ID Flashcards
disease NP will see Neuro, derm, Resps, immune
which one needs referral? 2
NEURO
Meningitis (C)
DERM Lyme Disease (D) Pityriasis Rosea (D)
RESP
Croup (D)
Influenza (D)
Epiglotittis (C)
IMMUNE
Infectious mono in adults (D)
8 ID in kids
Coxsackie (D) Fifth’s Disease (D) Roseola (D) Mumps (D) Measles Rubeola (D) Rubella (D) Varicella (D) Infectious mono (D)
what conditions will have rash
Meningitis
MMR
Varicella
Mono - with pen
Meningitis
Inflammatory disease of membranes (meninges) surrounding the brain and spinal cord
Defined by elevated WBCs in the CSF
Neurological sequelae are common among survivors
Community acquired Meningitis bacterial 2
other 2?
most cause?
fungal?
Bacterial
Streptococcus pneumoniae - has vaccine
Neisseria meningitidis - has vaccine
Haemophilus influenzae (haemophilus). Listeria monocytogenes (listeria). These bacteria can be found in soft cheeses, hot dogs and luncheon meats.
most cases are caused by a viral infection - usually mild and often clears on its own.
Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS
s/s of meningitis - Triad
non-blanching petechial or purpuric rash, stiff neck
acute febrile illness with rapid onset
intense headache, fever, nausea, vomiting, photophobia
Classic TRIAD
1 Fever
2 Nuchal rigidity (neck stiffness – the inability to flex the head forward due to rigidity of the neck muscles)
3 Change in mental status (increasing intracranial pressure can cause confusion)
if sepsis what happens?
if sepsis - Meningococcemia - circulatory collapse, haemorrhagic skin rash and a high fatality rate.
has long term sequelae which include hearing loss, neurologic disabilities, and digit or limb amputations.
Meningococcus organism releases a toxin which activates the clotting factor, can cause DIC - variety of small clots form in the vessels. These clots use up all the platelets and then there is bleeding throughout the body.
Meningitis Bacterial Dx
Bacterial – Diagnosis
Nuchal rigidity
+ Kernig flex knee and pull straigh
+ Brudzinski - bend head, knees automatically goes up
CSF – increased opening pressure
Leukocytosis, increased protein, decreased glucose
Blood Cultures
meningitis Vaccines? 4
Hib
Pneumococcal (Prevnar 13)
Meningococcal C (Neisvac-C) and B (Bexsero)
Menactra and Menveo (quadrivalent conjugate) – A, C, Y, W-135
S/E of lyme disease :
first stage
2nd
late signs - months - years
Erythema Migrans - bull eyes rash - spirochete Borrelia burgdorferi bacteria
2nd: Bell’s palsy (temporary paralysis of one side of the face, CN7) - usually self limiting arthralgia, joint to joint pain Headache, myalgia, fatigue, pruritis Cardiac involvement
late: Chronic arthritis-large joints affected Neurological complaints Memory loss Atrophic skin
test for lyme disease
treatment
CDC criteria for Lyme Disease
Serological testing IgG and IgM antibodies to B. burgdorferi
cdc : Presence of EM OR
At least one late manifestation plus laboratory confirmation of infection.
Joint swelling, Bell’s palsy, AV block
Tests: ELISA and Western Blot
Treatment:
Doxycycline (adults) 100mg po BID x 14-21 days Amoxicillin Cefuroxime Supportive
Pityriasis Rosea looks like? 2 followed by? tx? other tx?
heralds patch, xmas tree pattern
follows a viral infection
self limiting - clear in 4-6 weeks - supportive measures
Pruritis – topical corticosteroid or antihistamines
Severe itching–po acyclovir x 1 week (may reduce symptoms by 1-2 weeks)
2 Etiology of croup
whos at risk?
tx
Parainfluenza virus
Respiratory syncytial virus RSV
Children 3 months – 5 years
Peak at 18-24 months
Supportive treatment
Usually mild, lasting less than 1 week
Cool night air exposure or air humidifier (even though there is no evidence of benefit for this practice)
Stay calm.Comfort or distract your child — cuddle, read a book or play a quiet game. Crying makes breathing more difficult.
Acetaminophen for fever
Warm fluids – loosen secretions
No smoking in child’s home
Dexamethasone (0.15 – 0.6 mg/kg) – single dose - Max dose 10 mg
Epiglottitis definition and etiology
s/s?
what to do?
Rapid inflammation of the epiglottis which results in edema and airflow obstruction.
Etiology
H. Influenza type B
s/s toxic appearance Drooling High fever Muffled voice Severe sore throat
ER
mono virus?
SS Triad
dx?
tx? precaution?
Epstein-Barr virus
SS-TRIAD 1 Fever 2 Tonsillar pharyngitis 3 Lymphadenopathy (posterior cervical) Malaise, Fatigue, Headache Splenomegaly (50% of patients) rash with PEN
dx Lymphocytosis – 40-50% Throat culture to detect strep Mono spot test - bw for antibodies May see elevated LFTs
tx Symptomatic – rest, fluids, Tyl Corticosteroids (Prednisone) for tonsillar obstruction Acyclovir not recommended If + strep, do NOT use Amoxicillin Avoid saliva contact No contact sports X 1 month
precaution - no contact sports to prevent rupture of spleen
etiology for each condition
Hand foot mouth disease
Fifth’s Disease
Roseola
Mumps (D)
Measles Rubeola (D)
Rubella (D)
Chickenpox (D) Infectious mono (D)
HFM - Coxsackie virus
Fifth’s Disease - parvovirus b19
Roseola - herpes 6
Mumps - mumps - supportive tx
Measles - morbillivirus
Rubella - RNA virus
chicken pox - Varicella - need shringrix to prevent herpes zoster
Infectious mono - Epstein-Barr
HFM disease - virus?
seen in what age
ss
tx
Coxsackievirus A16
Highest in children under 10
ss - fever
Oral lesions – 5-10 vesicles on hard palate, tongue, mucosa-PAIN
Skin lesions – 2-8 mm. vesicles on palms, soles, skin
Symptomatic tx
Vesicles heal without scarring
Usually resolves in 2-3 days
5th disease - virus, aka?
when most contagious
ss
tx
Parvovirus B19 aka “slapped cheek”
Most contagious before onset of rash - laced rash
Prodromal -3-7 day fever, headache, cough, 20% without symptoms Rash in 3 stages Slapped cheek 1-4 days Lacy maculopapular starts on trunk Rash subsides
Supportive tx
Roseola - signature s/s
tx
High fever x 3-5 days, abruptly resolves
Lymphadenopathy, red TMs, irritability
Then, onset of macular rash begins on trunk and spreads to face, neck extremities
Non-pruritic lesions disappear 1-2 days
tx Supportive Acetaminophen for fever Fluids to prevent dehydration Teach parents that the high fever does not mean serious disease Most cases, benign and self-limiting
Measles
4 c’s
dx
Respiratory infection caused by the morbillivirus - airborne
Complications include: sepsis, pneumonia, encephalitis, and death
Conjunctivitis
Coryza (rhinitis)
Cough
Koplik spots - in mouth and body
dx - bw for antibodies
mmr vaccine
Adults born between 1970 and 1996 should ensure that they have received two doses of MMR vaccine.
hep a how contract
how many vaccine
how long protection?
fecal oral route
2 doses, 0. then 6-12 months
up to 25 in adults 14-20 in kids
hep b how contract
how many vaccines
how long proctection
twinrex
blood, fluids
3 doses, 0, 1, 6
hep a n b - Schedule: 0, 1, 6 months
typhoid risk
cause?
route?
vaccine
caution with abx?
risk up 6-30x in asian countries
An acute, life-threatening febrile illness caused by the bacterium Salmonella enterica serotype Typhi.
Fecal-oral transmission route
Both typhoid vaccines protect 50%–80% of recipients;
Travelers should be reminded that typhoid immunization is not 100% effective, and typhoid fever could still occur.
Vivotif (oral, live attenuated) >6yrs - good for 5 yrs
Typhim Vi (injectable, inactivated) >2 yrs - good for 2 years
Vaccination with Vivotif should be delayed for >72 hours after the administration of any antibacterial agent
meningitis risk
vaccine
how long good for?
Travelling in the African meningitis belt during the epidemic season
vaccine - Quadrivalent meningococcal conjugate vaccine (Menactra)
good for 5 years
TD bugs
tx
at risk for?
non rx tx to prevent
Enterotoxigenic E. coli, Campilobacter jejuni, Shigella spp, Salmonella spp.
cipro has more resistance, now use Azithromycin
when get TD, at risk for IBS in future
to prevent - Non-antimicrobial options for prophylaxis
BSS (Bismuth subsalicylate)
Probiotics
Dukoral
infection through mosquito - 5
use what to prevent -
1 yellow fever virus - live vaccine, lifelong protection,
if get it avoid aspirin or NSAIDs, which may increase the risk for bleeding
Because of the risk of serious adverse events that can occur after yellow fever vaccination, clinicians should only vaccinate people who:
1) are at risk of exposure to YFV or 2) require proof of vaccination to enter a country.
2 malaria
3 zika
4 Japanese Encehpalitis - vaccine 0, 28d, up 3 yrs
5 Dengue Fever
1 Permethrin on clothes
2 on skin - Picaridin 20% - PiActive – up to 12 hours protection
Oil of lemon eucalyptus
