IDz Block 3 Flashcards
How do Cestodes eat?
What are the body parts?
Absorb through integument
Scolex (attachment)
Neck
Segmented body- proglottids
Cestodes are AKA ? and what are the 4 types
Tapeworms
Hymenolepiasis- Nana, Diminuta
T solium Saginata
D Latum
H Nana are AKA and grow to be ? big
These are the MC cause of ?
How is the infection started and where does it reside?
Dwarf Tapeworm, 15-40mm
Cestode infections worldwide
F-o ingestion of eggs
In ileum, attach to villus
S/Sx of Hymenolepiasis infections
What S/Sxs are rarely seen?
Since PE is rarely useful, what is seen on lab results and how is this Tx
Restless Abd pain Irritable Diarrhea Nasal/Anal pruritus
HA Extremity pain Hive Anorexia Dizzy Bloody diarrhea Inc appetite Behavior N/V
Eosinophilia
Eggs in stool
Tx w/ Praziquantel
Life cycle of Taeniasis
Human SmInt- eggs in feces
Cattle/pig ingest eggs
Embyos penetrate gut lumen, encyst muscular tissue= infection 2-3mon
Cysticercus attaches in SmInt
Taeniasis adults can develop ? many eggs and live for ?
Since most of these infections are ASx until large worm burden, what are the S/Sx?
50K eggs/day
25yrs
Hunger Epigastric Anorexia Diarrhea Malaise Abd pain Weight loss Nausea
What is the most striking/main feature of the other form?
What can happen w/ migrating proglottids during a Taeniasis infection
T Saginata- passing proglottis
Appendicitis
Cholangitis
What PE finding of Taeniasis is less/more common in kids and more in adults?
What form can present with an odd presentation?
Adults: Subcutaneous nodules
Peds: weight loss
Cysticercosis- Neuro abnormalities
What labs are drawn during a Taeniasis infection
How is this Tx
Stool sample
Ab detection- early/invasive
Cellophane swab
CBC
Praziquantel
Surgery if obstruction present
Define Cysticercosis
Where is this seen in the US
What is the definitive host and how does it get infected??
Systemic dissemination d/t larval form of T Solium
SoCal
Humans, F/o route
What tissues can Cysticercosis infect?
This parasite is also the MC ?
Muscle Eye CNS Heart Skin
Parasitic infection of CNS
What are the S/Sxs of Neurocysticercosis
S/Sxs of Cysticercosis
Seizure HA AMS Vision change N/V
Papilledema Hyperreflex Afebrile Nystagmus SubQ nodules
What Labs/Rads are ordered for Cysticercosis
CT* MRI
Biopsy nodule ELISA CBC CSF Stool for Taeniasis
How is Cysticercosis Tx
Main focus= Sx care
CCS Osmotic Diuretic
O2
Anticonvulsant
Not for NeuroCystic:
Albendzaole/Praziquantel + Dexamethasone
Maybe Etanercept (anti-TNF)
Where are Diphyllobothriasis infection acquired from
Where does it reside in and for how long
Embryo from crustacean eaten by fish consumed raw by human
Small Intestine x 10yrs
MC presentation of Diphyllobothriasis infestation
What other S/Sx may be seen
ASx
Hunger Dizzy
Fatigue Weak*(rare) Numb Diarrhea
Diphyllobothriasis has unusual affinity for ?
This may cause PTs to present w/ issues resembling ? issue
Vit B12
Megaloblastic anemia
What would be seen on lab results in Diphyllobothriasis infections
How are these infections T
Stool ova/parasites
CBC- dec Hgb/Hct
Inc MCV, Eosinophils
Low B12/Folate
Praziquantel w/ vitamins
Trematodes have ? body parts and are AKA
What is seen on lab results in suspected Trematode infections?
Flat body w/ cuticle and sucker, Flukes
Eosinophilia= migrating, none during intestinal phase
What are the types of Trematodes?
Blood: Schistosomiasis- Haematobium Japonicum Masoni
Liver- F Hepatica
Lung- P Westermani
Eosinophilia is not present during ? infections?
Where do the different types of Blood flukes like to invade?
Protozoa
Haematobium- veicals
Japonicum- SM Vein
Masoni- IM Vein
Trematodes are hermaphrodites except for ?
What are the 3 types of Schistosoma species that invade humans and in ? countries
Schitosoma spp.
Haematobium- Africa ME
Japonicum- Far East
Masoni- SAmerica Caribbean Africa ME
What Schistosomiasis’ are excreted from feces or urine?
Which ones are indicted in bladder cancer
Where do Schistosomiasis mature prior to invading human hosts?
Japon/Masoni- feces
Haematobium- urine
Haematobium- due to vescile plexus invasion
Snails (snail fever)
What is acute Schistosomiasis AKA?
These S/Sxs are due to ? etiology
Katayama fever d/t Mansoni/Japonicum
Serum Sickness reaction
How is Schostosomiasis Dx?
When are samples needed when Dx Haematobium?
How are Schistosomiasis infections Tx?
Eggs in stool/urine
Ab detection
Urine samples Noon-3pm
Praziquantel
F Hepatica is AKA and found in ?
How are these infections acquired and where do they mature w/in the host?
Sheep liver fluke
Larvae in fish
Raw water cress
Bile ducts
What are the two phases of a Fascioliasis infection and Sxs seen in each
These infections are also suspected of causing ? in Vietnam vets
Acute- V/D/F x months
Chronic- tumor/obstruction Sxs
Cholangiocarcinoma
How are Fascioliasis infections Dx?
How are they Tx?
Egg identification
Ab detection ELISA
Triclabendazole
What is the MC form of Paragonimiasis infections in humans?
How long can these infections last for in humans?
Westermani in Far East
20yrs
How are Paragonimiasis infections acquired?
Unembryonated egg leaves human via stool/sputum
Reconsumed in crab/crayfish
Duodenum to diaphragm
Eggs in sputum swallowed and passed
How are Paragonimiasis Dx
How is it Tx
Eggs in stool/sputum
Confirmed w/ biopsy
Complement fixation
Praziquantel
Define Nematode
Since these are AKA Helminthes, these are the MC of what 2?
Unsegmented worm w/ round body, mouth gut anus
MC world: Ascariasis
MC US: pinworm
What are the 4 types of intestinal nematodes?
What are the two cutaneous nematodes?
Strongyloidiasis
Hookworm
Ascariasis
Enterobiasis
Toxocariasis
Trichinellosis
How are Strongyloidiaisis infections acquired
Larvae in soil penetrate feet
Travels via blood to lungs
Swallowed, attaches to intestines
What are the S/Sxs of Strongyloidiasis infections
When is eosinophilia seen/absent?
Loefflers Synd. (pulm migration)
Urticaria
GI
Seen- acute/chronic
Absent- dissemination
How are Strongyloidiasis infections Dx
How is this Tx
Larvae in stool/duodenal fluid
EIA recommended
Ivermectin
Albendazole
What is the 2nd MC infection worldwide and what are the types
How are infections acquired
How long do these infections last?
Hookworm:
A Duodenal
N Americanus
Larvae in dirt penetrate feet
Travel via blood to lungs, swallowed
Attaches in small intestine
5yrs, makes 7K eggs/day
What are the S/Sx of Hookworm infections?
How is this Dx?
How is it Tx
Pica/Protein malnutrition
IDA- MC Sx
Ground itch- penetration site
Eggs in stool
Larvae needed to differentiate
Albendazole
Mebendazole
What is the largest intestinal nematode?
This one is also the MC ?
Ascariasis lumbricoides
MC helminthe worldwide
How are Ascariasis infections acquired?
Where do the infect in the body
F/o route
Eggs hatch to larvae, penetrate intestine wall
Travel via blood to lungs, swallowed
Matures, NOT in Jejunum/Ileum releasing 200K eggs/day
What are the S/Sxs of an Ascariasis infection
How is this Dx
How is this Tx
Migrating= biliary occlusion,
PO expulsion
Lung migration= Loefflers Hemoptysis
Eggs in stool
Albendazole
Mebendazole
Human pinworms are AKA ?
What is the only host of this parasite and makes it the MC ?
Enterbius Vermicularis
Human, preschool/kids
MC helminthe in US
Where do Enterobiasis infections mature?
What are two rare outcomes possibly seen, especially in female PTs?
Larve reside in cecum
Females travel to anus, lay 11K eggs/night= pruritus
Appendicitis
Salpingitis
How are Enterbiasis infections Dx
How is this Tx
Scotch tape test for eggs
Mebendazole
Cutaneous Larva Migrans is caused by ?
What is different about this infection and host
This is the MC ?
Ancylostoma Caninum
Humans accidental hosts, penetrate skin from walking barefoot on beach
Tropically acquired dermatosis
What are the S/Sxs of a Ancylostoma Caninum infection
How is it Dx
How is it Tx
Intense pruritus
Erythematous linear lesions
Lesion appearance
Albendazole Ivermectin
Toxocariasis is AKA ?
This can cause ?
How is an infection acquired
T Canis/Cati- dog/cat roundworm
Visceral larva migrans
Ocular larva migrans
Fecal/oral
Toxocariasis ocular larva migrans can be mis-Dx as ?
How is it Dx
How is it Tx
Leukokoria/retinoblastoma
Clinical Dx
Albendazole, Mebendazole
How are Trichinellosis infections acquired
What are the different types and from eating ?
Eating carnivore meat
Not killed by smoke/salting
T psudospirilis- mammal/bird
T nativa- arctic bears
T nelsoni- African meats
T britovi- Europe/Asian carnivores
What are the S/Sxs of Trichinellosis
What life threatening issues can develop from infection?
Larval migration= invasive phase:
Facial edema
Conjunctivitis
Splinter hemorrhage
Pneumonia
CNS- encephal/meningitis
Myocarditis
How is Trichinellosis Dx
How is it Tx
Eosinophilia during migration
CT/MRI
Muscle biopsy
Steroids
Albendazole
Mebendazole
Define Protozoa
What infectious microbes fall in this class?
Unicellular motile eukaryotes
Giardiasis Crypto Leishmaniaisis Amebiasis Malaria Babesiosis Toxoplasmosis
Amebiasis is caused by ?
What does this cause
E Hystolytica
Amebic liver abscess, M>F in 10% of world population
Where does Amebiasis infect the body
What are the S/Sx
What past Hx may indicate PT has Amebiasis
Tophozite colonizes colon, invades mucus, spreads in circulation
Fulminant/necrotizing colitis
Rectovaginal fistula
Dysentery
Who does fulminant/necrotizing colitis present in?
What do amebic liver abscesses present with that is different from colitis form?
Malnutrition
Younger PTs
Pregnancy
CCS use
Fever, RUQ pain
Single abscess= weight loss w/out fever/pain
PE findings of Amebic Colitis and Amebic Liver Abscess
Colitis: Fever Weight loss Diffuse abdominal tenderness Heme pos stool
Abscess: more severe Fever Weight loss RUQ tenderness Hepatomegaly Jaundcie
What is the DxToC for Amebiasis
What would be seen on US of Amebiasis
What would be seen on CT?
Enteric Parasite Panel PCR-
Stool exam for trophozoites/cysts
OnP- Hystolytica and Dispar look identical
Homogenous Hypoechoic round lesion
Round low attenuation w/ enhanced rim
Low attenuation= started calcification
How is Amebiasis Tx
Metronidazole Tinidazole Iodoquinol luminal agent Paromomycin luminal agent Fulminant colitis- surgery
What is the MC parasite ID’d in stool specimens w/ ? type of syndrome
How is this infection acquired
What are the two MC infections in the summer, especially in kids
G Lamblia
Malabsorption
F/o ingestion of contaminated water
Giardiasis Pinworms
What does Giardiasis do to the body
What can it release in the body?
Alters epithelial function
Vilous atrophy
Cytopathic substances= damaged intestinal epithelium
S/Sxs of Giardiasis
Since PE is usually benign, what may be seen
Urticaria Frothy/greasy stool that float* Anorexia Nausea Sleep d/o
Abdominal tenderness
How is Giardiasis Dx
How is it Tx
EPP PCR- DxTOC
Alt- duodenal biopsy
Tinidazole
Metronidazole
Most of Leishmaniasis infections are ? and AKA ?
What are the different types
Visceral- Kala-azar
AKA Black Fever
Skin- PKADL, Recidivans
Mucocutaneous
Viscerotropic
How is Leishmaniasis transmitted
What type of microbe is it
Zoonosis- Sand flies (Lutzomyia Longipalpis)
Obligate intracellular protozoa
How does cutaneous Leishmaniasis present
If this turns into a systemic infection, where does it reside and w/ ? Sxs
Raise edge, central crater
Regional lymphadenopathy
Marrow Spleen Liver
Fever
Weight loss
Spleen>liver megaly
Leishmaniasis ‘Wet Pizza’
Leishmaniasis Dried
This can be an opportunistic infection along w/ ?
L Major
El Tropica
HIV
What is a common lab finding w/ Visceral Leishmaniasis
What is the characteristic PE finding of this infection
Pancytopenia
Skin darkening
How is Leishmaniasis Dx
Criteria for Mild Dz
Tissue isolate- Giemsa stain
Cutaneous lesion
<4 lesions
None >5cm
No cosmetic sensitive areas
No joint involvement
How is Mild Leishmaniasis Tx
How are other cases Tx
Paromomycin
Liquid N2 w/ IDz consult
Sodium Stibogluconate Liposomal amphotericin Impavido- Tx all forms Meglumine Antimoniate Fluconazole- cutaneous Thermo Radio frequency
What populations have the highest Crypto infection rates
Where does it infect in the body?
What are the two types of Crypto
Kids 1-5yo
MSM
HIV/AIDS CD4<200
Jejunum if healthy
ImmComp- whole GI tract if CD4 <200
Parvum, Hominis
What are two rare S/Sxs of Crypto
How is it Dx
How is it Tx
Icterus, Ascites
EPP PCR
Healthy: Nitazoxanide
ImmComp: HAART therapy
What causes Babesiosis in US and Europe
What is the vector and host for this microbe
US: B Microti
Europe: B Divergens, more severe
Tick vector
Vertebrate host
How does Babesiosis present
Sxs are due to ?
Fever
Malaria-like paroxysm
Fatigue
Parasitism of RBCs
PTs w/ ? SurgHx have a poor prognosis if infected w/ Babesiosis
How is this transmitted
Splenectomy
In Utero
Blood transfusions
How is Babesiosis Dx
Wright/Giemsa stain:
Thin blood smears
Ring forms
Maltese cross- pathognomonic
Serology: IgM IFA 1:64= Dx
CBC: anemia, thrombocytopenia
Inc LFTs/ESR
How is Babesiosis Tx
Atovaquone + Azith
Clinda + quinine
Transfusion exchange
Malaria infections are characterized by ?
What microbe causes this?
What is the carrier?
Cyclic F/C/Sweat
Protozoan of genus Plasmodium
Anopheles
Define Archaic
Majority of malarial cases and deaths are due to ? subtype
Malaria term
Archaic, bad/foul air, miasma
P Falciparum in sub-saharan peds <5y/o
What are the 4 types of malarias
What is the new type that was found in SE Asia?
P Falciparum- tropics
P Vivax- most wide spread
P Ovale- tropical west Africa
P Malariee- tropic
P Knowlesi- simian malaria
What temp is needed for malaria?
Usually these infections don’t occur above ? elevation
> 77*F
6,000 ft
What form of malaria starts infectious process
Sporozites migrate to hepatocytes= Liver Phase
Erythrocytic phase after few wks= invade/rupture RBCs
Fever/Merozoite release
Vivax/Ovale are ? form and linger in ? organ for months
How long are the incubation and fevers for the different forms
Hypnozoite
Liver
Falci 12d, 48hrs
Viviax 14d, 48hrs
Ovale 17d, 48hrs
Malariae 28d 72hrs
Which forms of malaria can relapse?
Which one doesn’t have hypnozoite stage but is unique because ?
Vivax Ovale
Malariae, prolonged erythrocyte infection or ASx
What are the 3 phases and lengths of malaria infections
What is Falciparum so bad
Cold 15-60m
Hot 2-6hrs
Sweat 2-4hrs
Microvascular sequestration
Hyperparasitemia >250K/>5%
Targets RBCs, dec Hct 8-10% in 48hrs
? form of malaria causes anemia
? form causes nephrotic syndrome
? types can cause splenic rupture
P Falciparum
Chronic P Malariae
Vivax Ovale 2-3mon later
What lab result is absent in malaria
What non-Dx lab features indicate poor prognosis
Eosinophilia
Cr > 3mg Acidosis Jaundice Hyperlactatemia Hypoglycemia Elecated ATLs
How is malaria Dx
Define Parasitemia
Thick/thin smears, 12-24hrs apart
Highest yield, soon after fever spikes
Thick 20x more sensitive
Thin better for speciation
Parasites per 1000 RBCs
What are the alternate Dx tests for malaria
Rapid dipstick for LDH
Facliparum from others
BinaxNOW Falciparum Vivax
Malaria prevention/prophylaxis
What meds are used, s/e or length of use
DEET
Permethrin clothes
Doxy qd- sunburn, vaginitis Atovaquone- 7d after return Primaquine- 14d after return and terminal prophylaxis Chloroquine- CNS s/e Tafenoquine- neurotoxic s/e
What drug is used for preventing P Vivax relapses
What drug is used for eradicating persistent hypnozoites
PART w/ Primaquine
Primaquine phosphate
Tafenoquine for Vivax
What drug is used for malarial Tx in PTs w/ Chloroquine sensitivity
What if they’re Chloroquine resistant
What is Falciparum Tx with
Chloroquine Phosphate
Artethemer and Lumefantrine
Atovaquone and Proguanil
Quinine Sulfate and Doxy
Artesunate
What serial lab tests are done during malarial Tx
Smears q6-12hrs for decline parasite loads
Decline of 75% in 48hrs or parasites not cleared of blood in 7days= Tx regimen needs to be changed
What needs to be avoided when treating cerebral malaria
Which forms are likely to relapse
Which one has recrudescence
Steroids
Vivax Ovale
Flaciparum and reinfection
What form of malaria has low levels of infection
Dogs are more likely to bite ?
Cats are more likely to bit ?
P Malariae
Hand Thigh/Head
Hand Arm
Why would CT be ordered for dog bite
How are these Tx
Penetrating head injury
200mL NaCl flush
Staph/Anaerobe coverage
Tetanus/Rabies
Amox Clavu- TxOC
What is the MC pathogen from cat bites
What is the MC pathogen from dog bites
Paturella multocida
Capnocytophaga Canimorsus
Animal bites on the ? rarely become infected
Wounds on ? are left open to heal
Face
Hands/LE
Older than 6hrs
What microbe causes Cat Scratch Fever
This causes the MC cause of ?
Overall, this is the MC cause of ?
Bartonella Henselae
Chronic adenopathy in Peds
Regional adenopathy
What nodes are affected by Cat Scratch
If PT has prolonged fever x 1-2wks w/out source, suspect ?
What Sx can remain for months
Cervical Submandibular Preauricular
Cat Scratch
Fatigue
What syndrome may present w/ Cat Scratch
How is it Dx and confirmed
How is it Tx
Parinaud Oculoglandular
Node biopsy
Serology confirms
Azith
What type of microbe is Toxoplasmosis
How is it transported and disseminated in the body
Obligate intracellular parasite
Trans: lymphatics
Diss: hematogenously
How does Toxo kill AIDS PTs
In ImmComp PTs how does it present
Encephalitis, MC manifestation
Mono-like w/ visual changes
What is the MC presenting Sx of Toxoplasmosis
How is Toxo Tx
Chorioretinitis- 4yr later w/ blurred vision/blindness
None necessary except,
Peds <5y/o
How are AIDS PTs w/ cerebral toxoplasmosis Tx
What med is used as primary prophylaxis for these PTs
Pyrimethamine Sulfadiazine Leucovorin
Trimeth/Sulfameth
What 4 microbes can cause atypical
Which one causes fish tank granuloma
Chelonae Leprae Ulcerans Marinum
Marinum as granuloma or sporotrichotic lymphangitis
How is M Marinum Dx
How can this infection mislead a PHA?
How is it Tx
Culture grown 77-89.6*
Photochromogenic:
Dark- White
Light- yellow
False Pos PPD
Clarith Ethambutol
Rifampin Ethambutol
M Uclerans infection is AKA ?
This is the ? MC mycobacteriosis of humans
Buruli Ulcer in Africa Australia
3rd after TB and Leprosy
How is M Ulcerans Tx
M Leprae is AKA ? Dx
Rifampin and Clarith/Moxiflox
Debrisment/grafts
Hansen Dz
How does M Leprae present
How is it Dx
How is it Tx
Dec sensation
Peripheral neuropathy
Bilateral ulnar neuropathy
Skin biopsy
Nasal scrapings
Rifampin Dapsone and Clofazimine
M Chelonae is associated w/ ? animals
Also associated w/ ? hobby
How is it Tx
Frog/turtles
Tattoos
Tobramycin/Clarith x 4-6mon
What causes Leptospirosis
This is the MC ?
How is it contracted?
Pathogenic spirochetes
Zoonosis in world
Body fluid contact
Urine contaminated water/soil
What are the two syndromes of a Leptospirosis infection
What is the gold standard to Dx
Anicteric- mild flu-like
Incteric- Wells Dz, can lead to organ failure
Isolation from tissue/urine
Extent determined w/ CBC Liver panel Coag studies
What are the classic PE findings of a Leptospirosis infection?
How is Leptospirosis Tx
Lumbar/calf muscle pain
Severe: IV PCN G
OutPT: PO Doxy
What bacteria can cause encephalitis
What viruses can cause it
Cerebritis
HSV Varicella MMR Arbovirus Rabies N Fowleri Toxoplasmosis
What are the MC presenting Sxs of Encephalitis
How is this Dx
AMS
Personality change
CT w/ and w/out contrast
MRI
CSF- essential
If HSV causes encephalitis, where was it laying dormant
How does HSV travel to the CNS?
Trigeminal ganglia
Olfactory bulbs
What subacute form of encephalitis does HSV 1 cause
What subacute form does HSV 2 cause
Brainstem encephalitis
Myelitis
Anterior opercular syndrome is AKA ?
How is HSV induced encephalitis Dx
How is it Tx
Benign recurrent meningitis
PCR for DNA
CT scan- low density lesions in temporal lobes
Acyclovir
What carries Arbovirus
What is the cornerstone to Tx
Mosquito, get infected from birds
Ticks
Prevention
How is arbovirus encephalitis different than encephalitis?
Most of Arbovirus Encephalitis are due to ? microbe
Dys/pyuria
Movement d/o
West Nile- Flavivirus
How does West Nile encephalitis present?
How is it Dx
Extreme lethargy
Flacid paryalysis
Leukopenia
Serology testing
What are the 3 pathways for microbes to cause meningitis
What microbe causes Meningitis in adults and kids
Invasion of bloodstream
Retrograde neuronal pathway
Direct spread- sinusitis/OM
Strep Pneumo
What is the presenting triad of meningitis
What Sx do elderly PTs present without
Fever
AMS
Nuchal rigidity
- Meningeal Sxs
+ lethargy
How is meningitis Dx
What 3 bacteria can cause meningitis
What 3 are more common in neonates
CSF
Strep pneumo
N meningitidis
H influenzae
Listeria monocytogenes
E Coli
Groupd B Beta strep
How is Strep Pneumo meningitis Tx
What will be seen on lab results
What vaccine can be used to prevent this strain?
Cefotaxime/Ceftriaxone and Vanc and Dexameth
PMNs >1000, low glucose
PCV13
What type of microbe is Meisseria meningitidis
How many serogroups are there
How is this Tx
Gram-neg diplococcus
A B C W X Y
B more common in US
Cefotaxime/Ceftriaxone and Vanc and Dexameth
What are the two vaccines that can prevent N Meningitidis in college dorms/military barracks?
Slide 32 Deck Encephalitis
MenACWY
MenB
Questions off of chart
Where are Listeria Mono infections common
How is it Tx
Cellmediated immne deficiencies
Amp + Gentamicin
What drugs are used for post-exposure prophylaxis after N Meningitidis exposures
Ceftriax
Rifampin
Cipro
What microbes cause viral meningitis
What cause parasitic meningitis
What causes fungal meningitis
What special microbes can cause meningitis
Enterovirus HSV Arthropod HIV
Amebic meningitis
C Neoformans C Immitis B Dermatidis Candidiasis H Capsulatum
TB Syphilis
What microbe that causes meningitis has been found in vials of Methylpredisolone acetate
How is TB meningitis Tx
How is Syphilis meningitis Tx
Exserohilum
Aspergillis
INH + Pyrazinamide
Aqueous crystaline PCN G
Benzathing PCN G
What microbes are associated w/ Prion Related Dzs
Why are these Dxs so bad
Kuru
Creutzfeldt Jakob Dz
Bovine spongiform encephalopathy
All prion dzs= fatal
How are Prion Dzs Dx
What joints are most likely to become infected
What will be seen on lab results
MRI- inc intensity
CSF- inc proteins
Knees
Inc ESR
Synovial WBCs >50K
90% PMLs
Low Glucose
What microbe is most likely to cause joint infections?
What microbe is most likely to infect prosthetic joints
What microbe is most likely in PTs under 30y/o
Staph A
MRSA
Strep pyogenes
N Gonorrhea
What would an initial x-ray of an infected joint show?
When would an x-ray be more useful and not as useful?
Negative
Less useful in osteomyelitis
What drugs are used for joint infections?
What part of the body is more likely to contract septic/infectious bursitis
MSSA- Nafcillin/Oxacillin
MRSA- Vanc + Rifampin
P Aeruginosa- Ceftazidime
N Gonorrhoeae- Ceftriaxone
Patellar/Olecranon of older adults
S/Sxs of septic bursitis
What two presenting Sxs require immediate aspiration
What is the MC microbe of septic bursitis and where does it infect
Fever Cellulitis Boggy swelling
Dec motion
Fever + Cellulitis
Staph A in Olecrannon/Prepatellar
What are the 4 stages of osteomyelitis pressure injuries
Define Suspected Depp Tissue Injury
1: intact injury
2: partial thickness loss of dermis
3: full thickness tissue loss
4: full thickness w/ exposed bone
Purplish area due to damage of tissue, thin blister over dark wound bed
What must be done during osteomyelitis Tx prior ABX
What part of the bone does osteomyelitis MC infect
Bone biopsy
Metaphases
Osteomyelitis microbes that is MC, diabetic foot infection, joint or Sickle Cell
What is the best way to Dx
What lab is used to track Tx progression
MC- Staph A
Diabetic- anaerobe
Joint- MRSA
Sickle- Salmonella
Bone scan + in 2days
MRI*/CT + in 2days
Bone biopsy
ESR
PT stepped on nail, penetrated skin and causes osteomyelitis, how is it Tx?
What does prosthetic joint infections of Periostitis look like?
Cipro
Endosteal scalloping focal/diffuse osteolysis
What type of organism is Ricketts
What color do these microbes stain during lab work?
Obligate intracellular gram-neg coccobacilli
Red w/ Giemsa stain
Rickets are usually transmitted to humans by arthropods except for ?
What part of the body does Rickettsial Dz infect
Q-fever
Skin and Adrenals
How is Rickettsial Dz Tx
This Dz is caused by ? microbe
What vector carries the microbe?
Doxy
Rickettsia Prowazekii
Pediculus humanus
Since Rickettsial Dz is becoming Doxy resistant, what drug is used for Tx
How does Rieckettsial Dz rashes spread
Azithromycin
Trunk to extremities, spares face palms and soles
What causes Murine Typhus
What causes RMSF
Rickettsia typhi carried by rat flea
Rickettsia rickettsii carried by Wood/Dog tick
How does Rickettsial Dz progress in presentation
Day 1-2: abrupt onset fever/Ha
Day 2-4: rash on wrist/ankle spreads centrally
Day 5-7: fever 104*F, rash spreads to palm/sole
Day 7-9: rash necrosis, most fatalities
How is Rickettsial Dz Tx
What microbe causes Q Fever and what does this cause
Doxy- TxDoC, best if started w/in 5 days of Sxs
Coxiella burnetii- macrophages in lungs, vegetated heart valves
How does Q-fever present
What is the mainstay for Dx
Intractible HA
NO Rash
Serology cross reactivity
What microbe causes Lyme Dz
What is the carrier?
Borrelia burgdorferi
Ixodes ticks- AKA Deer Tick
What are the two stages of initiating a Lyme Dz infection by time of year
How long does the tick have to be attached for an infection to take root?
Nymph stage, spring-summer
Adult stage, fall
24hrs
What are the three stages of Lyme Dz
What is the characteristic sign of an infection?
Localized Disseminated Persistant
Local/Dissem part of early infections
Persistent- late infection, w/in 1yr
Erythema migrans
Lyme Dz usually infects ? CN
If PT presents w/ this manifestation, what Tx adjustment is made
7 and Bells Palsy
Add 10 day taper of steroids
What is the cardiac manifestation of Lyme Dz
What is the hallmark of a late Lyme infection
Carditis/Lyme Carditis- 1 2 or 3rd degree blocks
Arthritis, usually knee/large joints
What joints are more likely to be involved in monoarticular Lyme Dz
How long can it take for this to occur
Knee Ankle Wrist
Within 6mon of erythemous migrans
How are Lyme infections identified
What would be seen on lab results
Ab detection proves exposure, not active infection
Confirm w/ Western Blot
AB blocks
Inc CBC ESR
WBCs in joint fluid
How is each of the Lyme infections Tx
Tick bite, endemic Tick bite, non endemic EM Carditis Facial nerve paralysis Meningitis Arthritis
Doxy
None
Doxy/Amox
IV Ceftriaxone/PO Doxy
Doxy
IV Ceftriaxone
Doxy
What is the MC rabies carrier
Rabies is not a Dz of rodents w/ ? exception
How can human to human infections occur
Cats-1
Bats- 3rd most reported
Dogs- MC worldwide, NHPs second
Groundhogs
Organ/Corneal transplant
What Genus is Rabies
What part of the NS does it infect
Bites on ? part of the body are bad
Lyssavirus
Gray matter, limbic, midbrain and hypothalamus
Head/neck
What findings are pathognemonic for rabies
What is the acute neuro period called
Paresthesia/pain at site
Hydro/aerophobia
Negri bodies
Parayltic/Dumb/Apathetic rabies
How is rabies Tx
Wound cleansing w/ 1 part soap/4 parts water
Human diploid cell vaccine
Purified chick embryo vaccine
Pre-exposure: immunization on day 0 7 21 28 then booster
No vaccHx- HDCV/PCEC on day 0 3 7 14
Prior Vacc- re-vacc on day 0 and 3
