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Foundations of Clinical Medicine > Foundations: Infectious Disease 2 > Flashcards

Foundations: Infectious Disease 2 Flashcards

1
Q

What is an infectious dose?

A

The amount of pathogen required to cause an infection in the host

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2
Q

What is “shedding”?

A

The successful reproduction, expulsion, and host-cell infection caused by virus progeny

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3
Q

What does PCR do?

A

Amplifies a single or a few copies of a piece of DNA to generate thousands to millions of copies

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4
Q

What does immunofluorescent assays and ELISA do?

A

Use an enzyme immunoassay to detect the presence of a substance (antigen)

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5
Q

What 3 diseases account for half of deaths due to infectious diseases?

A

Tuberculosis
Malaria
AIDS

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6
Q

How is African Trypanosomiasis spread?

A

By the tsetse fly spreading protozoa Trypanosoma brucei

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7
Q

What do parasites produce in African Trypanosomiasis?

A

Tryptophol

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8
Q

Describe symptoms that would present during the early (hemolytic) phase of African Trypanosomiasis.

A

Fever, headaches, arthralgia, pruritis

Parasites invade circulatory and lymphatic systems

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9
Q

Describe the symptoms that would present during the second (neurologic) stage of African Trypanosomiasis.

A

Confusion, poor coordination, disrupted sleep

Parasites invade CNS, pass thru blood brain barrier

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10
Q

How is Cholera spread?

A

Through contaminated drinking water, unsanitary conditions

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11
Q

What bacterium is responsible for Cholera?

A

Vibrio cholerae
gram-
facultative anaerobe
unipolar flagellum

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12
Q

What does Vibrio cholerae secrete and what does it cause?

A

Secretes cholera toxin which produces watery diarrhea

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13
Q

What symptoms would a person with Cholera present with?

A 
Abdominal cramps
watery diarrhea
excessive thirst
dry mucus membranes
sunken eyes
lack of tears
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14
Q

What is one of the most common causes of waterborne illness in the US?

A

Cryptosporidiosis enteritis

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15
Q

How is Cryptosporidiosis spread?

A

Fecal oral

parasites transmitted by microbial cysts (oocysts)

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16
Q

What is the incubation period of Cryptosporidiosis?

A

1-30 days, median of 7 days

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17
Q

When does Cryptosporidiosis shedding stop?

A

After 2 weeks

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18
Q

What cells are primarily affected by Cryptosporidiosis?

A

Intestinal epithelial cells of small intestines and proximal colon

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19
Q

Describe sporadic Cryptosporidiosis.

A

Water-related outbreaks of self-limited diarrhea in immunocompetent host

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20
Q

Describe chronic Cryptosporidiosis.

A

Life-threatening in immunocompromised patients, especially those with HIV

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21
Q

Describe the third main form of Cryptosporidiosis.

A

Diarrhea and malnutrition in young children in developing countries

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22
Q

Where is Cryptosporidiosis most commonly isolated?

A

In HIV+ patients presenting with diarrhea

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23
Q

What populations are at high risk of catching Cryptosporidiosis?

A

Animal handlers
MSM
Ppl having close contact with infected ppl
Young children

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24
Q

How can you diagnose Cryptosporidiosis?

A

Find the antibody in stool
Parasite exam with microscope
Immunofluorescent assays and ELISA to detect antigen and oocysts

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25
Q

How is Dengue Fever spread?

A

Through bites of Aedes aegypti mosquito in Asia and Africa

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26
Q

What symptoms would someone with Dengue Fever present with?

A

Abrupt fever > 40*C of 2-7 days duration

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27
Q

How does mild Dengue Fever present?

A

Usually in infants and young children

Nonspecific febrile illness

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28
Q

How does moderate Dengue Fever present?

A 
In older children and adults
High fever
Severe HA
Myalgia/arthralgia
Rash
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29
Q

How does severe Dengue Fever present?

A

As Dengue hemorrhagic fever
High fever
Hemorrhaging
Circulatory failure

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30
Q

How would you test for Dengue Fever?

A

Look for the antibody (IgM or IgG)
A CBC for leukopenia and thrombocytopenia
PCR for dengue virus types

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31
Q

How would you treat Dengue Fever?

A

Get rid of standing water.

No specific treatments.

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32
Q

How many leukocytes would you find in a CBC for Dengue Fever?

A

<3500 WBCs/mL (leukopenia)

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33
Q

How many platelets would you find in a CBC for Dengue Fever?

A

<50,000 platelets/mL (thrombocytopenia)

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34
Q

What type of infection usually causes hepatitis?

A

Viral infections

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35
Q

Which types lead to chronic disease?

A

B & C

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36
Q

What can hepatitis commonly cause?

A

Liver cirrhosis
cancer
transplant

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37
Q

What types are typically caused by ingesting contaminated food or water?

A

A & E

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38
Q

What types are usually caused by parenteral contact with infected body fluids?

A

B, C & D

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39
Q

How is HAV spread?

A

Fecal-oral
Ingestion of contaminated water/food (shellfish)
Direct contact with infected person

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40
Q

When is the greatest infectivity of HAV?

A

2 weeks before onset of symptoms

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41
Q

How long is the incubation period for HAV?

A

About 28 days

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42
Q

Does HAV infection severity increase or decrease with age?

A

Increases with age

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43
Q

What symptoms would a person with HAV present with?

A 
Fever
dark urine
malaise/fatigue
jaundice
distaste for smoking
44
Q

What would you find during a physical exam of someone with HAV?

A 
Hepatomegaly
fever
jaundice
icterus
hives
RUQ tenderness
45
Q

What population accounts for over 50% of cases in north American and Europe?

A

Foreign travel to developing countries

46
Q

What is a normal level of Aspartate Aminotransferase (AST)?

A

2-4 IU/L

47
Q

What is a normal level of Alanine Aminotransferase (ALT)?

A

2-40 IU/L

48
Q

What is the normal AST:ALT?

A

<1

49
Q

What is an AST:ALT >2:1 associated with?

A

Viral/alcoholic hepatitis, hepatocellular carcinoma

50
Q

What is an AST:ALT 1-2 associated with?

A

Cirrhosis

51
Q

How high could the AST:ALT get with HAV?

A

Could exceed 10,000

52
Q

What immunoglobulins are present?

A

Anti-HAV IgM (onset of symptoms)

Anti-HAV IgG (soon after IgM, persists for years)

53
Q

What titer would appear positive for HAV before IgM and IgG?

A

Fecal HAV

54
Q

What do you have to do whenever someone tests positive for HAV?

A

Report to local public health department

55
Q

What would the follow-up recommendations be for someone with HAV?

A

Can return to work/school 10-14 days after onset of symptoms

56
Q

How would you treat HAV?

A

No antivirals… resolves spontaneously

57
Q

What type of virus is HAV?

A

RNA enterovirus

member of Picornavirdae family

58
Q

What type of virus is HBV?

A

DNA virus

member of Hepadnaviridae family

59
Q

What is the most common infectious disease in the world?

A

HBV

60
Q

What sex is affected more by HBV?

A

Male>Female (2:1)

61
Q

How would an individual with acute HBV present?

A 
Fever/malaise
Anorexia
Jaundice/icterus
Dark urine/pale stools 
RUQ pain
62
Q

How would an individual with chronic HBV present?

A

Asymptomatic

63
Q

What would you find during a physical exam of someone with noncirrhotic chronic HBV?

A

Usually normal

64
Q

Who should you screen and vaccinate if screen is negative?

A 
Ppl from endemic areas
IV drug users
MSM
HIV and HCV+ ppl
Inmates of correctional facilities
65
Q

What is the incubation period for HBV?

A

6 weeks to 6 months with insidious onset

66
Q

What will be the first evidence of clinical HBV infection?

A

Elevated HBsAg

67
Q

What does HbeAg indicate?

A

Viral replication and infectivity (secretory form of HBcAg during incubation period)

68
Q

What is the second evidence of clinical HBV infection?

A

Anti-HBc (since HbcAg does not appear in the serum)

69
Q

What results would indicate an acute HBV infection?

A

+IgM HBcAb

70
Q

What results would indicate a chronic HBV infection?

A

-IgM

+IgG or total HBcAb

71
Q

When does Anti-HBs show up?

A

After clearance of HBsAg and after successful vaccination against HBV

72
Q

What type of virus is HCV?

A

RNA virus

family Flaviviridae

73
Q

What ages are most prevalently affected by HCV?

A

Between 40-60

74
Q

How does acute HCV present?

A

Symptoms develop about 2 weeks after exposure (rare)

75
Q

How does chronic HCV present?

A

Mildly symptomatic (fatigue) or asymptomatic elevated ALT/AST for 2-12 weeks

76
Q

What symptoms would a person with acute HCV present with?

A

Fever, malaise, nausea, jaundice/icterus, dark urine, RUQ pain

77
Q

What percentage of acute HCV become chronic?

A

70-80%

78
Q

What percentage of chronic HCV is curable?

A

~50%

79
Q

What are some conditions associated with HCV?

A 
Diabetes
Metabolic syndrome
Iron overload
Depression
Substance abuse
80
Q

What would you find on a physical exam of someone with HCV?

A

Normal unless advanced fibrosis/cirrhosis

81
Q

What lab tests can be used to test for HCV?

A

Test for Ab to HCV (4-10 weeks after infection)

Qualitative test for presence/absence of virus (PCR) (2-3 weeks after infection)

82
Q

Why is it beneficial to catch an HCV infection early?

A

The earlier you catch the disease, the healthier the patient is, the better the patient can take the harsh treatment

83
Q

What type of virus is HDV?

A

RNA virus that requires the presence of HBV

84
Q

What part of HBV envelopes HDV?

A

A lipoprotein coat from HBsAg

85
Q

What populations are at high risk for HDV infection?

A

HBsAg-positive prostitutes, MSM

IV drug users

86
Q

How is HDV spread?

A

Percutaneous or mucosal contact with infectious blood

87
Q

What signature symptom develops after the disappearance of typical hepatitis symptoms?

A

Jaundice reflects the initial acute infection

88
Q

What is more likely to happen with concurrent HBV and HDV infections?

A

Fulminant hepatitis

progress to chronic liver disease

89
Q

Who would you screen for HDV?

A

Patients who are HBsAg+
Patients with acute/chronic hepatitis
Patients with acute HBV

90
Q

How would you diagnose HEV?

A

Reverse transcriptase PCR to detect the HEV RNA

Immune electron microscopy

91
Q

What is Hepatitis F?

A

dsDNA that is different from HAV and HEV (both RNA)

92
Q

What is GBV/C?

A

Usually patients with “hepatitis G” are infected with HBV and/or HCV

93
Q

What cell is infected with HIV?

A

CD4+ cell

94
Q

What does the HIV release into the CD4+ cell?

A

Viral RNA and reverse transcriptase

95
Q

How long would it take for an HIV+ patient to develop AIDS without antiretroviral treatment?

A

About 10 years after transmission

96
Q

What CD4 count defines AIDS?

A

<200 CD4 cells

97
Q

What is the biggest risk factor for HIV infection?

A

Sexual activity. It accounts for 70% of world transmission.

98
Q

What is the strongest predictor of heterosexual transmission?

A

Viral load

99
Q

What is the strongest predictor of transmission risk from mother to child?

A

Maternal HIV-1 RNA level

100
Q

Can HIV be transmitted via breast milk?

A

Yes

101
Q

How do you treat HIV+ pregnant women?

A

Until viral load is undetectable

102
Q

Name another risk factor for HIV infection besides sexual activity.

A

Recipients of blood products (1975-1985)

IV drug use

103
Q

Name some conditions associated with HIV.

A

More aggressive Syphilis
100x greater risk for developing TB
More rapid cirrhosis in HCV

104
Q

What symptoms could an HIV+ patient present with?

A 
Similar to mononucleosis:
Fever
Adenopathy
Pharyngitis
Rash
Myalgia/arthralgia
105
Q

What defines acute retroviral syndrome?

A

Decline in CD4 lymphocytes
Increased viremia
1-4 weeks after transmission
high HIV RNA in absence of HIV Ab

106
Q

What defines seroconversion?

A

Positive HIV Ab test within 4 weeks of acute infection and invariably by 6 months

107
Q

How does acute retroviral syndrome acquired by sexual activity cause infection?

A

Virus enters in infected macrophages
Dendritic cells carry virus to lymph nodes
CD4+ cells become infected

Foundations of Clinical Medicine (5 decks)

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