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PAS 506 > Exam 8 (Infectious Disease) > Flashcards

Exam 8 (Infectious Disease) Flashcards

1
Q

Pathogen

A

Organism or agent that can infect individual causing disease

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2
Q

Virulence

A

Potency/severity of pathogen
Yersinia pestis kills 50-75%
Candida albicans low risk of serious illness

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3
Q

Colonization

A

Host is carrying organism but no clinical expression or immune response

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4
Q

Infection

A

Invasion of pathogen causing immune response
Pathogen evasion

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5
Q

Opportunistic infection

A

Organism invades host and waits to cause disease till immune system is compromized by something else

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6
Q

Mycoplasm

A

Smallest bacteria,
Not visible under microscope.
Don’t gram stain
Must use acid-fast to see

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7
Q

Capsule

A

Hydrophilic gel
Protects cell from immune attack
Helps adhesion

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8
Q

Cell wall

A

Rigid
Prevents lysis
Provides shape for cell
Gram (+) or Gram (-)

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9
Q

Gram positive cell wall make up

A

Peptidoglycan with cross linked peptide chains.
Hard to get rid of bc of thick membrain.
Resistant to mammalian enzymes except for lysozime.
Teichoic acids help with adhesion and induces inflammatory reaction

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10
Q

How do we attack gram positive cell clinically

A

Target peptidoglycan with penicillin.
Blocks peptide cross linking.
Causes cell lysis

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11
Q

Gram negative cell wall make up

A

Impermeable outer membrane containing lipoplysaccharide endotoxin, phospholipid A, and O antigen.
Periplasm is single layer of peptidoglycan that makes beta-lactamase.

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12
Q

Gram stain

A
  1. Crystal Violet
  2. Iodine (mordant) makes crystal violet hang on
  3. Acetone or ethanol washes out gram negative
  4. Saffranin dies gram negative
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13
Q

Acid fast stain

A

Stain poorly
1. Carbolfuchsin dye (mycolic acid soluble) stains red
2. Organic solvent (acetone or ethanol) extracts stain from non-acid fast
3. Methylene blue stains non acid fast

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14
Q

LPS endotoxin

A

Gram negative
O antigen
H antigen

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15
Q

Exotoxin

A

Secreted from bacteria into surrounding body fluids.
Local or systemic
A is pathogen
B is recepto binding facilitating A delivery

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16
Q

C reactive protein

A

APR
Best lab value to judge treatment response.
Rises within hours of infection.
Takes a week to normalize

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17
Q

Erythrocyte Sedimentation Rate

A

Rises within 2 days of infection
Can rise 3-5 days after antibiotics initiated
Normalizes in 3-4 weeks

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18
Q

Wet mount

A

Normal saline to identify cells as pathogens
Potassium hydroxide (KOH) to identify fungi

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19
Q

Dark field microscopy

A

Identifies syphilis spirochetes

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20
Q

Minimum Inhibitory Choncentration

A

Minimum amount of ABx to prevent growth after 24 hours of incubation.

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21
Q

Minimum Bacteriocidal Concentration

A

Minimum concentration of ABx that causes microbial death killing 99.9% of colonies in 18-24 hrs

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22
Q

Blood agar hemolysis

A

Tests bacteria ability to lyse red blood cells.
Hemolysins.
Alpha is partial
Beta is complete
Gama is none

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23
Q

Coagulase test

A

Coagulase forms fibrinogen into fibrin to form clot

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24
Q

PCR

A

Polymerase Chain Rxn
Detects RNA or DNA in viruses
Very specific test.
Amplifies nucleiic acid levels

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25
Q

Antigen testing

A

Reagent ANTIBODY detects antigens and binds them triggering postive test

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26
Q

Serology

A

Detect antibody response by measuring antibody levels.
IgM in current or recent infection.
IgG from past infection
In newborns IgM is congenital infection and IgG is just antibodies from mom

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27
Q

Fungus Structure

A

Thick cell wall of chitin and beta glucan.
Hyphae develop after infection
Spores can be infective

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28
Q

Thermal dimorphism

A

Spores are infective, not hyphae.
Once in host at body temp fungus grows and becomes infection

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29
Q

Lab testing fungi

A

Hard to do.
Antigen testing is sensitive and not specific
KOH wet mount

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30
Q

Bacterial medicine target

A

DORA
DNA
Organelles (lack of nucleus, lack of membrane, 70s ribosomes)
Reproduction
Average size (smaller)

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31
Q

Empiric antimicrobial therapy

A

Educated guess at best treatment.
Used while waiting on culture to grow.

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32
Q

What influences empiric antimicrobial therapy

A

Site of infection
Pt history
Local susceptibility data (antibiogram)

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33
Q

Broad spectrum ABx

A

Work for lots of bacteria.
Saved for emergency situation when pt is going downhill and we don’t know what microorganism is causing it
Saved to avoid causing ABx resistance.
Can alter normal bacteria and precipitate superinfections like C. diff

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34
Q

Bacteriostatic

A

Stop growth of bacteria

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35
Q

Bacteriocidal

A

Kill bacteria.
Kill 99.9% in 18-24 hrs.

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36
Q

What to consider with site of infection

A

Capillaries carrie ABx into tissues.
Capillary permeability varies depending on where at in the body.
BBB
Prostate, testes, and placenta are natural capillary barriers
Lipid solubility of drug.
Size of drug.
Protein binding.
Transporters/efflux pump interaction in CNS

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37
Q

Least toxic ABx

A

Beta lactams
(ex. penicillin)

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38
Q

Additive risk

A

Using multiple drugs with same potential toxicities increases risk of pt having that problem

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39
Q

Oral ABx

A

Appropriate for mild infections
Outpatient
Bioavailability may limit use

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40
Q

Parenternal ABx

A

For drugs that are poorly absorbed in GI.
Serious infections that require high serum concentrations.
Switch to oral when pt stable

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41
Q

Concentration dependent klling

A

More effective at higher concentrations.
4-64x MIC
Bolus infusion can achieve high levels of rapid killing

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42
Q

Concentration dependent killing examples

A

Tobramycin
Azithromycin

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43
Q

Time depending killing dosing

A

Efficacy determined by percentage of time blood concentration is above MIC.
Used for long time.

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44
Q

Examples of Time dependent killing ABx

A

Beta-lactams
Clindamycin
linezolid

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45
Q

Post antibiotic effect

A

Continued suppression of microbial growth even after concentration falls below MIC.
Drugs with long post-antibiotic effect usually only needed once daily

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46
Q

ABx with long post antibiotic effect

A

Aminoglycosides
Fluoroquinolones

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47
Q

Narrow spectrum ABx

A

Act only single or limited group of bacteria

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48
Q

Extended spectrum ABx

A

Effective against G+ bacteria and a good number of G-.

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49
Q

ABx Combination therapy

A

Single agent is usually best but combonation is useful in certain pts.
Drugs can work really good together but rare (synergism = beta lactams + aminoglycosides).
Some ABx only work if organisms are multiplying.
Can induce resistance

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50
Q

What causes most antibiotic resistance

A

Genetic alterations of the microbe

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51
Q

Prophylactic use of antimicrobials

A

Prevention of infection instead of treatment.
Used shortest duration possible
Dental procedures especially if pt has cardiovascular disease.
Surgery to prevent postsurgical infection.

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52
Q

Common ABx after dental procedure preventative

A

amoxicillin

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53
Q

Common ABx postsurgery preventative

A

Cefazolin
Vancomycin

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54
Q

Inactivated vaccine

A

Killed version of pathogen.
Not as strong immunity.
Ex. flu, hep A, rabies

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55
Q

Live-attenuated vaccine

A

Weakened form of pathogen
Strong, long lasting
One or two doses good for life.
Not good for immunocompromised pts.
Refrigeration required.
Ex. MMR, rotavirus

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56
Q

mRNA vaccine

A

Inject mRNA for making specific proteins.
mRNA enters human cell and causes protein to be made.
Immune response develops to that protein

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57
Q

Subunit, recombinant, polysaccharide, conjugate vaccines

A

Uses a piece of specific pathogen.
Strong immune response.
Can be used in immunocompromised.
Boosters may be needed.
Ex. H. flu, Hep B, HPV, Varicella zoster, meningitis, pneumonia

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58
Q

Toxoid vaccine

A

Contain toxin made by pathogen.
Immune response to toxin.
Booster shots.
Ex. Diptheria, Tetanus

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59
Q

Viral vector vaccine

A

Uses modified version of different virus as vector for protection.
Johnosn & Johnson COVID-19 pulled from market

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60
Q

Concentration in liquid drugs

A

Weight of drug per volume

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61
Q

Pediatric antibiotic and antifungal

A

Usually from dry powder.
Some require refrigeration after mixing
Stable 10-14 days after mixing

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62
Q

Units of dosing

A

mg of drug/kg of pt
mg/kg/day split that up between however many daily doses

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63
Q

1 kg in lb

A

2.2 lbs

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64
Q

Incidence

A

Number of NEW cases in population over certain time

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65
Q

Prevalence

A

TOTAL number of cases of disease at specific time

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66
Q

Mortality rate

A

Frequency of death over certain time

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67
Q

Risk

A

Probability individual in population will develop a disease over time

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68
Q

Clostridium botulinum

A

Botulism
G+ bacilli
Spore forming
Found in soil
Exotoxin producing

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69
Q

Clostridium botulinum epidemiology

A

200 annual cases
Foodborne from honey in infants, canned food
Wound botulism IV drug abuse

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70
Q

Clostridium botulin pathogenesis

A

Toxin taken up in presynaptic terminal.
Acts on SNARE protein inhibiting ACh release into synaptic cleft so muscle can’t contract (flaccid paralysis)

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71
Q

Clostridium botulin clinical findings

A

Symptoms start 18-24 hrs after ingestion
Inability to swallow
Speech difficulty
Death from respiratory or cardiac arrest
Floppy baby

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72
Q

Clostridium botulin management

A

ICU
Ventilation
Antitoxins through IV
Botulinum immune globulin

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73
Q

Clostridium tetani

A

Tetanus
G+ bacilli
Spore forming make it look like tennis racket
Exotoxin producing

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74
Q

Clostridium tetani epidemiology

A

Rare
Neonatal tetanus
High risk for elderly, diabetics, newborn, unvaccinated mothers, migrants

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75
Q

Clostridium tetani pathogenesis

A

Spores into body through wound
Spores multiply.
Anaerobic conditions ideal
Necrotic tissue
Makes tetanolysin and tetanospasmin (Low lethal dose)
GABA and glycine blocked by tetanospasmin causing spasms and convulsions

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76
Q

Clostridium tetani clinical findings

A

Localized tetanus where only one area of body affected is rare.
Generalized tetanus more common

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77
Q

Generalized tetanus

A

Muscle of face and jaw affected first.
Stiffness
Spasms
Hyperreflexia
Respiratory muscle spasm causing respiratory failure
Opisthotonos posture

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78
Q

Neonatal tetanus

A

Symptoms at 7 days old
In infants 28 days older or less
From umbilical stump from unvaccinated mother

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79
Q

Tetanus mangement

A

IM human tetanus Immune globulin within 24 hrs (most important)
Clean wound
Give antibiotics
Keep in calm, quiet environment

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80
Q

Clostridium tetani prevention

A

Vaccination and boosters every 10 yrs
Infection does NOT confer immunity
Immunization of pregnant women

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81
Q

Yersinia pestis

A

Bubonic Plague
G- coccobacilli looks like safety pin
Facultative anaerobe
Epizootic

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82
Q

Yersinia pestis etiology

A

usually rodent to flee to human (arthropod vector).
Then human to human (respiratory droplet).
Can also be directly from rodent (direct)
Prairie dogs and rats

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83
Q

Yersinia pestis mechanism

A

Capsular Antigen F-1 protects it against phagocytosis.
Lipopolysaccharide exotoxin causes systemic shock and pro-coagulation
V and W antigens
Plasminogen activator allows adhesion to extrcellular matrix proteins

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84
Q

Bubonic plague clinical findings

A

Incubation 2-7 days.
Sudden onset of severe fever, malais, myalgia, chills.
Large lymph nodes (lymphadenitis)

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85
Q

Septicemic plague clinical findings

A

Sudden onset of fever, chilld, AMS
Tissue necrosis
Purpuric papules

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86
Q

Pneumonic plague

A

Incubation is 2-3 days.
From droplet inhalation.
Sudden onset of myalgia, weakness, dizziness
Cough, dyspnea, chest pain

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87
Q

Yersina pestis treatment

A

Aminoglycosides (streptomycin and gentamicin) are first line
Doxycycline
Chloramphenicol in poor countries
Exposure prophylaxis use fluoroquinolones (levofloxacin, moxifloxacin, ciprofloxacin)

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88
Q

Myobacterium leprae

A

Leprosy
Hansen’s disease
Acid fast bacilli
Aerobic

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89
Q

Myobacterium leprae epidemiology

A

mostly in india, Brazil, Indonesia
Happens in second and third decades of life.
Twice as common in men.
Rare in children.

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90
Q

Myobacterium leprae transmission

A

Human to humans from respiratory droplets.

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91
Q

Myobacterium leprae etiology

A

2-10 yrs
Only 1-5% of human population susceptible

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92
Q

Myobacterium leprae pathogenesis

A

Intracellular
In cooler body tissues
Skin
Peripheral nerves (Schwann cells)
Nose, pharynx, larynx, eyes , testicles

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93
Q

Myobacterium leprae Tuberculoid

A

Strong CMI response
Positive lepromin test
Limited growth
CD4 T cells
Cytokines
INterferon-gamma
Inflmmatory response causes nerve damage

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94
Q

Myobacterium leprae Lepromatous

A

Pooor CMI response
Negative lepromin skin test
Lesions have lots of bacteria
Infected skin histiocytes
Interferon-beta
Direct contact of organisms causes nerve damage

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95
Q

Myobacterium leprae clinical findings

A

Myopathy
Neuropathy
Peroneal nerve palsy (foot drop)
Nasal congestion
Epistaxis
Lagopthalmos
Blindness

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96
Q

Myobacterium leprae treatment

A

Dapsone
Rifampin
Clofazamine
all together

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97
Q

Ebolavirus etiology

A

Reservoir in fruit bats
Given to humans through contact with bushmeat or apes.
Human to human after zoonotic transmission
Blood born
Reusing needles
Burial of diseased

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98
Q

Ebolavirus pathogenesis

A

Hepatocyte and endothelial cell damage
Multiorgan failure
Hypovolemic shock
Hypoxia
Hemorrhage.

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99
Q

Ebolavirus cllinical findings

A

SUdden onset
Fever, chills, malaise, headache
Myalgia
Arthralgia
Maculopapular rash.
SOB
Focal hepatic necrosis
Post ebola syndrome
Recovery takes 7-12 days

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100
Q

Ebolavirus diagnosis

A

RNA levels peak 7 days after onset.
Early use antigen capture ELISA and RT-PCR
Later use IgM and IgG serology labs

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101
Q

Ebolavirus management

A

IV fluids
Inmazeb (monoclonal antibodies)
Remdesivir and favipiravir antiviral therapies

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102
Q

Ebolavirus prevention

A

21 day quarentine
Don’t mess with apes or fruit bats.
PPE
Contact tracing, disinfection, sanitization

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103
Q

Smallpox

A

Poxviridae family
Linear double stranded DNA virus
8 categories (Orthopoxvirus most important)
Only fully eradicated virus.
Only virus that fully replicates in cytoplasm.

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104
Q

Smallpox pthogenesis

A

Respiratory droplet inhalation
Spread through lymph nodes

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105
Q

Smallpox clinicla findings

A

Incubation is 12-14 days
Fever, headache, backache at start.
Lesions erupt over 14-18 days.
All lesions at same stage
Orophayngeal ulceration
Severe systemic. Cold be hemorrhagic and malignant

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106
Q

Smallpox diagnosis

A

Rule out chicken pox, HSV, VZV first.
PCR.
Vesicular scrapings.
Consult infectious disease and CDC

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107
Q

Smallpox Vaccination

A

First was live vaccinia virus (cow pox) caused symptoms sometimes.
Second was cloned vaccine used in military

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108
Q

Small pox treatment

A

No antiviral therapy
Cidofovir may have high activity against poxviruses
Vaccinia immune globulin used.

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109
Q

Poliovirus

A

Picornaviridae family.
Single stranded RNA
Enterovirus.
Acute flaccid paralysis

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110
Q

Poliovirus etiology

A

Eradicated in US, but had outbreak in 2022

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111
Q

Poliovirus pathogenesis

A

Fecal-oral transmission
Viral replication in tonsils and ileum (Peyer’s patches)
Viral dissemination effects peripheral nerve axons and lower motor neurons in the anterior horn.

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112
Q

Poliovirus clinical findings

A

Incubation is 7-14 days.
90% asymptomatic.
Aseptic meningitis
Can be paralytic or nonparalytic
Postpoliomyelitis happen years later

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113
Q

Paralytic poliomyelitis

A

Flaccid asymmetric parlysis
Muscle wekaness
Incoordinaition
Painful spasms
Max recovery in six months

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114
Q

Nonparalytic poliomyelitis

A

Aseptic meningitis
Neck stiffness
Fever
Headache
Rapid and complete recovery

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115
Q

Postpoliomyelitis syndrome

A

Happens years later.
New onset of weakness and pain.
Progressive muscle limb paresis.
Muscle atrophy.
More common in women

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116
Q

Poliovirus diagnosis

A

Suggested by aseptic meningitis with acute flaccid weakness and travel to endemic areas
Stool analysis.
CSF analysis.
Lots of diagnoses for acute flaccid paralysis

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117
Q

Poliovirus treatment

A

No antiviral therapy.
Immune globulin
Respiratory support
Physiotherapy

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118
Q

Poliovirus eIPV vaccine

A

Inactivated
IM
Trivalent
In US and developed countries
Induces IgA

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119
Q

Poliovirus OPV vaccine

A

Live, attenuated
Oral administration.
Preferred in eradication efforts.
Don’t give to immunosuppressed
Trivalent OPV associated with vaccine derived polio.
Bivalent better for eradication

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120
Q

Rickettsia prowazekii transmission

A

Person itches and bacteria from flea (Pediculosis humanus) poop goes inside person.
Flying squirrels have the lice

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121
Q

Rickettsia prowazekii

A

Epidemic Typhus
Intracellular
G-

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122
Q

Epidemic typhus epidemeology

A

Uncommon.
Crowded unsanitary regions
Outbreaks in colder months

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123
Q

Epidemic typhus clinical findings

A

10-14 day incubation
Fever
Cough
Delirium
Rash
Improvement 13-16 days after onset with quick recovery
Myalgia
Arthralgia

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124
Q

Epidemic typhus diagnosis

A

THrombocytopenia
PCR testing
IgM or IgG serology

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125
Q

Epidemic typhus treatment

A

Doxycycline (no preg)
Choramphenicol

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126
Q

Borrelia burgdorferi

A

Lyme disease
Spirochete
Transmitted by deer tick (Ixodes scapularis) that live on deer or mice

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127
Q

Lyme disease epidemiology

A

Occur more in late spring and summer
Seen more in northeast US

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128
Q

Lyme disease Clinical Findings

A

Erythema migrans (bullseye)
CN VII palsy
Arthritis
Neuropathy
Encephalitis

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129
Q

ELISA Test

A

Uses enzyme immunoassay to detect presence of ligand in liquid sample using antibodies against protein being measured

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130
Q

Wester blot

A

Tests for IgM or IgG.
Hard to tell if infection is current or past

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131
Q

How to test for Lyme Disease

A

1.ELISA
2. Western blot or second ELISA

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132
Q

How long does tick need to be on person to consider treatment

A

Between 36 and 72 hours
Give doxycyclin

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133
Q

Lyme disease treatment

A

1.Doxycycline
2. Amoxicillin
3. Cefuroxime

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134
Q

Rickettsia rickettsii

A

Rockymountain spotted fever
G-
Intracellular
Rocky Mountain Wood tick and American dog tick

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135
Q

Rocky Mountain spotted fever Epidemiology

A

Lots in TN.
Length of tick attachment increases risk of transmission.
Most common and severe rickettsial disease

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136
Q

Rocky Mountain Spotted Fever clinical findings

A

Abrupt symptoms 2-14 days after bite.
Fever
Chills
Headache
RASH.
Vomiting
Myalgias
Restlessness

137
Q

Rocky mountain spotted fecer diagnoses

A

Leukopenia
Thrombocytopenia
Hyponatremia
Skin biopsy
Serologic antibody Rickettsia rickettsi IgG

138
Q

Rocky mountain spotted fever treatment

A
  1. Doxycycline even in preg
  2. Chloramphenicol
139
Q

West Nile Virus Etiology

A

Arbrovirus
Mosquitos transmit
Birds give to mosquitoes
Severe neurologic disease

140
Q

Where is west nile virus

A

High temps and high rainfall

141
Q

West nile virus clinical presentation

A

Incubate for 2-14 days
Only 20-40% symptomatic
NO fever
Maculopaplar rash
Neuroinvasive disease like meningitis, encephalitis, acute flaccid paralysis

142
Q

West nile diagnosis

A

IgM antibody-capture ELISA
Plaque reduction neutralization test (PRNT)
Antibodies persist for life so can’t tell if recent or not

143
Q

West nile treatment

A

No antiviral meds
Pain control

144
Q

Dengue virus etiology

A

Flaviviridae family
Aedes mosquito infect the whole house

145
Q

Dengue epidemiology

A

Tropical regions
Second most common mosquito vector borne disease

146
Q

Dengue clinical finding

A

ONset 7-10 days after exposure.
Fever
Shock
Bone pain
Thrombocytopenia causing loss of blood.

147
Q

Dengue diagnosis

A

Leukopenia
THrombocytopenia
IgM and IgG ELISA
Blood PCR

148
Q

Dengue treatment

A

Just pain meds.
NO NSAIDS bc thrombocytopenia
Severe cases need vasopressors and blood transfusion

149
Q

Zika virus etiology

A

Flavivirus
Aedes mosquitoes
Spread through Sex
Mother to fetus

150
Q

Zika virus clinical findings

A

3-14 day incubation
Often asymptomatic or mild
Zika syndrome

151
Q

Zika syndrome

A

Born microcephaly (small head)
Intracranial cerebral malformation
Ocular lesions
Congenital contractures
Hypertonia

152
Q

Zika diagnosis

A

PCR early on
ELISA igM after 14 days

153
Q

Zika treatment

A

No vaccine or meds.
Just supportive

154
Q

Most important parasitic disease

A

Malaria

155
Q

Malaria etiology

A

Most important parasitic disease
Plasmodium falciparum from Anopheles mosquito

156
Q

Malaria clinical findings

A

Night sweats.
Jaundice
Spleonmegaly
Up to after two months of travel.
Metabolic acidosis
Renal or hepatic failure
Encephalopathy (can cause cerebral palsy, deafnesss, blindness, etc.)

157
Q

Malaria diagnosis

A

Giemsa-stained blood smear is best.
Rabpid diagnostic test not as good because won’t test positive for one of the plasmodium species.
PCR used but doesn’t guarantee infection is current.
Trombocytopenia
anemia

158
Q

Malaria treatment

A

Artemisnin-based combination therapy (ACT)

159
Q

Yellow fever

A

Flavkvirus transmitted by Aedes mosquito

160
Q

Yellow fever clinical findings

A

Headache, retroorbital pain, photophobia, bradycardia
Jaundice, hypotension, hemorrhage, delirium

161
Q

yellow Fever diagnosis

A

ELISA for IgM

162
Q

Yellow fever treatment

A

Supportive
20-50% Mortality.
Vaccination for travelers

163
Q

Platyhelminths

A

aka FLATWORMS
Tapeworms (cestodes)
Flukes (trematodes)

164
Q

Taenia saginata

A

Beef tapeworm

165
Q

Taenia solium

A

Pork tapeworm

166
Q

Taenia asiatica

A

Asian tapeworm

167
Q

Tapeworm treatment

A

Albendazole or praziquantel

168
Q

Tapeworm diagnosis

A

ELISA stool Ag assay
Capsule endoscopy
CSF

169
Q

Fasciolopsis buski

A

Intestinal fluke
Effects pigs and humans.
Eggs in snail poop that gets into water and fish.
Eating undercooked fish
Most common in southeast asia

170
Q

Intestinal fluke diagnosis

A

Eggs in poop or puke

171
Q

Intestinal fluke treatment

A

Praziquantel

172
Q

Ascariasis

A

Round worm.
Ascaris lumbricoides.
Poor sanitation
Human feces.
Worms eggs hatch in small intestine then to lungs to grow then back to GI tract to lay eggs.

173
Q

Ascariasis diagnosis

A

Eggs and larva in stool

174
Q

Asariasis Treatment

A

Albendazole

175
Q

Pinworms

A

Nematode (roundworm)
Enterobius vermicularis.
Larva hatch in large intestin.
Females go to anus and lay eggs at night.

176
Q

Pinworm treatment

A

Albendazole one now and another a couple weeks later for the whole family.
Wash all bedding and clothing

177
Q

Hookworms

A

Ancylostoma duodenale
Necator americanus
Tropical areas.
Itchy foot.

178
Q

Hook worm clinical findings

A

Itchy foot.
DIstinct rash on foot (looks like a worm)
Cough during lung migration.

179
Q

Hookworm diagnosis

A

Eggs in stool.
Iron deficiency.
hemocult

180
Q

Hookworm treatment

A

Albendazole

181
Q

Hookworm prevention

A

Mass treatment of children in endemic areas

182
Q

Pasteurella multocida

A

Gram negative coccobacilli
Transmitted by dog and cat bite (30-50% of cat and 5% of dog)

183
Q

Pasteurella multocida clinical findings

A

Bite or scratch
Symptoms 3-24 hrs after bite
Soft tissue infection
Bone and joint infection
Respiratory infection
Bacteremia
Osteomyelitis
Septic arthritis
Endocarditis
Meningitis

184
Q

Pasteurella multocida clinical diagnosis

A

Wound cultures
Radiograph

185
Q

Pasteurella multocida management

A

Wound debridement and irrigation
Amoxicillin-clavulanate (augmentin)
DO NOT suture

186
Q

Bartonella henselae

A

CAT SCRATCH FEVER
G- bacilli

187
Q

Bartonella henselae clinical findings

A

Brown or red papule/ulcer at site of injury
Painful lymphadenopathy
Splenomegaly
Eyes mess up
Neurology problems
Found in immunocompromised

188
Q

Bartonella henselae diagnosis

A

Serology
Lymph node biopsy
PCR

189
Q

Bartonela henselae management

A

Self limited
Azithromycin first line
Doxycyclin or azithromycin and rifampin(ocular and neuro) for severe.

190
Q

Francisella tularensis

A

TULAREMIA
G- coccobacillus
Virulent
Grade A bioterrorism
Rabbits
Tick or insect bites around rabbits
Inhalation

191
Q

Tularemia pathogenesis

A

Hematogenous spread
Spreads in lymph
Kill macrophages and spread

192
Q

Tularemia clinical findings

A

Sudden onset after 3-5 days.
Splenomegaly
Fever
Papule or ulceration at site
GI involvement
Meningitis
Pericarditis
30-50% hospitalized

193
Q

Main type of tularemia

A

Ulceroglandular

194
Q

Tularemia diagnosis

A

Serology
PCR
Antibodies to F. tularensis
Measure at symptom onset and two weeks later

195
Q

Tularemia managament

A
  1. Streptomycin
196
Q

Lyssavirus

A

RABIES
Rhabdovirus family
Highest fatality of infectious disease
From animal bite (mostly bats)

197
Q

Rabies pathogenesis

A

Transmitted by saliva.
Replicates in peripheral tissues
Enters nervous system
Disseminates salivary glands and replicates

198
Q

Rabies clinical findings

A

80% cephalic
Once symptoms start its too late.
Delerium
Hydrophobia
Aerophobia
Autonomic instability
20% paralytic causing coma and death (from respiratory failure)

199
Q

Rabies diagnosis

A

Nigri bodies in brain.
FLuorescent antibody testing
PCR

200
Q

What to do after bite when suspecting rabies

A

Clean wound
Give immunization
Give immunoglobulin time of exposure
Give vaccine on days 0 3 7 14
Both if pt never had vaccine
Don’t give imunnoglobulin if been vaccinated

201
Q

Hantavirus

A

HEMORRHAGIC FEVER
Enveloped RNA bunyavirus
Aerosol inhalation of contaminated soil with urine and feces.
From field mouse and deer mouse
35-40% mortality

202
Q

Hantavirus clinical findings

A

Hemorrhagic fever with renal syndrome
Flu-like
oliguria
diuresis
Hantavirus cardiopulmonary syndrome
Pulmonary edema
Vascular leakage

203
Q

Hantavirus diagnosis

A

Serology
ELISA for igG and igM
Reverse PCR
Autopsy testing for viral N antigen

204
Q

Hantavirus treatment

A

Supportive care
Renal support
Ribavarin (antiviral)

205
Q

Chlamydia psittaci

A

PSITTACOSIS
PARROT FEVER
G- cocci
Inhalation of bird feces

206
Q

Psittacosis clinical findings

A

Rapid onset after 5-10 days
Flu like symptoms
SOB
Dry cough
Encephalitis
Respiratory failure

207
Q

Psittacosis diagnosis

A

CXR
Serology is best
Rales/crackles in lung
Pleural friction rub
Hepatosplenomegaly

208
Q

Psittacosis management

A

Tetracycline and doxycycline first line
Macrolides second line or for kids

209
Q

Brucella melitensis, abortus

A

Brucellosis
G- coccobacilli
Ingestion of unpasteurized milk or cheese
Meat from cattle, hogs, goats

209
Q

Brucellosis clinical findings

A

Fever
Sweating
Odor
Weight loss
Weakness
Endocarditis
Meningitis
Miscarriage

210
Q

Brucellosis diagnosis

A

Bone marrow culture is best
Blood or urine culture also used
ELISA for IgM and IgG

211
Q

Brucellosis management

A

First lineis doxycylclin for 6 weeks followed by Rifampin

212
Q

Brucellosis relapse

A

Most occur in first three months

213
Q

Brucellosis prevention

A

Vaccinate livestock
Milk pasteurization

214
Q

Bacillus anthracis

A

ANTHRAX
G+ rod
aerobic
spore forming
Sheep wool (Woolsorter’s disease)

215
Q

Anthrax clinical finding

A

Cutaneus is papule vesicles and Ulcerations
Inhaled is viral-like illness and sepsis
GI is bloody emesis, constipation, diarrhea Mortality is 85%

216
Q

Anthrax diagnosis

A

Culture from cutaneous lesions or blood.
PCR testing
Microscopy with grams stain
CXR
Mediastinal widening
Hemorrhagic lymphadenitis

217
Q

Anthrax management

A

Ciprofloxacin for cutaneous.
Ciprofloxacin + meropenem + minocycline + raxibacumab for systemic (2 bactericidal, 1 protein synthesis, 1 RNA synthesis inhibitor)

218
Q

Coxiella burnetti

A

Q FEVER
G- coccobacilli
Aerosolized inhalation of spores, dust droplets
From feeces, urine, parturition material of goats, cattle, sheep
Ingestion of raw milk

219
Q

Q fever clinical findings

A

Febrile
Pneumonia
Endocarditis
Aortic aneurism
Increased incidence of lymphoma
Pregnancy problems

220
Q

Q fever management

A

Doxycycline
Duration depends on presence of native valve vs prosthesis

221
Q

Q fever prevention

A

Milk pasteurization
Detect infection livestock

222
Q

Toxoplasma gondii

A

TOXOPLASMOSIS
Parasitic infection
TORCH infection
Congenital infection that effects fetus

223
Q

Toxoplasmosis trasmission

A

Contact wit cat feces, undercoooked meat or contaminated soil
Tranplacental

224
Q

Toxoplasmosis clinical findings

A

Can be asymptomatic
Nontender bilateral, symmetrical cervical or diffuse LAD
AMS
Focal neurologic problems
Eye pain
Chorioretinitis

225
Q

ToxoplasmosisToxoplsamosis diagnosis

A

Serology
Test for IgG and IgM

226
Q

Toxoplasmosis management

A

Pyrimethamine and sulfadiazine
For pregnant use Spiramycin to reduce risk of transmission

227
Q

What patients are normally effected by toxoplasmosis in CNS

A

Pts with AIDS bc low CD4 T cells
Encephalitis
Chorioamnionitis
dissemiated disease
MRI

228
Q

Giardia lamblia

A

GIARDIASIS
Parasitic infection from dirty water.

229
Q

Giardiasis clinical findings

A

Acute noninflammatory diarrhea for possibly over 3 weeks.
Abd pain
Malobsorption
50% of pt go chronic

230
Q

Giardiasis diagnosis

A

Stool exam for eggs of parasitess
Stool antigen assay

231
Q

Giardiasis management

A

Tinidazole first line
Metronidasole

232
Q

Virus strain

A

When variant comes very unique from other strains it is considered another strain.
Not all variants are strains
All strains are variants

233
Q

Alpha covid

A

First variant
More deadly than original

234
Q

Beta covid

A

South Africa in 2020
More transmisible than original strand but not many cases in US

235
Q

Gama covid

A

Japan and brazil in 2020
Not much around now

236
Q

Delta covid

A

India 2020
Highly transmissible.
More severe in unvaccinated
Spreads faster

237
Q

Omicron covid

A

South Africa 2021
Currently circulating
>98% of cases since 02/2022

238
Q

When was covid not health emergency anymore

A

May 5, 2023

239
Q

Covid mode of transmission

A

Respiratory droplets.

240
Q

Covid symptoms

A

Respiratory
Neurologic (confusion)
GI issues

241
Q

What people were effected by covid worse

A

Blacks
Hispanics
Males
Elderly

242
Q

Physical exam findings of covid

A

Diaphoresis
Dry mucous membranes
Tachycardia
Tachypnea
Crackles or rhonchi
Wheezing
Abd tenderness
Lower extremity pain or edema

243
Q

What labs to order for someone with covid symptoms

A

CMP
CBC
ABG
CXR
Strep test
Flu test
RSV screen
COVID test

244
Q

What O2 sat do we keep covid pts at

A

At least 94%

245
Q

Covid lab findings

A

Neutrophilia
Lymphocytpenia
Thrombocytopenia
Elevated bilirubin
Elevated D-dimer
High fibrinogen
Elevated con Willebrand factor
coagulopathy

246
Q

Standard to diagnose covid

A

PCR

247
Q

Imaging for suspected covid

A

CXR
Head CT
Chest CT
Doppler ultrasound of lower extremities to rule out DVT

248
Q

Chest CT and Xray early on

A

Could seem normal

249
Q

What meds to not start covid pts on but if they are already on it continue meds

A

NSAIDS
ACEi/ARBs
Statins and aspirin

250
Q

Nebulizers with covid pts

A

Don’t give nebulizer because risk of infection through respiratory droplets

251
Q

Only drug approved by FDA against COVID

A

Remdesivir
200mg IV on day 1 then 100 mg IV for next four days
Don’t give if GFR<30
Can be given to anyone as long as weigh atleast 1.5kg

252
Q

What drug is given to covid pts with respiratory failure and are on oxygen

A

Dexamethasone (decadron) (a steroid)
Significantly lowered mortality.
Not useful for pts with no respiratory issues

253
Q

Plasma use in covid

A

Not recommended anymore.
Didn’t do any good
Case by case for pediatric

254
Q

Tocilizumab

A

IL inhibitor (antiinflammatory)
Can’t be given with Baricitinib
Don’t give if underlying bacterial pulmonary infection

255
Q

Baricitinib

A

JAK Inhibitor (antiinflammatory)
Helps in children with covid that require oxygen.
Give with dexamethasone
Can’t be given with Toxcilzumab
Don’t give if underlying bacterial pulmonary infection

256
Q

Anticoagulants approved for pediatrics

A

Unfractioned heparin
Low molecular weigh heparin
Warfarin
Rivaroxaban
Dabigatran
Deep vein thrombosis

257
Q

Inflammatory labs to check

A

Procalcitonin
Ferritin
Erythrocyte sedimentation rate
C-reactive protein
D-dimer
Lactate dehydrogenase
Fibrinogen
Troponin
Creatine phosphokinase

258
Q

Acute respiratory distress syndrome

A

Lung tissue widespread injury that diminishes ability to get enough oxygen

259
Q

Lung issues from covid

A

Pulmonary fibrosis
Pneumomediastinum
Subcutaneous emphysema (rice crispies)
Pneomothorax

260
Q

Outpatient meds for covid

A

Nirmatrelvir (paxlovid)
Developed by Pfizer
Metallic taste side affect
Helps prevent long covid

261
Q

First oral antiviral against covid

A

Molnupiravir.
Reduces time to recovery, but doesn’t work that good.
Second choice after paxlovid

262
Q

Multisystem inflammatory syndrome in children

A

Occurs in <1% after covid.
Macrophage activation syndrome
Cytokine releases syndrome
Usually occurs 6-8 weeks after covid.
GI
Rash
Respiratory
Neurocognitive
Red or swollen lips
Strawberry tongue
Kidney injury
Lymphadenopathy
Swollen hands and feet
Hepatitis
Myocardial dysfunction

263
Q

How to treat Multisystem inflammatory syndrome in children

A

IV immunoglobulin
Glucocorticoids (IV methylprednisolone)
TNF inhibitors, IL 1 and 6 inhibitors

264
Q

Common complications of covid

A

Cardiovascular
Kidney
Death
Seizures
Stroke
Memory loss
Depression

265
Q

How old do you need to be for covid vaccine (mRNA)

A

12
6 months-11yrs for only emergencies

266
Q

Common side effects of Moderna and Pfizer vaccine

A

Endocarditis and pericarditis at first
Overall benefits outweigh risk

267
Q

Long covid

A

Symptoms continue for at least three months

268
Q

Contamination

A

Bacteria is there but not replicating

269
Q

Critical colonization

A

Replicating bacteria with no invasion but affecting wound healing

270
Q

Staphylococcus aureus

A

Methicillin resistant is MRSA
G+

271
Q

Healthcare associated MRSA

A

Infection over 48 hrs from hospitalization or within 12 months of care exposure.
Makes biofilm on foreign devices like tracheal tube orcatheter.

272
Q

Community associated MRSA

A

Skin and soft tissue infections in young, healthy individuals outside of hospital.
Sharing needles
Sports
Prisons
Military

273
Q

Group A. Streptococcus

A

S. pyogenes
Pharyngitis
Skin
Soft tissue (non-necrotizing) tissue

274
Q

Group B Streptocci

A

S. agalactiae
Neonatal sepsis/meningitis
Sepsis
in GI and GU tract

275
Q

Groups CFG streptococci

A

Bacteremia
Endocarditis
Septic arthritis

276
Q

Group D streptococci

A

Associated with clononic malignancy
Endocarditis
Hepatobiliary disease

277
Q

Enterococcus

A

G+
In GI of humans and animals
E. faecalis
E. faecium

278
Q

Enterococcus risk

A

Indwelling catheters
Cardiovascular abnormalities
Prolonged hospitalization
Mechanical ventilation
ABx use
Immunodeficiency

279
Q

Vancoomycin-resistant enterococci

A

G+
Hospital acquired
Colonize in GI
Live for 5-7 days on counter
24 hours on bed rails
60 mins on phone
30 mins on stethoscope

280
Q

Vancomycin-resistant enterococci ris

A

ABx use
ICU for 72 hours
Underlying medical problems

281
Q

Clostridium

A

Rod shaped bacilli
G+ anaerobes

282
Q

C. perfringens

A

Gas gangrene
Food poisoning
Supportive vare treatment

283
Q

Clostridial gas gangrene

A

C. perfringens
Subcutaneous gas
Traumatic wound, post-opp, or spontanious in immunocompromised or intestinal disease

284
Q

Pseudomonas aeruginosa

A

G- aerobic bacillus
In water
Prefers immunocompromised host
“no flowers in the burn unit” - Dr. Beck

285
Q

Pseudomonas aeruginosa pathogenisis

A

Some strains just in lungs causing cystic fibrosis.
Some invade tissues causing pneumonia or bacteremia leading to septic shock and death.

286
Q

Pseudomonas aeruginosa soft tissue infections

A

Sweet smell
Green
Ulcers
Malignant otitis externa

287
Q

Escherichia coli

A

G- bacillus
Normal in GI tract
Isolated from stool cultures
GU infections causing cystitis, pyelonephritis, prostatitis, abdominal infections, pneumonia, meningitis

288
Q

Cellulitis

A

Grup A strep (pyogenes)
Usually unilateral lower extremities.
Indistinct borders
Can become bullous or necrotic

289
Q

Cellulitis predisposing factors

A

Skin trauma
Inflammation
Edema from lymphatic drainage or venous insufficiency.
Obesity

290
Q

Cellulitis treatment if MRSA present

A

Trimethoprim/sulfamethoxazole or amoxicillin

291
Q

Cellulitis treatment if MRSA not present

A

Dicloxacillin, cephalexin, or cefadroxil

292
Q

Cellulitis treatment in immune compromised

A

IV Cefazolin, naficillin, or oxacillin for Immune compromised

293
Q

Stasis dermatitis

A

Very similar to cellulitis symptoms
Raise leg above heart, if redness goes away, it is stasis dermatitis

294
Q

Eryspelas

A

Beta-hemolytic streptococci
Involves upper dermis and superficial lymphatics.
Usually unilateral
usually lower extremities
Erysipelas nonpurulent
Clear border
Milian’s ear sign

295
Q

Erysipelas ad cellulitis labs

A

Draw with marker around area to see if grows over time.
No labs needed or diagnosis, just physical exam

296
Q

Erysipelas treatment

A

Penicillin V potassium
Amoxicillin
Cephalexin
Cefadroxil

297
Q

Erysipelas treatment for high risk or immunocompromised

A

Cefazolin
Nafcillin
Oxacillin

298
Q

Skin abscess

A

Colllection of puss in dermis or subcutaneous space
Usually S. aureus (can be MRSA)
Painful
Spontaneous drainage can occur

299
Q

Skin abscess treatment

A

Incision and drainage
Culture drainage for anaerobic/aerobic bacteria.
Give antibiotics that cover MRSA (trimethoprim-sulfamethoxazole, doxycycline, minocycline)
Large abscess needs IV therapy after.
Don’t pack wound

300
Q

Treatment for abscess followed by sepsis

A

Vancomycin and cefepime or Meropenem

301
Q

Carbuncle

A

Made up of furuncles.
Usually S. aureus.
most common presentation of MRSA
Furuncles are firm, tender, red nodules
Carbuncles larger

302
Q

Furuncle and carbuncle treatment

A

Incision and drainage
Culture of drainage
Trimethoprim-sulfamethoxazole, doxycycline, minocycline
IV vancomycin or daptomycin if septic
Severe sepsis needs vancomycin and cefepime or meropenem

303
Q

Folliculitis

A

Inflammation of hair follicle.
Usually infectious
Staph aureus most common (MRSA possibly)
Follicular pastules and inflammed papules

304
Q

Folliculitis barbae

A

Bacterial folliculitis of hair follicles of beard and face

305
Q

Hot tub folliculitis

A

Pseudomonas aeruginosa

306
Q

Folliculitis diagnosis

A

Pt history and physical exam.
Gram stain
KOH for fungal

307
Q

Folliculitis treatment if MRSA suspected

A

Doxycycline
Trimethoprim-sulfamethoxazole
Clindamycin

308
Q

Persistent folliculitis treatment

A

Dicloxacillin
cephalexin

309
Q

Impetigo

A

Direct bacterial invasion or infection at skin trauma.
Usually staph aureus
Could be Strep A

310
Q

Nonbullous impetigo

A

most common impetigo
Lesions to papules
Thick honey crust

311
Q

Mild impetigo treatment

A

Mupirocin or retapamulin

312
Q

Extensive impetigo treatment

A

Dicloxacillin
Cephalexin

313
Q

Impetigo treatment with penicillin allergy

A

Erthtomycin or clarithromycin

314
Q

Impetigo treatment if MRSA suspected

A

Doxycycline
Trimethoprim-sulfamethoxazole
Clindamycin

315
Q

Type I soft tissue infection

A

Polymicrobial
Aerobic or anaerobic
Co-morbidities at older ages

316
Q

Type II necrotizing soft tissue infection

A

Monomicrobial
Group A-hemolytic strep or
Staph. aureus

317
Q

Necrotizing myositis

A

Very rare
Blunt trauma or heavy exercise

318
Q

Necrotizing cellulitis

A

Anaerobic pathogens

319
Q

How to diagnose and treat necrotizing soft tissue infections

A

Surgical exploration.
Surgery needed in 24 hours
Amputation may be necessary
CT scan gas seen from bacteria
In OR gas can be heard from bacteria eating
Broad spectrum ABx

320
Q

Clostridial myonecrosis

A

Gas Gangrene
Necrotizing infection
Traumatic is Clostridium perfringens.
Spontaneous is Clostridium septicum

321
Q

Traumatic clostridial myonecrosis clinical manifestation

A

Sudden onset of pain at trauma site.
May appear pale then bronze then red/purple
Crepitus in soft tissue
Gas in deep tissues seen in CT

322
Q

Tramatic clostridial myonecrosis labs

A

Blood and tissue cultures
CBC
CMP
Large Gram variable rods at injury

323
Q

Traumatic clostridial myonecrosis treatment

A

Surgical debridement.
Antibiotics that cover clostridium and group A strep
Same for spontaneous

324
Q

Spontaneous clostridial myonectosis

A

Clostridium septicum
GI tract
Neutropenic pts
GI lesion allows it into blood.
Purpleish fluid

325
Q

Direct specimen

A

Pathogeni localized in sterile site
Surgical or needle aspiration
CSF, liver, lung, blood

326
Q

Indirect specimen

A

Pathogen localized but must pass through site containing normal flora to be collected
Sputum or urine sample

327
Q

Mixed sample

A

Sample site with normal flora.
Throat and stool

328
Q

Susceptible

A

Organism inhibited by serum concentration of drug using usual dosage

329
Q

Intermediate

A

Organism inhibited by only maximum dosage

330
Q

Resistant

A

Organism resistant to achievable serum drug levels

331
Q

What to consider when choosing ABx

A

Efficacy
Cost
Side effects
Resistance
Drug availability at site of infection

332
Q

Class I wound

A

Clean wound with no iflammation
Mostly closed

333
Q

Class II wound

A

Clean-contaminated

334
Q

Class III wound

A

Contaminated
Open, fresh, accidental

335
Q

Class IV wound

A

Dirty/infected
Old traumatic would with stuff inside

336
Q

When should prophyalctic antimicrobial therapy start for surgery

A

60 minutes before surgery

337
Q

When to discontinue prophylactic antimicrobial therapy for surgery

A

24 hrs after surgery

338
Q
A

PAS 506 (9 decks)

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