Infectious Flashcards
“Valley Fever”
aka Coccidiomycosis
grows in soil
Transmission: inhaling spores
Sx of Cocci/”Valley fever”
Can be:
- Pulmonary
- “Valley fever” mixture
- Disseminated or persistent
Primarily pulmonary sx of Valley fever/Cocci
Mild flu like illness
Fever, chills, runny nose, HA, cough, pleuritic CP
“Valley fever” classic sx
Fever Joint pain (ankles and knees) Skin rash- Erythema nodosum, Erythema multiform, or maculopap
Disseminated/ persistent Cocci sx
CNS (meningitis)
Can affect any organ esp the lungs, skin, soft tissue, lymph nodes, and joints
Diagnosing Cocci
Order serology (igG, igM) or Culture
What is seen in tissues if someone has Cocci?
Spherules- thick walled spheres containing endospores
If someone has meningitis from Cocci
CSF: fungal pattern- lymphocytosis (inc) and decreased Glucose
What will CXR show on someone who has Cocci
Persistent cavitations
Miliary PNA
Abscess
Nodules***
Tx of Cocci
None if mild dz and localized lung dz- just symptomatic
CNS: Fluconazole or Itraconazole
How is CNS Meningitis from Cocci treated?
like a fungal dz
Fluconazole or Itraconazole
How to treat Severe case of Cocci or a Pregnant woman in 1st trimester
Amphotericin B
Transmission: Soil, crush and puncture injuries
Trismus, Lockjaw, muscle spasm, inc DTR
Tetanus
(Clostridium tetani) gram +
Risus sardonicus
a/w Tetanus
Facial contractions
Spatula test
a/w Tetanus
Masseter muscle spasms when the posterior pharynx is touched w tongue blade/ spatula instead of the Normal gag reflex
Tx of Tetanus
Metro + Tetanus immunoglobulin (5000 units)
What can you give for muscle spasms a/w Tetanus
Benzos
Magnesium, may prevent
If adult was never vaccinated, what is Tetanus recommendation
Tetanus IG 250 u + initiation of tetanus toxoid vaccine
2nd dose at 4-8 weks
3rd dose 6-12 months later
Normal TdaP booster schedule
2,4,6 mo
1 year
5 year
TdaP booster
11-12 yo
Pregnant mothers
then every 10 year interval
Life threatening muscle infection
Traumatic injury, IVDU, puncture, Post op: risks
Crepitus
Gas Gangrene, Myonecrosis
Sudden onset of extreme swelling and muscle pain
Skin color: pale–> brown–> dark purple
Gas Gangrene
X ray shows: Air in soft tissues
Culture: gram + bacilli
Gas Gangrene
Tx for Gas Gangrene other than Urgent Surgical Debridement
PCN + Clinda
Other tx options for Gas gangrene
Hyperbaric O2 therapy
Alt abx: Metro, Tetracycline
Inhibition of Ach release
Sx: WEAKNESS and Flaccid paralysis
Botulism
Clostridium Botulinum
anaerobic, gram +
Types of Botox poision
Adult: canned foods
Infant: honey
Wound; RARE (this one is treated differently)
Foodborne Botox poisoning
GI upset followed by 8 Ds
-Diplopia, Dysphagia, Dry mouth, Dilated fixed pupils, Dysarthria, Dysphonia, Desc decreased muscle strength, Decreased DTRs
Tx of Botulism poison
Antitoxin 1st line
DO NOT GIVE ABX unless wound type
If wound cause of Botulism poison
Antitoxin + Pen G
Wound debridement
Diptheria
rare now bc of DtaP vaccination
Diptheria
Transmisson: resp secretions
Sx: sore throat, exudate on pharynx, fever, malaise
SERIOUS CONCERN: Arrhythmia, Heart failure, Myocarditis
White, friable exudate on pharynx
“Bull neck” cervical lymphadenopathy
Diptheria
Tx for Diptheria
Antitoxin + PCN (Or Erythromycin)
What to consider ordering in someone with Diptheria
EKG and Cardiac markers!!!
Caution looking for Myocarditis
Proph for Diptheria for Close contacts
Same Abx as tx:
Erythromycin or Pen G
MRSA tx
“B,C,D” and then Linezolid
MRSA tx
Bactrim
Clinda
Doxy
and Linezolid
IV tx options for Mrsa
Vanco
Linezolid
Gonorrhea has the risk of becoming
Disseminated
Triad of: skin Dermatitis, Arthralgia, and Tenosynovitis (tendon inflammation and pain)
Skin, Joints, Tendons
Diagnosing Gonorrhea
Nucleic acid amplification test
Synovial fluit NAAT
Tx for Gonorrhea STI
Azithro AND Ceftriaxone (Rocephin)
Tx for Gonorrhea if it’s just joint stuff
Ceftriaxone (Rocephin)
Most common bacterial STI in the United States
Chlamydia
Sx of Chlamydia
Pain w sex
D/c, Pruritis, dysuria, Hematuria
Often A-sx (esp men)
Can have Reactive Arthritis w Chlamydia
Urethritis
Uveitis
Arthritis
“can’t pee, can’t see, can’t climb a tree”
Diagnosing Chlamydia
Nucleic acid amplification
Tx of Chlamydia
Azithro OR Doxy
Dosage of Chlamydia tx
Azithro 1 gram x 1 dose
Doxy 100 mg bid x 10 days
Retest in 3 weeks
Lymphogran Venereum
caused also by Chlamydia Trachomatis
PAINLESS genital ulcer –> groin Lymphadenopathy (buboes)
Tx of Lymphogran Venereum
Doxy x 21 days
maybe IandD of the Lyphadenopathy (Buboes)
Group A Streptococcus is AKA
Strep Pyogenes
2 unique Dz caused by GAS “Strep Pyogenes”
Acute Rheumatic Fever
Scarlet Fever
They are DIFFERENT
Diff b/w Rheumatic fever and Scarlet fever
Rheumatic: Autoimmune MULTI SYSTEM
Scarlet: Skin eruption
Rheumatic fever follows a Strep infection
2-6 wks later
The antibodies are damaging the host tissue and organs directly
Sx of Rheumatic Fever
multisystem, 2-6 wks after strep infection
Polyarthritis: Large joints, red, hot, swollen, PAINFUL
!!!CARDITIS!!!!: Valve dysfx, Myocarditis, Pericarditis
Sydenham’s chorea: jerky movements
Erythema marginatum: rash w central clearing to trunk
Rheumatic fever breakdown
Joints
Heart
Chorea jerky movements
Rash w central clearing
Jones Criteria
consists of Major (JONES) criteria and Minor
for Rheumatic Fever MAJOR CRITERIA are the "Jones" J: joint O: oh my heart N: nodules (subcutaneous) E: erythema marginatum S: sydenham's corea
Minor criteria a/w Jones
Clinical:
- fever
- joint pain
Labs:
- elevated ESR/CRP, leukocytosis
- prolonged PRI on EKG
What is often a backup if someone is PCN allergic?
Erythromycin
What is a positive Rheumatic fever dx based on the Jones criteria?
2 major criteria (JONES)
OR
1 major + 2 minor
Tx for Rheumatic fever
ASA, Steroids, and Pen G
Aspirin, PCN G, and Steroids are tx for
Rheumatic fever
Complication of Rheumatic fever
Cardiac valvular dz- YIKES
usually Mitral
Flushed face w Circumoral pallor
“Strawberry tongue”
Pastia lines
Scarlet fever!
Scarlet fever
Sandpaper rash
+ fever, chills, sore throat
The rash of Scarlet fever
Diffuse redness, blanches w pressure + multiple small raised sandpaper lesions
Starts in armpits
What are Pastia lines
linear petechial lesions seen at pressure points- Armpits, antecubital, abdominal, inguinal
Tx for Scarlet Fever
PCN G or PCN VK
either way, PENICILLIN
Scarlet fever rash is diff from Rheumatic fever bc
Scarlet fever is more diffuse, and Sandpaper-y
Where does Scarlet fever rash start?
Armpits
Tx for both Rheumatic and Scarlet is
PENICILLIN
except Rheumatic needs to add Aspirin and Steroids
RMSF
spring and summer months
fever + joint pain + rash
Treat with DOXY
RMSF
Vascular injury
Tiny clots–> infarcts
HA, fever, pedal edema, conjunctivitis, encephalitis, ARDS (respiratory distress), cardiac or bleeding disorders!!!
BIG YIKES
RMSF labs may show
Thrombocytopenia
Pancytopenia
Hyponatremia
LOW EVERYTHING
Tx for RMSF
Doxy
Chloramphenicol if pregnant
When should you begin RMSF tx?
within 5 days of sx onset
HA, fever, chills, myalgia, arthralgia, n/v, lethargy
RECENT CAMPING or outside in summer/spring months
RMSF
dont wait for rash to appear. Tx w Doxy
