Inf 1 Flashcards
Infectious mononucleosis causes prolonged fever, pharyngitis, fatigue, and lymphadenopathy and is diagnosed by the
heterophile antibody ( monospot test )
Triad of tenosynovitis, dermatitis, migratory polyarthralgia
Disseminated gonococcal infection
Purulent monoarthritis
Disseminated gonococcal infection
Disseminated gonococcal infection treatment
3rd-generation cephalosporin IV AND oral azithromycin
Disseminated gonococcal infection causes
high fever, chills, tenosynovitis, polyarthralgia, and pustular lesions on the trunk and extremitie
Pharyngitis, fever, and lower abdominal pain in a sexually active patient are caused by………………… , …………………… is due to orogenital contact.
gonococcal pharyngitis and associated pelvic inflammatory disease. , Gonococcal pharyngitis
We treat herbes zoster by
It is treated with antiviral agents (eg, acydovir, famciclovir, valacyclovir).
Treatment of HSV encephalitis
Acyclovir
Brain MRI: temporal lobe hemorrhage/edema
HSV encephalitis
Diagnostic findings of …………
CSF analysis:
o ⬆️WBCs (lymphocytes), ⬆️RBCs
o ⬆️Protein, normal glucose
o HSV DNA on PCR
HSV encephalitis
Clinical findings
. Fever
• Headache
• Seizure
• Altered mental status (eg, confusion, agitation)
• ± Focal neurologic findings (eg, hemiparesis, cranial nerve palsies, ataxia)
HSV encephalitis
Septic pulmonary emboli occur in up to 75% of patients with……… endocarditis, most commonly due to……… in IVDU with IE
tricuspid , Staphylococcus aureus
………… is not often associated with a rash (<30% in adults) and is described as “Rocky Mountain spotted fever (RMSF) without the spots.
Ehrlichiosis
……… can present with cerebrospinal fluid findings of elevated white blood cell count with a lymphocytic predominance
Viral encephalitis
…………… is the most likely diagnosis in this patient from Mississippi who was initially thought to have sarcoidosis (cough, hilar adenopathy, erythema nodosum, and non-caseating granulomas in an African American individual) but deteriorated following high-dose corticosteroid therapy
Histoplasmosis
Histoplasmosis caused by
Histoplasma capsulatum
pulmonary histoplasmosis should be considered when pulmonary symptoms are accompanied by ……………… or by arthralgias and erythema nodosum.
mediastinal or hilar lymph nodes (or masses)
Histoplasma urinary antigen testing, are used for diagnosis of
Pulmonary Histoplasmosis
………………… is required in patients with HIV who develop progressive disseminated histoplasmosis (PDH). After 1-2 weeks of clinical improvement, patients are often transitioned to oral …………… for >1 year of maintenance therapy.
Amphotericin B , itraconazole
Infectious mononucleosis, most commonly due to ………… infection, presents with prolonged fever, malaise, and sore throat.
Epstein-Barr virus (EBV)
Infectious mononucleosis, most commonly due to EBV infection, presents with
prolonged fever, malaise, and sore throat.
Patients may develop autoimmune …………… up to 2-3 weeks after the onset of initial symptoms of infective mononucleosis
Clinical manifestations of ………………… include fatigue, sore throat, fever, lymphadenopathy, and splenomegaly. Atypical lymphocytes on peripheral smear are characteristic; heterophile antibodies, while specific for Epstein-Barr virus infection, may be negative early in the illnes
infectious mononucleosis
is a Gram-negative anaerobe and a common constituent of normal human oral flora
Eikenella corrodens
is the most common complication of influenza and is the result of either secondary bacterial infection ( eg, Streptococcus pneumoniae) or direct viral attack (influenza pneumonia).
Pneumonia
accounts for about 50% of cases of pyogenic spinal osteomyelitis
Staphylococcus aureus
exquisite focal tenderness on percussion at the posterior spinous process of the affected vertebra
Osteomyelitis
Kaposi sarcoma is
vascular tumor due to co-infection with HIV and human herpesvirus-8, and is most common in men who have sex with men.
Commonly involved regions of kaposi sarcoma include
legs, face, oral cavity, and genitalia, and KS can also be seen in the gastrointestinal tract and lungs.
lesions of KS typically begin as…………… , and later develop into ……………
The color can change from light brown to…………… , and patients often have multiple lesions.
papules , plaques or nodules.
violet
causes pneumonia in patients with AIDS who have CD4 cell counts <200/mm3 . Although extrapulmonary disease may present as papules and nodules in the ear canal, it is uncommon.
Pneumocystis jiroveci
………… causes diffuse mucocutaneous lesions associated with systemic symptoms beginning 1-3 months after the initial infection.………… can occur years after the initial infection, and is characterized by nodular or ulcerating lesions with necrosis and scarring.
Secondary syphilis , Tertiary gummatous syphilis
patient’s recent oral infection (likely thrush) and history of intravenous drug use suggest…………
HIV
The lesions usually appear as multiple
violaceous papules
KS
Contaminated water
Legionella pneumonia
Treatment of Legionella pneumonia
Respiratory fluoroquinolone or newer macrolide
an intracellular, gram-negative organism commonly spread by aerosols or droplets from cvntaminated water supplies
Legionella pneunmphila
Clinical clues of legionella pneumonia
• Fever >39 C (1022 F)
• Bradycardia relative to high fever
• Neurological symptoms (especially confusion)
• Gastrointestinal symptoms (especially diarrhea)
• Unresponsive to beta-lactam & aminoglycoside antibiotics
Laboratory clues of legionella pneumonia
• Hyponatremia
• Hepatic dysfunction
• Hematuria & proteinuria
• Sputum Gram stain showing many neutrophils, but few or no microorganisms
Entamoeba histolytica Risk factors
• Developing nations (travel/residence)
• Contaminated food/water
• Fecal-oral, sexual transmission (rare)
Liver abscess (RUQ pain, fever) seen in
Entamoeba histolytica
Diagnosis of entsmoeba Histolytica
Stool ova & parasites, stool antigen testing (colitis)
E hislolytica serology (liver abscess
Treatment of entamoeba histolytica
Metronidazole followed by paromomycin to eradicate intestinal colonization.
.Macular, anesthetic skin lesions with raised borders
• Nodular, painful nearby nerves with loss of sensory/motor function
Leprosy الجذام ر
الجذام يعالج ب
Dapsone + rifamp
Manifestations of leprosy include
chronic, anesthetic, macular (often hypopigmented) skin lesions with raised, well-demarcated borders. Nearby nerves often become nodular and tender, and segmental demyelination may result in loss of sensation and motor function.
Lyme disease due to
Borrelia burgdorferi
The hallmark feature is erythema migrans (EM), a flat, annular macule at the tick bite site that slowly expands outward as the spirochete moves through the dermis.
Lyme disease
bull’s-eye appearance.
Lyme disease
Empiric treatment of Lyme disease with
a 14-day course of oral doxycycline is curative in most patients.
Treatment of Lyme disease In pregnant women
oral amoxicillin
doxycycline is more controversial (eg, possible risk of fetal tooth discoloration and retardation of skeletal development) and is generally only
considered on a case-by-case basis
Nocardia is
filamentous, aerobic, gram-positive bacteria that is partially acid-fast. It causes pulmonary or disseminated disease (particularly to the brain) in immunocompromised hosts
The treatment of choice for Nocardia is
trimethoprim-sulfamethoxazole.
is a tapeworm transmitted to humans by the ingestion of undercooked, contaminated pork.
Taenia solium
Neurocysticercosis typically manifests as an
adult-onset seizure
Treatment of Neurocystocercosis ( tenea solium )
antiepileptics (eg, phenytoin)
antiparasitics (eg, albendazole)
corticosteroids (for brain inflammation).
Complications of malaria
• Children: Seizure, coma, hypoglycemia, metabolic acidosis
• Adults: Jaundice, acute renal failure, acute pulmonary edema
Thin & thick peripheral blood smears
Malaria
Protection from malaria
• Hemoglobinopathies (Hgb S, Hgb C, thalassemia)
• Partial immunity from previous malarial illness
Prevention for malaria
Antimalarial drugs
Insecticide-treated nets
Household insecticide residual spraying
Antimalarial drugs
• Atovaquone-proguanil
• Doxycycline
• Mefloquine
• Chloroquine
• Hydroxychloroquine
Atovaquone-proguanil
Antimalarial drugs
The hallmark is cyclical fever, coinciding with
Plasmodium-induced RBC lysis.
Antiretroviral therapy should be initiated in all patients with …………… (usually 2 weeks after antifungal treatment).
HIV who develop PDH
Necrotic invasion of palate, orbit, brain
Rhino-orbital-cerebral mucormycosis*
Rhino-orbital-cerebral mucormycosis* treatment
Surgical debridement
Liposomal amphotericin B
Elimination of risk factors eg, ⬆️glucose, acidosis)
Risk factors of Rhino-orbital-cerebral mucormycosis*
Diabetes mellitus (ketoacidosis)
• Hematologic malignancy
• Solid organ or stem cell transplant
Mucormycosis is a
highly destructive fungal infection
Rhino-orbital-cerebral mucormycosis is usually caused by
Rhizopus species
(sulfur granules) on or near the jaw ?
Actinomyces
Complications of Meningococcal meningitis
Shock
Disseminated intravascular coagulation
Adrenal hemorrhage
Meningococcal meningitis treatment
Ceftriaxone
………… is a 4- generation cephalosporin that covers most of the major organisms of bacterial meningitis (eg, Streptococcus pneumoniae, Neisseria meningitidis, group B streptococci, Haemophilus influenzae) as well as Pseudomonas aeruginosa.
Cefepime
provides coverage against cephalosporin resistant pneumococci,
Vancomycin
covers Listeria monocytogenes.
ampicillin
Streptococcus pnewnoniae, Neisseria meningitidis at age 2-50 treated by
Vancomycin + 3rd-generation cephalosporin
S pnewnoniae, N meningitidis, Listeria >50 years old treated by
Vancomycin + ampicillin + 3rd-generation
cephalosporin
lmmunocompromised pt. Infected by
S pnewnoniae, N meningitidis, Listeria, gram negative rods treated with
Vancomycin + ampicillin + cefepime
Neurosurgery/penetrating skull trauma infected by staphylococci , Gram-negative rods, MRSA, coagulase-negative treated with
Vancomycin + cefepime
Alternatives to cefepime
ceftazidime or meropenem
Alternative to ampicillin
trimethoprim-sulfamethoxazole for Listeria
Cryptococcal meningoencephalitis treatment
Amphotericin B with flucytosine initially
Fluconazole maintenance
Transparent capsule seen with India ink stain
Cryptococcal meningoencephalitis
Headache, fever & malaise
• Develops over 2 weeks (subacute)
• Can be more acute & severe in HIV
Presentation of Cryptococcal meningoencephalitis
Ecthyma gangrenosum occurs primarily in immunocompromised patients with………… bacteremia/sepsis.
P aeruginosa
multiple nonenhancing brain lesions with no mass effect (edema).
Progressive multifocal leukoencephalopathy
asymmetric white matter lesions; no enhancement/edema
Progressive multifocal leukoencephalopathy
Lymphocyte-predominant leukocytosis
Pertussis Pertussis
Fifth disease
Parvovirus B19 infection
Diagnosis of Parvovirus B19 infection
• Acute infection
o B19 lgM antibodies in immunocompetent patients
o NAAT for B19 DNA in immunocompromised patients
• Previous infection: B19 lgG antibodies (documents immunity)
• Reactivation of previous infection: NAA T for B19 DNA
Erythema infectiosum (fifth disease): Fever, nausea & “slapped cheek” rash (more common in children)
Parvovirus B19 infection
To prevent Pneumocystis pneumonia , most patients receiving prolonged glucocorticoid therapy are prescribed
primary prophylaxis with TMP-SMX
Diffuse bilateral reticulonodular infiltrates on pulmonary imaging
Pneumocystis pneumonia
Manifestations of Pneumocystis pneumonia
• Indolent (AIDS) or acute respiratory failure
(immunosuppressive treatment)
• Dyspnea, hypoxia, dry cough, fever
• j Lactate dehydrogenase level
• Diffuse bilateral reticulonodular infiltrates on pulmonary
. . imaging
This patient’s history of multiple sexual partners and evidence of oropharyngeal thrush (white mucosa! plaques) raise strong suspicion for
underlying…………… The presence of subacute pulmonary symptoms (dyspnea, dry cough, fever}, tachypnea, hypoxemia, and bilateral
interstitial infiltrates indicates likely ……………
HIV infection. ,, Pneurnocystis pneumonia (PCP},
patients with PCP often have significant………
and a……… alveolar-arterial oxygen gradient
hypoxia , large
Indications for corticosteroids in pat with pneumocystis pneumonia
, a Pa02 < 70 mm Hg
, an alveolar-arterial (A-a) gradient > 35 mm Hg, or
, pulse oximetry <92o/o on room air.
tick-borne illness caused by Rickeltsia lickettsii
Rocky Mountain spotted fever
Can develop complications of encephalitis, pulmonary edema, bleeding, shock
Rocky Mountain spotted fever
Clinical features of Rocky Mountain spotted fever
Nonspecific fever, headache, myalgia, arthralgia
Macular & petechial rash on wrists/ankles
JC virus reactivation
Progressive multifocal leukoencephalopathy
