ID Flashcards
Seafood diarrhea
vibrio P
-watery or inflammatory
Shigella dysentery
common cause of food-borne illness. usually daycare, institutions
Colitis from improperly cooked ground beef
EHEC
Colitis from raw pork
Yersinia Entercolitica
Colitis from undercooked/infected poultry
Campylobacter. Watery or hemorrhagic, severe cramps
Presentation and species Malaria
-Cyclical fever with cold/hot phases. Vomiting, arthralgias, etc. +/- splenomegaly
-Vivax, ovale: 48 hr cycle
-malariae: 72 hr cycle
-Falciprum: no periodicity
Most deaths due to falciprum
Hemolytic anemia, jaundice, renal failure in someone with functional asplenia or splenomegaly
Babesiosus
- RBC parasite (like plasmodium)
- transmitted by tick
Crypto meningitis Tx
-Ampho + flucytosine. Maintenance on fluconazole
Histo meningitis Tx
-Ampho. Maintenance on itraconazole
PPx vs Tx toxoplasmosis
PPx: TMP-SMZ
Tx: sulfadiazine - pyrimethamine
Mycobacterium avium
CD4 < 50
fever, cough, malaise, splenomegaly
prophylax with Azithromycin!
Tx CMV, when to prophylax in HIV pts
- Gancyclovir
- PPx when CD4 <50 and IgG or biopsy is positive
2ndry syphilis
- fever, malaise, sore throat, GENERALIZED LNOPATHY
- non-pruritic maculopapular rash on trunk, SOLES, PALMS
- Tx: PCN. Doxy if allergic
Pityriasis rosea
pruritic papulosquamous rash with initial “herald” lesion
does NOT involve palms and soles
follows viral illness
RMSF
tick borne
rash on wrists/ankles that generalizes + severe headache, myalgias
most common cause of rash in children
viral exanthem
Complication mononucleosis
thrombocytopenia and hemolytic anemia
2/2 cross reactive antibodies
Splenic rupture 2/2 trauma (not infarction)
Colonic hyperplasia/ UC and endocarditis
Increased risk of IE from strep bovis (gallactolyticus)
Nosocomial UTIs and endocarditis
Enterococcus
IVDU and endocarditis
staph aureus
Cat-scratch disease
- Bartonella henselae
- immunocompetent pts
- localized pruritic rash with REGIONAL LNADENOPATHY
- Tx: Azithromycin
Leprosy
- Mycobacterium
- Starts as hypopigmented patch
- progressive nerve damage –> muscle atrophy –> hand deformities
- Dx: AFBs on biopsy
Creeping eruption
- helminthic disease -ancylostoma braziliense (hookworm)
- often transmitted by soil (sandboxes)
- tropical/subtropical regions (Florida)
- pruritic erythematous papules –> elevated, serpiginous red/brown
sporotrichosis
fungal
gardeners
papule at inoculation site –> ulceration and LNadepathy
Scabies
- parasite
- sarcoptes scabei.
- volar wrist and interdigit webs
- short burrows accompanied by papules, vesicles, or plaques
- transmitted by close contact
Antimalarials
- Areas w/o P Falciprum (Central Am, Brazil, Turkey): primaquin. Teratogenic
- Areas w chloro-susceptible Falciprum: chloroquin. Need to start 1-2 weeks early
- Areas w chloro-resistent Falciprum (Sub-saharan africa, Southern, south-east Asia): Mefloquin (Best in Pregnancy. Neuropsych SEs). Doxy (GI, teratogen). Atovaquone-proguanil (Expensive, GI)
CMV mononucleosis
- syndrome, without pharyngitis and LNadeopathy
- Atypical lymphos on smear
Tx GC/CT
- GC: ceftriaxone
- CT: Azithro
Tx PID
- Tx both GC/CT (Cef, azithro).
- RPR, HIV, HBV testing
Testing warts for HSV
Tzanck smear
IV catheters and IE
coag-neg Staph
Fungal IE
- immunocompromise
- chronic indwelling catheters
- prolonged Abx
Q Fever
- inhalation from infected livestock or drinking unpasturized milk
- Coxiella burnetti – rickettsial bacteria
Candida vs viral esophagitis in HIV
- Candida: thrush, mild/moderate esophagitis. If thrush and mild/moderate esophagitis, can Tx empirically with fluconazole
- Viral: severe esophagitis
- HSV: circular ulcers
- CMV: large, linear ulcers
Bacillary angiomatosis
Bright red, firm, friable, vascular nodules in HIV pt
- Bartonella (GNB)
- Oral erythromycin
Kaposi’s sarcoma
-HIV. Caused by HHV-8
papules –> plaques/ nodules over trunk, face, extremities
-light brown –> pink –> violet
PCP skin lesions
nodular/papular lesions of external auditory meatus
-HIV
Molluscum
poxvirus
centrally-umbilicated dome-shaped, non-pruritic papules
Histo and HIV
CD4 < 100 disseminated infection --> cytopenias, LNopathy, hepatosplenomegaly high mortality due to shock Dx: Urine/Serum antigen testing Tx: Itraconizole
Tx Positive PPD in HIV pt
-INH + pyridoxine (prevents INH neuropathy, but not hepatitis–check LFTs)
Coccidio
- SW US
- pulm infection + erythema multiformae and arthralgias
Blasto
- central US
- flu-like or asymptomatic infection. uncommon in immunocompetent
- in HIV, multiple nodules or dense consolidation on CXR. Contact with soil. Ulcerative/Verucous skin lesions
Cryptococcus
- HIV CD4 meningitis/encephalitis
- rare infection in immunocompetent
Thresholds for positive PPD
> 5 in HIV/immunosupressed or recently-infected
10 in risk factors
15 in healthy folks
if not strictly positive, Tx = observation
Nocardia pneumonia
HIV + or immunosuppressed
weakly acid-fast, branching, filamentous rod found in soil and water
-cavitary lesions in lung
-Tx: TMP-SMX
trichinosis
- parasite
- undercooked pork
- invades intestine (first phase–abd pain etc) –> systemic hypersensitivity rxn –> splinter hemorrhages, chemosis, retinal hemorrhages, periorbital edema
Botulism Sx
-constipation, descending paralysis, respiratory failure
HIV/IVDU and IE
- most commonly Staph, most commonly TV
- fewer peripheral manifestations
- septic emboli –> lungs –> cavitary lesions
Febrile neutropenia
-Admit, cover pseudomonas (cefepime)
recent BMT, pneumonia, colitis
CMV pneumonitis!
urease bugs and effect in UTI
- increases urine pH –> calculi formation –> reservoirs of bacteria –> recurrent UTI not clearable by Abx alone
- Happens in Hx, pts w Foleys
- Proteus, pseudomonus, Klebsiella, Morganella, Providencia, Staph, Ureaplasm
hemachromatosis pathogens
Listeria!
Also iron overload –> Yersinia, Vibrio
Podophylin
Tx option for warts. causes cell death
Tx Lyme in pts with doxy allergy
amox
PPx in post-transplant pts
TMP-SMX
Erysipelas
- specific type of cellulitis
- Sharply-demarcated, erythematous, edematous, tender lesion
- Group A Strep
Abrupt onset nausea/vomiting after meal
- preformed toxin!
- either Staph or B Cereus
- Mayonaise, meat, veggies: Staph
- Rice, etc: B cereus
C Perfigens
- Forms spores that live in meat, gravy, poultry
- Watery diarrhea
C Diff (Risk Factors, pathogen, presentation, Dx, Tx)
- RFs: Recent Abx(!), hospitalization, PPIs
- Path: Toxin A: water diarrhea. Toxin B: colonic necrosis
- Sx: fever, abd pain, leukocytosis, range from watery diarrhea to toxic megacolon
- Dx: PCR of toxin genes in stool
- Tx: metronidazole, PO Vanc, or fidaxomicin. NOT BROAD SPECTRUM ABX – will worsen
Diarrhea after contact with water in developing countries
microsporidia: cryptosporidium, giardia, etc
osteomyelitis
- most commonly Staph
- NAIL PUNCTURE wound –> pseudomonus
Tx Herpes Zoster
- Valacyclovir preferred
- Acyclovir also effective, and less expensive
Cysticercosis
-Caused by T Solidium
-Can cause neurocysticercosis in areas with pigs/poor sanitation. From direct ingestion of contaminated human feces. Causes fluid-filled cysts and seizures.
Tx neurocysticercosis: albendazole
Tx PCP
- TMP-SMX
- If gas exchange impaired (PaO2 < 70 or A-a gradient >35), add prednisone
“halo sign” on lung CT in immunosuppressed
Aspergillis
Ramsay-Hunt Syndrome
- Triad: ipsilateral CN7 palsy, ear pain, vesicles in auditory canal
- VZV
Tx human bite wound
- Need to cover Gram (+), Gram (-), and anaerobes.
- Amox-Clav.
Post-viral pneumonia with multiple necrotizing abscesses
Staph!
Dental/Respiratory procedures and IE
-Viridans group Strep e.g. Strep Sanguinis
