DISEASES Flashcards
fever of unknown origin (FUO)
- temp >38.3, >3wks, one week inpatient eval
- virus is most common
bacteremia/septicemia
-
sepsis/septic shock
-
nosocomial infections
-
bacterial endocarditis
-
what does exanthem mean?
-eruption on the skin (usually caused by viruses but can be other infections)
what does enanthem mean?
-eruption on mucous membranes (viruses or bacteria or hypersensitivity
Kawasaki syndrome (rash section) –fever AND 4 of 5 things?
- fever AND (4/5):
1. conjunctivitis (no exudate)
2. mucous membrane changes (injected pharynx, erythema, swelling/fissuring of lips, strawberry tongue)
3. peripheral extremity changes (edema, desquamation, erythema, beau lines (transverse lines on nails)
4. polymorphous rash
5. cervical lymphadenopathy
mainly kids 3mo-5yrs
Rocky Mountain spotted fever (rash section)
- tick bites (rickettsia)
- NORTH CAROLINA, tenessee, okla, missouri, ark
- faint macules to maculopapules to petechiae (appears 2-6 days into fever)
- starts on wrists/ankles, spreads centrally
- tx w/ doxycycline
erythema infectiosum (fifth disease) (rash section)
- parvovirus
- SLAPPED CHEEK rash (firey red)
- progresses to LACY RETICULAR rash on trunk and extremities
- school aged (5-15)
toxic shock syndrome (rash section)
- S. aureus toxin (cultures are negative)
- diffuse macular erythematous rash, DESQUAMATION of hands and feet
- rash appears AFTER fever
- adults
- rehydration (due to diarrhea and vomiting) and IV antistaphylococcal drugs
varicella / herpes zoster (rash section)
-both caused by varicella zoster
-vzv: dew drops on a rose petal (become vesicles, pustules then crust;
begin on face/trunk then move to extremities
-shingles: usually over 60yrs, dermatomal rash
scarlet fever (rash section)
- strep throat with a fever
- diffuse, erythematous rash, like a sunburn, intense in groin and axillas
- blanchable, recedes in 2-5 days
- tx w/ PCN or erythromycin
rubella (German measles) (rash section)
- blueberry muffin rash (fine pink maculopapular rash)
- togavirus
- worry about this w/ pregnancy (deafness in infant)
- face first then trunk/extremities
- post. cervical and post auricular lymphadenopathy
roseola (exanthem subitum, 6th disease) (rash section)
- primarily with young kids (3mo-3yrs)
- blanchable macules and papules AFTER resolution of fever
- starts on TRUNK and spreads to head/neck/extremities
Lyme disease (rash section)
-erythema migrans; TICK bite (borrelia bergdorferi)
-red TARGET LESION at site of tick bite
-rash before fever
stage 1: flu like with rash
stage 2: facial palsy, meningitis
stage 3: arthritis
-tx w/ doxycycline
rubeola (measles) (rash section)
- koplik spots (pathonogmonic)
- cough, coryza, conjunctivitis (3 C’s)
- BRICK RED irregular, maculopapular rash
typhus – endemic / epidemic
- endemic: flea borne (rickettsia typhi); maculopapular rash on TRUNK fades rapidly; appears after fever
- epidemic: louse borne (rick prowazeki) in africa, central/south america; maculopapular, after fever, begins in AXILLA then moves to body (NO FACE, PALMS, SOLES)
hemophilus influenza pneumonia
- 2nd most common chronic cardiopulm disease
- one of the most common CAP
- gradual onset - fever and sputum
- sudden onset - chest pain, dyspnea, sputum, chills, fatigue
- amoxycillin, macrolide
klebsiella pneumonia
- typical pneumonia; hospital acquired (common in alcoholics)
- currant jelly sputum
- flu like s/s; cough associated w/ aspiration
- aminoglycosides or cephalosporins
mycoplasmal pneumonia
- ATYPICAL pneumonia: walking pneumonia
- young adults, crowded areas
- incessant cough (non or mildly productive)
- xray is atypical (patchy infiltrates)
- macrolides, fluoroquinolones, tetracyclines
tuberculosis
- incarceration, household exposures, 1/3 world pop
- chronic cough (blood), slowly progressive, fatigue
- xray shows pulm opacities (apical)
- culture 3 consecutive sputum
- tx w/ mult drugs
pertussis (whooping cough)
-most cases occur before age 2
3 stages:
1. catarrhal - 2 wk prodrome w/ insidious onset hacking night cough, malaise, anorexia, coryza
2. paroxysmal - burst of rapid cough with deep WHOOPING inspiration
3. convalescent stage - 4wks post onset, decreases in severity and frequency
coccidiomycosis
- mold in soil of SW US, mexico, opportunistic inf.
- influenza like, erythema nodosum, arthralgia w/ pariarticular swelling
- respiratory tract (can be pneumonitis or cavitation on the xray)
diptheria
- coynebacterium
- exotoxin
- tenacious gray membrane over pharynx (mild sore throat, malaise)
- tx w/ antitoxin and removal of membrane
legionella pneumonia (Legionnaire’s disease)
- ATYPICAL pneumonia; affects immunocompromise
- 3rd or 4th most common CAP
- pleuretic chest pain, little sputum, toxic appearing, high fever
- xray: focal patchy infiltrates/consolidation
- higher mortality w/out tx
- tx w/ azithromycin, fluoroquinolone
pneumococcal pneumonia (strep pneumoniae)
- most common CAP
- typical
- productive cough, fever, rigors, dyspnea, pleuretic chest pain
- xray: consolidating lobar pneumonia
- amoxicilin
hantavirus
- rodent transmission (aerosols of feces, urine); SW US
- VASCULAR LEAKAGE, resp compromise, pulm edema
- supportive care; 35% fatality, intubation in many cases
influenza
- epidemic pattern in fall/winter
- abrupt onset: fever chills, malaise, non productive cough, myalgias
- reye syndrome: rapid hepatic failure & encephalopathy (DONT GIVE ASA TO KIDS)
mumps
- spread by resp droplets; mostly kids, severe in adults; spreads in spring time
- uni or bilateral swollen parotid glands and facial edema
- viral disease
psittaccosis
- ATYPICAL pneumonia
- from BIRDS
- delayed signs of pneumonitis but RAPID onset
- fever, chills, myalgia, dry cough (contact w/ infected bird)
- tx w/ tetracycline, erythromycin
severe acute respiratory syndrome (SARS)
- coronavirus
- ATYPICAL pneumonia
- horse shoe bat
- range from asymptomatic to severe resp illness
- fever, chills, rigor, dry cough, SOB
- antiviral therapy inconclusive
- mortality 10-14%
anthrax
- found in SOIL gram + anaerobe (SHEEP, CATTLE)
- cutaneous: painless, necrotic eschar w/ raised erythematous skin at site of innoculation - limited
- pulm: inhalation of spores (pneumonia and flu like sx) - fatal if no tx
- CIPRO or DOXY
dengue
- FLAVI VIRUS
- MOSQUITO in TEXAS AND MEXICO
- 1st infection=severe head, back, joint, muscle PAIN, rash (from extremities to torso)
- 2nd infection=fatal autoimmune response
- tx w/ volume support
cat scratch disease
- papule/ulcer develops at scratch site (KITTEHHH)
- bartonella henselae
- EPITROCHLEAR NODES
- erythromycin
toxoplasmosis
- KITTEEEEHHHH
- primary: fever, malaise, resembles mono
- congenital-infected momma, leads to CNS abnormalities in infant
- immunocompromised-encephalitis, necrotizing brain lesions
tularemia
- francisella tularensis (gram neg)
- RABBIT transmission - necrotic ulcer at site of infection; tick bite
- fever, headache, nausea
- pneumonia
- streptomycin
plague
- yersinia pestis (gram neg)
- rapid onset fever, tachycardia, headache
- regional BUBOS (around flea bite) hemorrhagic lymphadenopathy (neck, groin, axilla)
- pneumonia fatal if untreated
- CALIFORNIA, SW USA, 4CORNERS AREA
- vancomycin, streptomycin (IV)
brucellosis
- cattle, hogs, goats INGESTION OF UNPAST. MILK
- severe low back pain, fever, cervical/axillary lymphadenopathy
- MEXICO, MEDITERRANEAN, SPAIN, S. AMERICA
- doxy AND rifampin, strep, genta
malaria
- INTERMITTENT fever, chills, sweating
- anemia, splenomegaly
- FEMALE ANOPHELES MOSQUITO
- south/central america, africa, middle east, india, SE asia
typhoid fever
- salmonella typhi and paratyphi
- prolonged fever (4 wks)-step ladder
- GI s/s delayed
- PEA SOUP diarrhea
- macular rash (ROSE SPOTS)
- recurrent/sustained bacteremia common
- tx w/ quinolones or 3rd gen cephalosporins
enterohemorrhagic E. coli
- produces SHIGA toxin; more common in developed regions
- hallmark grossly bloody diarrhea (w/in few hrs or days)
- LACK OF FEVER; significant abd pain
- HUS in very young or elderly
- AVOID ABX!!–increases toxin production and HUS
- tx w/ h2o and electrolytes
salmonella
-salm. highest foodborne in US
-under cooked food and turtles/reptiles
-n/v THEN diarrhea
- +fever, RLQ tenderness
<7days
traveler’s diarrhea
- watery diarrhea, bloating, cramping
- blood uncommon
- ETEC a common bacteria (bacteria = 80-90% of cases)
- manage s/s if mild, cipro if severe
C. difficile
- abx associated colitis
- fecal oral
- common in hospital but community acquired increased
- watery mucoid diarrhea and abd pain, low grade fever, small amts of blood
- cobble stone appearance on endoscopy
- tx w/ metronidazole or vanco
cholera
- not seen a lot in US–CONTAMINATED SEAFOOD
- Asia/Africa
- “rice water” stool (gray w/ flecks of mucus, NO BLOOD)
- rapid severe dehydration
- oral rehydration salts
- abx can decrease duration (tetracycline or doxy)
giardiasis
- most common PARASITE in US from fecally contam. drinking water (person hiking or well water)
- cyst and trophozoite formation
- FOUL smelling and FATTY diarrhea, bloating, farting
- fever uncommon
- chronic illness: loose stool (not diarrhea) and sulfurous belching
- avoid lactose for 1 mo post tx
- tx w/ metronidazol or tinidazole
viral gastroenteritis
- most common cause of infectious gastroenteritis
- rotavirus (children) and norovirus (adults)
- blood not common, more mild
- fluid/electrolyte replacement
amebiasis
- 90% aysmptomatic
- entamoeba hystolytica
- MOSTLY blood and mucous in stool
- fecal oral (food and water)
- metronidazole
campylobacter
- poultry, second most common foodborne
- children/teens/young ppl
- diarrhea begins LATER (lasts up to 1 week)
- watery to bloody
- tx if >1wk, high fever, bloody, immunocomp.
- erythromycin w/in 3 days of start
cystitis – acute / recurrent
- E. coli
- hematuria, pain, suprapubic discomfort
- abx
pyelonephritis
-FLANK pain, fever, chills, sx of uti spread to kidneys
ascariasis
- nematode, contaminated food/water; most common helminth
- often asymptomatic
- can affect lungs, abdominal discomfort
- stool O&P shows eggs
- albendazole, mebendazole
trichinosis
- nematode
- UNDERCOOKED MEAT/PORK
- abd pain, vomiting, diarrhea
- later fever, myalgia, periorbital edema, rash
- eosinophilia
- albendazole, mebendazole
cysticercosis
- human fecal contam of food
- CESTODE
- Benign unless intraventricular cysts, intracerebral etc.
- seizures
- corticosteroids for seizure control
- albendazole
hookworms
- live in sm intestine, passed through stools
- mostly asymp
- anemia
- eggs in stool
scabies
- mite burrows
- severe itching, vesicles, pustules, finger webs, wrist creases
- permethrin cream
enterobiasis
- PINWORM
- common cause of intestinal problems in school aged kids
- mostly asx
- nocturnal PERIANAL PRURITIS, excoriation
- pinworm prep test (scotch tape over the butthole)
- NO eosinophilia, no eggs in stool
tapeworms
- undercooked pork, beef, freshwater fish
- asymp or gi s/s
- eosiniphilia, eggs in stool (several samples needed)
- praziquantel (single dose)
cutaneous larva migrans
- larvae of cat/dog hookworms, migrates through skin
- southeast us and children
- intensly pruritic erythmatous papules (feet and hands)
- serpiginous tracks
- no tx needed for mild cases
schistosomiasis
- TREMATODE blood flukes
- infected snails in fresh water
- fever, abd pain, diarrhea, urinary s/s
- praziquantel single dose
blastomycosis
- SOIL, S. central and E. US FUNGAL
- males
- pulm infection (resembles bacterial pneumonia)
- itraconizole
candidiasis
- opportunistic FUNGAL
- thrush (oral, vaginal, esophageal)
- scrapes off
- KOH
- Nystatin
- Itraconazole
histoplasmosis
- ohio/mississippi river valleys FUNGAL
- soil w/ bird/BAT droppings
- resembles TB, can be acute but benign and progress into chronic/fatal disease
- Itraconazole
- slow to grow on culture
mucormycosis
- spores in nature FUNGAL
- opportunistic!!
- sinuses and lungs
- High dose Amphotericin B.
- surgical debridement
- often fatal
cryptococcoses
- abundant in soil with pigeon droppings
- present in PACIFIC NW
- opportunistic FUNGAL
- INDIA INK!! of csf blood
- pneumonia like s/s, sob, fever
- Amphotericin B.
- most common fungal meningitis
- HIV pts put on fluconazole for prophylaxis
purulent (bacterial) meningitis
- S. PNEUMONIAE, N. MENINGITIDIS, H. FLU
- at least two of: fever, headache, stiff neck, aloc
- LP
- vancomycin AND …
meningococcal meningitis
- n. meningitis
- schools military barracks
- fever, HA, vomiting, confusion
- rash
- PCN G IV
- LP - cloudy/purulent CSF
brain abscess
- space occupying lesion
- bacterial usually
- HA, drowsiness, confusion, focal neuro deficits
- NO LP
- CT scan
- IV abx and surgical drainage
poliomyelitis
-
tetanus
-
aseptic meningitis
- VIRAL
- acute onset of ha, fever, chills, photophobia
- benign and self limited
- supportive therapy
encephalitis
-
rabies
-
botulism
-
West Nile virus
-
syphilis - primary, secondary and tertiary
- primary: PAINLESS CHANCRE
- secondary: diffuse macular rash (hands and soles too), fever, malaise
- tertiary: organ sys involvement, gummas
- PCN in all cases
- treponema palladium
gonorrhea
- N. gonorrheae
- purulent urethral discharge, dysuria, pain w/ intercourse, may become disseminated
- NAAT
- ceftriaxone, AND azithro or doxy
- can progress to PID if untreated
genital herpes - primary and recurrent
- primary=BAD
- recurrent = mild, less painful
- TZANCK smear
- acyclovir at first signs of sx
chancroid
- PAINFUL ulcer w/ necrotic base
- unilateral lymphadenopathy
- azithromycin
granuloma inguinale
- PAINLESS firm nodule, beefy red, rolled edges
- DONOVAN BODIES on wright stain
- Klebsiella
- doxycycline
lymphogranuloma venereum
- clamydia trachomatis
- primary lesion: lymph node abscess, turns into rectal fistula, proctitis (MSM)
- NAAT, PCR
- azithromycin
chlamydia
- cervicitis, urethritis
- LESS painful/purulent than gonorrhea
- NAAT
- azithromycin
human papilloma virus (HPV) / condyloma acuminata
- cauliflower like warts
- pap smear
- wart removal
streptococcal skin infections*
- impetigo, kids, amber colored crust
- erysipelas, adults, well demarcated, face
staphylococcal skin infections (MSSA/MRSA)*
- MSSA:
- MRSA:
gas gangrene*
- clostridium species (spores in soil)
- spreading necrotized tissue, see gas
necrotizing fasciitis*
-group A strep, staph aureus, clostridium perfringens
osteomyelitis
-
non-joint bacterial infection arthritis
-
septic arthritis (gonococcal, nongonococcal)
-
tuberculosis
- opportunist in HIV pts
- malaise, dyspnea, fever, hemoptysis
- given prophylaxis if exposed, if + test but no s/s and ppl w/ s/s
toxoplasmosis
- most common CNS lesion in HIV pts
- aloc, focal neuro deficits, headache
- tx w/ big gun chemotherapy
- prophylaxis=TMP-SMX (bactrim) once daily; avoid undercooked meats, avoid litter box
cryptosporidiosis
- opportunist in HIV pts
- chronic diarrhea w/ frequent foul smelling stools; malabsorption and weight loss
- avoid lakes and swimming pools
cytomegalovirus retinitis
- late stage HIV; blurred vision, loss of central vision
- dx w/ fundoscopy
- prophylaxis when CD4<50
- tx w/ valganciclovir
oral hairy leukoplakia
- opportunistic infection in HIV
- benign hyperplasia of oral mucosa
- EBV–white corrugated plaques
- antivirals help; reassure pt condition is benign
pneumocystis pneumonia*
- very common opportunistic cause of pneumonia in HIV patients
- happens early (CD4>500)
- tx w/ TMP-SMX (bactrim)–prophylaxis in compromised pts
cryptococcal meningitis
- opportunistic inf. of HIV pts
- immunocompetent: acute pneumonitis
- immunocompromised: CNS infection
- tx w/ amphotericin B and flucytosine
AIDS dementia complex
- subtle impairment can lead to aphasia and motor abnormalities
- tx if underlying cause can be determined
Kaposi Sarcoma
- lesions appear anywhere and can be visceral too
- purplish, non blanching papules or nodules
- tx w/ systemic chemotherapy
vaginal /oral /esophageal candidiasis
-systemic seen w/ CD4 ct <100
-nothing can reduce exposure
-systemic prophylaxis not recommended
-tx w/ potent antifungal:
itraconazole
fluconazole
enterocolitis
- very common complication of HIV
- profuse watery, recurrent diarrhea
- prophylaxis=avoid raw oysters
- tx based on organism and fluid replacement
- can be viral, bacterial, protozoal
shigella*
- person to person spread; S. sonnei and S. dysenteriae (complicated one)
- s/s start w/in 48 hrs
- bloody w/ mucus and pus
- <5y/o
what are the three most common causes of meningitis?
N. meningitidis
strep pneumoniae
H. influenzae
three most common diarrhea causing organisms?
shigella, salmonella, campylobacter
what are the six gram + bugs we need to know?
Strep, enterococcus, staph (cocci)
Clostridium, bacillus (spore causing)
Corynibacteria, listeria
what does haEMOPhilus influenza
epiglotitis
meningitis
otitis media
pneumonia
which bugs cause rash on palm and soles? CARS
Coxsakievirus A
Rocky mtn spotted fever
Syphilis
what does klebsiella cause (4As)
aspiration pneumonia
abscess in lungs and liver
alcoholics
diAbetics
