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IDz Block 3 Flashcards

1
Q

How do Cestodes eat?

What are the body parts?

A

Absorb through integument

Scolex (attachment)
Neck
Segmented body- proglottids

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2
Q

Cestodes are AKA ? and what are the 4 types

A

Tapeworms
Hymenolepiasis- Nana, Diminuta
T solium Saginata
D Latum

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3
Q

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?

A

Dwarf Tapeworm, 15-40mm

Cestode infections worldwide

F-o ingestion of eggs
In ileum, attach to villus

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4
Q

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

A

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

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5
Q

Life cycle of Taeniasis

A

Human SmInt- eggs in feces
Cattle/pig ingest eggs
Embyos penetrate gut lumen, encyst muscular tissue= infection 2-3mon
Cysticercus attaches in SmInt

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6
Q

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?

A

50K eggs/day
25yrs

Hunger Epigastric Anorexia Diarrhea Malaise Abd pain Weight loss Nausea

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7
Q

What is the most striking/main feature of the other form?

What can happen w/ migrating proglottids during a Taeniasis infection

A

T Saginata- passing proglottis

Appendicitis
Cholangitis

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8
Q

What PE finding of Taeniasis is less/more common in kids and more in adults?

What form can present with an odd presentation?

A

Adults: Subcutaneous nodules
Peds: weight loss

Cysticercosis- Neuro abnormalities

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9
Q

What labs are drawn during a Taeniasis infection

How is this Tx

A

Stool sample
Ab detection- early/invasive
Cellophane swab
CBC

Praziquantel
Surgery if obstruction present

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10
Q

Define Cysticercosis

Where is this seen in the US

What is the definitive host and how does it get infected??

A

Systemic dissemination d/t larval form of T Solium

SoCal

Humans, F/o route

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11
Q

What tissues can Cysticercosis infect?

This parasite is also the MC ?

A

Muscle Eye CNS Heart Skin

Parasitic infection of CNS

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12
Q

What are the S/Sxs of Neurocysticercosis

S/Sxs of Cysticercosis

A

Seizure HA AMS Vision change N/V

Papilledema Hyperreflex Afebrile Nystagmus SubQ nodules

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13
Q

What Labs/Rads are ordered for Cysticercosis

A

CT* MRI

Biopsy nodule
ELISA 
CBC
CSF 
Stool for Taeniasis
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14
Q

How is Cysticercosis Tx

A

Main focus= Sx care
CCS Osmotic Diuretic
O2
Anticonvulsant

Not for NeuroCystic:
Albendzaole/Praziquantel + Dexamethasone
Maybe Etanercept (anti-TNF)

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15
Q

Where are Diphyllobothriasis infection acquired from

Where does it reside in and for how long

A

Embryo from crustacean eaten by fish consumed raw by human

Small Intestine x 10yrs

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16
Q

MC presentation of Diphyllobothriasis infestation

What other S/Sx may be seen

A

ASx

Hunger Dizzy
Fatigue Weak*(rare) Numb Diarrhea

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17
Q

Diphyllobothriasis has unusual affinity for ?

This may cause PTs to present w/ issues resembling ? issue

A

Vit B12

Megaloblastic anemia

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18
Q

What would be seen on lab results in Diphyllobothriasis infections

How are these infections T

A

Stool ova/parasites
CBC- dec Hgb/Hct
Inc MCV, Eosinophils
Low B12/Folate

Praziquantel w/ vitamins

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19
Q

Trematodes have ? body parts and are AKA

What is seen on lab results in suspected Trematode infections?

A

Flat body w/ cuticle and sucker, Flukes

Eosinophilia= migrating, none during intestinal phase

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20
Q

What are the types of Trematodes?

A

Blood: Schistosomiasis- Haematobium Japonicum Masoni

Liver- F Hepatica

Lung- P Westermani

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21
Q

Eosinophilia is not present during ? infections?

Where do the different types of Blood flukes like to invade?

A

Protozoa

Haematobium- veicals
Japonicum- SM Vein
Masoni- IM Vein

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22
Q

Trematodes are hermaphrodites except for ?

What are the 3 types of Schistosoma species that invade humans and in ? countries

A

Schitosoma spp.

Haematobium- Africa ME
Japonicum- Far East
Masoni- SAmerica Caribbean Africa ME

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23
Q

What Schistosomiasis’ are excreted from feces or urine?

Which ones are indicted in bladder cancer

Where do Schistosomiasis mature prior to invading human hosts?

A

Japon/Masoni- feces
Haematobium- urine

Haematobium- due to vescile plexus invasion

Snails (snail fever)

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24
Q

What is acute Schistosomiasis AKA?

These S/Sxs are due to ? etiology

A

Katayama fever d/t Mansoni/Japonicum

Serum Sickness reaction

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25
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
26
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
27
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
28
How are Fascioliasis infections Dx? How are they Tx?
Egg identification Ab detection ELISA Triclabendazole
29
What is the MC form of Paragonimiasis infections in humans? How long can these infections last for in humans?
Westermani in Far East 20yrs
30
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
31
How are Paragonimiasis Dx How is it Tx
Eggs in stool/sputum Confirmed w/ biopsy Complement fixation Praziquantel
32
# 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
33
What are the 4 types of intestinal nematodes? What are the two cutaneous nematodes?
Strongyloidiasis Hookworm Ascariasis Enterobiasis Toxocariasis Trichinellosis
34
How are Strongyloidiaisis infections acquired
Larvae in soil penetrate feet Travels via blood to lungs Swallowed, attaches to intestines
35
What are the S/Sxs of Strongyloidiasis infections When is eosinophilia seen/absent?
Loefflers Synd. (pulm migration) Urticaria GI Seen- acute/chronic Absent- dissemination
36
How are Strongyloidiasis infections Dx How is this Tx
Larvae in stool/duodenal fluid EIA recommended Ivermectin Albendazole
37
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
38
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
39
What is the largest intestinal nematode? This one is also the MC ?
Ascariasis lumbricoides MC helminthe worldwide
40
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
41
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
42
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
43
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
44
How are Enterbiasis infections Dx How is this Tx
Scotch tape test for eggs Mebendazole
45
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
46
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
47
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
48
Toxocariasis ocular larva migrans can be mis-Dx as ? How is it Dx How is it Tx
Leukokoria/retinoblastoma Clinical Dx Albendazole, Mebendazole
49
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
50
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
51
How is Trichinellosis Dx How is it Tx
Eosinophilia during migration CT/MRI Muscle biopsy Steroids Albendazole Mebendazole
52
# Define Protozoa What infectious microbes fall in this class?
Unicellular motile eukaryotes ``` Giardiasis Crypto Leishmaniaisis Amebiasis Malaria Babesiosis Toxoplasmosis ```
53
Amebiasis is caused by ? What does this cause
E Hystolytica Amebic liver abscess, M>F in 10% of world population
54
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
55
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
56
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 ```
57
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
58
How is Amebiasis Tx
``` Metronidazole Tinidazole Iodoquinol luminal agent Paromomycin luminal agent Fulminant colitis- surgery ```
59
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
60
What does Giardiasis do to the body What can it release in the body?
Alters epithelial function Vilous atrophy Cytopathic substances= damaged intestinal epithelium
61
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
62
How is Giardiasis Dx How is it Tx
EPP PCR- DxTOC Alt- duodenal biopsy Tinidazole Metronidazole
63
Most of Leishmaniasis infections are ? and AKA ? What are the different types
Visceral- Kala-azar AKA Black Fever Skin- PKADL, Recidivans Mucocutaneous Viscerotropic
64
How is Leishmaniasis transmitted What type of microbe is it
Zoonosis- Sand flies (Lutzomyia Longipalpis) Obligate intracellular protozoa
65
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
66
Leishmaniasis 'Wet Pizza' Leishmaniasis Dried This can be an opportunistic infection along w/ ?
L Major El Tropica HIV
67
What is a common lab finding w/ Visceral Leishmaniasis What is the characteristic PE finding of this infection
Pancytopenia Skin darkening
68
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
69
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 ```
70
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
71
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
72
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
73
How does Babesiosis present Sxs are due to ?
Fever Malaria-like paroxysm Fatigue Parasitism of RBCs
74
PTs w/ ? SurgHx have a poor prognosis if infected w/ Babesiosis How is this transmitted
Splenectomy In Utero Blood transfusions
75
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
76
How is Babesiosis Tx
Atovaquone + Azith Clinda + quinine Transfusion exchange
77
Malaria infections are characterized by ? What microbe causes this? What is the carrier?
Cyclic F/C/Sweat Protozoan of genus Plasmodium Anopheles
78
# 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
79
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
80
What temp is needed for malaria? Usually these infections don't occur above ? elevation
>77*F 6,000 ft
81
What form of malaria starts infectious process
Sporozites migrate to hepatocytes= Liver Phase Erythrocytic phase after few wks= invade/rupture RBCs Fever/Merozoite release
82
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
83
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
84
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
85
? form of malaria causes anemia ? form causes nephrotic syndrome ? types can cause splenic rupture
P Falciparum Chronic P Malariae Vivax Ovale 2-3mon later
86
What lab result is absent in malaria What non-Dx lab features indicate poor prognosis
Eosinophilia ``` Cr > 3mg Acidosis Jaundice Hyperlactatemia Hypoglycemia Elecated ATLs ```
87
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
88
What are the alternate Dx tests for malaria
Rapid dipstick for LDH Facliparum from others BinaxNOW Falciparum Vivax
89
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 ```
90
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
91
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
92
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
93
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
94
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
95
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
96
What is the MC pathogen from cat bites What is the MC pathogen from dog bites
Paturella multocida Capnocytophaga Canimorsus
97
Animal bites on the ? rarely become infected Wounds on ? are left open to heal
Face Hands/LE Older than 6hrs
98
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
99
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
100
What syndrome may present w/ Cat Scratch How is it Dx and confirmed How is it Tx
Parinaud Oculoglandular Node biopsy Serology confirms Azith
101
What type of microbe is Toxoplasmosis How is it transported and disseminated in the body
Obligate intracellular parasite Trans: lymphatics Diss: hematogenously
102
How does Toxo kill AIDS PTs In ImmComp PTs how does it present
Encephalitis, MC manifestation Mono-like w/ visual changes
103
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
104
How are AIDS PTs w/ cerebral toxoplasmosis Tx What med is used as primary prophylaxis for these PTs
Pyrimethamine Sulfadiazine Leucovorin Trimeth/Sulfameth
105
What 4 microbes can cause atypical Which one causes fish tank granuloma
Chelonae Leprae Ulcerans Marinum Marinum as granuloma or sporotrichotic lymphangitis
106
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
107
M Uclerans infection is AKA ? This is the ? MC mycobacteriosis of humans
Buruli Ulcer in Africa Australia 3rd after TB and Leprosy
108
How is M Ulcerans Tx M Leprae is AKA ? Dx
Rifampin and Clarith/Moxiflox Debrisment/grafts Hansen Dz
109
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
110
M Chelonae is associated w/ ? animals Also associated w/ ? hobby How is it Tx
Frog/turtles Tattoos Tobramycin/Clarith x 4-6mon
111
What causes Leptospirosis This is the MC ? How is it contracted?
Pathogenic spirochetes Zoonosis in world Body fluid contact Urine contaminated water/soil
112
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
113
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
114
What bacteria can cause encephalitis What viruses can cause it
Cerebritis ``` HSV Varicella MMR Arbovirus Rabies N Fowleri Toxoplasmosis ```
115
What are the MC presenting Sxs of Encephalitis How is this Dx
AMS Personality change CT w/ and w/out contrast MRI CSF- essential
116
If HSV causes encephalitis, where was it laying dormant How does HSV travel to the CNS?
Trigeminal ganglia Olfactory bulbs
117
What subacute form of encephalitis does HSV 1 cause What subacute form does HSV 2 cause
Brainstem encephalitis Myelitis
118
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
119
What carries Arbovirus What is the cornerstone to Tx
Mosquito, get infected from birds Ticks Prevention
120
How is arbovirus encephalitis different than encephalitis? Most of Arbovirus Encephalitis are due to ? microbe
Dys/pyuria Movement d/o West Nile- Flavivirus
121
How does West Nile encephalitis present? How is it Dx
Extreme lethargy Flacid paryalysis Leukopenia Serology testing
122
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
123
What is the presenting triad of meningitis What Sx do elderly PTs present without
Fever AMS Nuchal rigidity - Meningeal Sxs + lethargy
124
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
125
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
126
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
127
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
128
Where are Listeria Mono infections common How is it Tx
Cellmediated immne deficiencies Amp + Gentamicin
129
What drugs are used for post-exposure prophylaxis after N Meningitidis exposures
Ceftriax Rifampin Cipro
130
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
131
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
132
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
133
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
134
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
135
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
136
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
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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
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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
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What must be done during osteomyelitis Tx prior ABX What part of the bone does osteomyelitis MC infect
Bone biopsy Metaphases
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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
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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
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What type of organism is Ricketts What color do these microbes stain during lab work?
Obligate intracellular gram-neg coccobacilli Red w/ Giemsa stain
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Rickets are usually transmitted to humans by arthropods except for ? What part of the body does Rickettsial Dz infect
Q-fever Skin and Adrenals
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How is Rickettsial Dz Tx This Dz is caused by ? microbe What vector carries the microbe?
Doxy Rickettsia Prowazekii Pediculus humanus
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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
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What causes Murine Typhus What causes RMSF
Rickettsia typhi carried by rat flea Rickettsia rickettsii carried by Wood/Dog tick
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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
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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
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How does Q-fever present What is the mainstay for Dx
Intractible HA NO Rash Serology cross reactivity
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What microbe causes Lyme Dz What is the carrier?
Borrelia burgdorferi Ixodes ticks- AKA Deer Tick
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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

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