Infections and Inflammation Flashcards
A 35 yo F PTC PTC after she noticed blurred vision and difficulty breathing. Her symptoms including abdominal pain, n/v, malaise, and dizziness abruptly started after eating a meal the night before (12 hours). PE revealed ptosis, diplopia, fixed/dilated pupils, suppressed gag reflex, and symmetrical descending paralysis.
What do you suspect? What’s your next step?
Botulism (food bourne)
Investigation:
- Toxin may be identified in serum, stool, vomitus, gastric aspirate, and suspected foods.
- R/O CNS pathologies with CT, MRI
Tx:
- ER!!! Airway management, anti-toxin therapy, and IV penicillin therapy.
An earliest and most common symptom of infant botulism? Other signs?
Constipation
Others: general weakness, a weak cry, a poor sucking reflex, irritability, lack of facial expression, and loss of head control, trouble breathing.
The general course of botulism: early vs later symptoms?
Early: cranial nerve complication
Later: paralytic ileus, severe constipation, urinary retention, respiratory failure
Drug for Rickettsia rickettsii?
Doxycycline
Drug for herpes simplex encephalitis and varicella-zoster virus?
Acyclovir
Most sensitive image for brain abnormalities?
MRI > CT
Brain - MRI/CT/EEG
Gold standard for encephalitis investigation?
Brain biopsy, histological exam
The presence of Negri bodies in the hippocampus and cerebellum indicates?
Rabies
Encephalitis caused by Poliovirus causes
Muscle paralysis (destroys upper and lower motor neurons)
Most common cause of AIDS dementia
Most common viral CNS infection in AIDS
HIV → AIDS dementia
Cytomegalovirus → Cytomegalovirus
36 yo M PTC feeling ill. Prior to his symptoms, he notes that he was sick with fever, HA, n/v, malaise, and myalgia about 7 days ago (viral prodrome). He appears in the office today with a rash and lymph node enlargement. He notes that his symptoms are progressively getting worse and is now having issues with memory.
PE revealed lymphadenopathy, hepatosplenomegaly, positive Brudzinski’s sign, photophobia, and behavior disturbances with a decreased level of consciousness
What do you suspect? Next step?
Encephalitis
- Brain biopsy
- CBC
- Serum glucose for hypoglycemic symptoms and compare to CSF glucose value
WBC is elevated in bacterial, but may be normal in viral
PCR and Tzanck test
HSV
Diagnosis for encephalitis and meningitis
Lumbar puncture → CSF (viral) → blood culture (bacterial)
but start with CT/MRI for those at high risk (increased intraocular pressure)
A 34 yo F PTC after a recent fall. She noticed lower limbs (bilateral) weakness a few days back that has progressed up to her upper limbs. She is having difficulty with breathing and started to notice difficulty pronunciation words.
PE revealed areflexia, ataxia, facial droop, diplopia, pupillary disturbances, arrhythmias, slurred speech, respiratory weakness and bladder dysfunction.
What do you suspect? Investigaton? Tx?
Guillain-Barré syndrome - ascending and symmetrical motor weakness
- Spinal tap - high CSF, normal glucose and WBC
- Electromyography and nerve conduction studies shows conduction block
Senf to ER! Plasmapheresis and infusion IV immunoglobulin or plasma exchange. Respiratory ventilation.
A 29 yo M PTC with pruritic rash on left side of the body. He notices some radicular pain and itching before the rash appeared. What do you suspect? Tx? How do you prevent this condition?
Herpes zoster (shingles)
Varicells-zoster vaccine to prevent
Tx:
- Acyclovir, Valacyclovir
- Gabapentin 300-600mg PO tid for post-herpetic neuralgia
A 19 yo F PRC with fever and headache. She notes stiffness and recently had seizures, level of consciousness, n/v. what do you suspect? Next step? Tx?
Meningitis
Investigation - same as encephalitis: lumbar puncture and obtain CSF, culture.
ED!
Viral and bacterial meningitis?
Increased CSF protein, increased total CSF leukocyte, normal CSF glucose, gram stain negative
Viral meningitis
Viral and bacterial meningitis?
Increased CSF protein, increased total CSF leukocyte, decreased CSF glucose, gram stain positive, culture positive test
Bacterial
Investigating options for neuralgia
Neurological testing
MRI for vascular compression - low sensitivity
Peripheral neuropathy causes (4)
- Diabetes Mellitus
- Alcohol, heavy metals
- Drugs - phenytoin
- Thiamine, Vitamin B12, pyridoxine deficiency
Peripheral neuropathy tx
Anti-seizure medicationL Gabapentin, carbamazepine, phenytoin
TCA: Amitryptyline (chronic pain)
This condition first starts with a prodrome of fever, paresthesia in and around the wound site, headache, and sore throat. It causes acute encephalitis leading to hyperactivity, agitation, confusion, and seizures. Spasms of the thread muscles when swallowing liquid result in hydrophobia and foaming of the mouth. In worst case, it can cause coma and death due to respiratory center dysfunction. What do you suspect? Tx?
Rabies
Wound cleaning, debriefment, heal by secondary intention to allow drainage of wounds and prevent infection.
Passive immunization with Human Rabies immunoglobulin into wound site
Active immunization with killed rabies virus vaccine
How do you check for rabies?
Direct fluorescent antibody test, viral cuture, PCR
- saliva
- CSF: monocytosis
- Brain tissue: Negri bodies are pathognomonic
- Blood analysis: normal to elevated WBC count
A 38 yo M PTC with lockjaw and jaw stiffness, neck rigidity, restlessness, and reflex spasms. He appears hot, sweating, and has difficulty speaking and breathing. He notes that he is starting to feel tension around his facial muscles and to the extensors of the limbs. What do you suspect? Next step?
Tetanus via clinical diagnosis
Clean wound
Metronidazole
Spamolytic medication
Drug for tetanus
Metronidazole
Most common neuralgia
Trigeminal neuralgia
Patient presents noting that they have the worst headache of their life. They experience facial pain, alterations in consciousness, seizures, weakness, hemisensory loss, language disturbance, memory loss, blurred vision, and epistaxis. What do you suspect? Next step?
Cerebral aneurysm
- CT angiogram
- MRI
- Angiogram
SEND TO ER
