Infectious Disease Flashcards

1
Q

What are the stages of HIV

A

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

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2
Q

CBC in Mono

A

Granulocytopenia lasting 1 week
Lymphocytic leukocytosis: >50% lymphocytes
–>10% atypical lymphocytes
Anemia
Thrombocytopenia

Also transaminitis and hyperbilirubinemia

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3
Q

Medication choice in immunocompromised patient with CMV

A

Valgancyclovir

Of note, CMV in a patient with HIV is an AIDS defining diagnosis

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4
Q

How is Mumps transmitted

A

Droplets of respiratory secretions

Incubation 12-25 days

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5
Q

Manifestation of Mumps

A

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

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6
Q

West Nile Virus - manifestations, diagnosis and treatment

A

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

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7
Q

Clinical manifestations of hemorrhagic diseases:
Ebola, Dengue Fever, Hantavirus, Yellow Fever

A

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

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8
Q

Treatment of Rickettsial infections

A

Doxycycline

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9
Q

Malaria: Causes, manifestations, treatment

A

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

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10
Q

Bebesiosis

A

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

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11
Q

Treatment of giardiasis

A

Tinidazole 2gm PO once
or
Flagyl 500mg PO BID x7 days

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12
Q

Lab findings with helmithic infections and treatment

A

Profound eosiniphilia - “Worms, Wheezes and Weird Diseases”

-Stool sample with be positive on ova and parasite test

Treatment is often praziquantel

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13
Q

Clinical features of Aspergillosis

A

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

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14
Q

Treatment of pneumococcal PNA

A

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

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15
Q

Clinical findings of necrotizing fasciitis

A

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

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16
Q

Treatment course if you suspect meningococcal meningitis

A

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

17
Q

What is the definition of AIDS

A

When CD4 count is <200 or if the pt develops an AIDS defining opportunist infection

18
Q

What are the tests available for HIV

A

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

19
Q

What is a prophylactic medication that patients with HIV can take to prevent pneumocystis jirovecii?

A

Bactrim

20
Q

Who should get PrEP (Pre-exposure Prophylaxis)

A

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

21
Q

What are examples of two PrEP?

A

Truvada:
Recommended to prevent HIV to all people through sex or IVDU

Descovy
Recommended to prevent HIV spread through sex excluding vaginal recipient