Infectious Disease Flashcards
INTRAVENOUS treatment for MSSA
bone, heart, skin, joint
- oxacillin
- nafcillin
- cefazolin (1st gen cephalosporin)
ORAL treatment for MSSA
bone, heart, skin, joint
- dicloxacillin
- cephalexin (1st gen cephalosporin)
treatment for MINOR MRSA infection
bone, heart, skin, joint
- trimethoprim/sulfamethoxazole (TMP/SMX)
- clindamycin
- doxycycline
treatment for MAJOR MRSA infection
bone, heart, skin, joint
- vancomycin
- linezolid
- daptomycin
- ceftaroline
- tigecycline
- telavancin
adverse effect of linezolid
thrombocytopenia
adverse effect of daptomycin
myopathy (elevated CPK)
treatment of Staph aureus if penicillin allergy: RASH
bone, heart, skin, joint
cephalosporins
treatment of Staph aureus if penicillin allergy: ANAPHYLAXIS
bone, heart, skin, joint
- macrolides (azithromycin, clarithromycin)
- clindamycin
treatment of Staph aureus if penicillin allergy: MINOR INFECTION
(bone, heart, skin, joint)
- macrolides (azithromycin, clarithromycin)
- clindamycin
- trimethoprim/sulfamethoxazole (TMP/SMX)
treatment of Staph aureus if penicillin allergy: MAJOR INFECTION
(bone, heart, skin, joint)
- vancomycin
- linezolid
- daptomycin
- telavancin
can you use the same antibiotics for Staph as Streptococcus?
YES
antibiotics SPECIFIC for Streptococcus
- penicillin
- ampicillin
- amoxicillin
Gram-negative bacilli (rods)
- Escherichia coli
- Enterobacter
- Citrobacter
- Morganella
- Pseudomonas
- Serratia
antibiotic classes that are EQUAL in efficacy for treatment of Gram-NEGATIVE bacilli (rods)
- cephalosporins
- penicillins
- monobactam
- quinolones
- aminoglycosides
- carbapenems
ONLY carbapenem that does NOT cover Pseudomonas
ERTAPENEM
cover GNR and ALSO cover Streptococci and anaerobes
- PIPERACILLIN
2. TICARCILLIN
EXCELLENT pneumococcal (Streptococcus pneumoniae) drugs
- LEVOFLOXACIN
- GEMIFLOXACIN
- MOXIFLOXACIN
work SYNERGISTICALLY against Staph and Strep
AMINOGLYCOSIDES
EXCELLENT anaerobic coverage, and cover Strep and MSSA
CARBAPENEMS
covers MRSA and GNR
TIGECYCLINE
adverse effect of imipenem
SEIZURES
BEST medication for gastrointestinal anaerobes (Bacteroides)
metronidazole
can also be used for gastrointestinal anaerobes (Bacteroides)
- carbapenems
- piperacillin
- ticarcillin
ONLY cephalosporins that cover anaerobes
- CEFOXITIN
- CEFOTETAN
BEST medication for respiratory anaerobes (anaerobic Strep)
clindamycin
antibiotics with NO anaerobic coverage
- aminoglycosides
- aztreonam
- fluoroquinolones
- oxacillin
- nafcillin
- all cephalosporins EXCEPT cefoxitin and cefotetan
red, flushed skin (particularly on neck) from histamine release is d/t?
vancomycin
red man syndrome treatment
slow rate of vancomycin infusion
treatment for herpes simplex, and varicella zoster (all 3 are equal in efficacy)
- acyclovir
- valacyclovir
- famciclovir
treatment for cytomegalovirus (CMV)
- ganciclovir
- valganciclovir
- foscarnet
BEST long-term treatment for CMV RETINITIS
VALGANCICLOVIR
adverse effects of ganciclovir and valganciclovir
- neutropenia
- bone marrow suppression
adverse effect of foscarnet
renal toxicity
treatment for influenza A and B
- oseltamivir
- zanamivir
(neuraminidase inhibitors)
treatment for hepatitis C (in combination w/ interferon), and respiratory syncytial virus (RSV)
ribavirin
treatment for hepatitis B
- lamivudine
- interferon
- adefovir
- tenofovir
- entecavir
- telbivudine
treatment for oral and vaginal candidiasis (alternative to topical medications)
fluconazole
best treatment against Aspergillus
voriconazole
adverse effect of voriconazole
visual disturbance
EXCELLENT for neutropenic fever patients
- caspofungin
- micafungin
- anidulafungin
(echinocandins)
which antifungals do NOT cover Cryptococcus?
echinocandins
adverse effects of echinocandins?
NONE
effective against ALL Candida, Cryptococcus, and Aspergillus
amphotericin
superior to amphotericin in treatment of Aspergillus
voriconazole
superior to amphotericin in treatment of neutropenic fever
caspofungin
superior to amphotericin in treatment of Candida
fluconazole (same efficacy, but LESS adverse effects)
adverse effects of amphotericin
- renal toxicity (increased creatinine)
- hypOkalemia
- metabolic acidosis
- fever, shakes, chills
occurs in DIABETES, PVD, or both with an ULCER, or SOFT TISSUE infection
OSTEOMYELITIS
best INITIAL test for osteomyelitis
plain X-ray
best SECOND-line test for osteomyelitis
MRI
most ACCURATE test for osteomyelitis
bone BIOPSY and culture
EARLIEST finding of osteomyelitis on X-ray
periosteal elevation
what percentage of calcium of bone must be lost in osteomyelitis before the X-ray becomes abnormal?
50%
how much time will it take before X-ray becomes abnormal in osteomyelitis?
up to 2 weeks
is osteomyelitis associated with fracture?
NO
best method for following response to therapy of osteomyelitis
ESR (erythrocyte sedimentation rate)
osteomyelitis is MOST COMMONLY caused by
direct contiguous spread from overlying tissue
what do you do in osteomyelitis if ESR is still markedly elevated after 4-6 weeks of treatment?
continue treatment
MCC of osteomyelitis
Staphylococcus
treatment for osteomyelitis if Staphylococcus is sensitive
OXACILLIN, or NAFCILLIN for 4-6 WEEKS
treatment for osteomyelitis if Staphylococcus is resistant (MRSA)
VANCOMYCIN, LINEZOLID, or DAPTOMYCIN for 4-6 WEEKS
can you treat Staphylococcal osteomyelitis with PO antibiotics?
NO
Gram-negative bacilli that can cause osteomyelitis
- Salmonella
- Pseudomonas
ONLY form osteomyelitis that can be treated with PO antibiotics
Salmonella, and Pseudomonas osteomyelitis
- ITCHING and DRAINAGE from external auditory canal
- form of cellulitis of external auditory canal
otitis externa
otitis externa is associated with?
- SWIMMING
- FOREIGN OBJECTS
treatment for otitis externa
- topical antibiotics
- topical hydrocortisone (decreases swelling/itching)
- acetic acid and water (reacidify ear)
OSTEOMYELITIS OF SKULL from Pseudomonas in patient with diabetes
malignant otitis externa
malignant otitis externa can cause
- brain abscess
- skull destruction
best INITIAL test of malignant otitis externa
SKULL X-RAY, or MRI
MOST ACCURATE TEST for malignant otitis externa
BIOPSY
treatment for malignant otitis externa
- SURGICAL DEBRIDEMENT
2. ANTIPSEUDOMONAL ANTIBIOTICS
antipseudomonal antibiotics that can be used in malignant otitis externa
- ciprofloxacin
- piperacillin
- cefepime
- carbapenem
- aztreonam
key features of otitis media
- redness
- bulging
- decreased hearing
- loss of light reflex
- TM immobility
MOST SENSITIVE finding in otitis media
TM IMMOBILITY
diagnostic testing for otitis media
NONE, based on PE
best INITIAL treatment of otitis media
AMOXICILLIN for 7-10 days
MOST ACCURATE TEST for otitis media
tympanocentesis and aspirate of TM for culture
if otitis media does not begin improving after 3 days, what do you do?
switch antibiotics!
- amoxicillin/clavulanate
- cefdinir
- ceftibuten
- cefuroxime
- cefprozil
- cefpodoxime
nasal discharge, headache, facial tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses
sinusitis
MCC of sinusitis
VIRAL
MCC of sinusitis that are NOT viral
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
best INITIAL test for sinusitis
X-ray
MOST ACCURATE TEST for sinusitis
sinus aspirate for culture
treatment for sinusitis
amoxicillin and INHALED STEROIDS
- pain/sore throat
- exudate
- adenopathy
- NO cough/hoarseness
pharyngitis
best INITIAL test for pharyngitis
RAPID STREP TEST
MOST ACCURATE TEST for pharyngitis
CULTURE
treatment for pharyngitis
PENICILLIN, or AMOXICILLIN
treatment for pharyngitis if penicillin allergy
azithromycin, or clarithromycin
- arthralgia
- myalgia
- cough
- headache
- fever
- sore throat
- feeling of tiredness
influenza
next best step to diagnose influenza
viral antigen detection
when should you treat influenza?
if patient presents within first 48 hours after onset of symptoms
what drug class works against BOTH influenza A and B?
neuraminidase inhibitors
treatment for influenza
- oseltamivir
- zanamivir
WRONG answers to treat influenza
- amantadine
- rimantadine
who should get vaccinated against influenza?
everyone
- most SUPERFICIAL bacterial skin infections
- weeping, crusting, oozing of skin
- Strep PYOGENES or Staph aureus
impetigo
treatment for impetigo
- topical mupirocin
2. topical retapamulin
treatment for SEVERE impetigo
- dicloxacillin
2. cephalexin
treatment for community-acquired MRSA impetigo
TMP/SMZ (trimethoprim/sulfamethoxazole)
treatment for impetigo if penicillin allergy: RASH
cephalosporins
treatment for impetigo if penicillin allergy: ANAPHYLAXIS
- clindamycin
- doxycycline
- linezolid
treatment for impetigo if penicillin allergy: SEVERE INFECTION WITH ANAPHYLAXIS
- vancomycin
- telavancin
- linezolid
- daptomycin
- group A (PYOGENES) streptococcal infection of skin
- very bright red, hot
- often affects FACE
erysipelas
can erysipelas cause rheumatic fever?
NO, but it can cause glomerulonephritis
what can cause rheumatic fever and glomerulonephritis?
PHARYNGITIS
best INITIAL treatment for erysipelas
- dicloxacillin
2. cephalexin
treatment for erysipelas if organism is CONFIRMED as group A beta hemolytic streptococci (Strep pyogenes)
PENICILLIN VK
- warm, red, swollen, tender skin
- usually presents in arm or leg
cellulitis
what should you order in a case of cellulitis of the leg?
LOWER EXTREMITY DOPPLER to exclude blood clot
treatment for cellulitis: MINOR disease
- dicloxacillin PO
2. cephalexin PO
treatment for cellulitis: SEVERE disease
- oxacillin IV
- nafcillin IV
- cefazolin IV
treatment for cellulitis if penicillin allergy: RASH
cephalosporins (cefazolin)
treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and MINOR disease
- macrolides
- clindamycin
treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and SEVERE disease
- vancomycin
- linezolid
- daptomycin
what skin infection does Staphylococcus epidermidis cause?
NONE
all skin infections can lead to?
post-streptococcal GLOMERULONEPHRITIS
but NOT rheumatic fever
Staph aureus-related skin infections beginning at the hair follicle
folliculitis
what is FOLLICulitis?
infected hair FOLLICle
what is a furuncle?
deep folliculitis
what is a Carbuncle?
a Cluster of furuncles
what is an abscess?
a collection of pus
diagnosis of folliculitis, furuncles, carbuncle, abscess
based on appearance
treatment for folliculitis/furuncles/carbuncles/abscesses: MINOR disease
- dicloxacillin PO
2. cephalexin PO
treatment for folliculitis/furuncles/carbuncles/abscesses: SEVERE disease
- oxacillin IV
- nafcillin IV
- cefazolin IV
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: RASH
cephalosporins (cefazolin)
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and MINOR disease
- macrolides
- clindamycin
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and SEVERE disease
- vancomycin
- linezolid
- daptomycin
abscesses respond well to?
drainage
severe itching of scalp, dandruff, bald patches
fungal SKIN infection
thickened nails, yellow, cloudy, appear fragile and broken
onychomycosis
best INITIAL test for fungal skin/nail infections
KOH preparation
antifungal treatment if NO hair or nail involvement
hint: 5 -azole’s, and 2 others
topical:
- clotrimAZOLE
- miconAZOLE
- ketoconAZOLE
- econAZOLE
- terconAZOLE
- nystatin
- ciclopirox
PO antifungal tx for scalp (tinea capitis), or nail (onychomycosis)
- terbinafine
- itraconazole
- griseofulvin (for tinea capitis)
adverse effect of terbinafine
increased transaminases
less efficacious than terbinafine and itraconazole
griseofulvin
- URETHRAL DISCHARGE
+/- dysuria
urethritis
diagnostic testing for urethritis
- urethral swab (gram stain, WBC count, culture, DNA probe)
- nucleic acid amplification test (NAAT)
treatment for urethritis
2 medications: one for gonorrhea, one for chlamydia
- polyarticular disease
- petechial rash
- tenosynovitis
disseminated gonorrhea
medications for gonorrhea in urethritis
- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO
treatment for gonorrhea if patient has urethritis and is PREGNANT
ceftriaxone IM
medications for chlamydia in urethritis
- azithromycin (SINGLE dose)
- doxycycline (for 1 week)
treatment for chlamydia if patient has urethritis and is PREGNANT
azithromycin
cervical discharge
cervicitis
diagnostic testing for cervicitis
- swab (gram stain, WBC count, culture, DNA probe)
- nucleic acid amplification test (NAAT)
is just as accurate as a speculum examination for cervicitis
nucleic acid amplification testing (NAAT)
treatment for cervicitis
2 medications: one for gonorrhea, one for chlamydia
medications for gonorrhea in cervicitis
- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO
treatment for gonorrhea if patient has cervicitis and is PREGNANT
ceftriaxone IM
medications for chlamydia in cervicitis
- azithromycin (SINGLE dose)
- doxycycline (for 1 week)
treatment for chlamydia if patient has cervicitis and is PREGNANT
azithromycin
- lower abdominal pain
- tenderness
- fever
- cervical motion tenderness
+/- dysuria
+/- vaginal discharge
pelvic inflammatory disease (PID)
measure of severity in pelvic inflammatory disease (PID)
leukocytosis
best INITIAL test for pelvic inflammatory disease (PID)
- pregnancy test
- cervical culture
- NAAT (nucleic acid amplification testing)
MOST ACCURATE test for pelvic inflammatory disease (PID)
laparoscopy (rarely needed)
OUTPATIENT treatment for PID
ceftriaxone IM AND doxycycline PO
INPATIENT treatment for PID
cefoxitin IV AND doxycycline IV (and maybe metronidazole)
antibiotics safe in pregnancy
- penicillins
- cephalosporins
- aztreonam
- erythromycin
- azithromycin
- extremely painful and tender testicle
- NORMAL position of testicle in scrotum
epididymo-orchitis
- extremely painful and tender testicle
- ELEVATED testicle in an ABNORMAL TRANSVERSE position
testicular torsion
treatment for epididymo-orchitis: if LESS THAN 35 years of age
ceftriaxone AND doxycycline
treatment for epididymo-orchitis: if MORE THAN 35 years of age
fluoroquinolone
PAINFUL ulcer caused by Haemophilus ducreyi
chancroid
best INITIAL test for chancroid
swab for gram stain and culture
treatment for chancroid
- ceftriaxone (single IM shot), OR
- azithromycin (single PO dose)
- LARGE TENDER NODES
- ulcer
- may develop suppurating, draining sinus tract
lymphogranuloma venereum (LGV)
diagnose lymphogranuloma venereum (LGV)
serology for Chlamydia trachomatis
treatment for lymphogranuloma venereum (LGV)
- aspirate the bubo
2. doxycycline, OR azithromycin
clear vesicular lesions
HSV2 (herpes simplex virus 2; genital herpes)
treatment for HSV2
- acyclovir
- valacyclovir
- famciclovir
for 7-10 days
best INITIAL test if roofs come off of vesicles making etiology unclear
Tzanck prep
MOST ACCURATE test for HSV2
viral culture
cause of syphilis
Treponema pallidum
- PAINLESS, firm genital lesion
- painless inguinal adenopathy
syphilis
MOST ACCURATE test for PRIMARY syphilis
darkfield microscopy
symptoms of PRIMARY syphilis
- CHANCRE
- ADENOPATHY
treatment for PRIMARY syphilis
SINGLE IM shot of PENICILLIN
treatment for PRIMARY syphilis if penicillin allergy
doxycycline
- fever, headache, myalgia
- develops 24 hours after treatment of primary syphilis
Jarisch-Herxheimer reaction
symptoms of SECONDARY syphilis
- RASH
- MUCOUS PATCH
- ALOPECIA AREATA (bald patches)
- CONDYLOMATA LATA (warts on genitals)
INITIAL diagnostic test for SECONDARY syphilis
RPR and FTA
treatment for SECONDARY syphilis
SINGLE IM shot of PENICILLIN
treatment for SECONDARY syphilis if penicillin allergy
doxycycline
manifestations of TERTIARY syphilis
- TABES DORSALIS
- ARGYLL-ROBERTSON PUPIL
- GENERAL PARESIS (paralysis)
- gumma
- aortitis
INITIAL diagnostic test for TERTIARY syphilis
RPR and FTA
FTA is more sensitive for neurosyphilis
best INITIAL diagnostic test for NEUROsyphilis
LUMBAR PUNCTURE
treatment for TERTIARY syphilis
IV PENICILLIN
treatment for TERTIARY syphilis if penicillin allergy
desensitization to penicillin
beefy red genital lesion that ULCERATES
granuloma inguinale
diagnostic test for granuloma inguinale
biopsy
causative organism for granuloma inguinale
Klebsiella granulomatis
treatment for granuloma inguinale
- doxycycline
- TMP/SMX
- azithromycin
- urinary frequency
- urgency
- burning
- dysuria
cystitis
best INITIAL test for cystitis
urinalysis
MOST ACCURATE test for cystitis
urine culture
treatment for UNCOMPLICATED cystitis
fosfomycin, or nitrofurantoin PO for 3 days
treatment for UNCOMPLICATED cystitis if high resistance to TMP/SMX
- ciprofloxacin
- levofloxacin
treatment for COMPLICATED cystitis
- TMP/SMX
- ciprofloxacin
for 7 days
what qualifies as “complicated” cystitis?
- stone
- stricture
- tumor
- obstruction
should you treat asymptomatic bacteriuria?
NO
who should get treated for asymptomatic bacteriuria?
only PREGNANT women
- urinary frequency
- urgency
- burning
- dysuria
- FLANK PAIN and TENDERNESS
pyelonephritis
best INITIAL test for pyelonephritis
urinalysis
MOST ACCURATE test for pyelonephritis
urine culture
OUTpatient treatment for pyelonephritis
ciprofloxacin
INpatient treatment for pyelonephritis
- ceftriaxone
- ertapenem
- quinolones
- ampicillin
- gentamicin
why are sonography or CT scanning done in a patient with a UTI?
- to determine etiology
- if pyelonephritis; stone? stricture? tumor? obstruction?
think of this in a patient who does not respond to treatment AFTER 5-7 days
perinephric abscess
necessary diagnostic test for perinephric abscess
biopsy to determine microbe
treatment for perinephric abscess
quinolone AND staphylococcal coverage
because treatment for GN bacteria selects out staphylococci
positive NITRITES indicate
gram negative bacteria in urine
- frequency
- urgency
- dysuria
- PERINEAL or SACRAL PAIN
- prostate tenderness
prostatitis
best INITIAL test for prostatitis
urinalysis
MOST ACCURATE test for prostatitis
urine WBC’s AFTER PROSTATE MASSAGE
treatment for ACUTE prostatitis
- ciprofloxacin
- TMP/SMX
FOR 2 WEEKS
treatment for CHRONIC prostatitis
- ciprofloxacin
- TMP/SMX
FOR 6 WEEKS
endocarditis is clinically diagnosed using
Duke’s criteria
2 MAJOR, or 5 minor criteria
what are the 2 MAJOR criteria for Duke’s criteria?
- 2 positive blood cultures
2. abnormal echocardiogram
what are the minor criteria for Duke’s criteria?
- fever
- presence of risk factors
- vascular findings
- immunologic findings
- microbiologic findings
fever + murmur =
POSSIBLE endocarditis
do blood cultures
2 positive blood cultures + positive echo =
ENDOCARDITIS
next best step in patient with fever, and new murmur or change in murmur
blood cultures
next best step in patient with fever, a murmur (new or changed), and positive blood cultures
echocardiogram
most common causes of culture NEGATIVE endocarditis
Coxiella and Bartonella
is associated even more with colonic pathology than Streptococcus bovis
Clostridium septicum
most common organisms for bacterial endocarditis
- Staph aureus
- MRSA
- Strep viridans group
best empiric therapy for endocarditis
vancomycin AND gentamicin in COMBINATION
(covers MC organisms)
for 4-6 weeks
if cause of endocarditis is Streptococcus bovis or Clostridium septicum, need to do what?
COLONOSCOPY
what are the indications for surgery (valve replacement) in endocarditis?
ANATOMIC DEFECTS
- valve rupture
- abscess
- prosthetic valves
- fungal endocarditis
- embolic events even after abx
when do you start HAART?
- CD4 count
adverse effect of NRTI (nucleoside reverse transcriptase inhibitors)
lactic acidosis
adverse effects of PI (protease inhibitors)
- hypERglycemia
2. hypERlipidemia
adverse effect of NNRTI (nonnucleoside reverse transcriptase inhibitors): efavirenz
drowsiness
adverse effect of zidovudine
anemia
adverse effects of didanosine
- pancreatitis
2. peripheral nEUropathy
adverse effects of stavudine
- pancreatitis
2. peripheral nEUropathy
adverse effect of abacavir
rash
adverse effects of lamivudine
NONE
adverse effect of tenofovir
renal toxicity
adverse effect of indinavir
kidney stones
postexposure prophylaxis:
- needle-stick injury
- unprotected sex
HAART for ONE MONTH
tenofovir, emtricitabine, AND integrase inhibitor, or protease inhibitor
blocks CCR5 receptor of CD4 cell
maraviroc
which protease inhibitor inhibits the hepatic p450 system increasing blood levels of other PI’s?
ritonavir
when do you start HIV meds in HIV+ pregnant women?
right away in first trimester
regardless of CD4 count/viral load
HIV+ with CD4 count
Pneumocystis jiroveci pneumonia (PCP)
best ppx for Pneumocystis jiroveci pneumonia (PCP)
TMP/SMX
ppx for Pneumocystis jiroveci pneumonia (PCP) if TMP/SMX causes RASH
- atovaquone
- dapsone
CANNOT be used for PCP ppx if G6PD deficiency
dapsone
HIV+ with CD4 count
Mycobacterium avium-intracellulare (MAI)
ppx for Mycobacterium avium-intracellulare (MAI)
azithromycin Qweekly
PCP presentation
- SOB
- dry cough
- hypoxia
- elevated LDH
best INITIAL test for PCP
CXR
increased interstitial markings B/L
MOST ACCURATE test for PCP
BAL
treatment for PCP
TMP/SMX IV
treatment for PCP if TMP/SMX causes RASH
pentamidine IV
when do you give steroids in PCP?
pO2 35
headache, N/V, FND in immunocompromised patient
toxoplasmosis
best INITIAL test for toxoplasmosis
CT head WITH contrast
“ring” enhancing lesions
treatment for toxoplasmosis
pyrimethamine and sulfadiazine for 2 WEEKS
HIV with
cytomegalovirus (CMV) retinitis
treatment for CMV retinitis
- ganciclovir
- foscarnet
adverse effect of ganciclovir
low WBC’s
adverse effect of foscarnet
high creatinine
maintenance therapy for CMV retinitis
valganciclovir PO LIFELONG, unless CD4 count increases
best INITIAL test for cryptococcal meningitis
INDIA INK STAIN on CSF
MOST ACCURATE test for cryptococcal meningitis
cryptococcal antigen test
treatment for cryptococcal meningitis
- amphotericin and 5-FC (flucytosine)
- then LIFELONG fluconazole, unless CD4 count increases
- HIV and
progressive multifocal leukoencephalopathy (PML)
best INITIAL test for PML
head CT or MRI
MOST ACCURATE test for PML
PCR of CSF for JC virus
treatment for PML
- no specific treatment
- HAART
(will resolve when CD4 counts increases)
does NOT cover crytpococcus
caspofungin
- HIV with
Mycobacterium avium intracellulare (MAI)
diagnostic tests in order from least to most sensitive
LEAST sensitive= blood cultures
more sensitive= bone marrow biopsy
MOST sensitive= LIVER BIOPSY
treatment for Mycobacterium avium intracellulare (MAI)
clarithromycin AND ethambutol +/- rifabutin
animal exposure + jaundice + renal =
fever, abdominal pain, muscle aches
leptospirosis
treatment for leptospirosis
- ceftriaxone
- penicillin
- rabbits
- ulcer at site of contact
- enlarged lymph nodes
- conjunctivitis
tularemia
diagnose tularemia with
serology
treatment for tularemia
- gentamicin
- streptomycin
- thin-walled cysts, often calcified on CTH
- infected pork that’s ingested
cysticercosis
treatment for cysticercosis
albendazole
camping/hiking + target-shaped rash =
- transmitted by Ixodes tick
Lyme disease
long-term manifestations/complications of Lyme disease
- joints = LATE manifestation
- cardiac = AV conduction block/defect
- neurologic = 7th CN palsy (Bell’s palsy)
diagnosis of Lyme disease
serology
treatment for Lyme disease: rash, joint, Bell’s palsy
- doxycycline PO
- amoxicillin PO
- cefuroxime PO
treatment for Lyme disease: CNS, cardiac involvement
ceftriaxone IV
- also transmitted by Ixodes tick
- common in northeast
- HEMOLYTIC ANEMIA
babesiosis
diagnosis of babesiosis
- PBS
- PCR
treatment for babesiosis
- azithromycin
- atovaquone
- also transmitted by Ixodes tick
- NO RASH
- elevated LFT’s
- THROMBOCYTOPENIA
- LEUKOPENIA
ehrlichia/anaplasma
diagnosis of ehrlichia/anaplasma
- PBS
- PCR
treatment for ehrlichia/anaplasma
doxycycline
- traveler returning from endemic area
- HEMOLYSIS
- GI COMPLAINTS
malaria
diagnosis of malaria
blood smear
treatment for malaria: ACUTE disease
- mefloquine
- atovaquone/proguanil
- quinine/doxycycline (severe cases)
prophylaxis for malaria:
- mefloquine (weekly)
- atovaquone/proguanil (daily)
- immunocompromised patients
- respiratory disease, can spread anywhere, usually skin or brain
- branching, gram positive filaments, weakly acid-fast
Nocardia
best INITIAL test for Nocardia
CXR
MOST ACCURATE test for Nocardia
culture
treatment for Nocardia
TMP/SMX
- normal immune system
- h/o facial/dental trauma
- branching, gram positive filaments
Actinomyces
diagnosis and confirmation of Actinomyces
- gram stain
2. ANaerobic culture
treatment for Actinomyces
penicillin
- WET areas (river valleys)
- a/w bat droppings from caves
- palate and oral ulcers
- splenomegaly
- pancytopenia if there’s bone dissemination
Histoplasmosis
best INITIAL test for Histoplasma
Histoplasma urine antigen
MOST ACCURATE test for Histoplasma
BIOPSY with culture
treatment for acute pulmonary disease d/t Histoplasma
none needed
treatment for disseminated Histoplasmosis
amphotericin
- VERY DRY areas (Arizona)
- joint pain
- erythema nodosum
Coccidioidomycosis
treatment for Coccidioidomycosis
itraconazole
- acute respiratory disease
- rural southeast
- BROAD BUDDING YEAST
- bone lesions are common
Blastomycosis
treatment for Blastomycosis
- amphotericin
- itraconazole
MOA of echinocandins
1,3-glucan inhibition in fungi ONLY
treatment for chronic hepatitis C
- boceprevir
- simeprevir
- sofosbuvir
- ledipasvir
(none used as a single agent)
which antiviral agents for chronic hepatitis C not to be combined with interferon?
- sofosbuvir
- ledipasvir
Should pregnant woman recieve a live vaccine?
No, but household members can
Do you have to notify a school of a childs HIV status?
No
Tuberculosis skin Interferon gamma releases Smear microscopy Sputum culture Nucleic acid amplificatin
Tuberculosis skin Interferon gamma released Smear microscopy Sputum culture Nucleic acid amplificación
Sputum AFB is?
Cheap afb testing is specific so cannot rule out disease due ro low sensitivity and poor differentiation so can’t tell the difference between active and latent tb. If skin test is posiitve then do gold standard mycobacterium culture and naa testing( which is also very sensitive)
What does macular papular rash look like?
Check website and upload online
How long does it take for lyme disease to develop after being bit by a tick?
Lyme diease is transfered by ixodes tick after 36-38 hours. And wheele formation after engorged tick is a sign of infection. However, small bite with out engorged tick is not likely to result in lyme disease. So no intervention is needed
