Infectious Disease Flashcards
What are the stages of HIV
Acute infection - acute seroconversion syndrome
–Influenza-like illness or mono-like illness 2-4 weeks after exposure others have no significant sxs.
–Usually include fever, night sweats, large tender lymph nodes, throat inflammation, a rash, headache, tiredness and/or sores in the mouth and genitals
—Very high viral load - most infectious
Clinical latency - could be years
AIDS
CBC in Mono
Granulocytopenia lasting 1 week
Lymphocytic leukocytosis: >50% lymphocytes
–>10% atypical lymphocytes
Anemia
Thrombocytopenia
Also transaminitis and hyperbilirubinemia
Medication choice in immunocompromised patient with CMV
Valgancyclovir
Of note, CMV in a patient with HIV is an AIDS defining diagnosis
How is Mumps transmitted
Droplets of respiratory secretions
Incubation 12-25 days
Manifestation of Mumps
Parotid swelling and tenderness is the most classic exam finding
High fever, myalgias/arthralgias and fatigue
Orchitis is the most common extrasalivary manifestation
Labs show leukopenia and elevated amylase
Treatment is supportive
West Nile Virus - manifestations, diagnosis and treatment
In most cases, it is a febrile syndrome that causes flu like sxs
In rare cases, can cause West Nile neuroinvasive disease, which is when the virus infects the CNS resulting in meningitis, encephalitis or poliomyelitis-like sxs
In CSF - lymphocytic pleocytosis - viral meningitis
CSF or serum IgM can be tested
Treatment is always supportive but some evidence to support IVIG
Clinical manifestations of hemorrhagic diseases:
Ebola, Dengue Fever, Hantavirus, Yellow Fever
Ebola - Starts as nonspecific febrile illness that then progresses to GI sxs, then neurologic sxs then hypovolemic shock
—Treatment is IV/oral fluid repletion
Dengue Fever - mosquito borne virus endemic to tropical areas
–high fever, severe myalgias/arthralgias, headaches
–Can result in pulmonary edema and hemorrhagic sxs
–Treatment is supportive
Hantavirus - caused by the inhalation of aerosols of infected rodent feces
–Hantavirus pulmonary syndrome - non-specific flu like sxs then pulmonary edema
–Hantavirus fever with renal syndrome - fever, then oliguric renal failure followed by diuretic phase
–Treatment is supportive
Yellow Fever - spread by mosquitos
–Mild - headache, fatigue, GI sxs, conjunctival injection - resolves in a few days
–Severe - follows mild course then appears to resolve and then a day later, fever with bradycardia, hypotension, jaundice, hemorrhage and delirium
—Treatment is supportive
Treatment of Rickettsial infections
Doxycycline
Malaria: Causes, manifestations, treatment
Mosquito borne illness
Hemolytic anemia and fevers often present
Reports headache, fatigue, chills, fevers although sxs are cyclical and complete resolution of sxs if common between cycles
Diagnosis made by parasite smear
Treatment is antimalarial drugs: Artemisinin-based combination therapy (ACTs) - Coartem
Bebesiosis
Carried by ticks - can also be spread by blood transfusion
Endemic to New England, especially Cape Cod
Sxs include myalgias/arthralgias, fever, fatigue, headache
Diagnosed by parasite peripheral blood smear
Treatment: Atovaquone plus azithromycin
Quinine plus clindamycin
Treatment of giardiasis
Tinidazole 2gm PO once
or
Flagyl 500mg PO BID x7 days
Lab findings with helmithic infections and treatment
Profound eosiniphilia - “Worms, Wheezes and Weird Diseases”
-Stool sample with be positive on ova and parasite test
Treatment is often praziquantel
Clinical features of Aspergillosis
Most common clinical finding is a severe necrotizing pneumonia which can itself cause disseminated fungemia
Often seen in patients that have been on ventilator for too long.
CXR will show a cavitary lesion with a mass in it “Aspergilloma”
Labs will show eosinophilia
Treatment is voriconazole 6mg/kg IV BID on day 1 then 4mg/kg IV BID thereafter
Treatment of pneumococcal PNA
Community acquired caused by the growth of Streptoccocus pneumoniae within the alveoli
Treatment is usually Penicillins - Amoxicillin 750mg PO BID x7-10 days (or Augmentin)
Or Cefpodoxime 200mg PO BID x7-10 days
However if hospitalized, CAP usually treated with “Respiratory quinolones” such as moxifloxacin or levofloxacin
-Could consider combo therapy: Ceftriaxone and azithromycin
If HAP - Get cultures and start with Vanc and Cefapime
Clinical findings of necrotizing fasciitis
Severe pain out of proportion to the exam of the infected skin or skin structure
Caused by Clostridial perfringens - common in soil
Edema, hemorrhagic bullae, purpura and gas are noted in the skin also terrible smell
Moves very fast
Treatment is always surgery
Treatment course if you suspect meningococcal meningitis
Obtain blood cultures immediately and start ceftriaxone 2gm IV every 12 hours - could also give Vanc
Ok to start antibx before obtaining the LP
Patient must be placed on airbourne precautions
Any patient that came in contact with the patient should receive a single dose of Ciprofloxacin 500mg PO
What is the definition of AIDS
When CD4 count is <200 or if the pt develops an AIDS defining opportunist infection
What are the tests available for HIV
HIV 1/2 antigen/antibody combination immunoassay
If that is positive proceed to,
HIV 1/2 antibody differentiation immunoassay
No longer use Western Blot or ELISA
What is a prophylactic medication that patients with HIV can take to prevent pneumocystis jirovecii?
Bactrim
Who should get PrEP (Pre-exposure Prophylaxis)
People who are HIV negative that have:
-Had vaginal or anal sex within the last 6 months and have:
—A sexual partner with HIV
—Not consistently used a condom
—Been diagnosed with an STD in the last 6 months
-Use IVDU
—Have shared needles with someone with HIV
-Considered for people who have been prescribed PEP for nonoccupational reasons
What are examples of two PrEP?
Truvada:
Recommended to prevent HIV to all people through sex or IVDU
Descovy
Recommended to prevent HIV spread through sex excluding vaginal recipient
