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Ash's Certification Study > Enterobacteriaceae, Legionella, Diarrheal Diseases, Hepatitis > Flashcards

Enterobacteriaceae, Legionella, Diarrheal Diseases, Hepatitis Flashcards

1
Q

Where are Enterobacteriaceae natural inhabitants?

A

GI tract

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2
Q

This gram-negative bacterial family is ubiquitous in environment and in gut

A

Enterobacteriacaeae

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3
Q

Enterobacteriaceae cause ____ of bacteremias

A

1/3

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4
Q

Enterobacteriaceae cause more than ____% of UTIs

A

80%

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5
Q

Basic description of enterobacteriaceae

A

Gram negative rods
Non-spore forming
facultative anaerobes

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6
Q

What agar is used to differentiate enterobacteriaceae?

A

MacConkey agar

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7
Q

Do all enterbacteriaceae ferment lactose?

A

No, both lactose fermenters or non-lactose fermenters

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8
Q

What common antigen do all enterbacteriaceae have

A

Enterobacterial common antigen (ECA)

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9
Q

selective and differential medium that inhibits gram + organism and differentiates between lactose fermenting gram negatives

A

MacConkey Agar

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10
Q

Enterobacteriaceae- lactose fermenter that is motile

A

E. coli

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11
Q

Enterobacteriaceae- non-motile lactose fermenter

A

Klebsiella pneumoniae

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12
Q

Enterobacteriaceae- motile non-lactose fermenters

A

Salmonella
Proteus

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13
Q

Enterobacteriaceae- Non-motile non-lactose fermenters

A

Shigella
Yersinia

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14
Q

What types of HAIs are associated most often with Enterobacteracieae?

A

Pneumonias
SSIs
Bacteremia
UTIs

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15
Q

What are the most familiar species of Enterobacteriaceae recovered from extraintestinal diseases?

A

E. coli
Enterobacter cloacae
Klebsiella penumoniae
Serratia marcesens
Proteus mirabilis

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16
Q

Most common Enterobacteriaceae agents of gastroenteritis and colitis?

A

Salmonella
Shigella
E. coli

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17
Q

Two species of Salmonella for which humans are the only reservoir

A

Salmonella typhi
Salmonella paratyphi

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18
Q

How often to patients become chronic carriers of salmonella?

A

1-5%

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19
Q

Which virulence factor is associated with Enterobacteriaceae and septic shock and Disseminated intravascular coagulation (DIC)

A

LPS polysaccharides and Lipid A endotoxin

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20
Q

Common to all aerobic and some anaerobic, gram, negative bacteria, released upon death. Activates the macrophages, white blood cells, releases cytokines, and causes septic shock, necrosis, DIC, and death

A

LPS-polysaccharides and Lipid A endotoxin

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21
Q

What do LPS polysaccharides and Lipid A endotoxins cause?

A
  • Septic Shock
  • Necrosis
  • DIC
  • Death
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22
Q

Structure that facilitates motility and adherence to GI, and urinary epithelial cells. Also assists in invasion of mucosa

A

Flagellar H antigens

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23
Q

Structure that prevents phagocytosis, evades immune mechanisms

A

Capsule K antigen

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24
Q

Provides resistance to antibiotics, production of toxins, hemolysins, may be chromosomal or plasmid mediated

A

Pathogenic islands

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25
Q

Antigen that provides resistance to antibiotics, production of toxins, hemolysins, may be chromosomal or plasmid mediated

A

Pathogenic islands

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26
Q

Enterobacteriaceae with a symptom of red currant jelly sputum and penumonia

A

Klebsiella pneumoniae

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27
Q

Two most common HAIs caused by Klebisella, Enterbacter, and serratia

A

Pneumonia and UTIs

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28
Q

Concern with HAIs from Klebsiella, Enterobacter, and Serratia

A

Multi-drug resistance

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29
Q

What antibiotic for klebsiella, enterobacter, and serratia?

A

carbapenem

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30
Q

Do Klebsiella, enterobacter and serratia ferment lactose?

A

Yes

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31
Q

Motility for enterobacter?

A

motile

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32
Q

motility serratia?

A

motile

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33
Q

motility klebsiella?

A

not motile

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34
Q

what color are lactose fermenters on MacConkey agar?

A

Pink

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35
Q

What pigment does Serratia have on MacConkey agar?

A

Bright red

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36
Q

3 As of klebsiella

A

Alcoholics (common risk)
Abscesses (what they cause)
Aspiration (How it starts)

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37
Q

Enterobacteriaceae HAI that has a capsule

A

Klebsiella

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38
Q

Enterobacteriaceae that causes cavitation in chest imaging and may be mixed up with TB

A

Klebsiella

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39
Q

Which HAI most commonly produces urease?

A

Protease

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40
Q

What is the microbial resistance concern with Klebsiella?

A

Carbapenemase- producing strains

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41
Q

What is the most frequently isolated carbepenemase producing enterobacterales?

A

Carbapenem- resistant Klebsiella pneumoniae (CRKP)

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42
Q

Which enterobactericaeae is most often associated with blood stream infections?

A

Klebsiella

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43
Q

Enterobacteriaceae most often associated with CAUTIs

A

E Coli

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44
Q

What family was the leading cause of CAUTIs?

A

Enterobacteriaceae

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45
Q

What was the top pathogen recovered from CAUTIs?

A

E. Coli

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46
Q

Basic description of legionella

A

aerobic
Gram negative
Fastidious bacteria

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47
Q

Tests for legionella

A

Urinary antigen detection

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48
Q

Clinical manifestations legionella

A

Pneumonia (Legionnaires disease)
Flu-like illness (Pontiac fever)

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49
Q

CDC estimates that less than ___% of the legionella cases are dx’d and reported to the CDC

A

5%

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50
Q

Incubation periods Legionnaire’s disease

A

2-10 days

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51
Q

Associated symptoms Legionairre’s Disease

A

Nonproductive cough
fever (usually above 104)
shortness of breath
Malaise
Anorexia
Headache
Confusion
Watery diarrhea
Nausea
Vomiting
Abdominal pain

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52
Q

What will a legionnaire’s disease chest radiograph look like

A

infiltrates in the lungs

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53
Q

What is common lab result for legionnaire’s disease

A

Hyponatermia

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54
Q

low concentration of sodium in blood

A

Hyponatermia

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55
Q

Incubation for Pontiac fever

A

24-48 hours

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56
Q

Pontiac fever symptoms

A

High fevers
Chills
Myalgia
Headache

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57
Q

Symptom resolution with Pontiac fever

A

Typically resolve in 2-5 days without treatment

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58
Q

Risk factors for legionella

A

advanced age
male gender
cigarette smoking
alcohol abuse
chronic pulmonary disease
immunosuppressed hosts
renal failure
corticosteroid use

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59
Q

natural habitat of legionella

A

Water

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60
Q

Mode of transmission legionella

A

Direct inhalation or aspiration

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61
Q

does person to person transmission happen for legionella?

A

no

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62
Q

How can legionella be transmitted in healthcare settings?

A

Aerosolization by use of respiratory tract devices (humidifiers, nebulizers)

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63
Q

Legionella infections can be traced to …

A

Multi-species biofilms

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64
Q

What is the gold standard definitive test for legionella?

A

Culture

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65
Q

What is the limitation of urinary antigen tests for legionella?

A

only able to detect serotype 1

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66
Q

Treatment for legionella

A

Quinolones or macrolides

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67
Q

Prevention of Legionella

A

-Water safety plan
- Disinfection

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68
Q

What are the disinfection methods for legionella?

A
  • Super heat and flush, hyperchlorination
  • Copper silver ionization systems
  • Chlorine dioxide
  • Monochloramine
  • Point of use water filters
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69
Q

Two organisms that are the waterborne pathogens that are most associated with outbreaks related to contaminated equipment. Tap water that is used to rinse instruments after disinfection and as a water source for medical instruments may be a source of these infections.

A

Pseudomonas and non-tuberculosis mycobacteria

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70
Q

What are the virulence factors for Klebsiella spp?

A

capsule
Endotoxins

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71
Q

What are common infections caused by Klebsiella spp?

A

CAP (alcoholics)
HAP (ventilator)
UTIs (indwelling catheters)

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72
Q

Incubation periods for ETEC

A

1-2 days

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73
Q

Symptoms of ETEC

A

Water diarrhea
Cramps
Nausea
Vomiting
Dehydration

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74
Q

Common name for ETEC

A

Traveler’s diarrhea

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75
Q

Transmission ETEC

A

fecal/ oral

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76
Q

Symptoms EIEC

A

Bloody/ mucoid stool
fever
cramps
watery diarrhea

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77
Q

Transmission EIEC

A

Travel
Contaminated H2O

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78
Q

Who is at risk for EPEC?

A

infants
Young children
Developing nations

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79
Q

Symptoms of EPEC

A

Watery diarrhea
Fever
Nausea
Vom
Muccoous in stool

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80
Q

Enteroaggressive E. Coli- where it’s a concern

A

Developing nations

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81
Q

Shigella virulence factors

A

neurotoxin
cytotoxin (B)
enterotoxin (A)

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82
Q

symptoms Shigella

A

cramps
diarrhea
fever
bloody stools
Can be asymptomatic

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83
Q

Transmission shigella

A

person to person
fecal oral

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84
Q

this organism cases 15-20% of pediatric cases of diarrhea in the U.S.

A

Shigella

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85
Q

Infective dose shigella (low/ medium/ high)

A

Low

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86
Q

How salmonella is transmitted

A

fecal oral or animal to person

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87
Q

Infective dose salmonella (low/ medium/ high)?

A

High infective dose

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88
Q

Who is at risk for salmonella?

A

kids under 5
>65
AIDS patients
Sickle cell
MSM

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89
Q

4 clinical manifestations of salmonella

A

Enteritis
Septicemia
Enteric Fever
Asymptomatic

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90
Q

Incubation for salmonella - GI

A

6-48 hours

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91
Q

Symptoms salmonella GI

A

nausea
vom
diarrhea
fever
ab cramps
myalgia

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92
Q

Treatment salmonella enteritidis

A

No treatment

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93
Q

Who is impacted by salmonella septicemia?

A

advanced age
HIV

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94
Q

Infections related to Salmonella septicemia (bloodstream infection)

A

osteomylitis
endocarditis
arthritis

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95
Q

Incubation period for salmonella enteric fever

A

10-14 days, lasts for weeks

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96
Q

What salmonella species cause asymptomatic Salmonella infections?

A

S. typhi
S. paratyphi

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97
Q

Where does salmonella live in the body during asymptomatic infections?

A

Gallbladder

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98
Q

Incubation period yersinia

A

3-7 days

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99
Q

Symptoms yersinia

A

fever
diarrhea
enterocolitis
acute mesenteric lymphadenitis

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100
Q

Source of nonenteric yersina bloodstream infections occur?

A

blood product

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101
Q

What are the two type of plague caused by yersinia pestis?

A

bobonic plague (most common)
pneumonic plague

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102
Q

Symptoms of bubonic plague

A

Buboes
Fever
Chills
sepsis
gangrene

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103
Q

What antigens are used on Enterobacteriaceae classification?

A

O antigen
K antigen (capsule)
H antigen (Flagella)

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104
Q

What increases the risk level for enterobacteriaceae?

A

medical intervention
disruption to normal GI microbiome
Exposed to contaminated H2O
Very young, old, debilitated

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105
Q

Resistance mechanisms for enterobacteriaceae

A

most common is beta lactamase- ESBLS

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106
Q

Enterobacteraceae most common MDROs

A

Enterobacter
Klebsiella
Serratia

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107
Q

Plasmid carrying
KPC
VIM
IMP
NDM
OXA-48
are resistant to what antibiotic?

A

Carbepenem

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108
Q

Most common carbapenem resistant bacteria

A

Klebsiella

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109
Q

Most common organism isolated from CAUTIs

A

E. coli

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110
Q

Most common organism isolated from SSIs

A

Enterobacter

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111
Q

Most common species isolated from bacteremias

A

Klebsiella spp

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112
Q

Common pathophysiology of enterbacteriaceae bloodstream infection

A

spreads from UTI, lungs, or GI tract to blood
Releases endotoxins

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113
Q

Enterobacteriaceae in top 10 CLABSI list

A

Klebsiella
Enterobacter
E. Coli

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114
Q

What enterobacteriaceae cause HAP?

A

Enterobacter
Klebsiella
E. Coli

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115
Q

What Enterobacteraceae organism most commonly casess VAP?

A

Klebsiella

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116
Q

What are the top 5 organisms for CAUTIs?

A

1) e. coli
2) Kelbsiella
3) Proteus
4) enterobacter
5) seratia

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117
Q

What is a risk for an SSI infection with enterbacteriaceae, esp e. coli

A

Antibiotic PEP with a 3rd gen cephalosporin

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118
Q

Who is at risk for a CNS infection with enterobacteriaceae?

A

premature babies
low birth weight in infants

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119
Q

What 2 Enterobacteriaceae organisms typically cause CNS infections?

A

E. coli
Klebsiella pneumonia

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120
Q

E. Coli is in the Top 10 organism list for which HAIs?

A

1 CAUTI

#3 SSI
#6 VAP
#9CLABSI

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121
Q

E. coli is not a common ________ pneumonia but is a common ________ pneumonia

A

community acquired pneumonia
healthcare acquired pneumonia

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122
Q

Enterobacteriaceae that cause oppurtunistic infections in immunocompromised patients, especially those on ventilators, and prolonged antimicrobials.

A

enterobacter

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123
Q

Enterobacter can cause the following infections

A

lower resp infections
UTI
wounds infections
septecemia

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124
Q

MDRO concern for enterobacter

A

carbapenemase + EBSL producer

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125
Q
A
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126
Q
A
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127
Q

Most dangerous type of EHEC that can cause HUS

A

O157: H7

128
Q

Incubation period for EHEC

A

1-9 days

129
Q

Incubation period for ETEC

A

3-14 days

130
Q

Incubation period for EPEC

A

3-6 days

131
Q

Epi of EPEC

A

Diarrhea for >2 weeks in children

132
Q

Precautions for E. coli

A

Contact

133
Q

Clinical symptoms for EHEC

A

Ab pain
Myalgia
headache
vom
hemorrhagic colitis

134
Q

Key difference between ETEC and EHEC

A

No leukocytes in stool of ETEC, just watery diarrhea

135
Q

Systemic complications of EHECt

A

HUS

136
Q

Culture for EHEC

A

macConkey agar (lactose fermenter)

137
Q

Is EIEC common in the U.S.

A

no, very rare

138
Q

How many serotypes of Salmonella enterica are there? based on what?

A

2400
O, Vi, and H antigen

139
Q

Where are Salmonella Typhi and Salmonella paratyphi prevalent

A

India and Asia

140
Q

Incubation period Salmonella typhi

A

5-21 days

141
Q

Symptoms Salmonella typhi

A

diarrhea
headache
anorexia
myalgia
general weakness
rose spots
hepatosplenomegaly

142
Q

Antibiotic for salmonella typhi

A

Fluloroquinolones

143
Q

Who is at highest risk for non-typhoid Salmonella

A

HIV
Infants

144
Q

Season for non-typhoid salmonella

A

summer, early fall

145
Q

Most common cause of salmonella outbreaks

A

Salmonella enteritidis

146
Q

Transmission non-typhoid salmonella

A

Ingestion of undercooked meat (esp poultry, eggs, dairy products)
Exotic pets

147
Q

Incubation of non-typhoid salmonella

A

6-48 hours

148
Q

Symptoms non-typhoid salmonella

A

Diarrhea
ab cramps
bacteremia (infants, elderly, immunocompromised, sickle cell)

149
Q

Extraintestinal infections Salmonella

A

UTI
Osteomyelitis
Joint infections

150
Q

Dx for salmonella

A

Stool culture

151
Q

Very virulent form of EnterobacteriaceaeEnterobacteriaceae with only humans as the host

A

shigella

152
Q

Are non-typhoid salmonella patients typically treated?

A

No, not unless high risk

153
Q

Epi- risk factors for shigella

A

daycare
migrant workers
international travel
custodial institution
MSM

154
Q

Can you have shigella twice?

A

no, infection confers immunity

155
Q

Clinical symptoms shigella

A

FEVER
Bloody diarrhea (20+ stools per day)
severe abdominal cramps
tenesmus

156
Q

Pathogenicity shigella

A

multiply and cause cell death and inflammation

157
Q

Treatment for shigella

A

Rehydration therapy
Antimicrobials

158
Q

Gram negative cocobacillus enterbacteriaceae that is invasive and cases disease in humans

A

Yersinia

159
Q

Where is yersinia common?

A

Europe

160
Q

What is a common source of yersinia?

A

chitterlings

161
Q

High risk populations yersinia

A

infants
African americans
iron chealtor
receive blood

162
Q

What animal is yersinia associated with?

A

pigs

163
Q

What is the incubation period for yersinia?

A

1-4 days

164
Q

Symptoms yersinia

A
  • enterocolitis
    -mesenteric adenitis (right lower quadrant pain)
  • terminalilitis
  • septicemia
  • reactive arthritis
165
Q

What antibiotics is yersinia resistant to?

A

macrolides

166
Q

Infection control for yersinia

A

-safe food handling, esp pork
- Test blood products
-treat H2O

167
Q

Very common enteric- gram negative, non spore forming rod, but not in enterobacteriaceae family

A

Campylobacter

168
Q

Reservoir for campy

A

intestines of cows and poultry animals

169
Q

Transmission of campylobacter

A

Undercooked meat
Unpasteurized dairy
Unchlorinated water
contact with sick pet

170
Q

Incubation campylobacter

A

1-7 days

171
Q

symptoms of campylobacter

A

Prodome- fever, headache, malaise, myalgia
1-2 days later- tenesmus, diarrhea, ab pain, lower right quadrant pain

172
Q

Is campylobacter common in healthcare?

A

No, very rare in healthcare\

173
Q

Gram negative bacteria that are transmitted via fish (aquarium to wounds, fishers, eating fish)

A

Edwardsiella tarda
Aeromonas speicies
Pleisiomonas Shigelloides

174
Q

Aeromonas species are rare except in ___ therapy

A

leech therapy

175
Q

Spore forming, gram+ enteric

A

Bacillus cereus

176
Q

Most common foods bacillus cereus

A

Rice, noodles, pastries

177
Q

Incubation period Bacillus cereus

A

8-12 hours

178
Q

What are the caliciviruses?

A

Norovirus and Sapprolike viruses

179
Q

Transmission
of caliciviruses

A

Fecal/oral
aersolized vom
Person to person

180
Q

Season for calciviruses

A

winter

181
Q

Where caliciviruses are the biggest risk

A

nursing homes
*cruise ships
*Schools
*camp
*military
*restaurants
*airplanes

182
Q

Incubation period for caliciviruses

A

12-48 hours

183
Q

Symptoms calicivirus

A

vomit
ab cramps
diarrhea

184
Q

How long can a patient shed norovirus?

A

3 weeks

185
Q

incubation 24-48 hours
illness 12-60 hours
more than 50% vom
no bacteria in stool

A

Kaplan criteria for noro

186
Q

Control norovirus

A

Wash hands soap and water
Exclude sick staff
No new admits
Disinfect

187
Q

Most common viral GI infenction

A

Rotavirus

188
Q

Transmission rotavirus

A

Fecal oral
P2P close contact within household

189
Q

How long can rotavirus survive on the hands?

A

60 minutes

190
Q

What age group most commonly is infected with rotavirus?

A

children

191
Q

Symptoms rotavirus

A

may have cough/ coryza
followed by fever and vomitting
followed by bloody diarrhea 2-3 days later

192
Q

Are there protective antibodies for rotavirus?

A

No

193
Q

Describe diarrhea for rotavirus

A

20x per day
non bloody diarrhea

194
Q

Treatment for rotavirus

A

Oral rehydration

195
Q

Prevention rotavirus

A

Vaccinate babies

196
Q

Virus that causes watery diarrhea from shell fish, H2O and fomites

A

astroviruses

197
Q

Describe symptoms of astroviruses

A

Watery diarrhea
nausea
headache
malaise
low-grade fever
**asymptomatic (most common)

198
Q

Which is more mild, rotavirus or astrovirus?

A

rotavirus

199
Q

Age effected by astroviruses

A

<9 years

200
Q

how long astroviral shedding last in stool

A

up to 35 days

201
Q

High risk age for enteric adenoviruses

A

Children <4

202
Q

transmission enteric adenoviruses

A

fecal/ oral
droplet
transplant
NOT FOOD

203
Q

Incubation period for enteric adenoviruses

A

8-10 days

204
Q

Does infection with enteric adenoviruses confer immunity?

A

Yes, lifelong

205
Q

symptoms adenoviruses

A

Protracted diarrhea
asymptomatic

206
Q

What organism causes amoebiasis?

A

Entamoeba histolytica

207
Q

Transmission amoebiasis

A

fecal oral

208
Q

High risks for amoebiasis transmission

A

Travel
Nursing homes
Immigrants
Institutionalized
MSM with HIV

209
Q

Symptoms amoebiasis

A

90% asymptomatic
otherwise- blood diarrhea, fever, dehydration, weight loss

210
Q

More severe symptoms of amoebiasis

A

Colon ulcers
invasive hepatic abcesses

211
Q

Dx amoebiasis

A

wet mount or serology

212
Q

This parasetic diarrheal diseases causes diarrhea, stomach pain, flatulence, and anoerexia, or asymptomatic colonization. It is unclear how it is transmitted.

A

Blastocytis heminis

213
Q

This is the most common parasite in the U.S.

A

Giardia (lamblia) deodenalis

214
Q

Transmission giardia

A

contaminated H2O
animals
diapers
MSM
fecal oral

215
Q

Size of inoculum giardia

A

low

216
Q

Most common clinical presentation giardia

A

asymptomatic

217
Q

When symptoms are present for giardia, what are the symptoms

A

foul smelling, profuse watery diarrhea

218
Q

Dx giardia

A

wet mountw

219
Q

treatment giardia

A

Metronidazole
Tridazole

220
Q

Transmission of cryptosporidum parvum

A

contaminated H2O (drinking and recreational)
P2P *handwashing MSM

221
Q

What is unique about crytosporidium parvum?

A

resistant to chlorine

222
Q

What type of organism is cryptosporidium parvum?

A

parasite

223
Q

incubation period cryptosporidium

A

5-28 days

224
Q

symptoms cryptosporidium

A

profuse, watery diarrhea
ab pain
fever
fatigue

225
Q

Type of agent of cyclospora cayetanesis

A

parasite

226
Q

Transmission of cyclospora cayetanesis

A

tropical climates
foodborne

227
Q

Incubation time cyclospora

A

1-7 days

228
Q

Symptoms cyclospora

A

Profuse, watery diarrhea
nausea
vom
appetite loss

229
Q

Dx cyclospora

A

modified acid fast stain

230
Q

Treatment cyclospora

A

TMP-SMP

231
Q

What are the most common legionella pneumophila serogroups?

A

1*, 4, and 6

232
Q

Virulence factors of legionella

A

LPS
Flagella
Pili
Exoproteases
cytotoxins
Outter membrane proteins

233
Q

Mortality rate legionella

A

1/10

234
Q

Risk for legionella

A

Advanced age
male gender
smoking
alcohol abuse
COPD

235
Q

Who is at biggest risk for HAI legionella

A

organ transplants

236
Q

Where do people typically get legionella CAP?

A

hotel
fountain
cruise ship
spas

237
Q

4th leading cause of CAP

A

legionella

238
Q

What makes a probable case of legionella healthcare acquired pneumo?

A

in setting <10 days before onset

239
Q

What makes a definite case of HC acquired pneumo due to legionella?

A

in hc setting for 10+ days b4 onset

240
Q

When to investigate legionella

A

2+ cases

241
Q

Where does legionella grow?

A

Drinking water dist systems
whirlpools and spas
decorative fountains
industrial equip

242
Q

Transmission of legionella

A

1) aersolization
2) aspiration
3) direct deposit from medical procedure

243
Q

Incubation period of legionairre’s disease

A

2-10 days

244
Q

Incubation period pontaic fever

A

24-48 hours

245
Q

what mental change is common in legionairre’s disease patients?

A

confusion

246
Q

Does legionella grow easily in culture?

A

No, fastidious

247
Q

Antibiotics for legionella

A

quinolones and macrolides

248
Q

Water safety plan steps

A

1) Describe the water system
2) Assess risk
3) control risk
4) Audit

249
Q

When do you need to culture the water system for legionella?

A

1 case- where patient was, high risk patient areas
2 cases- facility wide

250
Q

is superheating a flushing a long term solution for legionella?

A

No, will grow back

251
Q

Non-toxic chemical method to kill legionella

A

Chlorine dioxide

252
Q

Kills legionella and biofilm

A

monochloromine

253
Q

Where to use point of use filters for legionella

A

high-risk units

254
Q

Concerns with hyperchlorination for legionella

A

short term
carcinogens

255
Q

To prevent legionella use ___ water to rinse respiratory equipment, naso/ oro trach probes, CPAPS

A

sterile

256
Q

To prevent legionella, clean and disinfect these machines

A

ice machines
baths

257
Q

Should portable humidfyers be allowed in the room?

A

No, allow for legionella to grow

258
Q

Who should drink bottled water during a legionella outbreak?

A

immunocompromised patients

259
Q

What are the CAP- core quality measures?

A

-oxygen assessment within 24 hours or hosp arrival
- pts over 65 screened for pneumo vax
- blood cultures in ED b4 abx administered
- abx timing (within 6 hrs of arrival)
- Abx selection
- adult smoking cessation advise
-influenza vax

260
Q

What type of virus is Hep A

A

RNA

261
Q

transmission route Hep A

A

Fecal/ oral

262
Q

Primary modes of transmission for Hep A

A

Intimate contact
Poor hygiene
unsanitary conditions
contaminated food and water

263
Q

People at risk for Hep A

A

Children
MSM
IV Drug users
Occupation (sewage)
travel

264
Q

incubation for Hep A

A

15-50 days

265
Q

typically hep a symptom for children under 6

A

asymptomatic

266
Q

Typical symptom for adults and older children in prodromal phase

A

Fever
Ab discomfort
arthralgia
malaise
fatigue
nausea/ vomit

267
Q

Hep A symptoms iciteric phase

A

jaundice
dark urine
pale stool
pruritis

268
Q

Infection control for Hep A

A

Vax PEP within 2 weeks <40 years old
-IG within 2 weeks >40
- standard precautions

269
Q

Best prevention Hep A

A

Childhood vax
Vax high risk adults

270
Q

Type of virus Hep B

A

DNA virus

271
Q

Transmission of Hep B

A

blood
sexual
perinatal

272
Q

These fluids contain which type of Hep?
Blood
semen
vag secretions
saliva
tears
csf
ascites
serous fluids

A

Hep B

273
Q

Incubation period for Hep B

A

60-150 days

274
Q

How long before symptoms of hep B does the HbsAg, HBeAg, and HBV DNA start to convert to positive?

A

2-7 weeks

275
Q

Symptoms of Hep B in young children

A

asymptomatic

276
Q

Symptoms for adult prodromal acute infection with Hep B

A

uticarical rash
arthritis
fever

277
Q

Symptoms acute HBV

A

Fever
fatigue
loss of appetite
nausea
vom
ab pain
dark urine
jaundice

278
Q

How long does acute HBV last?

A

6 months

279
Q

What labs are elevated during acute Hep B?

A

IgM
ALT/ AST
Bilirubin

280
Q

What percentage of children with acute Hep B will develop chronic Hep B?

A

90%

281
Q

What percentage of adults with acute Hep B will develop chronic Hep B?

A

5%

282
Q

Outcomes chronic HBV

A

liver damage
cirrhosis
hepatocellular carcinoma

283
Q

When does HBsAg appear? test results mean?

A

1-10 weeks after exposure
Pt has Hep B

284
Q

What doe HBeAg test results mean?

A

patient is infectious

285
Q

What does a positive HBV test mean?

A

patient is infectious

286
Q

What does it mean if the HBsAg stays positive for 6+ months

A

Chronic case

287
Q

What does it mean if the HBsAg is positive and the DNA and HBeAg are negative

A

The person is a carrier

288
Q

What to do after HBV exposure

A

Test anti-HBC
if <10 miu/mL, single dose of HBIG + booster vax within 7 days

289
Q

What to do for HBsAg+

A

check viral loads
>1000, no non-emergency exposure prone surgeries until viral loads decrease

290
Q

Prevention hemodialysis hep b

A

Test patients total anti-HBC annually and revax if needed
- do not share med equip
- cleaning and disinfection

291
Q

Partners and infants of HBV patient

A

should get HBIG

292
Q

Most common Hepatits

A

Hep C

293
Q

who is at highest risk for Hep C?

A

-Born 1945-1965
- IV drug users
- multiple sex partners
- HIV
- hemophiliacs with blood before 1987
- blood products before 1992

294
Q

Transmission of Hep C

A

-Blood injection
- organ transplant
- transfusion HCV blood/ blood products
- sex (much less efficient)

295
Q

How long is the incubation period for Hep C for blood products?

A

4 weeks

296
Q

How long is the incubation period for Hep C

A

15-160 days

297
Q

Acute symptoms of Hep C

A

Asymptomatic*
Fatigue
Ab Pain
Hepatomegaly
jaundice (25%)

298
Q

How many individuals with acute Hep C will continue to have a chronic infcetion?

A

85%

299
Q

Outcomes of chronic Hep C

A

Cirrhosis
Hepatic carcinoma

300
Q

How long after exposure does anti-HCV become positive?

A

6-8 weeks

301
Q

How long after exposure can the PCR for HCV show an infection?

A

1-2 weeks

302
Q

Treatment for HCV

A

pegylated interferon +ribdavarin (PR)
protease inhibitors

303
Q

Infection prevention for HCV

A

-Screen blood, organs and tissue
- counsel patients with HCV
- Needle exchange

304
Q

What can inactivate HCV in blood products?

A

Heat

305
Q

This is an RNA virus that requires a Hep B infection

A

Hep D

306
Q

Where is Hep D prevalent?

A

Mediterranean- Italy
hemophiliacs
IV drug users

307
Q

Transmission of Hep D

A

Percutaneous only
Not sex or perinatal

308
Q

incubation period Hep D

A

30-180 days

309
Q

Acute symptoms Hep D

A

Fever
Fatigue
Loss of appetite
Nausea
vom
ab pain
dark urine
jaundice

310
Q

This is when Hep D infection occurs at the same time as a Hep B infection, which causes a slower moving pathogenesis

A

Coinfection

311
Q

This is when a Hep D infection occurs after a Hep B infection, and causes a quickly moving infections with chronic symptoms in 1-2 years

A

Superinfection

312
Q

Chronic symptoms Hep D

A

Cirrhosis
Hepatic carcinoma

313
Q

This hepatitis causes high mortality in pregnant women

A

Hep E

314
Q

This hepatitis is spread by the fecal oral route, but is not common in the US

A

Hep E

315
Q

Which is more severe in the Iceteric phase- Hep A or Hep E?

A

Hep E

316
Q

Precautions for Hep E

A

Standard precautions

Ash's Certification Study (22 decks)

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