ID: Block 1 Flashcards
Define Iatrogenic Dz
Define Virulence
Latros: greek for physician
Genic: derived from
Degree/availability of pathogenic organism to cause Dz
Define Virulence factors
Normal flora is AKA ?
Diagnosis is AKA ?
Features that enhance ability of microbe to cause Dz
Microbiome
Equivocal- vague, ambiguous
For an infection to be Dx as a nosocomial infection, it occurs within ? hrs of admission
Define Active Immunity
Define Passive Immunity
48hrs
Immunity from exposure and response to an Ag
Immunity from pre-formed Ab from another individual
Re-immunization of PTs is needed due to loss of ?
Nosocomial infections are usually due to ? 6 microbes
Partial immunity
Staph A Pseudomonas E coli Klebsiella Serratia Marc. Proteus mirabillis
Define Non-Sterile Immunity
Define Concomitant Infection
Define Empirical Tx
Traces of organism present, no presence of Dz
Two or more infections a the same time (Staph A + influenza, Ghon + Chlamyd)
Tx based off of experience
Define Sensitivity
Define Specificity
What type of microbe is a virus
Proportion of true positives
Proportion/accuracy of true negatives
Obligate intracellular parasite
Define Left Shift
O&P requires ? samples ? hrs apart
O&P doesn’t detect ? microbe
Increased number of immature neutrophils (band forms) suggesting acute inflammation
3 samples, 24hrs
Cryptosporidium
Purpose of ELISA test
Purpose of IFA test
Ab/Ag is linked to an enzyme to detect matches
IDs specific Abs/Ags
Abs tested w/ serum
Purpose of Immunohistochemistry
Purpose of Western Blot Tests
ID’s cellular/tissue Ags
Detection specific protein in a mixture (HIV)
What is the four standard criteria for FOUO
Fever > 38.3/100.9*
Three days of hospitalization w/out Dx
Three OutPT visits
Illness of 3wks of duration
What are the categories of FOUO
Nosocomial- hospitalized w/ fever 38.3*
Not at admission
Initial cultures will be negative
Neutropenic- neutrophil -500 and unknown Dx after 3 days
HIV- fever for 4wks OutPT or,
3 days InPT w/ 2 days of culture incubation in a known HIV Dx PT
Organ transplant- specific and unique DDx
If PT from long term care facility and is mostly bed ridden presents w/ FOUO, what 3 areas need to be examined for broken skin?
What are the 5 classifications of causes of FOUO
Occipital region
Sacral region
Heels
Infection Neoplasm- MC lymphoma and leukemia Autoimmune Miscellaneous Undiagnosed- factitious d/o
What lab tests are done when working up FOUO
All PTs w/ FOUO have ? image ordered?
Blood cultures prior to ABX w/ acute/convalescent titers
CBC
CRP/ESR
CXR
What are 4 types of biopsys that may be done when assessing FOUO
How are FOUO Tx
What Tx is considered controversial and may be avoided
LP
Lymph nodes
Skin
Bone marrow aspirate
Empiric ABX
Steroids
Anthrax
Bacillus Anthracis
Infected hides, meat
Inhaled spores that can remain viable in soil x 40yrs
No person to person transmission
S/Sxs of different forms of Antrhax
Cutaneous- Malignant Pustule w/ outer ring of non-tender Brawny-edema followed by black eschar
Inhaled- malaise, lymphadenopathy; two phases: Initial- w/ VRI, rhinorrhea and pharyngitis
Later- dyspnea, hemoptysis
Intestinal- GE Sxs, hematemesis, sepsis, massive ascites
What labs are ordered for suspected anthrax?
How is anthrax Tx
CXR- widened mediastinum
Rapid ELISA test
Nasal swab- identifies outbreak
Gram stain
Cipro + Linezolid or Clinda IV
What meds are used for post-anthrax exposure Tx
What is the name of the vaccine used for prevention?
Cipro or Doxy
In conjunction w/ vaccine
AVIP vaccine
Aerosolized anthrax treatment use is recommended for ? days and the recommended vaccine has ? doses in the series
Cutaneous anthrax from hides is Tx for ? days w/ ? med
60 days regardless of vaccination status
3 doses
7-10 days w/ Cipro
What are the two meds approved for post-anthrax exposure that is used if other therapies are not available
Obiltoxaximab
Biothrax
Plague
Yersinia Pestis
Still present in NM, AZ and CO, gives temporary immunity after infection
3 types:
Bubonic- rats
Primary septicemic
Pneumonic- aerosolized
How do the different forms of plague present
What will be seen on lab results in these PTs?
Pneumonic: F/C, HA, toxic
Bubonic: buboes primarily in inguinal region, legs MC flea bitten
Septicemia- no buboes, involves CNS and lungs
WBC +20K w/ inc bands
Inc fibrin split products
Inc liver function test
Gram neg w/ safety pin staining
How is Plague Tx
What is used for post-exposure prophylaxis?
What is the name of the virus that causes small pox?
Streptomycin or Gentamycin
Doxy or Cipro
No vaccine
Variola
What are the two types of smallpox
How is it transmitted
Major: hemorrhagic (MC in pregnancy), malignant (flat type)
Minor
Person to person by respiratory droplet
What is the sequence of smallpox seen on the skin
How long are these PTs contagious
Synchronus: Maculopapular Vesicles/oral ulcers Tense embedded pustules Crusts/scabs Scars w/ sebaceous gland destruction
Until last scab crusts and falls off
What is the difference in S/Sxs of Hemorrhagic and Malignant smallpox
Hemorrhagic: dusky erythema, petechia, hemorrhage
Malignant: confluence, flat/velvet vesicles w/ reddish grain coloration
No formation of pustules or scabs
How are suspected smallpox samples shipped to ? type of lab
How is it Tx
How often is re-vaccination needed
Vacutainer w/ tape top in water proof container to BL-4, ID under electron microscope
Tecovirimat
Cidofovir- covers Tx of Monkey Pox
10-15yrs
How are PTs post-exposure Tx for smallpox
What is the natural reservoir of Cow Pox
Vaccine if exposure within 4 days and no VaccHx
CDC guidance if Vaccinia Immune Globulin can be given within 3 days but best if w/in 24hrs
Wild rodents
Hemorrhagic smallpox is uniformly fatal by day ?
Why would lamb skin condoms be recommended and not recommended?
6 of rash
+ pregnancy prevention
- STD/HIV prevention
HSV can cause rare but serious illnesses in ? two PT populations?
How does the initial outbreak present?
Pregnant ImmSupp
GALT
Gingivitis Anorexia Lymphdenopathy Temp
Sxs gone in 2wks, shedding x 3wks
Once HSV goes dormant, where does it hide?
What type and PT have worse outbreaks?
Dorsal ganglia
Females w/ Type 2
In words, what does HSV look like
What form of HSV has an immediate referral to an ophthalmologist
Clustered vesicles on erythematous base that pustulate and ulcerate
Auto inoculated keratoconjunctiviits
How is HSV Dx
How is it confirmed
Clinically
Viral culture
Tzanck smear- multi nucleated giant cells
PCR
Punch biopsy
How is HSV Rx managed
Which med is most effective for decreasing HSV 2 transmission between couples
What are the topical forms that can be used?
FAV-clovir
Valacyclovir
Penciclovir
Acyclocir- no real efficacy
Doconasol
How are perinatal transmissions avoided?
What needs to be avoided
Highest risk during primary infection near delivery time, consider c-section
Scalp electrodes
What drug is recommended for HSV pos mothers that are not already on suppressive therapy
When working up a suspected STD, what tests are included in an STD panel?
Acyclovir at 36wks
Hepatitis
HIV
Syphilis
G/C
Genital warts are AKA ?
What are the two most common forms
What are the two most serious
Condyloma Acuminata
HPV
HPV 6 or 11
HPV 16 and 18
How are Condyloma cases Tx surgically or medicinally
Cyrotherapy
Carbon-dioxide or electro laser for internal lesions on female
Podofilox
Imiquimod
Trichloroacetic
What medication is used for Condyloma prevention
What is the dosing scheudle?
Gardasil 9 for M/F 9-45y/o, prevents cervical cancer in seronegative PTs
3 doses at Dx, 2mon and 6mon
Define JORRP
What is the triad
Juvenile Onset Recurrent Respiratory Papillomatosis- vertical transmission of HSV 6 or 11 during pregnancy
1st born
Vaginal delivery
Mother under 20y/o
What is AKA the Clap?
What type of microbe is it
Gonorrhea
Gram neg, intracellular aerobic diplococcus
What are the S/Sxs of Gonorrhea
What is the name of the disseminated form and what are the Sxs
M>F, a lot of F will be ASx
M: discharge, dysuria, epididymis tenderness
F: CMT, discharge/bleeding, dysparunia, dysuria
Both: fever, mucous membrane tissue infection
Arthritis Dermatitis Syndrome- Septic arthritis Tenosynovitis Endocarditis Meningitis Polyarthrlagia in knees, elbows, distal joints
What is the Dx standard for gonorrhea
How is it Tx
Isolation through culture
Transcription mediated acid test- UA test replaced bore punch
CDC recommendation: culture and susceptibility testing
Ceftriaxone and Azith
Alt: Azithromycin
Tx failure: Ceftriax and Azith PLUS test of cure in 1wk
What is the fear/risk behind a Gonorrhea infection
Chlamydia is AKA ?
This is the MC ?
Female develops PID (acute salpingitis) and inc risk for ectopic pregnancy
Non-gonococcal urethritis
Reported IDz in US
Chlamydia has the highest prevalence in ? PT population and results in ? if UnTx
How is it Dx?
How is it Tx
<25y/o
PID
TMA
Azith
Alt: Doxy
What microbe causes Lymphogranuloma Venereum
What are the stages?
C trachomatis, part of chlamydia family
Primary: painless papule
Secondary: unilateral painful lymph nodes (buboes)
Tertiary: genitoanorectal syndrome; more common in female
What is the classic finding of lymphogranuloma venereum that leads to men being Dx?
Why are most women PTs not Dx?
What PE finding is characteristic for this Dz
Groove sign
Lack of inguinal lymphadenopathy
Proctocolitis
Fever
Rectal pain/tenesmus
What lab finding is considered diagnostic for lymphogranuloma venereum
How is it Tx
Complement fixation 1:64
Needle aspirate/I&D for relief
Doxy for Tx
How is NGU Urethritis Tx
How is GU Urethritis Tx
Azithromycin
Doxy
Ceftriaxone and
Azithromycin
How does syphilis present
What is this AKA ?
Painless chancre 3wks w/ regional non-tender lymphadenopathy
Great Imitator/Imposter
What are the 2* Sxs of syphilis
When is syphilis considered non-infectious and what is it AKA
Rash Malaise, HA, Fever, myalgia 2-10wks after primary lesion
Tertiary- gummatous syphili
What is the test for any suspected syphilis
Time range for Dx of early or late congenital syphilis
RPR test
Early: first 2yrs of life
Late: after 2yrs old
What parts of the body are commonly affected by gummatous syphilis
What cardio finding may e seen
Liver
Skeleton
Testes
Cardiovascular syphilis- 10yrs after primary affecting ascending aorta
When does neurosyphilis present?
How can it present
Any stage
Argyle robertson- accommodate but not react
CN8 deafness
Dec DTRs
Congenital syphilis can affect fetus if mother acquires Dz ? far prior
CDC recommends that all pregnant women delivering still born at __wks or more of gestation are tested for syphilis
4yrs
20wks
How would an older PT w/ congenital syphilis present
Prominant frontal bone Depressed nasal area Pronounced mandible Hutchinson incisors- arched teeth Mullberry molars- too many cusps
What are 4 conditions that could cause a false-pos on a RPR test
What test is ordered to follw and evaluate the efficacy of care
Lupus Viral/bacterial illness Recent Imms Pregnancy Marijuana use
VDRL Titers
Don’t use confirmatory tests
How is syphilis Tx
How is neurosyphilis Tx
How is congenital syphilis under 30 days Tx?
Benzathine PCN G- DOC
Alt: Doxy/Tetra/Ceftriaxone
Aqueous crystaline Pen G or
Procaine Pen G w/ Probenicid
Aqueous Pen G
What is the physiological response seen post-syphilis Tx
Bacterial vaginosis is common in ? PT population but rare in ? one
Fever/chills called Jarisch-Herxheimer reaction
Common: adult
Rare: pre-puberty
Female PT w/ green d/c has ? infection
Female PT w/ cottage chees d/c has ?
Female PT w/ true BV has ? d/c
Trichomoniasis
Candidiasis
Gray w/ fish
What are the 4 criteria used for Dx BV
What is the most reliable sign/indicator of Dx?
3 of: White d/c Vag pH higher than 4.5 Fishy odor Clue cell w/ KOH
> 20% are clue cells
What additional Dx test can be done for BV on top of pH, and KOH
How is BV Tx
Amine test (whiff test)
Clindamycin
Tinidazole
Metronidzaole
Chancroids are rare but common coinfect w/ ? STDs
What microbe causes it?
HSV2
Syphillis
Haemophilus Ducreyi
How does Chancroid present
What appearance does it have on gram stain
What is the definitive Dx method
Malaise HA Anorexia
Painful genital ulcer w/ regional lymphandenitis (bubo)
School of fish
Culture
3 Dzs present w/ Bubos in DDx
How is Chancroid Tx
LGB
Chancroid
Plague
Ceftriaxone
Azithromycin
How does Granuloma Inguinale present
What happens w/ this Dz the longer it goes un-Tx
Small beefy red bump that’s painless but bleeds easily
Erosion and destruction of genital tissue
Spread to inguinal folds and depigmentation
How is Granuloma Inguinale (Donovanosis) Dx
How is this Tx
Punch biopsy to locate donovan bodies (speckled raw egg)
Azithromycin Add Gentamicin (aminoglycoside) if ulcers don't respond in first few days)
Pediculosis encompasses ? 3 infections
Bed bugs belong to ? species
Head, Body, Pubic louse
Climex
Where are P Capitus infections seen on PE?
Where are P Corpis infections seen on PE?
Where are P Pubis infections seen on PE?
Postauricular/occipital area
Distance of nits from scalp= duration of infestation
Anywhere but nits not in hair
Perineum/pubic area
Eyebrow/lashes
How are pediculosis infections Tx w/ topical meds?
When would a pediculosis infection be suspicious of sexual abuse?
Permethrin 1%
If resistant, Ivermectin 0.5%
Malathion 0.5% (8-12hr wait time)
Child w/ pubis infection
Unique fun fact about scabies?
Who is it usually seen in?
First human dz proven to be caused by pathogen
Younger than 15y/o w/ sexual activity
What is the most likely presenting Sx of Scabies?
How do scabies present on PE that is also pathognomoic for a Dx
Crescendo nocturnal pruritis
The Burrow: Serpiginous (s-shaped) tract in web spaces or flexors of wrist
If PT is ImmSupp: Bullous lesion
How are scabies Dx
How are they Tx
Skin scrapings
Permethrin cream 5%
Ivermectin
Bed bugs can be a carrier for Hepatitis ? and ? reactions
Although Tx is not required, what meds may be used?
B
Anaphylactoid reactions
Cream w/ CCS
PO antihistamine
Lect 3 video
59:25 ROS shotgun questions
Re-listen
What are the fecal/oral forms of hepatitis
What are the serum forms?
Hep A, E
Hep B C D G
What is a unique presenting of an acute hepatitis Dz
What may be seen in an advanced case?
Aversion to smoking
Coca cola urine
Juandice
Tender hepatomegaly
Viral hepatitis can progress into what 2 Dzs
Fulminant hepatic failure- failure w/ hepatic encephalopathy
Chronic Hep- CA, cirrhosis
What types of hepatitis can progress to Fulminant or Chronic?
How is viral hepatitis D
Ful: Hep E in Asia or Hep C if co-infected w/ A
Chronic: B and C, not A or E
UA: for bilirubin
Liver enzyme panel
Serum bilirubin: elevated= infectious hepatitis
Higher than 30mg= severe
What type of renal reaction can indicate fulminant hepatitis
What meds can induce hepatitis
Dec renal function
-azoles
Acetaminophen
Hep A is more common where?
All military get vaccines for Hep ? and ?
Endemic in underdeveloped
Western US
A and B
Hep A can infect through ? food especially if PT is ? or ?
What two modes of transmission can occur but are uncommon?
Shellfish
Pregnant
ImmComp
Blood exposure
Sexual contact
What Hep A Sx severity increases w/ age
How is Hep A Dx
Jaundice
IgM anti-HAV, present 5-10 days before Sxs, gone in 6mon
When are Hep A vaccines given
What is the Hep A and B combo vaccine and when is it given?
0, 6-12mon
Twinrix- 3 dose series at 0, 1mon, 6mon
Hep E transmission is same as A, F/o in undeveloped countries, but is typically benign except for in ?
How can this infection be dx?
Pregnant PTs, 25% mortality rate
IgM/IgG anti HEV
HEV RNA in serum/stool
What infection is 100x more infectious than HIV
Hep B from blood/sexual or perinatal exposure
What is the link between age and severity for Hep B
What is the first lab result seen that would indicate infection?
Younger PT- ASx chronic
Older PT- acute infection w/ recovery
HBsAg- first serum marker
IgM anti-HBc- first Ab seen
What lab result would be seen later in a Hep B PT and indicates immunity
What lab results indicate a PT is a carrier or has chronic Hep B
Anti-HBs (HBsAb)
HBsAg and or Anti-HBc
What can be given for acute Hep B Tx if within 7 days of exposure
What is the goal of Tx of chronic Hep B
HBIG and Hep B vaccine
Inhibit viral replication w/ Tenofovir, Entecavir or PEG-IFN
2nd/3rd line: Adefovir, Lamivudine
What lab result is used to monitor and plan Tx for chronic Hep B
What is the MC and less common transmission methods of Hep C
HBV DNA
MC: IVD abuse
Less w/ sexual transmission
What risk factors may increase the progression time for Hep C induced cirrhosis
How is Hep C Dx
Inc alcohol intake
+40y/o when infected
Hep B/HIV infected
Male
EIA for anti-HCV
Confirm w/ RT-PCR for HCV RNA
Repeat 1mon if neg
Since there are 6 genotypes of Hep C, which ones have better prognosis
Depending on the genotype, what meds may be used for Tx
2 and 3
4 is rare and hard to Tx
Pegylated Interferon + Ribavirin
Hep D is rare like E, but can infect 5% of ? carriers
How is it transmitted?
HBsAg
IVD abuse
Sexual contact
What’s the best way to prevent Hep D infection other than common sense?
HIV infection is highest occurrence in ? PT populations
Hep B vaccine
Hep C
Young gay/bi men
Where does HIV replicate in the body?
The initial presenting Sxs of HIV after infection are similar to ? infection
CD4 surface receptor
Mono and Sxs self resolve
HIV Abs are detectable ? long after exposure
What is the name of the phase when the virus is in the body and slowly replicating/building in numbers
3mon
Eclipse
What test is used to screen and confirm HIV infections
What may be seen on a CBC in a PT w/ a HIV infection
ELISA- screen
Western Blot- confirm
Thrombocytopenia
Anemia
Neutropenia
What lab result is the predictor of HIV progression
What is the newer screening test that may not be avail everywhere?
Absolute CD4 lymphocyte count
p24 Ag test
What are the top 3 S/Sx of a primary HIV infection
Fever Fatigue Pharyngitis
