Eval of bacterial, viral, fungal and parasitic organisms

Question 1

Suspected bacterial infection, CBC can tell you

Answer 1

Leukocytosis- may or may not be present. Neutrophilia. “Left Shift”

Question 2

Suspected bacterial infection, CMP can tell you

Answer 2

Really only useful if you suspect GI or GU infection, does not yield much information about respiratory or skin infections

Question 3

Suspected bacterial infection, UA can tell you

Answer 3

urinary or GI bacteria

Question 4

Suspected bacterial infection Radiology can tell you

Answer 4

CXR in pneumonia. Bony x-ray in osteomyelitis. Imaging (X-ray or CT for chronic sinusitis cases).

Question 5

Suspected viral infection, rapid tests?

Answer 5

Rapid influenza test- treat within 2 days of symptoms. Rapid mono test. Rapid RSV test.

Question 6

Suspected viral infection, CBC can tell you

Answer 6

Sometimes leukopenia/neutropenia. Lymphocytosis. Monocytosis.

Question 7

Suspected viral infection, CMP can tell you

Answer 7

Again mostly used when GI origin of infection, not respiratory infections

Question 8

Suspected viral infection, UA can tell you

Answer 8

Viruses do not causes urinary tract infections, only bacteria

Question 9

Suspected viral infection, Radiology can tell you

Answer 9

CXR may be useful for pneumonia (frequently viral cause)

Question 10

What Would Cheryl Do?

Answer 10

1. Rapid testing 2. CBC 3. CMP 4. UA 5. Radiology *What specific test applies to the disease I am investigating?

Question 11

Fungal infections

Answer 11

seen less commonly than bacterial or viral infections. Most commonly, the HCP will see fungal infections of the skin and vagina. Frequently, they are implicated due to their roles in infections in immunocompromised patients

Question 12

Types of microscopic fungi

Answer 12

Yeasts and molds

Question 13

Candida

Answer 13

predominant yeast found in and on the body. Can cause infection of the mouth, GI and vagina. immunosuppreseed and pts recently on abx are at risk. Can be found on blood cultures- pathogenic.

Question 14

Dermatophytes

Answer 14

usually a skin fungus. “Tinea” Minimal lab work up or evaluation, very characteristic. If there is concern, can do skin/hair scraping for diagnosis.

Question 15

Tinea corporis

Answer 15

caused by dermatophyte fungi

ringworm

treated with topical antifungal

Question 16

If fungal skin infection doesnt improve with topical tx, do a blood test

Answer 16

FALSE! You need to examine the specimen- do skin scraping and KOH exam.

Question 17

KOH test

Answer 17

Done to determine if skin infection is fungal or not. Say your diff diag is psoriasis vs. tinea, you woul do an in office KOH test. If it is fungal, you will see hyphae, psuedohyphae or budding yeast under the microscope.

Question 18

If you suspect a subcutaneous systemic fungal infection..

Answer 18

perform a biopsy

Question 19

If you susepect a fungal pneumonia

Answer 19

Get a sputum culture, do a bracnhioalveolar lavage or get a direct biopsy.

Question 20

If you suspect a systemic GI fungal infection,

Answer 20

get a biopsy

Question 21

If you suspect a systemic endocarditis

Answer 21

get a blood culture for fungal inspection

Question 22

If you suspect meningitis

Answer 22

get a CSF sample for inspection of fungi

Question 23

If you susepct encephalitis

Answer 23

get a brain biopsy for fungal inspection

Question 24

If you suspect osteomyelitis

Answer 24

get a bone biopsy for fungal inspection

Question 25

If you suspect OM

Answer 25

get a direct swab/culture for fungal inspection of the ear

Question 26

If you suspect fungal sinusitis

Answer 26

get a sinus biopsy or direct culture for fungal infection

Question 27

If you suspect fungal vaginitis

Answer 27

take a wet mount

Question 28

If you suspect systemic fungal infection, order a CBC/CMP

Answer 28

FALSE. Aspergillus can sometimes cause eosinophilia, but overall, bloodwork wont tell you much about a fungal infection.

Question 29

If you suspect systemic fungal infection, order a blood culure

Answer 29

yes, you can.

Question 30

Parastitic infections are more common in the US than anywhere else

Answer 30

False. Less common in the US, but you will still see them.

Question 31

Parasitic infections dont affect many people

Answer 31

False, millions are affected every year

Question 32

examples of parasitic infections

Answer 32

§Malaria §Rocky Mountain Spotted Fever §Lyme Disease §Hookworm §Giardiasis §Leishmaniasis

Question 33

infected with malaria annually

Question 34

estimated annual deaths from malaria

Answer 34

2-2.5M

Question 35

malaria primarily caused by

Answer 35

* Anopheles mosquitos carrying one of following: * Plasmodium falciparum * Plasmodium vivax * Plasmodium ovale * Plamodium malariae * Plasmodium knowlesi

Question 36

Clinical presentation of malaria

Answer 36

§**Occurs after exposure in infected region** §Tachycardia and tachypnea §Fever, Myalgias, Arthralgias §Headache §Chills §Cough §N/V/D and abdominal pain §Jaundice, splenomegaly, hepatomegaly

Question 37

Thick smear

Answer 37

Blood smear done to determine if a parasite is present in suspected malaria

Question 38

Thin smear

Answer 38

blood smear used to confirm the plasmodium species is present in suspected malaria.

Question 39

Blood smears for malaria

Answer 39

Need a skilled pathologist- this is a sensitive test even in trained hands. Stained with Giemsa stain. Not done in office Smears repeated ever 12-24 hours x3 before you can rule out malaria.

Question 40

Rapid malaria tests

Answer 40

available in the US. Detects antigents to plasmodium. Drawback- the ab has to keep a positive control of blood for plasmodium falciparum

Question 41

Lyme disease early presentation

Answer 41

erythema migrans

Question 42

As Lyme disese progresses

Answer 42

get lesions of the EM and migratory arthralgias.

Question 43

Diagnosis of lyme disease

Answer 43

based off of EM rash alone. Rash appears 7-14 days post bite. Can test for IgM and IgG abs. IgM peaks within 4-6 weeks and then declines. IgG can persist for years.

Question 44

Lyme disease caused by

Answer 44

•spirochete Borrelia burgdorferi in U.S. and transmitted by Ixodes scapularis (a.k.a dammini) or pacificus (deer ticks) Most common tick related disease in the US and Europe

Question 45

Rocky mountain spotted fever caused by

Answer 45

•by gram-negative bacteria Rickettsia ricketsii * Transmitted through vector Dermacentor variabilis (east and southcentral US) and Dermacentor andersonii (west of Mississippi) * Like Lyme Disease, transmitted through tick bites

Question 46

Rocky mountain spotted fever clinical manifestations

Answer 46

2-4 days post tick bite you get fever, headache, malaise, myalgias, arthralgias, N/V, abdominal pain. 90% of pts get a rash, its a blanching macular rash on palms of hands and soles of feet. Death can happen in 5 days.

Question 47

Diagnosis of Rocky mountain spotted fever

Answer 47

based primarily on presentation, but you cannot rule it out based off physical presentation alone. Thrombocytopenia is a clue, occurs later in disease. IgG and IgM can be done, but that takes about 7-10 days. Can do a skin biopsy to confirm bacteria

Question 48

Ova and parasites found in your poop

Answer 48

§Giardia §Entamoeba histolytica §Cyclospora §Helminth infection (roundworm, tapeworms and flukes)

Question 49

Parasitic infections that cause anemia

Answer 49

hookworm, whipworm