Green PANCE book Flashcards
How is norovirus spread?
Food
water
person to person
Onset 1-3 days
Watery diarrhea
Low grade fever
Duration= 1-2 days
Therapy= hydration! and prevention (hand washing)
Norovirus
How is cholera (vibrio spp.) spread?
Water
Onset 2-3 days Profuse, watery diarrhea Some N/V Rarely a fever Duration= days!
Therapy= hydration!
Cholera (vibrio spp.)
What is the source of enterotoxic E. coli
Food
Onset 5-15 days Cramping, watery diarrhea Some N/V Low grade fever Duration= 1-5 days
Therapy= hydration, bismuth/loperamide
Enterotoxic E. Coli
What is the source of Salmonella?
Poultry
Onset 6-72 hours Purulent diarrhea Nausea, some vomiting FEVER! Septicemia Duration= 4-7 days
Therapy= hydration!
Salmonella
What is the source of Enterohemorrhagic E. coli?
Undercooked ground beef
Onset 12-60 hours Purulent, bloody diarrhea. cramping No N/V Fever Duration= 5-10 days
Therapy= supportive, unless severe
Enterohemorrhagic E. Coli
What is the source of Shigella?
Fecal-oral
Onset 1-6 days Purulent, bloody diarrhea. cramping No N/V Fever Duration= 1-7 days
Therapy= supportive
Shigella
systemic immune response occurring 15-20 days after exposure to streptococcal pharyngitis
*early tx of streptococcal infection is imperative to prevent!
Acute rheumatic fever
A strictly anaerobic, spore forming bacillus found in the soil
*may accidentally end up in food (home canned, smoked or commercial)
Clostridium botulinum
Inhibits the release of Ach at the neuromuscular junction
- IV drug users at high risk!
- babies who eat honey are at high risk!
Botulism
Initial clinical sx= visual changes, including diplopia and loss of accommodation
*manifestation usually 12-36 H after ingestion
Additional sxs…ptosis, impaired EOM, fixed dilated pupils, cranial nerve palsies, dysphonia, dry mouth, dysphagia, N/V
Botulism
Tx of botulism?
Anti toxin
and respiratory support if needed
Produces a toxin than activates adenylyl cyclase in intestinal epithelia cells of the small intestine..results in hyper secretion of water and Cl ion and massive diarrhea
*death results from HYPOvolemia
Cholera
“rice water” diarrhea (gray, turbid and without odor, blood or pus”
Cholera
stool cultures positive for Vibrio cholerae
Tx of cholera
Fluid and electrolyte replacement
Oral if tolerated, IV if severe
*Abx will shorten duration and reduce severity of symptoms (tetracycline, ampicillin, etc)
Is a cholera vaccine available?
Yes! but protection is temporary, with boosters needed every 6 months
Clostridium tetani spores are found in…
soil
Spores germinate in wounds (esp puncture wounds!!) where the bacteria produce a neurotoxin, which interferes with neurotransmission at spinal synapses of inhibitory neurons
*result=uncontrolled spasm and exaggerated reflexes
Tetanus
incubation pd= 5 days to 15 weeks
Pain and tingling at site of inoculation, followed by spasticity of muscles nearby
- *jaw and neck stiffness, dysphagia, irritability
- hyerperreflexia and muscle spasms, especially in jaw (truisms) and face
Tetanus
Painful tonic convulsions, spasms of the glottis and respiratory muscles and asphyxia if pts is untreated
Tetanus
Treatment for tetanus?
Tetanus immune globulin given intramuscularly (IM)
Full course of tetanus toxoid once pt recovers
Salmonella enteric are transmitted by ingestion of contaminated….
food and water
Enteric fever (typhoid fever)
Gastroenteritis
Bacteremia
3 patterns of Salmonellosis
incubation pd 5-14 days
*organisms enter mucosal epithelium of the intestine and invade and replicate within macrophages in Peyer patches, mesenteric lymph nodes and the spleen
Enteric (typhoid) fever
Onset insidious with a prodrome of malaise, HA, cough and sore throat
*abdominal pain, distention and constipation and/or diarrhea (“pea soup”) develops as fever increases
*fever reaches peak on 7-10 days and the pt appears toxic, then generally improves over the next 7-10 days
Typhoid fever
Splenomegaly, abdominal distention and tenderness, bradycardia
- rash develops during second week
- organism can be isolated from blood during 1st week
Typhoid fever
DOC- ampicillin, chloramphenicol, TMP-SMX
if resistant, ceftriaxone or fluoroquinolones
Typhoid fever
Most common form of Salmonella infection
*incubation= 8-48 hrs after ingestion of food or drink that is contaminated
fever, N/V/D
BLOOD DIARRHEA 3-5 DAYS!
Gastroenteritis
Dx and treatment of Gastroenteritis
Dx= stool culture
Tx=usually self limiting
Caused by salmonella
*characterized by prolonged or recurrent fevers, can have local infection in bone, joints, pleura, pericardium, lungs or other sites
Bacteremia
Shigella sonnei
Shigella flexneri
Shigella dysenteriae
*most common species that cause dysentery
Shigellosis
Illness starts abruptly with diarrhea, lower abdominal cramps and tenesmus accompanied by fever, chills, anorexia, HA and malase
stools are loose and mixed with blood and mucus!***
Shigellosis
Stool positive for leukocytes and RBCs, culture yields shigella spp.
*sigmoidoscopy will reveal inflamed engorged mucosa, punctate lesions or ulcers
Shigellosis
Shigellosis tx
Replacement of fluid volume
Abx= TMP-SMX
Corynebacterium diphtheria is transmitted via…
respiratory secretions
organism has a propensity for mucous membranes, especially respiratory tract
- nasal infection produces few symptoms other than nasal discharge
- laryngeal infection causes upper airway and bronchial obstruction
- pharyngeal is MOST COMMON! a tenacious gray membrane cover the tonsils and phyarnx. pt will have mild sore throat, fever and malaise
- myocarditis ad neuropathy
types of Diphtheria infections
Pharyngeal infection= most common type!!
A tenacious gray membrane covers the tonsils and pharynx, and pts complain of mild sore throat, fever, malaise
Diphtheria
diagnosis is clinical!!!!
A horse serum antitoxin must be given in all cases of…
Diphtheria
Does diphtheria have a vaccine?
YES!
Human herpes virus 4, a universal virus transmitted via saliva
EBV
Mono Burkitt lymphoma Nasopharyngeal carcino,a Pediatric leiomyomas Collagen vascular dz
caused by EBV
Oral lesions: exudative pharyngitis, tonsillitis, gingivitis, soft palate petechiae
*malaise, anorexia, myalgias
EBV
An early granulocytopenia is followed by a lymphocytic leukocytosis
*atypical leukocytes appear as larger cells that stain darker and frequently vacuolated
EBV
Tx of EBV?
Symptomatic!
caused by orthomyxovirus
*readily transmitted thru droplet nuclei and occurs in epidemics and pandemics during fall and winter
influenza
3 strains exist: A (more pathogenic), B, C
*different types based on surface antigens hemagglutinin (H) and neuraminidase (N)
influenza
Incubation period 18-72 hours
fever, chills, malaise, muscle aches, substernal CP, HA, nasal stuffiness
fever lasts 1-7 days accompanied by coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection and flushed facies
influenza
Reye syndrome (fatty liver with encephalopathy) is a potential complication
influenza
Tx of influenza
supportive care
member of herpesvirus family
- highly contagious, especially the day before the rash appears
- incubation period is 10-20 days
benign in children, can be life threaetning in elderly or immunocompromised
Varicella(chicken pox)
lesions begin as erythematous eruption that follows a centripetal pattern
- lesions appear in crops
- mucous membranes may be involved
Varicella (chicken pox)
painful eruptions along dermatomal pattern
thoracic and lumbar regions!
trigeminal eruptions that include the tip of the nose (Hutchinsons sign) risk corneal involvement
Zoster (shingles)
Rhabdovirus is transmitted via infection from an animal bite or an open wound
*vectors= bats, dogs, foxes, raccoons, coyotes,
Rabies
incubation pd between bite and onset of symptoms in from 10 days-years (typically 3-7 weeks)
typically pain and prosthesis at site; skin is sensitive to changes in temp and wind
rabies
pts are restless, with muscle spasms and extreme excitability
Bizarre behavior, convulsions, paralysis
*THICK, tenacious saliva
*hydrophobia (painful spasms caused by drinking water)
Rabies
Suspect animals: brains tested for virus using fluorescent antibody markers
*CSF may show rabies revere transcriptase by PCR
Rabies
Is there a cure for rabies?
NO! prevention is key!!
Post exposure immunization includes rabies immunoglobulin (in wound and IM at a distant site)
Rabies
if pt has receives active immunization in past, immunoglobulin is NOT given
Pre exposure vaccination of persons at high risk
rabies
infects all cells containing the T4 antigen, primarily the CD4 helper inducer lymphocytes
*transmitted thru bodily fluids
HIV
CD4 count below 200
AIDS
the measure of actively replicating virus
viral load
if possibly exposed to HIV, post exposure prophylaxis should be started within…
72 hours
secondary prevention efforts include anti-retrovirals and chemoprophylaxis
HIV treatment
Spread via… Sex, breast milk, blood transfusions, respiratory droplets
- *owl eyes in biopsy
- *pizza pie retinopathy
Cytomegalovirus (herpes virus 5)
Dimorphic fungus found in soil infested with bird and bat droppings
Histoplasmosis
Urine assay can be used to confirm dx
DOC= itraconazole
Histoplasmosis
Encapsulated budding yeast found in soil with dried pigeon dung
Pulmonary dz can develop
Fever,cough dyspnea
Dx= CSF. Tx=Fluconazole
Cryptococcus
India ink stain or serology with latex agglutination used in dx of
Cryptococcus
Fungus found in lungs of humans and animals
**MOST COMMON HIV OPPORTUNISTIC INFECTIONS
SOB, nonproductive cough
Diffuse interstitial infiltrates
DOC: TMP-SMX
Pneumocystis jiroveci pneumonia
Enterobius vermicularis (humans only host)
Perianal itching
Scotch tape test
DOC= albendazole for whole house
Pinworms
