ID Flashcards
Lymes disease
Borrelia burgdorferi
Found on white footed mouse and white tailed deer
DX- bulls eye target 5 cm or more, lab, and late manifestation
Early-non tender warm rash, myalgia, fatigue, Arthralgia, HA
early disseminated- flu ss, no rash, up to 1 year post neuro ss, meningitis, neuropathy, CM, pericarditis, CHB
late-arthritis, neuro ss, chronic encephalopathy, paresthesia of limbs, memory loss, mood changes, red to blue modular plaques on UE
Lyme DX
ELISA
IgG and IgM
Remove tick
All stages respond to antibiotics
Doxycycline, amoxicillin, ceftin
Rash resolves usually after starting therapy
If cardiac or disseminated lesions needs to be tested for 21-28 days
Late stage need PO for 28 days and potentially IV therapy
Rocky Mountain spotted fever
Rickettsia rickettsi
Kills one to 5% of those infected even with treatment greater than 20% of untreated patients will die
Dog tick vector seen in the east of the Mississippi and southern most states in spring or summer
Starts as a viral type illness then rash appears popular with central petite eye, recent ankles, and goes towards the trunks and on the palms and salts of the feet
Death is from myocarditis , platelets are elevated, liver function is elevated
Treatment is doxycycline for seven days unless the patient has a life-threatening allergy due to severity of disease
Ehrlichiosis
Rickettsial agent that produces illness, but without a rash two strains include ehrlichiosis chaffeenis and anaphase phagocytophilia
Both are transmitted by ticks in the south
Treatment with doxycycline for 7 to 10 days
Other tick associated rash illnesses
Babesiosis
Relapsing fever
Tularemia
Mad cow disease
Prion base disease
Rapidly progresses, and is almost always fatal proteins, are thought to abnormally fold into shapes and become damaged
Creutzfeldt Jakob disease
Classic and variant
Also another Prion disease
Classic is not transmitted by a cattle really no recognizable pattern of transmission really sporadic
Variant type humans get from eating beef from a cow that’s infected. Diagnosed with brain biopsy, describes Alzheimer’s disease and fast-forward motion.
Osteomyelitis
Infection of the bone
For category types -following hematogenous spread of infection, from contagious focus of infection, infection of prosthetic joint, associated with vascular insufficiency
Can be acute or chronic chronic will last greater than 10 days with prior infection
Hematogenous osteomyelitis
Usually in children lesson 16 years staph aureus
Usually involves the femur or tibia usually have a history of non-penetrating trauma to the area
If it’s a create an adult, usually you’ll see in the vertebrae
Will present with pain, swelling, chills, and fever. If in the back they have back pain stiffness point tenderness over the infected vertebrae.
Contiguous osteomyelitis
Covers more than half the cases
Most common factor is previous surgery of the lower extremity or soft tissue of infected digits of the hands or feet usually occurs within one month of the precipitate event
Prosthetic joint infection osteomyelitis
If acute occurs within 12 weeks of surgery
If chronic 3-12 months post surgery
Usually present with painful unstable joint often little or no fever, nonspecific x-ray findings diagnose is with culture and sensitivity of the joint space
Vascular insufficiency osteomyelitis
Common and patient with diabetes or severe atherosclerosis
Mostly in the toes and small bones of the feet
Often found incidentally on routine x-rays
Usually, it’s gonna be anaerobes, coliforms, pseudomonas, streptococcal, or staph aureus
Osteomyelitis, labs and treatment
X-ray bone scan CTMRI bone culture and sensitivity
Antibiotic therapy is often prolonged, and it is based on accurate data so imperative treatment can often be hazardous
Immobilized a joint
IV. Antibiotics for about 3 to 6 weeks.
For staph- nafcillin, cefazolin, vanco, clindamycin
Modified- IV for 2-3 weeks then 4 weeks PO-clindamycin or dicloxacillin or fluoroquinolone
Surgery IND
If chronic PO for 6 months or longer- ofloxacin or cipro alone or
with flagyl
Osteomyelitis complication
Recurrence
Epidermoid cancer
Sepsis
Endocarditis
Lung abscesses
Can be acute or chronic
Can be nonspecific (aerobic, sputum, culture, and sensitive or negative) , primary (a current patient, prone to aspiration) Secondary (complications of local lesion, such as pulmonary cancer or systemic disease), putrid (odor of sputum indicates anaerobic infection)
Most lung abscesses are primary
Prevotella spp, bacteroides spp, anaerobic, fusobacterium nucleatum, staph aureus, klebsiella, TB
Usually present with fever, malaise, cough, sputum, often purulent, chest pain hemoptysis
Staff infections are common and younger children
Suspect klebsiella in alcoholic patients
Labs for lung abscess
Chest x-ray CBC, blood culture sputum for culture, intensity, and Gram stain
Treatment for lung abscesses
If anaerobic-clindamycin IV, augmentin or PCN plus flagyl PO
Aerobic- based on c/s, staph and gram negative bacilli need IV antibiotics
6 weeks or more
Chest x-ray needs to be clear to cereal every 2 to 3 weeks oral regiment should continue for at least six weeks
If failure to improve, especially in patients that are symptomatic either change medical therapy and do a bronch
Endocarditis
Infection of heart valves- bacteria, rickettsial, or fungi
Hospitalization
Vague and non specific symptoms- fever, murmur, blood culture
4-6 weeks antibiotics- could do 2 weeks of PCN and streptomycin for sensitive strep viridans and strep bovis
Long course for those with prosthetic valves
Staph on tricuspid-cipro plus rifampin, nafcillin or gentamycin IV, then cipro or keflex for 2 weeks
For prosthetic-staph epidermis most common, IV therapy for 6 weeks using nafcillin or oxacillin, vanco with genta
MRSA- vanco, plus rifampin, for 6 weeks, plus genta 2 weeks
Prolonged PO antibiotics after IV-dicloxacillin or keflex and maybe rifampin
Complications of endocarditis
CHF
Relapse
Mycotic aneurysm
New organism growth
Recheck BC 2-3 days post antibiotics completion
More likely to relapse if prosthetic valves or those with resistance
Follow cardiac function!
Anticoagulant avoided during ACTIVE endocarditis due to risk of bleeding BUT if already on Coumadin just continue
Antibiotic prophylaxis for procedures
Mononucleosis
EBV
Acute febrile illness for 15-25 years
Rare in above 30 due to exposure likelihood
Oral contact spread
Infects throat then B lymphocytes generate T cell response causing atypical lymphocytosis** hallmark of disease
Pharyngitis, lymphadenopathy, splenomegaly, fever, malaise, anorexia, rash
Months to fully recover, jaundice
Mononucleosis dx and tx and complications
IGgM antibody, IgM anti VCA, mono test
Complications-encephalitis, meningitis, peripheral neuropathy, GB, splenic rupture, superinfection
Throat culture as it resembles strep throat
No specific tx avoid strenuous activity
Avoid contact sports
No need for isolairon
CMV
Looks like mono but no pharyngitis
More common in those older than 25 years
Diagnosed with 4 fold increase in CMV complement fixing antibodies over 4-6 weeks
Presence of IgM antibodies to CMV ir cytolytic antibodies to CMV antigen
Toxoplasmosis
Looks like mono
Diagnosis with dye test or inmunofluorescent antibodies greater than 1:1000 plus IgM-IFA titer greater than 1.64
Chronic fatigue syndrome
Debilitating fatigue with sore throat, tender lymph nodes, myalgia, joint pain, HA, malaise, impaired memory and concentration
Suggest EBV infection but maybe other causes other viruses
Psych intervention needed
