Infectious Disease 1 Flashcards

1
Q

How often do you have to take the Tdap (tetanus, diphtheria, acellular pertussis) vaccine?

A

The Tdap vaccine is recommended as a 1 time vaccine for all adults with reactivation provided to women at each pregnancy.

Should give the tetanus-diphtheria toxoid (Td) booster at 10 year intervals or 5 years after major trauma.

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2
Q

What’s the MCC of erysipelas?

A

Erysipelas is a skin infection of the upper dermis and superficial lymphatic system by GAS (group A strep).

Most patients get IV abx (ceftriaxone, cefazolin) but those Pt without systemic sx may get oral meds (amoxicillin).

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3
Q

What’s the ideal treatment course for Pt with latent Tb?

A
  1. 9 mo of isoniazid Rx with pyridoxine supplement (to prevent peripheral neuropathy)
  2. 3 mo of once weekly INH and rifapentine.

Can alternatively give INH for 6 mo or rifampin for 4 months.

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4
Q

What’s the treatment course for active TB?

A

Active pulmonary TB is treated with RIPE for 8 weeks, followed by continuation phase of combined therapy with isoniazid and rifampin for an extra 4 mo.

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5
Q

What are the clinical manifestations of mycobacterium leprae infection?

A

Macular anesthetic skin lesions with raised borders. Nodular painful nearby nerves with loss of sensory/motor function.

Dx = full thickness biopsy of skin lesion
Rx = dapsonse + rifampin for paucibacillary lesions
and clozamine for multibacillary lesions.

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6
Q

What are some clinical manifestations of infective endocarditis and what is the causative organism after dental cleaning?

A

Infective endocarditis is commonly due to Strep mutans (viridians group streptococci). Presentation is mostly subacute with wks of low grade fever + fatigue. New regurg murmur (systolic when mitral valve is affected), and splinter hemorrhages due to microemboli under fingernails. Leukocytosis, anemia of chronic Dz, and proteinuria are present in 1/2 of cases.

Enterococci species (E faecalis) are common causes of IE and are due to manipulations of UTI tract.

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7
Q

At what CD4 count would you see cryptococcal meningitis?

A

Typically in CD4 < 100.

** Cryptococcus neoformans is an invasive fungus that&raquo_space; lung infection when spores are inhaled, but can progress to CNS infection&raquo_space; meningoencephalitis in immunocompromised host.

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8
Q

What would the CSF properties be of cryptococcal meningoencephalitis?

A

Presentation is similar to aseptic meningitis. HIGH opening pressure, Low glucose, high protein. Few WBC (< 50/uL) with mononuclear predominance.

^ ICP is due to occlusion of CSF by the organism.

** Transparent capsule on india ink stain (helps differentiate from toxoplasma).

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9
Q

How would PML (progressive multifocal leukoencephalopathy) present on imaging?

A

Neuroimaging shows patchy areas of white matter consistent with demyelination. Infection is confirmed with PCR testing of CSF.

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10
Q

At what CD4 count would cryptosporidium cause diarrhea in an AIDS patient?

A

CD4 < 180/uL . Presents with severe watery diarrhea, low grade fever, and weight loss.

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11
Q

At what CD4 count would microsporidium/isosporidium cause diarrhea in an AIDS patient?

A

CD4 < 100/uL. Presents with watery diarrhea, cramping, weight loss, and NO fever.

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12
Q

At what CD4 count would MAC (mycobacterium avium) cause diarrhea in an AIDS patient?

A

CD4 < 50/uL. HIGH fever, watery diarrhea, and weight loss.

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13
Q

At what CD4 count would CMV cause diarrhea in an AIDS patient?

A

CD4 < 50/uL. Causes hematochezia, frequent small volume episodes of diarrhea, abdominal pain, low grade fever, and weight loss.

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14
Q

What valve(s) are typically affected in infective endocarditis?

A

Mitral Valve is mostly affected (75%)&raquo_space; mitral regurg.

Can also have aortic valve affected if it has congenital biscupid valve or if it is assoc with aortic stenosis.

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15
Q

At what CD4 count would Kaposi’s sarcoma be found?

A

CD4 < 200 typically. This is considered an AIDS defining illness. Due to HHV8. KS will typically regress if underlying HIV is treated with HAART.

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16
Q

Ludwig angina is a rapidly progressive cellulitis of the submandibular and sublingual spaces. The source of infection is typically an infected mandibular molar. A CT scan of the neck confirms the Dx and rules out abscess. How would you treat Ludwig angina?

A

Most people are treated with IV Abx (clindamycin, and ampicillin-sulbactam) and removal of the decaying tooth.

May progress to airway compromise, necessitating mechanical ventilation.

17
Q

What blood disorders can occur as a consequence of EBV infection?

A

Autoimmune hemolytic anemia and thrombocytopenia. These result from cross reactivity of EBV induced Ab against RBC and platelets.

The Ab are IgM cold agglutinin Ab that lead to complement mediated RBC hemolysis. This can cause ^ transaminase and bilirubin levels.

Can also find decreased leukocyte # due to viral suppression.

18
Q

At what point are HIV patients at ^ risk for toxoplasmosis reactivation?

A

CD4 < 100/uL. Can confirm with ring enhancing lesions on MRI and presence of toxoplasma gondii IgG Ab. Rx with TMP-SMX as primary prophylaxis.

19
Q

What would you use as prophylaxis against MAC in HIV patients?

A

MAC can occur when CD4 <50/uL, prophylaxis is with azithromycin.

20
Q

What’s the pathological organism responsible for toxic shock syndrome?

A

TSS is due to Staph Aureus producing TSST-1 (toxic shock syndrome toxin 1) which acts as a superantigen causing T cells to release massive amounts of cytokines.

Management = supportive therapy and broad spectrum anti-staph Abx.

21
Q

What skin findings would be present in meningococcemia?

A

Petechial rash progressing to ecchymosis, bullae, vesicles, and eventually to gangrenous necrosis.

Pt can also present with fever, nausea/vomiting, myalgias, meningeal signs, and shock.

22
Q

How do you treat an infection of sporotrichosis?

A

3-6 mo of oral itraconazole is effective.