Hancock week 1, zoonosis, parasitology, mycosis Flashcards
Malaria transmission
anapheles mosquitos
Malaria Cause
plasmodium falciparum
Severe Malaria SX
unarousable coma/cerebral malaria, renal failure no imp with hydration
Peripheral smear findings
thick tells you detection of parasites
thin: identification of species
Malaria poor prognosis SX
marked agitation, respiratory distress, bleeding spontaneously, anuria, hypothermic,
Chloroquine
lots of resistance only use when patient going to Haiti
Mefloquine
taken 1x a week start 2-3 wks before to weed of psych effects travel and continue 4 wks after. Use for long travel periods (missionaries)
Doxycycline
cheap commonly available take everyday up to 4 wks after return from travel Side effects: photosensitivity/ GI
malarone
atovaquine + proguanil
take everyday start 2 days before entering the country and continue for 7 days after leaving the country. EXPENSIVE CI: renal dz and pregnancy. Hancock uses this plus doxy.
Malaria Management
therapy based on plasmodium Consult w/ CDC
Uncomplicated Malaria TX
Artemether +lumefantrine
Malaria Haiti TX
Chloroquine
Primaquine
can cause hemolytic anemia d/t G6PD or fava beans.
Severe Malaria TX
Artesunate IV
Schistosomiasis causative agents
snail fever schistosoma species
Schistosomiasis transmission
blood flukes entering skin from contaminated water
Schistosomiasis Katayama fever
occurs with S mansoni and S japanicum. bright red poop, vesicular rash
Diagnostic testins Schistosomiasis
esonophillia
Tx Schistomisasis
Praziquantel
Toxoplasmosis causative agent
toxoplasma gondii
Toxoplasmosis transmission
cat feces
Toxoplasmosis Congenital vertical transmission
highest risk in the third trimesters eye issues
Toxoplasmosis congenital infection early
early fetal infections the body makes an abortion,
Congenital infection late
Retinochroiditis MC late finding and worse
Management of toxoplasmosis
pyrimethamine
Pregnant mom and toxoplasmosis
wear a mask and gloves when changing litter box, wash pork and fruits properly
Scabies findings
scaroptes scabiei. intense itch, serpentious tract, burrow scabies
flea bite difference from scabies
more disctinit lesions
Scabies tx
permethirin 5% cream repeat 1-2 wks
lice tx lindane 1% ADE
nuerotoxic side effects
pediculosis
transmission: hat, towewls, combs
Body lice complication
body louse caries epidemic typhus
How can you find lice
Woods lamp
how do you know if you have bedbugs?
get the bug get the rash
bedbugs management long term
malathion
Ascariasis causative agent
ascaris lumbricoides
transmission way of ascariasis
fecal oral
ascariasis tx
ivermectin
Pinworms sx
itchy butt
Pinworms mate site
adult male and female mate in the terminal ileocecal region tx: scotch tape test
pin worm Tx
pyrantel pamoate, proper hygiene treat 2 weeks apart
Hook worm necatoriasis
dermal to exposure to fecal contaminated soil
necatoriasis findings
iron deficiency micorcytic anemia, loss or protein
necatoriasis tx
tx with iron pills d/t deficiency
cysticercosis pork tapewrom
taenia slium (pork)
pork tapeworms finidngs
seizures, ring enhnced lesions in mri, egggs in teh stool
Pork tapeworms tx
Praziquantel prevention: sanitation and proper hygiene
beef tapewrom causative agent
taenia saginata
Trichinellosis transmission
trichinella spiralis eating uncooked pork
Trichinelosis cause of death
myocardidtis rare but causes death
Rocky mountain spotted fever
ricketssa richetssi
transmission of spotted fever
tick bites animal bites you then you get this rash
Rocky mountain spotted fever rash
centripital inward rash starts at wrists then comes in affects soles of feet
Rocky mountain spotted fever to
doxycicline 100 mg x7 days
Prevention of rocky mountain fever
wear clothes
Lyme Dz causative agent
borrelia Bugdoferi spirochete
Vector of Lyme dz
tick related
Lyme stages Stage 1
bulls eye lesion, erythema migrans
Lyme stage2
cranial neuropathy bilateral bell spalsy caridaca AV block
Lyme stage 3
neurologic manifestations chronic fatigue, chronic arhtritis
Lyme Diagnosis
HX AND TX!!!
lYM dZ CAN TEST POSTIIVE FOR CYPHILIS
So do VDRL test
Lyme Dz Tx
Oral doxycicline x21 days CI in pregnancy Kids under 8 d/t staining of teeth
amoxocillion and cefuroxime- increase therapy 30-60 days if neuro involvment
causative agents of Tularemia
francisella tularensis
Tularemia reservoir
rodents parie dogs
Tularemia Ulcerglandular
Most common kind of tularemia
oculoglandular tularemia
touched ur eye ulcerations in the conjuctiva after you killed the praire dog you touch yourself
Talareumia pnuemonia
30% likley hood of death hlar lymphnodanenopathy “lawn mover tularemia” mowed dead rabiit
TX Tularemia
streptomyocin, or gentamycin
Tularemia BW agent
developed resistant strains for war
Ocular tularemia Hallmark
prearicular LAD
Relapsing fever
fever comes and goes and fever and come chill and flush phase
Relapsing fevers complications
pregnancy complications, iritis, uveitis
Relapsing fever tx
Doxycicline
causative agent of Dengue Fever
dengue fever, flaviviridae
Dengue fever manifestations
retroorbital headache, malaisse, rash, shock, saddleback pattern where it gets better then worse
Dengue phases
febrile, critical, recovery
Febrile phase
fever, HA, rash, easy bleeidng, + torniquete test petichae
Critical phase Dengue hemorrhagic fever phase
massive bullae gi hemmrhage, ulcerations, dengue shock syndrome may occur
Dengue recovery phase
rash of white islands in the sea of red
Dengue fever management
supportive, avoid NSAIDS D/T Thrombocytopenia
Causative agent of Zika
aedes aegypti
Zika manifestations
mosquito borne illness, rash starting at teh face and spreading out
Zika clinical manifestations in pregnancy
microcephaly shrinking of the head and brain defect
Zika and semen
zika can be detected in semen up to 3-6 mo after initial infection
Zika diagnosis
serology testing avoid nsaids until dengue is ruled out
Zika prevention
avoid mosquitos, sex, use condoms 8 weeks after travel, vertical mom to fetus transtion
Ebola Hemorrhagic fever causative agent
ebola virus reservoir fruit bats
Geographic area of Ebola
africa west and central
Transmission of ebola
humans and primates w/ high mortality
Ebola transmission
consuming bushmeats, bats, gorillas, chimps, shrew, dead bodies
Ebola resvoir
fruit bats
Ebola sx
turns internal organs in to garbage, if a hole, bleeds
Ebola tx
supportive
Western nile virus
vector mosquitos
manifestations Western nile
fevers, ha, encephalation less than 1 %
western nile mortallty
will have neurologica sequela if they get encephalitis
west nile tx
supportive
Wester equine virus
encephalitis mostly in kids.
western equine tx
supportive
mosquito japanese encephalitis
asia and western pacific regions and common after heavy rainfall mortality 30%
Japanease encephalitis tx
vaccines and supportive
Mosquitos borne eastern equine encephalitis
the most sever mosquitos borne illness in the US, progresses from mental status change, seizures and coma
eastern equine tx
supportive
Hantavirus pulmonary syndrome reservoir
deer mice sin nombre virus inhalation from mice saliva, poop.
Hantavirus prodromal, cardiopulmonary, convalescent
Three phases
Cardiovascular collapse hanta virus
pulmonary edema, dyspnea, cardiovascular collapse
convalescent phase hanta virus
onset of massive diuresis
Hantavirus TX
antiviral ribavirin ICU may help
Plagues causative agent
Yersina pestis
Vector of plague
rat flea
plagues reservoir
rats, mice, rodents, foxes, coyotes, wild cats
Bubonic plague
MC form of the dz by bite of infected flea big lymph-nodes
Bubos are ?
open ulcers
Bubonic plague named black bc
blood clots leading to arteriolar obstruction and gangrene
Pneumonic plague
inhaled into lungs peron to person or BW
Pneumonic plague
1-6 days after exposure pneumonia occurs
Pneumonic plague
high mortality rapid decline respiratory failure
Septisemic plague
gets into the blood sudden insent of fever no bullae high high mortality rate
Plague testing
leukocytosis with immature neutrophils sample the fluid
Plague TX
Streptomyocin and gentamyocin
Rabies causative agent
rhabdoviridae
Rabies
bats and doggos
Rabies and severity/ development
Wound severity wound location in relation to the nerves and relative distance to the brain
Rabies
fatal viral encephalitis
Rabies and corneal transplant
CAN GIVE YOU RABIES
Rabies manifestation
Rabies treated right away you are good. vaccine tx and rabies immunoglobin if in first 72 hours. if not then your screwed
Rabies manifestation
hydrophobia inability to drink, laryngeal spasm
Two types of rabies
furious rabies more common the second type paralytic rabies
Furious rabies
aggressive, agitaion, hypertension, tachy, hydrophobia
Paralytic rabies
confusion, loss of coordination, stupor, ascending paralysis
Rabies dx
virus antigen and PCR indetification of virus in the NEGRI BODIES
Rabies tx
clean wound soap and water capture animal if possible destroyed and send evaluation of brain tissue
Rabies tx
passive immunizations administer human rabies to the wound and immunoglobulin
Rabies tx active immunizations
three IM doses in the deltoid or thigh over a 28 day period
Cat scratch DZ
bartonella henselae
cat thing Vector
cat flea
cat dz resevoir
kitten
cat scratch dz
linear papules and nodules refelct cat scrathc
Cat scrathc dx manifestations rare
meningitis, osteomyolitis, endocarditis
Cat scratch DZ
parinuads oculoglandular syndrome conjuctivitis
scrtach cat tx dz
azithrmycin
Cat Bite Pasteurella multocida
encapsulated gram negative rod do not suture these closed
Pateurella mulocida hallmark
cellulitis near the bite and complicated by osetomyilitis
tx pasteruella multocida
augementin
causative agent Chagas Dz
trypanosoma cruzi
chagoma
localized erythema and edema where parasite entered the skin
romana sign
painless palpebral edema and conjuctivitis
tramsmission Chagas DZ
mom to baby, contaminated food water
chagas phase acute
showing of chagoma and romana sign
chagas intermediate/ chronic phase
state of latency
Chagas chronic
dilated cardiomyopathy, megaesophagus,achlasia, megacolon
Psittacosis causative agent
chlamydia psittaci comes from BIRDS SHIT
Psittacosis manifestations
atypical pneumonia, sever HA, w /photophobia ,
TX Psitttacosis
DOXYCICLINE OR TETRACYCLINE RAPID IMPORVEMNT, Z PAK CAN HELP
Causative agent of Brucellosis
brucella found in sheep
Manifestations of Brucellosis
effects, lungs, heart, eyes
Tx Brucellosis
cipro+ rifambin or +doxy
Where is HIV the worse
Africa hardest hit area
Who should get tested for HIV
everyone ages 15-65 regardless of risk at least 1 time
Healthcare workers how do they get it
Needle sticks on accident cries
CD4 Count under 200
opportunistic infections start to present
CD4 count
measure status of immune system and dz progression
Viral load serology
measures efficacy of HAART therapy
Viral load vs CD4 count
The higher the CD4 count the more response to the virus.
HIV initial manifestation
mimics mono truncal macular papular rash this phase 3 days 2 wks
Seropositive
longest HIV phase, no sx of HIV infection phase lasts 4-7 yrs.
“Pre Aids” symptomatic HIV infection
persistent lymphadenopathy, fungal infections, hairy leukoplakia, molluscum contagious
AIDS
Marked immune suppression malignancies and infections begin CD4 count below 200
HIV Transmission
male sex, IV drug abuse, hetero sex, perinatal transmission
Can I get HIV from saliva and tears
no
What is the highest risk
unprotected anal and receptive intercourse
Latex condoms
70 to 80% decrease in risk
Cocaine injection sex
bartering for sex higher risk
Vertical Transmission
in utero, childbirth, breast feeding
Breast feeding
50% increase risk with prolonged breast feeding
perinatal transmission
most common transmission of HIV to children
Postexposure prophylaxis for HIV
emtricitabine, raltegravir, tenofovir Continue for 4 wks
HIv post : efavirenz
side effect: CNS
hiv post: Indinavir
crystal induced nephropathy
HIV TX post: protease inhibitors
end in navir- inhibits protease
Pharmacokinetic enhancers
goal to improve efficacy of antivrial agents by affing this agent
HIV Pre exposure drug
Truvada = emtricitabine and tenofovir
Defer Therapy
inability to adhere to therapy, high CD4 count
CD4 COUNT THRUSH tx
nystatin spit and swish
Kaposi sarcoma
cancer cause by HHV 8 black purple, brown papular lesions
Pneumocystis jiroveci
aids defininf illness, bat wing pattern on cxr
pneumocystitis pneumonia prophylaxis
TMP/SMX BACTRIM
ISOSPORIASIS
AIDS DEFNING DZ
Esophageal candidiasis
sx- retrosternal cp and pain when swallowing, Diagnostic test upper endoscopy tx: systemic antifungals
cd4 count under 100 cryptococcosis
yeast causing disseminated dz, meningitis
Toxoplasmosis tx
pyrimethamine
cryptosporiodiosis
protozoa infection in small bowel causing diarrhea
cytomegalovirus
retinitis with scotoma vision floater and esophagitis
women and aids
9th leading cause of death
Gender specific findings women
recurrant yeast infections, hpv dysplasia, increased toxicity w/ anitvirals
How do children get HIV
transplacental
Elderly and HIV
this population less knowledgeable of HIV and prevention
Pre exposure prophalaxis
emtricitabine/ tenofovir DF
intial assesment before prep
HIV test negative r/o previous HIV
PReP prescription
Emtricitabine/ TDF daily Truvada 1 tablet orally for 90 days
How often test for HIV antibody
every 3 months
causative agent Aspergillosis
aspergillus fumigatus
asperigilosis Most common found in
post transplant children
allergic bronchopulmonary aspergillosis
attacks patients with chronic lung disease, asthma or cystic fibrosis
chronic aspergillosis
chronic lung dz but no immunocompromised state
Aspergilosis tumor
found in cxr ring enhanced lesion
invasive aspergillosis found in
hematopoitec stem cell transplant patient Most common is pulmonary dz
Ct finiding of halo
suggests invasive asperigillosis
blastomycosis
dismorphic fungus
blastomycosis yeast
at 37 degrees celsius
blastomycosis mold
at 25 degrees celcius
blastomycosis cxr
mediastinum w/ LAD
blastomycosis Mild moderate DZ
itraconazole
blastomycosis severe DZ
amphotericin B
coccidiodomycois
aka san joaquin valley fever
coccidiodomycosis spread
via inhalation due to disturbed soil
coccidioidomycosis cxr
granulomas
cryptococcosis gatti found
in pigeon poop definifn aids dz
cryptococcosis manifestations
nuchal rigidity and meningeal signs less likely in HIV
histoplasmosis
dismorphic mold at 25 c and yeast 37 c
histoplasmosis favors
soil and with bird and bat poop
histoplasmosis spread to
the spleen and liver from the lungs
histoplasmosis and fatality
not fatal typically
cxr finidng of mucormycosis
reverse halo
