Infectious 2 Flashcards
The patient started on empiric vancomycin and culture grow susceptible S.Mutans to penicillin what to do?
Change to penicillin V or ceftriaxone
Disseminated gonococcal infection?
Purulent Arthritis
Triads of tenosynovitis, dermatitis, and migratory polyarthralgia
NAAT: From genital area
Culture is less sensitive
Symptoms of CNS Toxo?
Headache
Confusion
Fever
Focal neurologic deficiet
Diagnosis?
AIDS with CD4<100
Positive Toxo IgG
Multiple ring-enhancing lesions on MRI
managment?
sulfadiazine & pyramitamine(lukovorine)
ART whithin 2 week
Prophaxis:TMP-SMX(CD4 < 100)
Progressive multifocal leukoencephalopathy?
JC virus reactivation(JC virus infect in childhood and remain dormant in kidney and lymphoid thishu, Reactivation in CD4 < 200 and cause oligodendrocyte damage in white matter)
In IC patient
Manifestation?
Slowly progressive Confusion Paresis Ataxia Seizure
Diagnosis?
MRI: Asymmetric, hypodense, white matter lesion with no enhancement and edema.
LP: PCR JC virus
Biopsy: rarely needed
Treatment?
Often fatal
Antiretroviral
Most patients develop a neurologic complication
HIV-associated dementia imaging?
Cortical atrophy
Ventriculomegaly
Reduced attenuation of white matter
Fungal pneumonia and erythema nodusum?
Histoplasmosis
Especially people come from Mississippi and Ohio
Differential dignosis in same rigion(M & O)?
Blastomycosis But B: Skin ulcer, bone erosion, and prostatitis but In H: erythema nodusum and HL
When to consider meningitis?
Presence of >=2 signs from 4 signs and symptoms 1-Headache 2-Fever >38 3-Nuchal rigidity 4-AMS
A common cause of bacterial meningitis in age >2?
S.pnumonia
hemophilus ducri(Chancroid) symptoms?
Large, deep ulcer with gray/yellow discharge
well-demarcated border with & soft friable mass
Severe, painful LDP that may be superlative
Diagnosis requires culture
azithromycin is curative
tissue invasive CMV infection?
Common inpatient with IC and not receiving Px(indicated in organ transplant patient)
manifestation
-Hepatitis
-gastroenteritis
–intersticilal pnumonia
-Meningoencephalitis
diagnose with blood/tissue biopsy(GS)– PCR
Manage with IV gancyclovir in severe cases and PO in mild
Gonnococal pharengitis?
In sexually active by orogenital contact
Bilateral non tender LD
Prharengial erythema and edema w/o exudate
Concomitant PID/STI
HIV prophylaxis recommended in?
High-risk exposure
- mucosal, nonintact skin, and subcutaneous exposure
- Blood, Semen, Vaginal fluid, and anybody secretion with blood content.
What and when to give?
Initiate urgently
Continue for a 28 day
>= 3 drug
2NRTI + 1 II/PI/NNRTI
even if the patient serostatus not known but at risk
De serostatus at a spot for a baseline then 6 weeks,3 months, and 6 month
Cryptosporidium?
CD4 <180 animal contact, water, and person to person tm Severe watery diarrhea low-grade fever wight loss examine with modified acid-fast stain (3-6 um oocyst) Treatment is supportive and ART Infection persist until CD4 improve
Mirosporidium/isospora?
CD4 < 100
watery diarrhea
lower abdominal pain
wight loss
fever is rare
Microsporidia(spore in stool and treat with albenda)
Isospora Belli (oocyst and treat with TMP-SMX)
MAC?
CD4 < 50
Sever fever(>39)
watery diarrhea and fever
CMV?
CD4 <50 frequent Bloody diarrhea low-grade fever Wt loss Abdominal pain
Tetanus PEP?
------Clean minor wound Td/TDaP If the last dose is given> 10 year History of childhood Vx<3, uncertain or not Given -----Dirty/sever wound Td/TDaP If the last dose is given> 5 year With Tetanus immunoglobulin if History of childhood Vx<3, uncertain or not Given
Childhood vaccination?
2,4 and 6 month
15-18 month
Every 10 year Td
Why TD/TDaP?
Diphtheria and pertussis need booster
Babisiosis epidimology?
babesia microti
NE USA
Ixodus scapularis thick bite
Clinical menifestasion?
Flu-like symptom
sign of IV hemolysis
ARDS, CHF, DIC, and splenic rupture in severe case
mild hepatosplenomegaly
Anemia,thrombocytopenia,Elevated LDH/LFT/bilirubin
Diagnosis?
thin blood smear(intraerythrocytic ring(maltase cross)
treatment?
Atovaquone + azithromycin
sever: Quinine + clindamycin
7-10 days and up to 3 months until resolve
watery diarrhea in HIV patient approach?
microscopy/Culture stool for ova and parasite
Clostridium difficile AG
AFS: for cryptosporidium
Infectious mononucleosis etiology?
EBV
Clinical manifestation?
Fever and fatigue Tonsilitis/pharengitis +-exudate Posterior cervical/diffiuse LDP \+-Hepatosplenomegaly \+-rash after amoxicillin
Diagnostic finding?
Hetrophile Ab(monospot test)–FN in first 1 week
Lymphocytosis
transient hepatitis
Managment?
Avoid sport for > 3 weeks and contact sport >4 week
Varicella vaccine for HIV?
If CD4 >200–Since it is LAV
For Low anti varicella Ab on serology
immediately at diagnosis of HIV
Pertussis clinical presentation?
cathera l(1-2 weeks): mild cough and rhinitis
paroxysmal(2-6)week: cough with an inspiratory whoop,posttusive vomiting, apnea in an infant
convalescent: weeks to month:resolve
diagnosis?
Pertussis culture/PCR
Lymphocytosis
treatment?
Macrolide
what about allergic aspergillosis?
occur in patients with CF/Asthma
bronchial obstruction symptom
eosinophilia/not lymphocytosis
Mycoplasma pneumonia symptom?
Respiratory droplet
winter/fall
close-quarter/young military and dorm
CM?
indolent headche,fever,mailase
persistent dry cough
nonexudative pharengitis
vesicular/macular rash on extremity
Diagnosis?
Normal leukocyte count intersticial pnumonia/infilitrate on CXR subclinical hemolysis(Cold agglutinin)
Treatment?
usually emperic
Macrolid or respiratory floouroquinolol
Acute HIV infection CM?
Lasts 2-4 week
Mononucleosis like symptoms
Generalized macular rash(oral ulcer(painful), oval,pink macular lesion)–Transient and stay for a week
GI symptom
Diagnosis?
High viral load(>100,000)
Normal CD4 count
Serology may be negative
Managment?
Start HAART
Partner screening and secondary prophylaxis based on serology
Prophylaxis should be given?
TMP-SMX–PCP
Gancyclovir–CMV(based on donor serostatus)
PCV and HBV vaccination prior to transplant–to make sure of immune response
IM influenza vaccine yearly
Antifungal prophylaxis for lung and liver transplant
ehrlichiosis?
Transmitted by tick bite(Lonestar thick)
SE & Central USA
clinical manifestation?
Flue like illness Nurologic symptom(AMS and Neck stiffness) rash uncommon(<30 % RMSF like lesion w/o spot)
Diagnosis?
Lukopnia and thrombocytopnia
Intracytoplasmic morula(on monocyte)
Elevated TA and LDH
PCR
managment?
Doxycycline while waiting for the result
S.pnumonia is common in what CD4 count?
If CD4 <200
Indolent murmur can be seen in patients with fever?
Mid systolic, G2 murmur on left cost sternal –Due to high blood flow.
UTI with alkaline urine indicates?
Urase producing bacteria infection
- -proteus(MC)
- -Klebsiella
Neurocysticercosis epidemiology?
Tenia Solium(pork tapeworm) egg
feco-oral transmission
C & S America,Subsaharan Africa and asia
CM?
Prolonged incubation(month-years) Seizure ICH sign cysticercosis can involve liver and muscle Systemic sympoms are absent
Diagnosis?
MRI/CT
cyst(hypodense/edema or enhancement)
Treatment?
Seizure/ICH treatment
Antiparasitic therapy(Albendazole)
Corticosteroid
Treatment of latent TB IN HIV?
Positive PPD(Induration >=5 mm) or Positive INTY assay Rule out active disease(Symptom + CXR) ( month of INH + pyridoxine)
Microbiology of IE?
based on patient risk
S.Aures?
IV drug user
Implanted devise
catheter
prosthetic valve
Viridian streptococci(SM and SS)?
Gingival manipulation
Respiratory incision or biopsy
streptococcus epidermidis?
Implanted devise
Iv catheter
prosthetic valve
Enterococcus?
Nosocomial UTI
GU procedure
Streptococcus gallolycoticus/bovis?
Colonic CA
IBD
Fungi(candidia)?
IV drug
IC
prolonged antibiotic
Parvovirus B-19 infection CM?
Flu-like symptom Slapped check rash in children and lacy in adult Erythema infectiousum(fifth disease) Acute, Symmetric arthritis Transient pure cell aplasia
diagnosis?
Acute IgM in Imunocompitent NAAT in immunocompromise Reactivation IgG and NAAT
Nocardia Tx when the brain is involved?
TMP-SMX + carbapenem
If possible drain abscess
Fluconzole proflaxise in HIV?
Given as secondary prophylaxis
Pateint previous history with still low CD4 count
Early HAART tx benefit?
early CD4 recovery
decrease inflammation related cardiac and renal complication
Decease oncogenic virus reactivation
Decrease public transmission risk
IE treatment?
Acute; empiric vancomycin
Subacute; Based on culture result
Syphilis diagnosis?
Non-treponemal
Treponemal
Non-treponemal?
RPR and VDRL Ab to cardiolipin -cholesterol-lecitine Ag Quantitative(tITER) Possible -Ve in early disease Decrease titer confirms treatment
Treponemal?
FTA-AB and TP-EIA Ab to treponemal antigen Qualitative(R/NR) High sensitivity in early disease Positive after treatment
HAV vaccination indication?
Chronic hepatitis
Gay
IV drug user
Treatment of NG positive and CT negative urethritis by NAAT?
Ceftriaxone and azithromycin(dec resistance)
If azithromycin C/I substitute doxycycline
ecthyma gangrenosum?
Typical pseudomonal skin infection
Occur in immunocompromised patients
Vascular invasion of media and adventitia–vascular obstruction–skin necrosis(gangrenous skin ulceration
fever
Managment for patients with severe penicillin allergy and have syphilis?
P-Doxyxycline 14 day S-Doxyxycline 14 day L-Doxyxycline 28 day T-Ceftriaxone 14 day Do NTAB titer after 6-12 month
Travelers diarrhea cause?
profuse watery diarrhea Transmitted by water Cryptosporidium Giardiasis Cyclospora
Managment of pyelonephritis?
Complicated
oral FQ or TMP-SMX
complicated
IV cephalosporins,FQ, aminoglycoside or ESBL
Complicated?
DM URT obstruction Renal failure Instrumentation Immunosuppression Hospital aquired
Monospot test negative and strong suspicion for IM?
IgM and IgG for EBV
IgM for CMV
Leprosy CM?
A macular anesthetic lesion with a raised border
Nodular, painfully nearby nerve with loss of sensory and motor function
Diagnosis and managment?
Full skin biopsy Tubercloid Dopson + rifampicin Lepromatous Dapsone + Rifampcine + CFZ
