Infectious 2 Flashcards
Linked to gastroenteritis in enclosed populations (daycare, schools, cruises) – clinical features? Duration? Diagnosis? Management?
Norwalk virus
- Vomiting most prominent
- 2-3 day duration (shorter than other viral causes)
Diagnosis based clinical features
Supportive
Most common infectious agent causing gastroenteritis? Peak incidents? Incubation? Clinical Features? Diagnosis? Management? Complication?
Rotavirus; winter; Picogordo
- 1-3 Day incubation
- Vomiting, diarrhea, dehydration for 4-7 days
- Sometimes URI symptoms
ELISA test
- Supportive therapy and early feedings to prevent gut atrophy
- Transient lactose intolerance
Bacterial diarrhea with absent stool WBCs? Present stool WBCs? Either present or absent stool WBCs?
Toxigenic E. coli, pathogenic E. coli, campylobacter, Yersinia
Hemorrhagic E. coli, Shigella
Salmonella
Bacterial diarrhea
- Major cause of travelers diarrhea? Tx?
- Commonly Causes hemolytic uremic syndrome? Tx?
- Bloody diarrhea and seizures? Tx?
- Most common cause of bloody diarrhea in US? Tx?
- Can cause mesenteric adenitis? Tx?
- With water loss? Tx?
- toxigenic E. coli – quinolones, sulfonamides
- Enterohemorrhagic E. coli
- Shigella – ceftriaxone, fluoroquinolone
- Campylobacter – Erythromycin
- Yersinia – ceftriaxone
- Cholera – just fluid replacement
Classic electrolyte finding in diarrhea (chlorine)?
Non-anion gap hyperchloremic metabolic acidosis
HIV transmission in children? Factors that increase transmission? Factors that decrease transmission?
- Perinatal transmission (95%)
- Breast-feeding
- High maternal viral load
- Advanced maternal disease
- maternal genital infections (Chorioamnionitis)
- Premature birth
- Prolonged rupture of membranes
- Undetectable viral load
- C-section
- Compliance with therapy
- Infant postexposure prophylaxis
Clinical features of neonatal HIV infection? Diagnose by? Test that should be avoided?
Most infants are asymptomatic first year of life
- Failure to thrive
- Recurrent infections, thrush
- Lymphadenopathy, parotitis
- Loss of developmental milestones
- Thrombocytopenia
- Severe varicella infection
HIV DNA PCR monthly until four months page
ELISA - Maternal antibody present in children until two years of age
Management of infant born to mother with HIV?
- Zidovudine for six weeks – postexposure prophylaxis
- Bactrim for PCP until four months of negative HIV PCR
- No breast-feeding
- Urine CMV culture
Management for children positive for HIV?
- HAART therapy
- Prophylaxis based on CD4 count and age
- Immunizations (except varicella)
- Annual eye exams for CMV retinitis in children who are CMV antibody positive
Infectious mononucleosis – causes? Clinical features? Lab findings? Diagnosis based on age? Management?
EBV, CMV, HIV, toxoplasmosis
- Fever, malaise, fatigue
- Pharyngitis – exudative
- Posterior cervical adenopathy
- Hepatosplenomegaly
- Macular rash
Labs shows atypical lymphocytes, neutropenia, thrombocytopenia, elevated transaminases
- Monospot to test for heterophile antibody (only in children over four)
- EBV antibody titers in children under four
- PCR
Supportive. Corticosteroids sometimes for severe pharyngitis
Complications of infectious mononucleosis in short term? During tx? Long term?
- Splenic rupture
- Neurologic – cranial nerve palsies, encephalitis
- Severe pharyngitis – upper airway obstruction
Amoxicillin-associated rash – diffuse juridic maculopapular rash one week after starting abx
Malignancy – nasopharyngeal carcinoma, Burkitt’s lymphoma
Measles – cause? Clinical features? Diagnosis? Management?
Paramyxovirus rubeola
- Three C’s (cough, conjunctivitis, Coroza)
- Enanthem – Koplik spots on buccal mucosa
- Exanthem – rash beginning in the head and spreading within 24 hours
- Fever
Serologic testing
Vitamin A, supportive care
Complications of measles?
- Bacterial pneumonia – most common cause of mortality
- Otitis media
- Laryngotracheitis
- Encephalomyelitis
- Subacute sclerosing panencephalitis
Rubella – virus family? Incubation? Clinical features? Diagnosis? Management? Complications?
Togavirus
Often asymptomatic with incubation period of 2 to 3 weeks
- Prodrome of URI and fever
- Painful suboccipital, posterior auricular lymphadenopathy
- Exanthem beginning on face and spreading to trunk
- Fever less than 38
Viral culture and serology
Supportive
- Meningioencephalitis
- Polyarteritis in females
Congenital Rubella?
- Blueberry muffin baby -Thrombocytopenia, jaundice
- Hepatosplenomegaly
- Congenital cataracts
- Sensorineural hearing loss
- Patent ductus arteriosus
- Mental retardation, hypertension, DM
Allergic bronchopulmonary aspergillosis – characterized by? Labs? Management?
- Wheezing
- Eosinophilia
- Pulmonary infiltrates
Elevated Aspergillus specific immunoglobulin E
Corticosteroids and antifungal
Patients with a high-risk of giardiasis?
- Travelers to Russia
- Drink contaminated Mountain water in western United States
- Day care center outbreak
Diagnosis malaria with?
Giemsa stain
Most common cause of infectious chorioretinitis? Triad? Transmission?
Toxoplasmosis
Hydrocephalus, intracranial calcifications, chorioretinitis
Cat feces
- Most common Helminth infection in the US? Treatment?
- Loffler syndrome? Treatment?
- Helminth infection that causes tenesmus, bloody diarrhea, rectal prolapse? Treatment?
- Helminth that can cause Fe deficiency anemia? Tx?
- Migrating, pruritic, erythematous tracks on skin? Tx?
- Ocular larva migrans? Tx?
- Enterobius – albendazole
- Ascaris lumbercoides - transient pneumonitis from migration through lungs causing fever, eosinophilia
- Trichuris trichuria - Albendazole
- Necantor americus and Ancylostoma duodenale - Albendazole
- Cutaneous larva migrans – ivermectin
- Toxocara canis – albendazole
Cysticercosis - organism? Transmission? Clinical features? Diagnosis? Management?
Taenia solium. Fecal-oral.
- No symptoms until tapeworm is in muscle, subcutaneous tissue, brain
- Subcutaneous nodules – calcified on x-ray
- Neurocysticercosis – 4th ventricle involvement causing Seizures, hydrocephalus, stroke
- stool O&P
- Serology
- CT/MRI – solitary parenchymal cyst on multiple calcifications
Anti-parasitics or if only calcified lesions – anticonvulsants
Rocky Mountain spotted fever – Gram stain shows? Clinical features? Laboratory findings? Diagnosis? Management?
Gram-negative intracellular coccobacillus
- Hypotension
- Petechial rash beginning on the wrist/ankles moving centrally
- Hepatosplenomegaly
- CNS – headache, seizures
- Fever and myalgia
Thrombocytopenia, elevated transaminases, hyponatremia
Serologic testing
Doxycycline
Ehrlichiosis – Clinical features? Laboratory findings? Diagnosis? Management?
Same symptoms as Rocky Mountain spotted fever WITHOUT rash (Fever, headache, myalgias, lymphadenopathy)
Thrombocytopenia, elevated transaminases, hyponatremia
Serology and PCR
Doxycycline
Bartonella – clinical features? Diagnosis? Management?
- Papule along the lines of scratch, followed by lymphadenopathy after two weeks
- Fever
- Parinaud oculoglandular syndrome (conjunctivitis and preauricular lymphadenitis)
Elevated serum IgM antibody to bartonella
Supportive care
Tuberculosis disease (vs tuberculosis)? Transmission of TB in children under 12? Extrapulmonary TB?
Signs and symptoms of TB without positive findings chest radiograph
Not contagious because cough is minimal and lesions are small
- Scrofula (cervical lymphadenitis)
- meningitis
- ileitis
- joint
- Pott’s disease
- Miliary
Radiographic features of TB?
- Hilar/mediastinal lymphadenopathy
- Ghon complex – parenchymal infiltrates with enlarged hilar lymph nodes
- Lobar involvement, pleural effusion
Positive tuberculin skin test in children if?
> 5 mm in children with close contact with persons with TB, suggestive x-ray findings, immunocompromised
> 10 mm in children younger than four, chronic medical condition, area endemic for TB
> 15 mm in children older than four with no other risk factors
Definite diagnosis of TB if?
- Positive culture from gastric aspirates
- Positive staining of fluid for acid-fast bacilli
- Caseating granulomas on biopsy
