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Clin Med I Exam I > Infections > Flashcards

Infections Flashcards

1
Q

Zika Virus description?

This virus is carried by
?

How is this virus transmitted?

A

-Flavivirus(flavus latin for yellow due to its propensity to cause jaundice)

-Aedes Mosquito (lives in tropical locations)
○ day time and twilight feeders

The virus is transmitted via

  • infected mosquito
  • maternal-fetal
  • sex
  • blood transfusions
  • organ transplants
  • lab exposure
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2
Q

Clinical Manifestations of Zika Virus

A

-acute: disease is usually mild
• low-grade fever(100.4-101.3 F),
• maculopapular pruritic rash
• arthralgia (usually small joints hands and feet)
• conjunctivitis (non-purulent)
★ clinical diagnosis if 2 or more symptoms are present

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3
Q
  • Incubation period between bite and clinical manifestations is usually ?
  • Symptoms resolves in ….?
  • Clinical manifestations occur in how many people who become infected with zika?
A

-Incubation period between bite and clinical manifestations is usually ?
○ 2-14 days
-Symptoms resolves in ….?
○ 2-7 days
-Clinical manifestations occur in how many people who become infected with zika?
20-25%

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4
Q

Complications of Zika ?

A
  • fetal loss
  • microcephaly of fetus(abnormal small size head)
  • Guillian- Barre Syndrome
  • Brain ischemia
  • Myelitis
  • Meningoencephalitis
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5
Q

Management and Prevention of Zika

A 
■ Management: No specific management 
-Supportive-rest, hydrate, acetaminophen 
-NSAIDS avoided until Dengue ruled out 
-ASA avoided in children due to risk of Reye syndrome  
■Prevention:
-no vaccine yet 
-limit travel
-remove standing water 
-mosquito repellant 
-long sleeves and pants 
-protected intercourse
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6
Q

Describe Chikungunya

A
  • Alphavirus
  • Transmitted by Aedes mosquitos (during the day)
  • Endemic to West Africa ★
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7
Q

Clinical Manifestations of Chikungunya

A
  • begin abruptly with fever, joint pain, and malaise (starts 3-7 days from bite)
  • acute phase usually lasts 7-10
Progress stage:
-High grade fever 104F (last 3-5 days)
-Polyarthralgia ★ begins 2-5 days after fever onset (commonly involves multiple joints-bilateral & symmetrical)
→ hands 50-76%
→ wrists 29-81%
→ ankles 64-3%
(Pain is usually intense and disabling)
  • Rash in 40-75% of pts (macular or macularpapular-start on limbs and trunk)
  • Pruritus 25-50%
  • Death in pt’s older than 65 with comorbidities
  • respiratory, renal and heart failure
  • Some pts have persistent or relapsing of disease (18mo-3yrs)
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8
Q

Diagnostic Studies?

Most common lab findings with Chikungunya are?

A

D.S.:
-Sereolgy:
→ 1-7 days PCR for
Chikungunya virus RNA
→ >8 days Elisa IgM anti-Chikungunya virus antibodies
→ IgM presents following 5 days onset of symptoms and up to 3 months
→ IgG appear after 2 weeks and persist for years

Most common non-specific lab findings with Chikungunya are?

  • Lymphopenia
  • Thrombocytopenia
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9
Q

Management of Chikungunya

A
  • NSAIDS
  • Supportive care
  • Steroids
  • Methotrexate
  • Immune modulating agents
  • No Vaccine thus far
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10
Q

Dengue Virus Description and Transmission

A

Single-stranded RNA virus

  • 4 stereotypes -DENV 1-4: all cause full disease
  • Mosquito borne(evidence of maternal-fetal transmission)
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11
Q

Dengue Virus Affects what areas the most

A

tropics and subtropics -rare occurrence in the U.S.

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12
Q

Severe and Mild Symptoms of Dengue ?

A

Mild:

  • n/v
  • rash
  • headache, eye pain
  • muscle ache, joint pain

Severe:

  • abdominal pain and tendernesss
  • persistent vomiting
  • clinical fluid accumulation
  • mucosal bleeding
  • lethargy or restlessness
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13
Q

Phases of infection of Dengue

A

Febrile:

  • sudden onset high fever >101.3 (last 3-7 days)
  • accompanied by headache, rash, vomiting , myalgia, arthralgia
  • On PE see conjuctival injection, pharyngeal erythema, LAD, hepatomegaly, facial puffiness, petechiae
  • Leukopenia, thrombocytopenia, and ↑ LFT’s
  • after which patients recover w/o complications

Critical:

  • Systemic vascular leak syndrome, -plasma leak, bleeding , shock , organ failure
  • Days 3-7 and last 24-48 hours
  • US for fluid
  • Moderate to severe thrombocytopenia

Convalescent Phase:(starting to recover)

  • plasma leakage and hemorrhage resolve, vital signs stabilize (2-4 days)
  • additional rash may appear
  • profound fatigue
  • retinal vasculitis is common
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14
Q

Diagnostic Studies for Dengue

A

Nucleic acid amplification test (NAAT)

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15
Q

Management and Prevention of Dengue

A

Management:

  • supportive
  • fever mangement (Acetaminophen- NO NSAIDS)
  • bleeding management (blood replacement)
  • Plasma leakage (volume replacement )
  • Shock treatment

Prevention
-Vaccination-Dengvaxis ★

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16
Q

EEE Transmission ?

End Result after contraction of EEE?

A
  • Transmitted through mosquitoes (4-10 day incubation period)
  • 30% die and many survivors have ongoing neurological problems
17
Q

Clinical Manifestations of EEE

A
  • Sudden onset
  • Fever
  • Headache
  • N/V
  • 2% of adults and 6% children develop encephalitis
  • Once neuro sx begin condition deteriorates rapidly → 90% of patients becoming comatose ★
  • Seizures, focal neurologic signs, including nerve palsies develop in 1/2
18
Q

Diagnostic Studies and Findings of EEE

A

Studies:

  • Serum of CSF
  • IgM antibody capture ELISA
  • Fatal cases→ histopathology, autopsy tissues

Diagnostic Findings:

  • Leukocytosis
  • Hyponatremia
  • CSF- pleocytosis (↑ WBC) elevated protein
  • MRI/CT abnormalities
19
Q

Management of EEE

A

Supportive

no vaccine for humans just horses

20
Q

Ebola virus Tranmission

A
  • direct contact with infected body fluids (vomit, feces, & blood) or meat
  • those that provide hands on medical care or prepare bodies for burial are most at risk
  • less infectious in early stages
  • virus can live on surfaces from hours to days
21
Q

What are the five species of Ebola virus

A
  • zaire (worst)
  • Sudan (50% case fatality)
  • Tai forest-irony coast(only one identifiable case)
  • Bundibugyo(case fatality 30%)
  • Reston(maintain animal reservoir only)
22
Q

Clinical Manifestations of Ebola virus

A
  • hemorrhage is less common( could have some bleeding in stool)
  • Fever chills malaise
  • Maculopapular Rash (may develop day 5-7)
  • volume loss from vomiting and diarrhea contribute more to severe illness ★
  • symptoms come on suddenly
  • incubation period is 6-12 days post exposure
  • produces a systemic inflammatory response
23
Q

When do you recover from Ebola virus?

A

Recovery days (7-12) but up to 2 years of prolonged ex’s of arthralgia, weakness, fatigue, insomnia, uveitis

24
Q

Diagnostic Studies and Lab findings of Ebola virus

A

DS-
→ PCR viral RNA in serum
→ ReEbov deters virus antigen used in field

Lab Findings:

  • ↓ WBC’s
  • ↓ platelets
  • ↑ ALTs and ASTs due to liver damage
  • Coagulation abnormalities→ can lead to DIC in severe cases
  • Proteinuria
  • ↓ sodium and calcium
25
Q

Ebola Management and Prevention

A

-Supportive care and aggressive fluid and electrolyte resuscitation with caution

PreventionL

  • proper use of PPE
  • rVSV-ZEBOV (recombinant vesicular stomatitis virus-zaire Ebola virus (effective when used in ring vaccination)
  • Merck Vaccine
26
Q

Ebola virus is considered category A?

A

bioterrorism

27
Q

Etiology of Bacteremia

A
  • may result from dental work or vigorous tooth brushing
  • from infections like pneumonia, UTI, ENT(tract)
  • colonization of indewelling devices
  • Gram neg bacteria→ GU, GI, or decubitus ulcers, immunocompromised, or chronically ill
  • Staphylococcal bacteremia- IV drug users, IV catheters SSTI
  • Bacteriodes bacteria -infections of abdomen and pelvis
  • gram pos bactermia- infections above the diaphragm respiratory
  • sepsis develops in 25-40% of patients
28
Q

Clinical Manifestations of Bacteremia

A
  • asymptomatic
  • mild or persistent fever/chills
  • MS changes
  • hypotension
  • tachypnea
  • focal symptoms
29
Q

How do you diagnosis /manage

A

Diagnose:
-pos blood cultures
→ up to 50% of pos BC can be contaminated w/ coagulase neg staph, corynebacterium, viridian’s

Manage:

  • appropriate antibiotics
  • prophylaxis (when going to the dentist after total knee replacement
30
Q

What causes sepsis?

What people are the most at risk for sepsis?

A

What causes sepsis?
-Caused by dysregulated inflammatory response to infection (don’t need bacterium to cause sepsis)

What people are the most at risk for sepsis?
•lowest doses vaspressor 5%
•older, chronic illness, renal dysfunction 13%
•inflammation and pulmonary dysfunction 24%
•liver dysfunction and septic shock 40%

31
Q

Pathophysiology of Sepsis

A

Infection → bacteremia (can skip this step) → sepsis → septic shock( circulatory collapse, cellular and metabolic abnormalities) → MODS → death

-gram pos bacteria most frequently identified (approx 50% cases organism is not identified )

32
Q

Systemic inflammatory response syndrome is clinically recognized by the presence of two or more of the following…

don’t use clinically anymore but medicate and medicaid still do

A

temp: less than 38C or greater than 36C

HR: >90bpm

Resp rate: > 20 breaths/min or Pa CO2 < 32mmHg

WBC:

  • > 12,000
  • <40000
  • 10% immature band forms
33
Q

Risk factors for sepsis

A
  • ICU admission
  • Bacteremia
  • Advanced age
  • Immunosuppression
  • Obesity
  • Diabetes and cancer
  • Community acquired pneumonia
  • Previous hospitalization
34
Q

Clinical Manifestations of Sepsis

A 
Hypotension SBP<90
Tachycardia
Tachypnea >22
Fever >100.9
Altered MS 
Oliguria
Cough
35
Q

Lab Findings for Sepsis

A
  • Leukocytosis >12 or Leukopenia<4
  • Hyperglycemia >140
  • Elevated CRP
  • Elevated Cr
  • Coag abnormalities
  • Thrombocytopenia<100
  • ★ elevated serum lactate(what your cells put off when they are dying (used to monitor progression of sepsis)
  • Elevated procalcitionin
  • Decreased PaO2(BBG and ABG)
36
Q

Septic Shock

Tx?
Si/Sx’s?

A

Circulatory collapse
-vasodilatory shock
→ circulatory, cellular and metabolic abnormalities with greater risk for mortality than just sepsis

Tx: requires vasopressors

Si/sx:

  • cool skin
  • cyanosis
  • oligouria
  • altered metabolism
  • elevated lactate
37
Q

MODS:

si/sx and management

A

Si/sx:
-progressive organ dysfunction

management:

  • supplemental oxygen
  • aggressive IVF
  • peripheral and central access
  • empiric broad spectrum abs w/n 1 hr tailored to patient ★
  • vasopressors PRN

Clin Med I Exam I (9 decks)

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