ID Flashcards
where are atypical mycobacterial infections most frequently located in children?
Superior anterior cervical or submandibular nodes
what age group is commonly affected by atypical mycobacteria
1-5 year olds becasue there is an increased tendency of these children to put objects contaminated by soil or stagnant water into their mouths.
Who is affected by Mycobacterium avium complex (MAC)
HIV pateints with CD4 <50
what is the presentation of MAC
fever, diarrhea, weight loss, anemia
present in soil and water (not person to person)
how is MAC diagnosed?
AFB (Acid- Fast Bacilli) Smear and culture
how is MAC treated?
clarithromycin + ethambutol for at least 12 months (+/- rifampin)
what is the prophylaxis for HIV pts at risk of MAC
azithromycin or clarithromycin if their CD4 count is < 50
What is the presentation and treatment of Mycobacterium kansasii
causes tuberculosis like disease
tx with Rifampin + ethambutol
where is mycobacterium marinum found?
fresh and salt water
how is mycobacterium marinum diagnosed?
culture
how is mycobacterium marinum treated
tetracylclines, fluoroquinolones, macrolides, sulfonamides for 4-6 weeks
what viral illness is characterized by Fever + lymphadenopathy + pharyngitis (+ atypical lymphocytes)
Epstein Barr mononucleosis
what is the incubation period for EBV?
How is it transmitted?
30-50 days
transmitted via oropharyngeal secretions and saliva “kissing disease”
how is EBV mononucleosis diagnosed?
positive heterophile antibody screen (Monospot)
atypical lymphocytes with enlarged nuclei
maculopapular rash
LUQ pain
how is EBV treated
supportive
-acetaminophen or ibuprofen PRN
corticosteroids in severe cases
what is the return to sport recommendations for a patient with EBV mononucleosis
-athletes should avoid vigorous sports for at least first 3-4 weeks of illness
what is another name for erythema infectiosum
fifths disease
what virus causes erythema infectiosum
parvovirus B19
what is the presentation of erythema infectiousum
slapped cheek rash on the face and 2-4 day lacy reticular rash on extremities
what are sickle cell patients at a high risk of developing with erythema infectiosum
aplastic crisis
how is erythema infecttiosum diagnosed
based primarily on clinical observation, history and physical
(PARVO b19-specific IgM antibodies and PCR)
what is the treatment of erythema infectiosum
symtpomatic
resolved in 2-3 weeks
what is a common childrens infection caused by coxsackievirus type A virus producing sores in mouth, hands, feet and buttocks
hand-foot-and-mouth disease
what are symptoms associated with hand-foot-and-mouth disease
fever, sore throat, feeling unwell, irritability, and loss of appetite
what is the treatment of hand-foot-and-mouth disease
supportive, anti-inflammatories
- virus clears up on its own within 10 days
what are the two herpes simples virus and what do they affect
HSV1 - oral lesions (cold sore)
HSV2 - genital lesions
what are the different Herpes Human Viruses (HHV)
HHV3 - varicella zoster virus (VZV)
HHV4 - EBV
HHV5 - CMV (cytomegalovirus)
HHV6 - Roseolovirus
HHV7 - not yet classified
HHV 8 - Kaposi’s sarcoma - associated herpesvirus (KSHV)
what virus causes influenza
orthomyxovirus
Three strains: A, B and C
what is the treament for influenza
symptomatic (for most) or antivirals (ideally <48hours)
what virus causes Measles and how is it transmitted?
Paramyxovirus
transmitted by respiratory droplets
how are the stages of measles characterized
prodrome (1-3 days) - cough, coryza, conjunctivitis and fever
Enanthem (48hours prior to exanthem) - Koplik spots
Exanthem (2-4 days after fever) - rash from face spreading cephalocaudally.
how is measles dx
clinical dx of measles requires hx of fever of atleast 3 days wtih at least one of the three C’s (cough, coryza, conjunctivation)
Koplik spots
IgM antibodies or isolation of measles virus RNA from respiratory sample
how is measles treated?
supportive and MMR vaccine
when is MMR vaccine given
12-15 months and then again at 4-6 years old
what supplement helps to limit morbidity and mortality in pts with measles
vitamin A
is there an isolation period for measles
isolated for 1 week after onset of rash
what virus causes Mumps
paramyxovirus family
what is hallmark sign for mumps
parotitis (painful parotid gland swelling)
can see orchitis or aspectic meningitis
what is the treatment for Mumps?
supportive
scrotal support if painful
MMR vaccine
what is another name for whooping cough
pertussis
what type of bacteria causes pertussis
gram-negative bacteria
bordetella pertussis
How is pertussis diagnosed
nasophayngeal swab and culture
what is the treatment of pertussis
Macrolide (erythromycin/azithromycin)
supportive care with steroids / beta2agonists
when is the DTap given
5 doses: 2, 4, 6,15-18 months and 4-6 years
who else should recieve a Tdap vaccination and when
pregnant/expecting mothers during each pregnancy , usually 27-36 weeks
what is the most common reason for itching in anal area making sleep difficult
pinworms
how are pinworms diagnosed?
“scotch tape test” in the early morning
(eggs visable under microscopy)
what is the treatment of pinworms
albendazole or mebendazole
what is the only childhood viral exanthem that starts on the trunk and spreads to the face/legs
Roseola
what are other names for Roseola
exanthema subitum
roseola infantum
rose rash of infants
sixths disease
baby measles
what virus causes roseola
HHV 6 and 7
what age range is often affected by roseola
6 months - 2 years of age
what is the presentation of roseola
sudden high fever (102-104)
just as child appears to be recovering, red rash appears on trunk
how is roseola diagnosed
clinically
what is the treatment of roseola
supportive - typically benign - self-limited disease
what is know as the “3-day rash”
Rubella
what is the presentation of Rubella
“3 day rash” pink light-red spotted maculopapular rash first appears on face and spreads caudally to trunk and extremities
does Rubella affect pregnancy?
teratogenic in 1st trimester - TORCH infection and can cause serios complications
how is Rubella diagnosed?
lab dx warranted when congenital rubella syndrome is suspected
serologic assay and primarily enzyme immunoassays
rubella virus-specific IgM antibodies
what is the treatment of Rubella
supportive care and prevention with MMR
what virus is classically identified as ‘dewdrops on a rose petal’
varicella (chickenpox)
where does Varicella lay dorment
dorsal root ganglion
what is the reactivation of Varicella
herpes zoster (shingle)
dermatomal pattern
what is Hutchinson’s sign
lesion on the nose - an early indicator of opthalmic (eye) shingles
what is Zoster ophthalmicus
shingles involving CN5, dendritic lesion on slit lamp exam if keratoconjunctivitis is present
what is zoster oticus
Ramsay-Hunt syndrome
facial nerve (CN7) otalgia, lesions on ear, auditory canal and TM, facial palsy, auditory sympotms
how is herpes zoster treated
acyclovir, valacyclovir and famciclovir - given within 72 hours to prevent post-herpetic neuralgia
what is postherpetic neuralgia
pain > 3months, paresthesias or decreased sensation.
what is the treatment of postherpetic neuralgia
gabapentin or TCA, topical lidocaine gel and capsaicin
when is Varicella Vaccine given
first dose at age 12-15 months and second dose at 4-6 yo
if a patient 13+yo who has never had chickenpox or recieved vaccine - what is their vaccine schedule
two doses at least 28 days apart
when is REcombinant zoster vaccine recommended
to prevent shingles in adults 50+
2 dose series: 2-6 months apart
