Inf Dz Flashcards
abx ladder for gram (+) coverage
PCNs –> naficillin –> Vanco –> Linezolid
abx ladder for gram (-) coverage
PCNs –> ampicillin/amoxicillin ( + beta lactamase - gives some gram (+) coverage) –> pipicercillin ( + tazobactam gives some gram (+) coverage) –> carbapenams
generations of cephalosporins
1st gen - gram + coverage
2nd gen - gram + coverage
3rd gen - gram (-) coverage
4th gen - gram (-) coverage and some gram (+) coverage
fluoroquinolones
1st - cipro
2nd - levofloxacin
3rd - moxifloxacin
each generation contains prior generation benefits
anaerobic coverage
metro - groin and abdomen
clindamycin - everywhere else
abx coverage of CAP
ceftriaxone + azithromycin (IV) or moxifloxacin (oral or IV) or azithromycin (oral)
abx coverage of health care association pna
vancomycin
+
pip/tazo
abx coverage of meningitis
ceftriaxone \+ vancomycin \+/- steroids (M3 level everyone) \+/- ampicillin (if immunocompromised)
abx coverage of UTI
amoxicillin (pregnant) or nitrofuranotin (female) or TMP-SMX or Ceftriaxone (inpatient pyelo tx) or Cipro (ambulatory pyelo)
basic tx of HIV
antiretrovirals 2+ 1
2 - NRTs - emtricitabine + tenofovir
+
1 - either NNRT, PI + ritonavir, entry inhibitors, fusion inhibitors
pre exposure prophylaxis
2 NRTs
- emtricitabine + tenofovir
post exposure prophylaxis
2 NRTs + 1
- emtricitabine + tenofovir (+/-) raltegravir (PI)
pregnancy
AZT
to prevent vertical transmission
risk factors of HIV
sex (0.2%)
IV drug use and needle sticks (0.3%)
vertical transmission (25%)
antiretroviral syndrome
acute HIV infection
“flu like symptoms”
dx - PCR (elisa is too soon here)
dx of HIV
ELISA –> confirmatory test = western blot –> tell pt now —–> run viral load + CD4 + genotype (shows sensitivity to meds)
CD4 counts bugs emperic abx
CD4 count bugs abx
<200 PCP TMP-SMX or dapsone or atovaquone
(if G6PD)
<100 . toxo TMP-SMX - propymethramine + leucovorin
<50 MAC . weekly azithromycin
primary TB infection
lobar pneumonia that just doesn’t get better
cavitations - casseating granulomas
secondary TB infection (reactivation)
ghon complex
apical lesions - low O2 tension
hemopytsis, night sweats, weight loss
asymptomatic screening
TB test –> PPD or quantiferon assay –> + –> CXR –> + AFB smear –> + –> activation TB –> RIPE
PPD readings that are positive
> 5mm - if immunocompromised
10mm - if health care worker, travel to endemic areas, prison, homeless
15mm - soccer mom
TB tx for latent infection and active infection
latent TB - INH + B6
active TB - RIPE
R - rifampin - ADR - red body fluids
I - INH - ADR - peripheral neuropathy give B6
P - Pyrazinamide - ADR - hyperuricemia, gout
E - ethambutol - ADR - red green colorblindness
pt with history of BCG vaccine
PPD or interferon gamma assay
interferon gamma assay
+PPD and (-) CXR –>
INH + B6
most sensitive and specific TB test =
NAAT
PCR
adenosine deaminase for bodily fluid testing
SIRS (systemic inflammatory response syndrome) criteria
Temp >38 or <36
WBC > 12 or < 4
HR > 90
RR > 20
Sepsis severity
SIRS - if 2/4 (+)
Septic - if SIRS + and source present
Severe sepsis >1 organ dysfunction - that responds to fluid
(vs)
Septic Shock >1 organ dysfunction - that does not respond to fluid - needs pressors
MOD - multi organ dysfunction >2 organ dysfunction
Goals of tx of sepsis
central venous pressure 10-12
urine output > 0.5cc/kg/hr
MAP >65
Centreal venous oxygen sat > 70%
therapy for sepsis
abx
fluids 2-3L
remove source - foley, central line, ET tube, abscess, etc
vasopressors if needed
organs affected by sepsis
heart - hypotension brain - AMS kidney - increased BUN/Cr Liver - increased LFTs Lungs - ARDS
safe to do an LP or not
if any + cant do LP --> do CT if (-) --> LP F - FND A- AMS I- immunocompromised L - local lesion impeding LP S- seizures
not typical bacterial causes of Meningitis
Crypto Rocky Mountain Spotted Fever Lyme Disease TB Syphillis
crypto meningitis
AIDs pt with fever and HA
>20cm opening pressure
crypto antigen»_space;> india ink
tx - amphotercin
Rocky Mountain spotted fever meningitis
fever
rash from arms to trunks
tick bites
camping
ab on CSF
tx - ceftriaxone
lyme dz meningitis
connecticut
targetoid rash with arhralgias
arrhythmias
lyme ab
tx - ceftriaxone
TB meningitis
night sweats weight loss hemoptysis
homeless prison
endemic area
tx - RIPE
Mass lesion found on non con CT head –>
HIV/AIDs -> yes -> Toxo ab -> yes -> toxo tx -> rescan in 6wks to see if lesion gone
(if lesion still there go to biopsy
if no to toxo ab or HIV/AIDs –> brain biopsy
- brain abscess -> drain/abx
- cancer -> chemo/radiation
LP showing predominantly lymphocytes –> encephalitis ->
HSV - temporal lobs and hemorrhagic LP
HSV PCR –> + –> tx HCV –> acyclovir
HSV PCR –> (-) –> other causes - st louis, quine, west nile etc –> supportive tx
LP needed but meets FAILS criteria next step
give emperic abx –> CT scan –> if no lesion seen –> LP good to go
cellulitis path
staph aureus (likes to form abscesses)
strep group A (no abscesses)
presentation of cellulitis
red hot tender well demarcated site of entry
dx of cellulitis - clinical
tx of cellulitis -
non toxic
- staph - oral TMP-SMX or clinda
- strep - 1st gen cephalosporin
Toxic
- staph - vanc, linezolid, or clinda (IV)
- strep - Pip/Tazo and ampicilli/ calvulanate
tx of cellulitis if diabetic
vanc and pip/tazo
path of osteomyeltis
infection of bone
hematogenous or direct innoculation via a penetrating injury
pt presentation of osteomyelitis
wound - probe bone
sinus draining tracts
recurrent or refractory cellulitis
dx of osteomyelitis
1st x-ray (+after 2wks) –> if (-) –> MRI (best test)
bone scan okay if no cellulitis present
biopsy is great gets specific bug
tx of osteomyelitis
debridment
4-6wk (vanc and pip/tazo)
follow up with ESR and CRP
Gas gangrene path
clostridium perfinges
gas gangrene presentation
penetrating wound that got contaminated
crepitus present
dx of gas gangrene
x-ray shows you gas
tx of gas gangrene
debridment
PCN and clindamycin (ribosome 50s - blocks toxin production)
necrotizing fascitis path
staph and strep
if in groin called fournier gangrene
presentation of nec fasc
cellulitis and ……
- toxic person
- pain out of proportion to the physical exam
- blue/gray discoloration
- rapidly spreading
- crepitus
dx of nec fas
x-ray shows gas –> immediate debridment which includes biopsy
tx of nec fas
immediate debridment –> get biopsy
3rd gen cephalosporin + clinda + ampicillin
MCC of osteomyletis
staph auerus
Sickle cell pt and staph not on option
salmonella
penetrating wound and sneaker involved in osteomyeltis
cause
pseudomonas
diabetic with osteomyeltits
pseudomonas
oyster consumption in cirrhotic
vibrio vulnificus
gardening osteomyeltis
sporotrichix
CAP vs HCAP (HAP)
-CAP
>90 days from med building
<48 hrs admission
-HCAP
<90 days from med building
>48hrs admission
CAP Bugs
Strep Pna - MCC
Moraxella Catarhalis
H Influenza - COPD
Klebsiella (aspiration/etoh/AMS)
Staph Auerus (postviral) Legionella (immunosuppressed, smoker)
tx of CAP
3rd gen cephalosporin \+ Macrolide or Moxifloxacin
HAP = HCAP bugs
pseudomonas
MRSA
HCAP tx
pip/tazo
vancomycin
immunosuppressed and PNA bugs
TB
Fungal
PCP
influenza PNA
fever cough myalgias
dx - nasopharyngeal swab or BAL
tx - oseltamavir - prevent with vaccine
ED
PNA - admit or nah?
CURB-65 C - confusion U - bUn >19 R - rr >30 B - blood pressure - sys <90, dias <60 65 - >65 y/o
Fever and cough work up
CXR
- > (-) –> bronchitis –> oral abx
- > cavitary lesion -> CT scan -> fungus/TB/abscess
- > (+) consolidation -> PNA -> building and time?
bronchitis tx
oral abx macrolide (azithromycin) or doxycyline or moxifloxacin
lung absces tx
DONT DRAIN
3rd gen cephalosporin
+
clindamycin
PNA in an HIV/AIDs
patchy bibasilar infiltrates
CD4 <200
dx - sputum silver stain
tx - TMP-SMX
—-> if hypoxemic or low PaO2 give steroids
abx duration for uti to pyelo
uncomplicated cystitis - 3days
complicated cystitis - 7days
pyelonephritis - 10days
perinephric abscess -14days
bugs in urinary infections
E coli 80%
klebsiella
proteus
risk factors for UTIs
18-25 year old females on contraception having sex
females = shorter urethrea
men -anal sex
diagnosing UTIs
UA: (+) if leukocyte esterase, nitrites, >10 wbcs/hpf
urine culture: if pt preg, urological procedure, 10^5 CFU, abx sensitivities
CT scan - non preg pts
US - preg pts
complicated cystitis
uncomplicated = non preg female
P's penis - male plastic - catheters, foleys procedures - urological Pyelo
urethritis
STD - gonorrhea, chlamydia
discharge
dx - swab/urine test
tx of urethritis
ceftriaxone 250mg x1 IM \+ azithromycin po x1 or doxycycline po daily x7days
f/u - hiv screen
asymptomatic bacteruria screen
preg female or urologic procedures
path - gram neg rods and group B strep
tx - preg - amoxcillin (if PCN allergy nitrofurantoin)
repeat screen in f/u
cystitis
path - gram - rods
urgency, frequency, dysuria, young female
dx - U/A
tx of cystitis
empiric - TMP-SMX (unless CKD) or nitrofurantoin or fosfomycin
complicated 7 days
uncomplicated 3 days
pyelonephritis
path - gnr
urgency frequency dysuria fever chills CVAT
dx - U/A - wbc casts -> urine culture
tx of pyelonephritis
IV - ceftriaxone - hospitalized -> see if abscess is present -> if no improvement in <72hrs –> CT scan or US (if preg)
IV cipro –> Po cipro (ambulatory pyelo)
10days in duration
tx of nephritic abscess
14 days of IV ceftriaxone
ulcer work up –>
of ulcers
is there pain?
lymphadenopathy present?
types of genital ulcers
syphillis
lymphogranulomvenerum
chancroid
herpes
Syphillis
path and pt presentation
path - trep pallidum
1 - painless singular ulcer and non tender LAD
2 - fever and rash, targetoid rash - palms and soles
3 - neurosyphillis, tabes dorsalis (DCLMS), argyll roberston pupil
Dx of Syphillis
1 - darkfield microscopy
2- RPR + –> FTA -abs trep
3 - LP –> RPR on CSF –> FTA-ABs on CSF
Tx of Syphillis
1 - PCN x1 IM
2 - PCN x1 IM
Early latent (exposure <1yr) - PCN x1 IM
3 - PCN IV Q4 hr 10-14 days Late latent (exposure >1yr) - PCN IM weekly x3 weeks
Lymphogranulomvenerum
path - C Trachamotasis
painless singular ulcer
(+) tender Lymph Nodes - suppurative and draining
dx - NAAT
tx - doxycycline
Chancroid
path - Haemophils Ducreyi
Painful single ulcer with tender Lymph Nodes
dx - gram stain and culture
tx - azithromycin or cipro
Herpes
path - HSV1 or HSV2
painful burning prodrome
painful ulcers - vesicles on erythematous base, (coalesce into an ulcer shape)
dx - PCR
tx- Acyclovir or Valacyclovir
RPR measurements
1:3
1:3000
the bigger the 2nd number the worse the dz
otitis media path
URI bugs - strep pna, moraxella catarhalis, H influenza
middle ear - TM
otitis media presentation
Unilateral Ear Pain - relieved by puling on pinna
bulging erythematous TM
loss of light reflux
fluid behind ear
Otitis Media Dx
pneumatic insuflation - TM rigid = (+)
tx of Otitis Media
1st line - amoxicillin
recur - amox + clavulanate
recur 3/6 or 4/12 –> tymphanoplasty
PCN allergy - non life threatening - Cefidinir
PCN allergy - life threatening - Azithromycin
Otitis Externa
path - outer ear - pinna canal
Swimmers ear - Pseudomonas
Digital trauma - Staph Aureus
Otitis Externa presentation
unilateral ear pain - made worse puling pinna
outer canal is erythematous - no bulging TM
dx and tx of Otitis externa
dx - clinical
tx - spontaneously resolves
if toxic —-> abx - Cipro drops + steroids
Complication of otitis exertna
Mastoiditis
Mastoiditis
path - URI bugs - ppl with ear tubes
loos like AOM + swelling behind ear, anterior rotation of ear
dx - clinical
tx - surgical decompression
Sinusitis path and presentation
path - URI Bugs - strep pna
congestion
bilateral purulent discharge - thick and white smelly
facial tap = painful
Sinusitis
dx and tx
airfluid levels -xray opacification - CT
dx - clinical
tx - supportive unless:
–> temp >38
–> >10days
–> worsening
(if any (+) —-> PCN - amox + clavulanate)
recurrent sinusitis –>
CT scan to see if anatomical abnormality
Cold “nasal viral”
path - rhinovirus, air droplets
congestion, bilateral clear discharge, rhinorrhea-copius
tx - supportive
Pharyngitis
path - viral, group A strep
sore throat, odynophagia C - no cough E - exudates N - nodes T - temp >38 OR: <14 = +1 >44 = (-1)
pharyngitis tx
amoxicillin + clavulanate
major criteria in IE
bacteremia
new regurgitation murmur
Echo - vegetation
Minor criteria in IE
Risk Factors - IV drug abuse, prosethetic valves, hx of endocarditis
Fever - >38
Vascular - septic emboli, embolic CVA, Acute Limb ischemia, Splinter hemorrhage - nail beds, janeway lesions painless
rheumatological - roth spots, osler nodes (painful) glomerulonephritis
Acute IE
aggressive
path - staph auerus and strep pneumoniae
CHF presentation, bacteremia, toxic, no time = (-) rheum symptoms
Give empiric abx until blood cultures are (-)
Subacute IE
indolent
path - HACEK
fever on and off, nontoxic, (+) rheum symptoms enough time
blood cultures then if (+) –> empiric abx
tx of acute IE
native valve –> Vancomycin
prosthetic valve <60 –> vanc +gent + cefepime
prosthetic valve 60-365 –> vanc + gent
Prosthetic valve >365 –> vanc +gent + ceftriaxone
tx of subacute IE
gent + ceftriaxone
Surgical indications for IE
CHF
vegetations >15mm
Vegetations >10mm and embolization
abscess/fungus - abx wont work
prophylaxis tx for IE
when bad valve or dental oral procedure
amoxicillin = tx choice
dx test of choice of IE
TEE
multilobular consolidation indicates
severe pneumonia
a normal pulse in the setting of a high fever is suggestive
of atypical CP pneumonia
pulse-temp dissociation
what PNA bug associated with nursing home residents
pseudomonas
Ventilatory associated PNA RF
increased risk due to not being able to cough
decreased mucociliary clearance
dx - new infiltrate on CXR - purulent secretions from ET tube, fever and increasing WBC
tx of ventilator associated pna
cephalosporin (ceftazidine or Cefepime) \+ aminoglycoside \+ vancomycin or Linezolid
lung abscess pearls
posterior segments of upper lobes
superior segments of lower lobes
right lobe
lung abscess CXR
air fluid levels
thick walled cavitations
TB transmission
aerosolized droplets from someone with ACTIVE TB
secondary TB reactivation
common in immunocompromised hosts HIV Malignancy Immunosuppressants substance abuse poor nutrition
risk factors for TB
HIV + prisoners health care workers diabetes close contact alcoholics glucocorticoid use IV drug use hematologic malignancy
symptoms of primary secondary TB
primary - asymptomatic - ghon complex
secondary - fever night sweats, weight loss, malaise
ghon complex
calcified primary focus with an associated lymph node
ranke complex = ghon complex that undergoes fibrosis and calcification
tx of TB
RIPE for 2 months –> INH and Rifampin for 4 months
influenza
epidemics vs pandemics
epidemics - common - due to minor genetic reassortment
pandemics - rare - due to major genetic recombination
TB meds and hepatotoxicity
all meds cause it
dont discontinue unless 3 to 5x upper limits of nml
complications of meningitis
seizures
coma
brain abscesses
subdural empyema
deafness, brain damage, hydrocephalus
CSF profile of bacterial meningitis
increased WBC - PMNs predominate
Low glucose
High protein
viral causes of Meningitis
herpes (HSV-1)
arbovirus - eastern equine encephalitis, west nile virus
Enterovirus - polio
non viral infectious causes of meningitis
toxoplasmosis
cerebral aspergillosis
non infectious causes of meningitis
metabolic encephalopathies
T cell lymphoma
risk factors for encephalitis
AIDs - CD4 <200 - think toxo Immunosuppression Travel to underdeveloped countries mosquitos (endemic areas) Bats
nonbacterial causes of brain abscesses
toxo and fungi in aids pts
candida spp, aspergillosis, zingomycosis (neutropenic pts)
Hep B associations
Hep C associations
Hep B - PAN
Hep C - Cryptoglobulinemia
transmission of Hepatitis
Hep A and E - fecal oral
Hep B - drugs and sex
Hep C - drugs
causes of transaminases >500
acute hepatitis - viral
shock liver
drug induced hepatitis
fulminant hepatitis
severe complication of hepatitis
liver failure - life threatening
other complications of hepatitis
hepatic encephalopathy - asterexis and palmar erythema
hepatorenal syndrome - venous thrombosis
bleeding diathesis - only when liver function is severe
Tx of hepaititis
Hep B
Hep C
hep B - IFN alpha or Lamivudine
Hep C - IFN alpha and ribavirin
most frequent indication for liver transplant in the US
HCV
presentation of botulinism
symmetric descending flaccid paralysis –> starting with dry mouth, diplopia, and/or dysarthria, –> paralysis of limb musculature
causes of intrabdominal abscesses
spontaneous bacterial peritonintis pelvic infections tuboovarian abscesses pancreatitis* gi tract perf * osteomyelitis of vertebral bodies
non infectious causes of cystitis
cytotoxic agents - cyclophosamide
radiation to pelvis
dysfunctional voiding
interstitial cystitis
when to obtain a urine culture
> 65 y/o
DM
recurrent UTIs
> 7 days with symptoms
use of diaphragm as contraception device
when do you tx asymptomatic bacteruria
pregnant
before having a urological procedure
risk factors for upper UTI
pregnancy
diabetes
VUR
tx of dysuria specifically
pyridium (phenazopyrdime) - urinary analgesic - 1-3 days
acute prostatis
fever
tender prostate
boggy prostate
younger men
due to ascending infection from urethra
chronic prostatis
well appearing
nml prostate just large
recurrent UTIs
chlamydia is a risk factor for
cervical cancer
leading cause of infertility in women
due to chlamydia infections that lead to tubal scarring
C-section in HIV women
indicated if viral load >1,000
if viral load is >50 after 4 months of tx for HIV
change regiment
gold standard for dx of HSV
culture
tzanck smear = quickest
Chancroid
haemophilus ducreyi
painful raw ragged borders beefy red
tx - azithro
causes of false (+) RPR or VDRL
SLE
antiphospholipid syndrome
Lyme dz
lymphogranuloma venereum
C trachomatis
painless ulcer
tender inguinal lymphadenopahty (Unilateral)
tx - doxy
causes of cellulitis with exposure to water
pseudomonas
vibrio vulnificus
Predisposing factors to erysipelas
lympahtic obstruction radical mastectomy local trauma abscess, fungal infections DM alcoholism
risk factors for necrotizing fascitis
surgery
diabetes
trauma
IV drug use
bugs that cause of necrotizing fascitis
strep pyogenes
clostridium perferenges
pathophys of tetanus
causes by neurotoxins produced by spores
exotoxin blocks inhibitory transmitters at the NMJ
tetanus managment
give diazepam for tetani
IM tetanus IG (TIG)
tetanus wound management
< 3doses of Td or >10yrs
- clean - Td
- dirty - Td + TIG
> 2 doses of Td
- clean - nothing
- dirty - nothing
bugs for osteomyletis
- catheter
- prosthetic joint
- diabetic foot ulcer
- nosocomial infections
- IV drug use or neutropenia
- Sickle cell -
- catheter - staph
- prosthetic joint - coagulase neg staph
- diabetic foot ulcer - polymicrobial
- nosocomial infections - pseudomonas
- IV drug use or neutropenia - fungal
- Sickle cell - salmonella
pott disease
osteomyeltis of the vertebral bodies due to M tuberculosis
clinical findings of osteomyelitis
pain over the involved area of bone
localized erythema or swelling
some systemic symptoms
draining sinus tract - chronic issue
for osteomyelitis how do monitor response to tx
ESR and CRP
dx test of choice for osteomyelitis
MRI
Gonococcal arthritis
presents with acute monoarthritis
progresses within days in a migratory or additive pattern
tenosynovitis is present in the hands and feets
complications of septic arthritis
destruction of joint and surrounding structures (ligaments, tendons) –> stiffness and pain and LOF
avascular necrosis (hip) sepsis
Clinical features of rocky mountain spotted fever
sudden onset of fever, chills, malaise, N/V
rash - appears after 4-5 days of fever
- starts on peripherally –> centrally
- papular –> maculopapular –> petechial
tx - doxy
fever patterns of malaria
falciparum - constant - worst one
ovale and vivax - q48hrs
malariae - q72hrs
tx of malaria
chloroquine if not resistant
if resistant - quinine sulfate + tetracyclines
prophylaxis for malaria
mefloquine if chloroquine resistance
ADR of malaria meds
atovaquone
mefloquine
chloroquine - benefit
primaquine
atovaquine - C/I - preg and renal dz
mefloquine - C/I - sz and psych
chloroquine - good in preg
primaquine - C/I - G6PD def —> HA
Leptosporosis
contaminated water
reservoir - rodents, farm animals
rash, LAD, increased LFTs
renal and/or liver failure
vasculitis, vascular collapse
tx - oral abx - tetracycline or doxycycline if severe IV PCN G
Q Fever
farm animals
acute - constitutional symptoms N/V
chronic - endocarditis
CXR - multiple opacities in acute illness
tx - acute - doxy and chronic - rifampin
Cat scratch disease
bartonella henselae
serology
LAN or lymphadenitis
Tx - self limiting,
severe doxy or cipro
cutaneous candidiasis
erythematous eroded patches with satellite lesions
more common in obese diabetics pts
appears in skin folds, underneath breasts and in macerated skin
allergic bronchopulmonary aspergillosis
type I HSR
asthma and eosinophilia
avoid exposure and corticosteroids
pulmonary asperigiloma
inhalation of spores into the lungs
RF - hx of sarcoidosis, histo, TB and bronchiectasis
tx - pts with massive hemopytsis may need lobectomy
invasive aspergillosis
immunocompromised pts
(+) fever, resp distress, despite use of broad spectrum abx
hyphae invade lung vasculature -> thrombosis and infarct
bilateral pulm infiltrates
tx of invasive aspergillosis
IV amphotercin B
cryptococcosis neoformans
dx
tx
dx - latex agglutination, india ink smear - encapsulated yeasts, biopsy - lack of inflammatory response
tx - amphotercin B + flucytosine –> fluconazole
causes of hyperthermia
neuroleptic malignant syndrome
malignant hyperthermia
heat stroke
hyperthemia
responds to
doesnt respond to
doesnt respond to antipyertics
does respond to external cooling measures
Toxic shock syndrome risk factors
menstruating women with tampons
surgical wounds, burns and infected insect bites
toxic shock syndrome caused by
enterotoxin of staph aureus or group A strep (rare)
clinical features of TSS
abrupt
flu like
diffuse macular erthematous rash - desquamates over palms and soles
strawberry tongue
hypotension
tx of TSS
hemodynamic stabilization –> remove source, drain and debride wounds –> give anti staph abx (naficillin, oxacillin, vanc)
MCC of catheter related sepsis
central lines
increased risk with emergent placement, femoral lines, indwelling of the line
bugs of catheter related sepsis
staph aureus
staph epidermidis
neutropenia def
ANC < 1,500
ANC <500 –> severe infection risk
causes of MONO
EBV mainly (CMV - rare)
CMV mono
sexually active young adults
(-) cervical adenopathy
(-) pharyngitis
(-) heterophile abs
complications of mono
bells palsy
blastomycosis basics
dimorphic fungi
inhaltion of spores
chronic indolent - constitutional symptoms, LAN, PNA
tx - itraconazole
histo basics
dimorhphic fungus with septate hyphae
exposure to bird/bat shit
ohio and mississippi valleys
flu like, erythema nodosum, hepatosplenomegaly
tx - itraconazole
coccidiomycosis
dimorhic fungi
inhalation of spores
asymptomatic
dissemination -> CNS issues
tx - fluconazole
sporotrichosis
dimorhphic - cigar shaped yeast
invasion of skin via thorn - gardening
lymphocutaneous form - hard sub q nodules - > ulcerate and drain
disseminated .-> pna and meningitis
tx - potassium iodide x itraconazole
cryptosporidiosis
spore forming protozoa
fecal oral
watery diarrhea - immunocompromised
oocytes
tx - supportive
amebiasis
entamoeba histolytica
fecal oral, contaminated water/food/ anal oral sex
bloody diarrhea, tenesmus, abd pain +/- liver abscess
trophozoites
tx - metro for liver
giardiasis
fecal oral, daycare camping
watery diarrhea, chronic infection, weight loss
trophozoites or cysts
tx - metro
ascariasis
round worm
ingestion of food or water contaminated by human feces
postprandial abd pain, vomiting, heavy worm burden
pancreatic duct, common bile duct obstruction
eggs or adult worms
tx - albendazole, mebendazole, or pyrantel pamoate
hookworm
necator americanus
larvae invade skin - travel to lung - cough and swallow -> intestine
cough, anemia, malabsorption, weight loss, eosinophilia
adult worms
tx - mebendazole or pyrantel pamoate
tapeworm taenia saginata (beef) taenia solium (pork) diphyllobothrium latum (fish)
eating raw or undercooked meat
usually asymptomatic, abd pain, weight loss
fish tapeworm: vit b12 def
tx - praziquantel vit b12
Schistosomiasis (trematodes)
schistosoma haematobium
schistosoma japonicum
penetrating human skin —> migrate to lungs -> portal vein –> venules of mesentery, bladder or ureters
S mansoni and S japonicum: fever, diarrhea, -> liver fibrosis, portal HTN
tx - praziuantel
