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Post TAV II > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is a carrier

A

A person or animal that harbors the infectious agent/disease and can transmit it to others but does not demonstrate signs of the disease

i.e. - COVID-19 living dormant in the body

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2
Q

What is contact

A

Exposure to a source of an infection; a person who has been exposed. Contact does not imply infection, it implies possibility of infection

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3
Q

What is a host

A

An organism that harbors a parasitic, mutualistic, or commensalism guest. The host is the house and the parasite is the freeloader

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4
Q

What is zoonosis

A

A pathogen that is transmissible from non-human animals (typically vertebrates) to humans

i.e. swine flu, bird flu

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5
Q

What is arbovirus (arthropod-borne virus)

A

Any of a group of viruses that are transmitted between hosts by mosquitoes, ticks, and other arthropods

i.e. malaria, dengue, WNV, Lyme, RMSF

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6
Q

What is herd immunity

A

When a majority of a given group is resistant/immune to a pathogen, they achieve “herd immunity”. This confers protection to unvaccinated or susceptible individuals/group by reducing the likelihood of infection or spread

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7
Q

What is passive immunity

A

Transfer of active humoral immunity of ready-made antibodies produced by another host or synthesized. Passive immunization is used when there is a high risk of infection and insufficient time for the body to develop its own immune response. Short term!

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8
Q

What is a parasite

A

An organism that lives on or in a host organism and gets its food from or at the expense of its host

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9
Q

What are the main classes of human parasites

A

Protozoa
Helminths
Ectoparasites

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10
Q

What is the organism type of a protozoa

A

One-celled organisms that are free-living or harbors on a host

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11
Q

What harbor in human GI track that are transmitted via fecal-oral route through contaminated food or water, or person-to-person contact

A

Protozoa

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12
Q

Protozoa are classified further into groups based on mode of movement

A

Sarcodina - the ameba
Mastigophora - the flagellates (Giardia, Leishmania)
Ciliophora - the cilates
Sporozoa - non motile adult stage organisms (Cryptosporidium - the leading cause of waterborne disease in the US

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13
Q

What is a large multicellular organism visible to the naked eye in adult stage, that are free-living or harbors on a host

A

Helminths

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14
Q

What are the types of helminths that reside in the GI tract

A

Flatworms (platyhelminths) - blood flukes and tape worms
Thorny-headed worms (acanthocephalins)
Roundworms (nematodes) - also reside in blood, lymph system or subcutaneous tissues such as hookworms or pinworms

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15
Q

What are some examples of ectoparasites

A

Ticks, fleas, lice, and mites - burrow into the skin and remain there for weeks to months. This category of parasites also include other blood-sucking arthropods such as mosquitos

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16
Q

What is the treatment for parasitic infections

A

Treatment is based on the affected organ, symptoms, specific parasite, and other disease secondary from parasite

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17
Q

What type of organism is West Nile Virus (WNV)

A

Single-stranded RNA virus of the family Flaviviridae and the leading cause of domestically acquired arboviral disease in the US

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18
Q

How is WNV transmitted

A

Primarily via the Culex mosquito

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19
Q

What is the incubation period for WNV

A

2-6 days, but can range from 2-14 days

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20
Q

Is WNV reportable

A

Yes

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21
Q

What percentage of people are asymptomatic with WNV

A

70-80% of human WNV infections are subclinical or asymptomatic

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22
Q

What is the typical patient presentation of WNV

A

An acute systemic febrile illness may be accompanied by:
Headache, weakness, myalgia, or arthralgia
GI symptoms
TRANSIENT MACULOPAPULAR RASH

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23
Q

<1% of infected patients develop neuroinvasive what? Which typically manifests as meningitis, encephalitis, or acute flaccid paralysis

A

West Nile virus

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24
Q

What lab diagnosis is used to diagnose WNV

A

Diagnosis via identifying IgM in serum or CSF

ELISA is used to detect IgM antibody

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25
Q

What is the treatment for WNV

A

There is no specific reatment for WNV disease, and no antiviral treatment is available

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26
Q

MEDEVAC is warranted if there are signs of what

A

Encephalitis, meningitis, or paralysis

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27
Q

What has an organism type of protozoan parasites of the genus plasmodium

A

Malaria

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28
Q

What are all the subtypes of malaria

A

P. Falciparum
P. Vivax
P. Ovale
P. Malariae

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29
Q

How is malaria transmitted

A

Via the female anopheles mosquito

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30
Q

What is the incubation period for malaria

A

7 - 30 days, depending on the species of malaria infection

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31
Q

Is malaria reportable

A

Yes

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32
Q

Which type of malaria is lethal

A

P. Falciparum - yes (blood cycle phase)
P. Vivax, p. Ovale, p. Malariae - maybe (reside in the liver)

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33
Q

Uncomplicated malaria is characterized by:

A

Paroxysmal (cyclical) fever
Influenza-like symptoms including chills, headache, myalgias, malaise
Jaundice and mild anemia secondary hemolysis

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34
Q

Severe malaria is characterized by:

A

Small blood vessels infarction, capillary leakage and organ dysfunction
Altered consciousness
Hepatic failure and renal failure
Acute respiratory distress syndrome
Severe anemia

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35
Q

What is they typical patient presentation of malaria

A

Paroxysmal fevers are typical and considered a clinical hallmark of the infection

Cold stage - lasts approx. 1 hour
Febrile stage - lasts 2-6 hours
Diaphoretic stage where fever drops - lasts 2-4 hours
Patient then returns to normal
Cycle repeats itself in 48-72 hours depending on species of infection

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36
Q

What is the treatment for malaria

A

Treatment options are dependent on :
Species of malaria
Severity of infection
Likelihood of drug resistance
Patients age and pregnancy status

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37
Q

What are the reliable-supply treatment regimens available in the US

A

Atovaquone-proguanil (Malarone)

Artemether-lumefantrine (Coartem)

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38
Q

What is the treatment of uncomplicated malaria

A

Chloroquine phosphate 1g (600 mg base) PO
THEN 0.5g in 6 hours
THEN 0.5g daily for 2 days

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39
Q

What is the treatment of severe malaria

A

Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours

Followed by doxy 100mg BID x7 days after parental therapy

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40
Q

What is the treatment of p. Ovale malaria

A

Add primaquine 52.6mg PO QD x 14 days

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41
Q

What is the treatment of malaria in areas with chloroquine resistance

A

Malarone 4 tabs PO QD for 3 days

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42
Q

What has an organism type of single-stranded RNA viruses of the genus Flavivirus

A

Dengue fever

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43
Q

How is dengue fever transmitted

A

Aedes aegypti mosquito

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44
Q

What percentage of dengue fever infections present asymptomatically and the person doesn’t realize they were infected

A

75%

The remaining 25% of infections present with mild to moderate, nonspecific, acute febrile illness, characterized by fatigue and malaise

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45
Q

What are the phases of dengue fever

A

Febrile phase
Critical phase
Convalescent phase

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46
Q

How long does the febrile phase last and what symptoms are present

A

Typically lasts 2-7 days and can be biphasic

May include severe headache, retroorbital pain, muscle/joint/bone pain, and TRANSIENT MACULOPAPULAR RASH, petichiae, eccymosis, purpura, epistaxis, bleeding gums, hematuria, or a positive tourniquet test result

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47
Q

How long is the critical phase of dengue and what symptoms preset with it

A

Critical phase begins at defervescence and typically lasts 24-48 hours - most patients clinically improve during this phase and move on to recovery and convalescence phase

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48
Q

The tourniquet test is also called what

A

Capillary fragility test

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49
Q

What is a fairly effective test used to further justify a presumptive dengue diagnosis without the ability or access to confirmatory laboratory testing

A

Tourniquet test

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50
Q

What qualifies as a positive tourniquet test

A

10 or more petechiae per 1 square inch

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51
Q

What is the treatment for dengue fever

A

Ensure patients stay well hydrated and avoid aspirin, aspirin containing drugs, and NSAIDS because of their anticoagulant properties

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52
Q

What is the treatment for severe dengue fever

A

Typically requires ICU-level monitoring and blood products

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53
Q

What is the disposition of a patient with dengue fever

A

MEDEVAC - medadvice on further management while awaiting MEDEVAC

Patients presenting with signs/symptoms of even mild dengue should be evacuated to definitive medical care facility as soon as possible

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54
Q

What has organism type of gram-negative, intracellular, coccobacillus bacterium

A

Tick borne illness - Rocky Mountain spotted fever (RMSF)

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55
Q

How is RMSF transmitted

A

Via American dog tick - east of Rockies and Pacific cost
Rocky Mountain Wood Tick - Rocky Mountain region
Brown dog tick - worldwide

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56
Q

How long is the incubation period for RMSF

A

Typically 2-14 days

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57
Q

Is RMSF reportable

A

Yes

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58
Q

What is a rapidly progressive disease and without early administration of doxy can be fatal within days

A

RMSF

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59
Q

What symptoms are typically present with RMSF during the early illness phase

A

Early illness (days 1-4)

Fever, headache, GI symptoms, myalgias, edema around eye and back of hands and rash

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60
Q

During the early illness phase of RMSF, when does a rash present

A

Rash typically present 2-4 days after onset of fever

Begins as small, flat, pink macula’s on wrists, forearms and ankles that spread to trunk

Can also involve palms of hands and soles of feet

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61
Q

Severe RMSF may cause permanent complications from:

A

Neurological deficits
Damage to internal organs (respiratory compromise, renal failure)
Vascular damage requiring amputation

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62
Q

Patients without what in the initial stages of RMSF typically experience a full recovery

A

Vascular damage

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63
Q

A classic RMSF involves a rash that appears 2-4 days after the onset of fever as small, flat, pink macules located where and at what stage of the rash

A

Located on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms of the hands and soles of the feet

Early rash

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64
Q

What is present during the late rash stage of RMSF

A

A petechial rash that typically appears 5-6 days of the illness (this indicates severe disease and every attempt should be made to treat before petechiae develop)

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65
Q

What is the treatment of RMSF

A

Doxycycline = treatment of choice for all tick borne rickettsial diseases.

Doxy - 100 mg PO BID for 5-7 days

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66
Q

What is the typical disposition of a patient with RMSF

A

MEDEVAC patient to higher echelon of care - IDC should initiate treatment with doxycycline

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67
Q

What is the organism type Lyme disease

A

Bordelaise burgdorferi complex

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68
Q

How is Lyme disease transmitted

A

(Black legged) ticks

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69
Q

What is the incubation period for Lyme disease

A

Typically 3-30 days

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70
Q

Is Lyme disease reportable

A

Yes

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71
Q

Ticks attach to any part of the host but often prefer groin axils, and scalp; how long must the tick be attached

A

In most cases, the tick must be attached for 36 to 48 hours or more before b.burgdorferi can be transmitted to the host

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72
Q

What are the stages of Lyme disease

A

Early localized stage
Acute/early disseminated stage
Neurologic manifestation

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73
Q

What symptoms are present for early localized stage of Lyme disease

A

Flu-like symptoms - malaise, headache, fever, myalgia, arthralgia, lymphadenopathy

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74
Q

At what stage of Lyme disease does erythema migrans (EM) present

A

Early localized stage

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75
Q

What is early migrans (EM)

A

Red ring-like or homogenous expanding rash; classic rash, not present in all cases

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76
Q

When does EM appear during the early stage of Lyme disease

A

EM appears about 1 week after the initial infection

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77
Q

How does the EM rash start and progress in Lyme disease

A

Begins as a slightly raised red lesion at the site of the tick bite

After several days, the rash expands out from the central lesion sometimes appearing as a “bulls-eye/target” lesion but more often as a muddled circular rash

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78
Q

What are the constitutional symptoms of the acute/early disseminated stage of Lyme disease

A

Multiple secondary annular rashes
Flu-like symptoms
Lymphadenopathy

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79
Q

What are the cardiac manifestations of the acute/early disseminated stage of Lyme disease

A

Conduction abnormalities
Myocarditis, pericarditis

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80
Q

What are the neurologic manifestations of the acute/early disseminated stage of Lyme disease

A

Bell’s palsy or other cranial neuropathy
Meningitis
Encephalitis

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81
Q

What symptoms present with late disseminated stage of Lyme disease

A

Same symptoms as acute disseminated stage with:

Rheumatologist manifestations - transient, migratory arthritis and effusion in one or multiple joints, migratory pain in tendons, bursae, muscle and bones

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82
Q

Serologic tests should NOT be performed for what in regards to Lyme disease

A

Asx patient in endemic areas
Asx patient after a tick bite
Patient with non-specific symptoms (subacute myalgias, arthralgias, or fatigue)

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83
Q

What serologic testing should be performed on acute/early disseminated Lyme disease

A

2 ELIZA test

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84
Q

What serologic testing should be done on late disseminated Lyme disease

A

Either 2 ELIZA tests or
1 ELIZA test followed by 1 Western blot

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85
Q

In persons with illness duration of Lyme disease of more than 1 month, what can detect the disease

A

IgG or combined IgG/IgM

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86
Q

What is the treatment for early Lyme disease (erythema migrans) and early disseminated (Bell’s palsy)

A

Doxycycline 100mg PO BID x 14 days

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87
Q

What is the treatment for late disseminated (arthritis) Lyme disease

A

Doxycycline 100mg PO BID x 28 days

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88
Q

What is the medication post-exposure prophylaxis

A

Doxycycline 200mg PO 1 dose - prophylaxis can be started within 72 hours of tick removal

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89
Q

What are some of the precautions that can be taken fr those with Lyme disease exposure

A

Wear protective clothing
Check skin for attached ticks and remove <24 hours - tick checks should be done every 12 hours
Bug sprays and creams containing DEET

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90
Q

What is the disposition of Lyme disease

A

Clinical suspicion of Lyme disease will necessitate MEDADVICE and treatment at the IDC level - abx treatment

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91
Q

What is the organism type of leishmaniasis

A

Obligate intracellular protozoan parasites

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92
Q

What are the subtypes of leishmaniasis

A

Old world (eastern hemisphere)
New world (Western Hemisphere)

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93
Q

What is the vector for leishmaniasis

A

Sand fly or sand flea (depending on where you’re from)

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94
Q

What is the incubation period for leishmaniasis

A

2 weeks to several months and in cases up to 3 years; some >20 years

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95
Q

Is leishmaniasis reportable

A

Yes

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96
Q

The most common manifestation of cutaneous leishmaniasis is characterized as what

A

Gradual-onset cutaneous lesions

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97
Q

How do infections of cutaneous leishmaniasis differ from normal sand fly bites

A

Begin as a pink colored papule that enlarges to a nodule or plaque-like lesion
Lesion ulcerates with infuriated border and may have thick white-yellow fibrous material
Lesions are often PAINLESS

(Lesions gradually heal over months to years with noticeable scarring at site)

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98
Q

What is the IDC treatment/first-line for cutaneous leishmaniasis

A

Ulcer should be derided and kept clean to avoid secondary infections from developing

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99
Q

What is the FDA approved treatment for cutaneous leishmaniasis

A

Oral miltefosine for treatment of CL, MCL, and VL caused by certain Leishmania species

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100
Q

What is the most commonly used drug to treat leishmaniasis in most areas

A

Pentavalent antimonials

Orally administered “azoles” (ketoconazole, itraconazole, and fluconazole) and topical formulations of paromomycin for CL

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101
Q

What is the organism type for methicillin-resistant staphylococcus aureus (MRSA)

A

gram-positive genetically distinct strain of staphylococcus aureus

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102
Q

What is the incubation period for MRSA

A

Variable; typically 4-10 days

103
Q

What is the definition of MRSA

A

Any strain of S.aureus that has developed multiple drug resistance(s) to beta-lactation antibiotics

104
Q

True or false: areas of fluctuance and purulent drainage are commonly present with MRSA

A

True

105
Q

What is the mainstay of therapy for any fluctuant lesion secondary to MRSA

A

Incision and drainage

106
Q

What antibiotics and dosages may be used to treat a MRSA infection

A

TMP-SMX (160mg/800mg) PO BID x 5-10 days
Clindamycin 300-600mg PO BID x 5-10 days
Doxycycline 100mg PO BID x 10 days

107
Q

What is the disposition of a MRSA patient

A

Unless complications develop, most cases of MRSA should be retained onboard and treated by the IDC

Patients with recurring infections should be referred to a MO

108
Q

How should “fight-bite” injuries be examined

A

Must be inspected with fist closed

109
Q

What is the patho-anatomy of a fight-bite

A

Teeth lacerate overlying skin and penetrate capsule of MCP joint during kinetic impact
Mouth flora (bacteria) enter joint
Bacteria are trapped under extensor tendon and/or joint capsule as fist is released from clenched position

110
Q

What immunizations should be assessed after a fight-bite injury

A

TDAP
HBV
HIV

111
Q

Why should human bite wounds not be closed

A

Due to the high risk for the development of infection

112
Q

What kind of human bites do not require prophylaxis

A

Human bites that do not break the skin or are very superficial

113
Q

What antibiotics should be avoided when treating a patient for MRSA

A

ABx without activity against Eikenella Corrodens should be avoided - meaning you cannot use:
Cephalexin (keflex)
PRPs (dicloxacillin)
Macrolides (erythromycin and azithromycin)

114
Q

What is an early antibiotic prophylaxis that can be used for MRSA

A

Amoxicillin/clavulanate 875/125mg PO BID x 5 days is preferred

115
Q

If concerned for osteomyelitis, what labs can be drawn

A

CBC
ESR
CRP

116
Q

When is MEDADVICE warranted for human bite/MRSA patients

A

Clenched-fist wounds
Complex facial lacerations
Deep wounds, especially if significant avulsion or amputation present (likely MEDEVAC)
Wounds associated with neurovascular compromise (likely MEDEVAC)

117
Q

What are some risk factors for OM

A

Bacteremia
Endocarditis
IV drug use
Trauma
Open fractures

118
Q

What are some common local sx of OM

A

Acute OM typically presents with gradual onset of sx over several days
Patients present with dull pain at the involved site, with or without movement
Local findings (tenderness, warmth, erythema, and swelling)
Systemic symptoms (fever, rotors)

119
Q

What are the pillars of treatment for OM

A

Surgical containment and prolonged antibiotic therapy

120
Q

What is the process of surgical containment treatment for OM

A

Surgical debridement of all diseased bone is often required due to poor antibiotic penetration

121
Q

What empiric ABx therapy is used for OM

A

IV Vancomycin and IV Ceftriaxone

122
Q

What is the organism type for tetanus

A

Spore-forming, ANAEROBIC, gram-positive bacterium

123
Q

What is the incubation period for tetanus

A

3-21 days, usually about 8 days - the further the inoculation site is from CNS, the longer the incubation period

124
Q

What is an acute, often fatal, exotoxin-mediated disease produced by gram positive, spore-forming anaerobic rod, HINT: clostridium tetani

A

Tetanus

125
Q

What are the commonly present presentations of tetanus in a descending pattern

A

The first sign is trismus or lockjaw, followed by unchallenged rigidity, dysphasia, and rigidity of abdominal muscles - muscle spasms may occur frequently (q10-15min) and other sx such as hyperthermia, diaphoresis, hypertension and episodic tachycardia

126
Q

Do you prescribe antibiotics for PROPHYLAXIS against tetanus

A

No; they literally do not provide any benefit

127
Q

If tetanus is actually suspected in a patient, what antibiotics are administered

A

Metronidazole 500mg IV Q6-8hours for 7-10 days
Pen G 2-4mil units IV Q4-6hours (alternate)

128
Q

What is meningitis

A

Defined as inflammation of the meninges

129
Q

What is encephalitis

A

Inflammation of the brain itself

130
Q

What are the bacterial etiologies of meningitis/encephalitis

A

Streptococcus pneumonia, group B streptococcus, N. Meningitidis, H. Influenza, HSV, VZV, EBV, arboviruses

131
Q

What are some risk factors for meningitis

A

Close contact exposure
Incomplete vaccinations
Immunosuppression
> 65 y/o and <5 y/o
Alcohol use disorder

132
Q

Meningitis typically occurs through what routes of inoculation

A

Hematogenous seeding - the bacteria cross the blood-brain barrier
Direct contiguous spread - organisms enter CSF via neighboring anatomic structures or foreign objects

133
Q

What is the classic meningeal tetrad

A

Fever
Nuchal rigidity
Altered mental status
Severe headache

The presence of all four signs is not necessary for clinical diagnosis; many patients may only have 2-3 out of the four signs

134
Q

What imaging can confirm meningitis

A

CT is the preferred imaging modality

Ideally, CT should be done prior to lumbar puncture and CSF collection

135
Q

What is the antibiotic treatment for meningitis

A

Ceftriaxone 2g IV Q12H x 7days
Pen-G 4 million units IV Q4H x 7days

136
Q

What is the chemoprophylaxis regimen for meningitis

A

Ceftriaxone 250 mg IM one time OR
Ciprofloxacin 500 mg PO one time

137
Q

What is the scientific name of infectious mononucleosis

A

Epstein-Barr virus

138
Q

What is the incubation period for infectious mono

A

Typically 4-6 weeks

139
Q

Is infectious mono reportable

A

No

140
Q

What is the initial presentation of infectious mono

A

Presents consistent with erythematous or exudative pharyngitis or tonsillitis

141
Q

What are some symptoms that present with infectious mono

A

Malaise
Fever
Cervical lymphadenopathy (typically posterior)
Splenomegaly (typically post-infection)

142
Q

What type of rash presents with infectious mono

A

Generalized maculopapular rash may occur in patients treated with cillin-class antibiotics for strep pharyngitis

143
Q

What labs may present abnormal with infectious mono

A

CBC: leukocytosis with lymphocytosis is most often seen
May present with anemia, thrombocytopenia
LFT: potentially elevated aminotransferases

144
Q

What is the treatment for infectious mono

A

Treated symptomatically:
Bed rest, Tylenol or NSAIDs
Saline gargles 3-4 times a day
AVOID THE USE OF ANTIVIRALS

145
Q

What is the typical disposition for a patient with infectious mono

A

Patients should be placed SIQ until acute symptoms subside - fever resolves within 10 days, but lymphadenopathy and splenomegaly may persist upwards of 3-4 weeks

Isolation is not necessary

MEDEVAC may be advised in severe cases where airway issues, or other complications arise

146
Q

What is the scientific name of rabies

A

Lyssavirus

147
Q

What is the incubation period for rabies

A

1-3 months, length of incubation period dependent on site of inoculation

148
Q

Is rabies reportable

A

Yes

149
Q

Clinical rabies typically manifests as what forms

A

Encephalitic “furious” - fever, hydrophobia, pharyngeal spasms, hypersalivation, diaphoretic, dilated pupils
Paralytic “dumb” - ascending paralysis that is similar to Guillain-Barre, loss of DTR and plantar reflex

150
Q

What is hydrophobia

A

Most characteristic feature of rabies; patient becomes afraid of water due to involuntary pharyngeal muscle spasms when they attempt to drink

151
Q

What is aerophobia

A

Pathognomonic pharyngeal muscle spasms triggered by feeling draft of air - leads to aspiration, coughing, choking, and if severe, asphyxiation and respiratory arrest

152
Q

Can rabies be managed by the IDC

A

No; a rabies case is far beyond the scope of an IDC, and requires immediate referral - patient should be referred to a higher echelon of care

153
Q

What is diarrhea

A

3 or more loose or watery stools within a 24-hour period

154
Q

What are the timeframes to diarrhea

A

Acute diarrhea - < 14 days
Persistent diarrhea - more than 14 days
Chronic diarrhea - > 30 days

155
Q

What diarrhea presents with blood in loose-watery stools and has a fever

A

Inflammatory diarrhea

156
Q

What are watery stools with NO blood and a scene of fever

A

Non-inflammatory Diarrhea

157
Q

Community outbreaks of diarrhea are highly suggestive of what

A

A common food source or viral etiology

158
Q

How is mild travelers diarrhea defined

A

Diarrhea that is tolerable, is not distressing, and does not interfere with planned activities

159
Q

How is moderate travelers diarrhea defined

A

Diarrhea that is distressing or interferes with planned activity

160
Q

How is severe travelers diarrhea defined

A

Diarrhea that is incapacitating or completely prevents planned activities; all dysentery is considered severe

161
Q

What are the viral etiologies of diarrhea

A

Norovirus
Rotavirus (primarily in children)

162
Q

What are the bacterial etiologies of diarrhea

A

ETEC
Campylobacter jejuni
Shigella
Salmonella
Bacterial toxin-releasing

163
Q

What are the protozoan etiologies of diarrhea

A

Giardia
Entamobea histolytica

164
Q

What symptoms are present with norovirus diarrhea

A

Acute onset of abdominal cramps, nausea, vomiting, and non-bloody diarrhea

Illness is generally self-limited and full recovery can be expected in 1-3 days for most patients

165
Q

What is the treatment for E. Coli (travelers diarrhea)

A

Treatment can prolong bacterial shedding

Tx consideration consists of oral rehydration therapy, anti motility agents and antiemetics, depending on illness severity level

166
Q

What is salmonella enterica

A

A gram-negative, rod-shaped bacillus

167
Q

What is campylobacter jejuni

A

A gram-negative, spiral-shaped microaerophilic bacteria; normally carried in intestinal tracts of domestic and wild animals

168
Q

What are the symptoms of campylobacter jejuni diarrhea

A

Characterized by diarrhea (frequently bloody), abdominal pain, fever, and occasionally nausea and vomiting

169
Q

What is the treatment for campylobacter jejuni diarrhea

A

Generally self-limiting and lasting < 1 week; ABx therapy decreases duration of symptoms and bacterial shedding if administered early in the course of the disease

170
Q

What antibiotic therapy can be used for campylobacter jejuni diarrhea

A

Severe disease with bloody stools, high fever, worsening or relapsing symptoms or sx lasting longer than 1 week - suggest Z-pac 500mg PO daily x 3days

171
Q

What is the organism type for Giardia

A

Protozoan parasite

172
Q

What is the incubation period for Giardia

A

1-14 days; mean incubation time is 7 days

173
Q

Is Giardia reportable

A

Yes

174
Q

What is the presentation for asymptomatic giardiasis

A

Many infected people are asymptomatic, but shed cysts in their feces and serve as a carrier of the protozoan parasite

175
Q

What is the patient presentation of acute giardiasis

A

Symptoms typically develop 1-2 weeks after exposure and generally resolve within 2-4 weeks with diarrhea characterized as foul-smelling and greasy

Gradual onset of 2-5 loose stools per day and gradually increasing fatigue

176
Q

What is the treatment for giardiasis

A

Primary treatment consists of drug regimen with activity against bacteria and protozoa - tinidazole 2pm PO single dose (non-AMAL)/ Metronidazole (Flagyl) 250 mg PO TID x 5-7 days (AMAL)

Avoid going into water until asymptomatic for 48 hours

177
Q

What is the timeline of symptoms and food history for infectious diarrhea

A

Within 6 hours of food consumption - suggest possible toxin from S. Aureus or B.cereus
Between 8 - 16 hours - suggests C.perfringens
More than 16 hours suggest viral or other bacterial etiology

178
Q

What are some physical findings of infectious diarrhea

A

+/- fever, possible mild tachycardia and hypotension secondary to dehydration, increased hyperactive Bowel Sounds in all quadrants

179
Q

What is the prophylactic antibiotics of treatment for infectious diarrhea

A

Not recommended for viral or unknown diarrhea suspicion

180
Q

When are antibiotics considered for infectious diarrhea - severe disease

A

Fever plus, >10 stools/day with signs/symptoms of dehydration, significant or complete loss of operational effectiveness

181
Q

When is MEDADVICE or MEDEVAC considered for infectious diarrhea

A

Fever >101.3 F
Episodes of bloody diarrhea with positive hemoccult
Severe dehydration (inability to hydrate the patient)
Multiple patients presenting at once with similar symptoms
Inability to control nausea and vomiting with antiemetics and Pepto

182
Q

What is the incubation period for influenza

A

24-96 hours

183
Q

Is influenza reportable

A

Yes

184
Q

True or false: influenza is NOT highly contagious and is readily shed by infected people

A

False

185
Q

What are the distinct glycoproteins of influenza

A

Hemagglutinin - 18 subtypes
Neuraminidase - 11 subtypes

186
Q

What are some constitutional symptoms of Influenza

A

Fever/chills (100.8 F), myalgias, headache, malaise, occasional nausea, sometimes vomiting

187
Q

What are some influenza specific symptoms

A

Nonproductive cough, sore throat, rhinitis, substernal soreness, nasal congestion

188
Q

What do rapid influenza test distinguish

A

Distinguish between A and B but not subtypes

189
Q

What is the treatment for influenza

A

Influenza typically resolves within 1-7 days

Treatment goal is to alleviate and control symptoms while preventing spread to other personnel

190
Q

What are the steps to treating an influenza patient with antivirals and what antiviral is given

A

Administer as soon was possible to patient at high risk of complications even if >48 hours has elapsed; can be considered for any previously healthy adult with confirmed or suspected influenza within 48 hours of sx onset

Oseltamivir 75mg PO BID x 5 days

191
Q

How is hepatitis A virus transmitted

A

Through consumption of contaminated water or food, and fecal-oral route to include certain sex practices - incubation period average is 28 days

192
Q

How is hepatitis B virus transmitted

A

Through exposure to infective blood, semen, body fluids, contaminated blood products, and IV drug use - incubation period average of 90 days

193
Q

How is hepatitis C transmitted

A

Through exposure to infected blood, HCV contaminated blood and blood products, and IV drug use - sexual transmission is possible but less common

194
Q

Which hepatitis infection occurs only with HBV infection

A

Hepatitis D (HDV)

195
Q

How is hepatitis E transmitted

A

Through consumption of contaminated water or food

196
Q

What is hepatitis

A

Inflammation of the liver from infection, toxins, autoimmune diseases, metabolic disorders

197
Q

What is the initial presentation of hepatitis

A

Initially presents with non-specific flu like symptoms of fatigue, fever, muscle/joint pains, runny nose, pharyngitis, abdominal pain, nausea, vomiting, anorexia

198
Q

What symptoms develop with hepatitis within 1-3 weeks

A

Jaundice, RUQ pain

Secondary to the virus infecting and killing hepatocytes
Hepatocyte death releases liver enzymes in the blood
Hepatic dysfunction leads to increased bilirubin and jaundice

199
Q

What are the physical findings of hepatitis

A

Low-grade fever
Hepatomegaly with liver tenderness
Jaundice and sclera icterus
RUQ abdominal pain
Dark or brown colored urine
Gray/clay colored stool

200
Q

What labs may present abnormal with hepatitis

A

LFT: increased levels of AST/ALT

Viral hepatitis = ALT>AST
Alcoholic hepatitis = AST>ALT

201
Q

What is the organism type of TB

A

Rod-shaped, nonmotile, slow-growing, acid-fast bacterium

202
Q

What is the scientific name for TB

A

Mycobacterium tuberculosis

203
Q

What is the incubation period for TB

A

3-12 weeks. Transition from latent to active can occur from 10-60 years

204
Q

Is TB reportable

A

Yes

205
Q

What is the leading infectious cause of death worldwide

A

Tuberculosis

206
Q

Primary infection of TB is characterized by GHON complex and GHON focus; explain

A

GHON focus - local granulomatous inflammation in periphery of the lung
GHON complex - may be accompanied by ipsilateral lymph node involvement

207
Q

What is Bacille Calmette-Guerin

A

It is a vaccine against TB and is primarily used in developing nations or third-world countries

208
Q

LTBI is defined as a positive result on what

A

TST
PPD
QuantiFERON Gold blood test
IGRA-TB blood test

209
Q

What are the typical lab and rad findings of an LTBI patient

A

Positive TST/PPD or blood test
Normal CXR
Negative acid-fast bacilli
Has Mtb bacteria in their body that are alive, but inactive
Remains asymptomatic
Is non-infectious

210
Q

What is the NAVMED 6224/7

A

Initial TB exposure risk assessment

211
Q

The evaluation of positive tests for TB must include what

A

NAVMED 6224/7
Chest radiograph
Sputum examination
Baseline LFTs are not routinely indicated for patients beginning treatment for LTBI but is suggested for those with an elevated risk for a liver disorder

212
Q

What is the treatment for LTBI

A

3HP - isoniazid and rifapentine PO once a week x12 weeks
4R - rifampin 1 PO QD x16 weeks (4 months)
3HR - isoniazid and rifampin 1 PO daily x12 weeks (3 months)

213
Q

What clinical monitoring must be done for a patient with LTBI

A

Monthly follow-up required until completion of treatment and document evaluations on NAVMED 6224/9

214
Q

With typical pulmonary - TB symptoms include what

A

Prolonged and productive cough with or without hemoptysis, chest discomfort and pain, low-grade fever, decreased appetite and anorexia, unexplained weight loss and night sweats

215
Q

Who is post-primary re-activation TB most common in

A

Adults (60-80%) and can occur years to decades after primary infection

216
Q

What is the specific name for cutaneous anthrax

A

Bacillus anthracis

217
Q

Who is cutaneous anthrax more common in

A

Ranchers, leather workers, veterinarians, wildlife researchers

218
Q

What is the incubation for cutaneous anthrax

A

1-7 days, upwards of 12 days in rare cases

219
Q

What is a disease primarily affecting ruminant herbivores such as cattle, sheep, goats, antelope and deer that become infected by ingesting contaminated vegetation, water or soil

A

Zoonotic

220
Q

What are the main clinical presentations of anthrax

A

Cutaneous, ingestion, injection and inhalation

221
Q

What is the hallmark of cutaneous anthrax

A

Eschar with extensive surrounding edema

222
Q

What is the presentation of cutaneous anthrax

A

Small, painless, Pruitt if papule emerge anywhere from 1-12 days after exposure
Papule s enlarge rapidly to vesicles or bulla
Vesicle or bulla start to erode and leave painless black necrotic ulcer

223
Q

How is cutaneous anthrax diagnosed

A

vesicular fluid and ulcers should be swabbed for gram stain and culture and PCR
Eschar edges should be lifted and swabbed

224
Q

Who do patients with cutaneous anthrax get referred to

A

Infectious disease specialist

225
Q

What antibiotics protect against anthrax

A

Cipro - 500mg PO BID x7-10 days
Levoflaxacin - 750mg PO QD x7-10 days
Doxy - 100mg PO BID x7-10 days

226
Q

What is the disposition of a patient with suspected anthrax

A

Immediate referral and MEDEVAC

If untreated, may result in sepsis or meningitis

227
Q

What is the scientific name of chlamydia

A

Chlamydia trachomatis

228
Q

What is the most frequently reported BACTERIAL STI

A

Chlaymdia

229
Q

How is chlamydia transmitted

A

Direct sexual contact or mother to child during birth

230
Q

What is known as the “silent” infection because most infected people are asymptomatic and lack abnormal physical examination findings

A

Chlamydia

231
Q

What patient presentation will be present with a female with chlamydia

A

Urethritis - dysuria, pyuria, increased urinary frequency
Cervicitis (MOST frequent clinical manifestation) - increased vaginal discharge, intermenstrual vaginal bleeding, dyspareunia

232
Q

What are the presentations of chlamydia in a male patient

A

Urethritis (MOST frequent clinical manifestation) - mucoid or clear watery discharge, dysuria, scant discharge
Epididymitis - unilateral testicular pain
Prostatitis - pelvic pain, pain with ejaculation, dysuria
Proctatitis - anorectal pain, discharge, rectal bleeding

233
Q

What is the gold standard for laboratory diagnosis of chlamydia

A

Nuclei acid amplification testing (NAAT)

234
Q

What is the preferred and alternate treatment of chlamydia

A

Preferred: doxy - 100mg PO BID for 7 days
Alternative: azithromycin - 1g single dose

Can treat with ceftriaxone if concerned for coinfection

235
Q

When should patients with chlamydia that have been treated be retested

A

3 months after treatment

236
Q

What is the scientific name of gonorrhea

A

Neisseria gonorrhoeae

237
Q

What is the incubation period for gonorrhea

A

1-14 days, however, can be as short as 2-4 days

238
Q

Most males are SYMPTOMATIC with gonorrhea and present with what symptoms

A

Uretheral symptoms - dysuria, white/yellow/green uretheral discharge
Testicular symptoms
Rectal infection
Sore throat but typically asymptomatic

239
Q

Most women with gonorrhea are typically ASYMPTOMATIC but may present with what symptoms

A

Uretheral - dysuria, increased vaginal discharge, vaginal bleeding between periods
Lower abdominal discomfort
Dyspareunia

240
Q

How is gonorrhea diagnosed

A

GC/NAAT

241
Q

What is the CDC recommended treatment regimen

A

Ceftriaxone - 500mg IM in a single dose AND doxy 100mg PO BID x7 days
Or
Azithromycin - 1g orally in a single dose

242
Q

What is the scientific name for syphilis

A

Treponema bacterium

243
Q

What is historically called “the great pretender” as its symptoms can look like many other diseases

A

Syphilis

244
Q

What are the distinct phases of infection for syphilis

A

Early stage: primary and secondary
Latent stage: tertiary

245
Q

At what stage of syphilis does it begin as a painless papule that proceeds to ulcerate into a 1-2cm painless ulcer with raised margins (called a chancre)

A

Primary syphilis

246
Q

What are some other primary syphilis patient presentation

A

Lymphadenopathy is typically appreciated in the inguinal lymph nodes
Chancre lasts 3 to 6 weeks
However it is often not reported because it is painless

247
Q

Which phase of syphilis presents with skin rashes and/or mucous membrane lesions and has additional symptoms of fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue

A

Secondary syphilis

248
Q

Which phase of syphilis is a period of no visible signs and symptoms

A

Latent stage

249
Q

Which phase of syphilis is rare and develops in a subset of untreated syphilis infections that appear 10-30 years after infection and can be fatal

A

Tertiary syphilis

250
Q

Tertiary syphilis can develop and vary depending on the organ system such as what

A

Cardiovascular syphilis - aortitis
Neurosyphilis
Gummatous syphilis - very uncommon

251
Q

What is a more complex and expensive test to perform therefore usually used to confirm syphilis

A

Treponemal test (FTA-ABS)

252
Q

What is the standard treatment for all stages of syphilis

A

Parental penicillin G

253
Q

What is Jarisch-Herxheimer reaction

A

An acute febrile reaction that can occur within 24 hours after initiation of therapy for syphilis and typically resolves in 12-24 hours
NSAIDs or antipyretics can help reduce symptom severity

Post TAV II (7 decks)

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