomyelitis
What type of polio involves: fever, headache, vomiting, diarrhea, constipation, sore throat AND signs of meningeal irritation, muscle spasm w/ absence of frank paralysis?
nonparalytic poliomyelitis
What type of polio is: flaccid asymmetric paralysis, affecting proximal muscles of lower extremities, with a fever 2-3 days, spinal or bulbar?
paralytic poliomyelitis
What puts someone at risk for polio?
<15 yo
traveling to developing countries
What is the polio virus?
poliomyelitis virus - fecal-oral
What s post-poliomyelitis syndrome?
chronic and new denervation, progressive muscle limb paresis w/ muscle atrophy, fasciculations, fibrillation, restless leg syndrome
How do you diagnosis polio?
PCR of washings, stool, CSSF:
* increased pressure/protein
* non-lowered glucose
* WBC<500
How do you treat polio?
- hospitalize
- pocapavir
How do you prevent polio?
PREVENT!!! IPV- 2 months, 4 months, 6-18 months, 4-6 years
How do you treat someone with polio who’s never been vaccinated?
3 doses w/ 2nd 1-2 months later, 3rd 6-12 months
Can you distinguish latent from active TB?
No
Is primary tubercolosis or latent TB asymptomatic?
generally, both!
What are some risk factors for TB?
malnourished, homeless, HIV, DM, CKD, organ transplant, silicosis, immunosuppressive drugs, illicit drug use
What happens with primary tuberculosis?
turns into latent
What is a Ghon complex?
pulmonary lesion usualy in middle or lower lobes of the lung that contain a granuloma
Is latent TB contagious?
No, but remains dormant
True or false: you have to report TB to the authorities
true
True or false: you can use a TB skin test/PPD test/Mantoux test w/ BCG vaccine
FALSE – CANNOT
How can you test for TB?
- skin test, results in 48-72 hours
- interferon-gamma release assay (Gold, T spot), results in 24 hours
- CXR
- morning sputum specimens (3 recommended, 8 hrs, 1 early morning) with Ziehl-Neelsen stain
- Need positive sputum culture for definitive diagnosis
- biopsy of caseating granulomas
- DNA/RNA amplification
What on a CXR can signify TB?
apical caseating granulomas, nodular infiltrates, hilar lymph node enlargement, Ghon or Ranke complexes
What could you find on PE for TB?
non-specific, usually absent in mild/moderate, crackles in inspiration or after cough
chronically ill, malnourished, weight loss
When should extra-pulmonary TB be considered with TB?
entering bloodstream
when foci develops in lungs = miliary TB
What does this triad signify: fever, weight loss, and severe night sweats (with the addition of productive cough and malaise)?
ACTIVE TB
How should you treat primary TB?
Isoniazid x 9 months
Rifampin x 4 months
2 drug therapy!
Isoniazid & Rifapentine weekly x 3m
Isoniazid & Rifampin daily x 3m
What characterizes TB?
latent TB becomes immunocomp, then no longer can contain infection –> moves to apices of lungs and adds lesions
Generally in at risk patients
In a patient with no risk factors, what is the minimum lesion size of concern in a TB test?
greater than 15mm
In a patient with medium risk factors, what is the minimum lesion size of concern in a TB test?
greater than 10 mm, RFs like travelers in high TB areas, IV drugs, healthcare workers, medical conditions, children <4 or exposed
In a patient with high risk factors, what is the minimum lesion size of concern in a TB test?
greater than 5 mm; RFs like HIV+, evidence of Tb on CXR, immunosuppressant, contact w/ active TB
How do you treat active TB?
6 month regimen:
4 medications x 2 months
* isoniazid
* rfampin
* ethambutol
* pyrazinamide
continue treatment for 4+ months if needed, and must treat 3 months longer than neg cultures (top two for longer)
regular physician visits!
How long do you have to treat active TB after a negative culture?
3 months
What should physician visits look like while treating active TB?
regular visits
check sputum @ 2 months
if positive, recheck at 3 months
if negative, check at 5 & 6 months
What indicates acute miliary TB?
multi-organ system failure, septic shock, acute respiratory distress syndrome
How may an extrapulmonary TB patient present?
failure to thrive, fever w/ unknown origin, dysfunction of organ systems (infection OUTSIDE the lungs)
What are common issues associated with extrapulmonary TB?
tuberculosis pleurisy, meningitis, constrictive pericarditis, acute hepatitis, Addison’s disease, lymphatic scrofula of neck, urogenital, Pott’s disease of the spine, arthritis, osteomyelitis, ulcer
What can help diagnose extrapulmonary TB specifically?
- biopsy (acid fast and culture of tissue, fluid, drainage)
- urine culture
- CT scan
- MRI –> needle biopsy for confirmation of CNS lesion w/ stain & culture
What indicates atypical mycobacterial disease?
persistent fever + weight loss
HIV = <50 CD4 count
What can cause atypical mycobacterial disease?
soil and water, NOT person to person, resistant to standard anti-TB drugs
1) avium
2) M. kansasii (lungs)
3) M. marinum (skn/soft tissue)
4) M. abscessus (skin/ soft tissue AND lungs)
5) M. Chelonae (skin/soft tissues)
6) M. fortuitum (skin/soft tissue/lungs)
How can you diagnose atypical mycobacterial disease
blood culture
skin and soft tissue = biopsy + positive culture
lymphadenitis = biopsy + positive culture
How can you treat atypical mycobacterial disease?
Clarithromycin or azithromycin + ethambutol
+/- rifampicin
can be d/c after 12 months if no active disease and CD4>100
When should you add prophylaxis for MAC in HIV patients?
CD4 <50
What is the treatment for prophylaxis of MAC?
clarithromycin/azithromycin/rifabutin
single drug therapy!
Treat until >100 for 3 months
What are M. kansasii treatments specifically?
isoniazid, ethambutol, rifampin for 18 months
What is the skin and soft tissue mycobacterial infections treatment?
2 abx x 3 months
azithromycin, clarithromycin, imipenem, linezolid, fluoroquinolones
What is the mycobacterial lymphadenitis treatment?
usually surgically, but if not, azithro + rifampin + ethambutol
What is also known as Lady Windermere syndrome?
Nodular/bronchiectatic NTM
What are symptoms of nontuberculosis mycobacteria (nodular/bronchiectatic)?
progressive respiratory symptoms + recurrent respiratory infections
Prolonged cough, fatigue, weight loss
In who are NTMs more common?
post-menopausal, non-smoking, white women
How can you diagnose NTM?
- CT - bronchiectasis w/ nodules “tree in a bud” appearance, classically RML and lingual
- culture from 2 sputum samples, 1 BAL sample, or lung biopsy w/ typical histology AND positive culture of biopsy, BAL, sputum
What are symptoms of fibrocavitary NTM?
progressive, systemic symptoms like fever, fatigue, weight loss, night sweats
worse outcome
In who are fibrocavity NTMs common in?
male >50, underlying lung condition
How can you diagnose fibrocavity NTMs?
- CT - fibrocavitary lesions and upper lobe involvement
- culture from 2 sputum samples, 1 BAL sample, or lung biopsy w/ typical histology AND positive culture of biopsy, BAL, sputum
What should be performed on all isolates of NTM?
susceptibility testing for macrolide resistance
How do you treat nodular NTM and fibrocavitary NTM?
3 drug therapy for at least 12 months:
- clarithromycin/azithromycin +
- rifampin/rifabutin +
- ethambutol
