Infectious Disease Flashcards
botulism is a gram _ bacteria
positive
presentation of botulism
respiratory paralysis
muscle weakness
floppy baby
in order to destroy botulism spores, they must be exposed to
moist heat at 120 C x 30 mins
when can you expose a kiddo to honey
12 months old
due to risk of botulism
tx for botulism
botulinum antitoxin
4 different types of candidial infxns to know
vaginal
esophageal
oral thrush
intertrigo
tx for vaginal candidiasis
miconazole cream
PO fluconazole
esophageal candidiasis is mc in _ pt’s
AIDS
sx of esophageal candidiasis
substernal dysphagia
GE reflux
nausea w/w.o pain
what is this showing
linear erosions on EGD -> esophageal candidiasis
tx for esophageal candidiasis
fluconazole
friable white plaques that bleed if scraped
oral thrush
tx for oral thrush
nystatin
what is this showing
intergrigo
hallmark rash of intertrigo
beefy red erythema w. distinct scallped borders and satellite lesions
tx for intertrigo
clotrimazole
ketoconazole
miconazole
mc STI:
most reported STI:
mc: HPV
most reported: chlamydia
describe chlamydia bacterium
gram negative rod
dx for chlamydia
NAAT
gram stain shows no organisms
tx for chlamydia
doxycycline
+
ceftriaxone (cover for gonorrhea)
tx for chlamydia in pregnancy
azithromycin
vs
amoxicillin
describe the vibrio cholerae bacterium
gram negative
hallmark sx of cholera
rice water diarrhea
2 mc modes of transmission for cholera
contaminated water
seafood
gs dx for cholera
stool culture
tx for cholera
aggressive rehydration
macrolides vs FQ vs tetracyclines
cryptococcus is a _ defining illness
AIDS
dx for cryptococcus (2)
CSF - india ink
serology
transmission of cryptococcus
inhalation of budding yeast from contaminated soil w. pigeon/bird droppings
tx for cryptococcus
ampho B + flucytosine
followed by
fluconazole
cryptococcus prophylaxis for HIV pt
fluconazole if CD4 < 100
enveloped double stranded linear DNA virus in the herpes family - aka herpesvirus 5
CMV
CMV may mimic _
but lacks what sx
EBV
lacks: severe pharyngitis
what is this showing
CMV retinitis
3 s/sx of CMV
PNA
retinitis
esophagitis (immunocompromised)
CMV is associated w. a CD4 count <
50
3 sx of CMV in neonates
hearing loss
sz
petechial rash
what is this showing
owl’s eye inclusion -> CMV
tx for CMV
ganciclovir
foscarnet
cidofovir
URI w. thick gray pseudomembrane in the throat that bleeds if scraped
diphtheria
what is this showing
gray pseudomembrane of diphtheria
what is this showing
bull neck swelling due to enlarged cervical LAD -> diphtheria
vaccination schedule for diphtheria
2, 4, 6, 15-18 mos
booster 4-6 yo
tx for diphtheria
antitoxin
pcn vs macrolide
EBV triad
fever
LAD
pharyngitis
dx for EBV
(+) heterophile abs screen
atypical lymphocytes w. enlarged nuclei
_ develops in 80% of pt’s w. EBV
maculopapular rash
athletes w. EBV should avoid contact sports for _ weeks
3-4
describe the gonorrhea bacterium
gram negative diplococcus
gonorrhea in women is often asymptomatic, what are some sx of gonorrhea in men
yellow, creamy, profuse, purulent urethral d.c
tx for gonorrhea
ceftriaxone
+
azithro vs doxy (tx for chlamydia)
4 complications of gonorrhea
neonatal conjunctivitis
septic arthritis
tenosynovitis
hand/feet pustules
2 hallmark sx of HSV infxns
prodrome burning/tingling > 24 hr
followed by
painful grouped vesicles on an erythematous base
name the HSV viruses type 1-8
HSV 1: oral HSV
HSV 2: genital herpes
HHV 3: varicella zoster: chickenpox, shingles
HHV 4: EBV, hodgkin lymphoma
HHV 5: CMV
HHV 6/7: roseola infantum
HHV 8: kaposi sarcoma
histoplasmosis is a _ defining illness
histoplasmosis
transmission of histoplasmosis
soil containing bird/bat droppings in the mississippi and ohio river valleys
most significant rf for histoplasmosis
CD4 < 100
lab findings of histoplasmosis
elevated ALP
(+) LDH
tx for histoplasmosis
- itraconazole
- ampho B
t/f: histoplasmosis prophylaxis for AIDS pt’s is recommended
f
dz’s associated with CD4 counts
-500-200: TB, kaposi sarcoma, thrush, lymhoma, zoster
-<200: PJP, histoplasmosis
-<100: toxoplasmosis, cryptococcus
-<50: MAC, CMV
prophylaxis for different CD4 levels
-500-200: isoniazide
-<200: bactrim, itraconazole
-<100: bactrim, fluconazole
-<50: valganciclovir
PEP administration guidelines
-w.in 72 hr of exposure
-chances of contracting HIV from needle stick injury in knwon HIV pt is <0.3%
-test worker and pt at 6 weeks, 3 mos, 6 mos
-if retrovirals: combo therapy w. drugs from 2 different classes x 4 weeks
full PEP reduces HIV transmission by up to _%
70%
influenza is caused by the _ virus
orthomyxo
everyone >/= _ yo should receive the influenza vaccination
6 mos
contraindications to the influenza vaccination
severe egg allergy
previous rxn
guillain barre hx w.in 6 weeks of prev vaccination
GBS in past 6 weeks
< 6 mos old
contraindication to flumist flu vaccine
asthma
CXR findings of influenza pna
bilat diffuse infiltrates
which 2 antivirals tx influenza a and b
oseltamivir
zanamivir
indications for antiviral tx for influenza
hosiptalized
op w, severe/progressive illness
op and immunocompromised
op w. chronic medical conditions
>65 yo
pregnant/2 weeks postpartum
describe borrlia burgdorferi
gram negative spirochete
what type of tick causes lyme dz
ixodes/deer
what 3 body systems are mc affected by lyme
joints
heart
nervous
3 stages of lyme dz
-localized: 3-30 days -> erythema migrans
-disseminated: days-months: flu like, myalgias, arthralgias, AV block
-late/chronic: months-years: HA, fatigue, joint pain
dx for lyme dz
- ELISA vs IFA
- IgM and/or IgG - western blot
tx and prophylaxis for lyme
doxycycline
helminth infxns to know
nematodes
cestodes
trematodes
2 nematode infxns
pinworm
ascaris (roundworm)
what sx are associated w. nematode infxns
GI
cough
tx for nematode infxns
mebendazole
AM anal pruritis in a kiddo
pinworm
dx for pinworm
scotch tape test
mc intestinal helminth infxn worldwide
ascaris (roundworm)
cestodes infxn is same same
tapeworm
2 sx of cestodes/tapeworm
GI
wt loss
tx for cestodes/tapeworm
praziquantel
trematodes infxns include
avian and mammal schistosoma
swimmers itch makes you think
trematodes/schistosoma
tx for trematodes/schistosoma
praziquantel
lab finding that may be characteristic of any parasitic infxn
eosinophilia
pinworm and roundworm are treated w.:
tapeworms and flukes are tx w:
pinworm/roundworm: mebendazole
tapeworms/flukes: praziquantel
4 pathogens that cause malaria
plasmodium vivax
p.malaria
p.ovale
p.falciparum
most virulent strain of malaria
p.falciparum
what type of mosquito transmits malaria
anopheles
hallmark sx of malaria
periods of chills/fever/sweats q 3 days
splenomegaly after > 4 days of infxn
gs dx for malaria
giemsa stain peripheral smear (think and thick)
tx for malaria
chloroquine
vs
mefloquine
triad of toxoplasmosis
encephalitis
chorioretinitis
incracranial calcifications
what 2 pt pop makes you think toxoplasmosis
HIV w. CD4 < 100
pregnant w. litter box
what is this showing
ring enhancing lesion -> toxoplasmosis
prophylaxis for toxoplasmosis
CD4 count < 100: bactrim
severe hacking cough followed by a high pitched intake of breath
pertussis
pertussis is caused by
bortadella pertussis - gram negative bacteria
consider pertussis in what 2 pt pops
adults w. cough > 2 weeks
pt’s < 2 yo
3 stages of pertussis
catarrhal: cold like sx, poor feeding.sleeping
paroxysmal: whooping cough
convalescent: residual cough (up to 100 days)
dx for pertussis
nasopharyngeal culture
tx for pertussis
macrolide
steroids
SABA
prophylaxis for pertussis
infant-11 yo: DTap
11-18 yo: Tdap
Tdap for moms during each pregnancy
mc opportunistic infxn in HIV pt’s w. CD4 count < 200
pneumocystis jirovecii (PCP)
what is this showing
diffuse, bilat perihilar infiltrates -> PCP
tx and prophylaxis for PCP
bactrim
indications for steroids w. PCP
PaO2 < 70
alveolar gradient > 35 on RA
who should get PCP prophylaxis
HIV w. CD4 < 200
tx for PCP if bactrim allergy
pentamidine
vs
atovaquone
virus that causes rabies
RNA rhabdovirus
6 mc vectors for rabies
raccoons
skunks
bats
foxes
coyotes
dogs
4 s/sx of rabies
hydrophobia
pharyngeal spasms
aerophobia
hyperactivity
dx for rabies
negri bodies: eosinophilic inclusion bodies on the cytoplasm of hippocampal n cells
pathognomonic for rabies
management of rabies
post exposure: rabies immunoglobulin + in activated vaccine
rabies is fatal when _ are present
neuro sx
what causes rocky mtn spotted fever
rickettsia rickettsii spread by the dog tick (dermacentor variabillis)
stages of RMSF
-2-14 days: flu like
-red maculopapular rash on hands/feet that spreads centrally
gs test for RMSF
IFA (indirect fluorescent abs)
tx for RMSF
doxycycline
2 categories of salmenollosis
induce typhoid and enteric fever
indyce GI sx
GI sx of salmonellosis
constipation
pea soup diarrhea
papular rash on trunk
what is enteric fever
flu like bacterial infxn characterized by fever, GI sx, and HA
how is enteric fever transmitted
consumption of fecally contaminated food/water
what is this showing
papular trunk on the rash -> salmonella enteric fever
major food source associated w. salmonella gastroenteritis
egg yolks
tx for salmonellosis
cipro
ceftriaxone
what pathogen is associated w. dysentery
shigellosis
hallmark sx of shigellosis/dysentery
frequent/painful passage of small amts of stool that contains blood/pus/mucus
tx for shigellosis
bactrim
vs
cipro
what spirochete causes syphilis
treponema pallidum
3 phases of syphilis
- primary: painless chancre in genital/groin area x 3-6 weeks
- secondary: erythematous rash on palms/soles vs condyloma lata
- tertiary: neurosyphilis - permanent CNS changes, gummas - benign mucosal growths
what is this
chancre: primary syphilis
what is this
palmar rash: secondary syphilis
what is this
gumma: tertiary syphilis
dx for syphilis
initial: RPR/VDRL
confrimed w.: FTA-ABS
tx for syphilis
primary/secondary: IM benzathine pcn
tertiary/congenital: IV pen G
what toxin causes tetanus
clostridium tetani - gram positive anaerobe
pathophys for tetanus
spores in soil infect wound -> bacteria produce a neurotoxin -> interferes w. neuron synapses -> uncontrolled spasm/exaggerated reflexes
what type of wound is most susceptible to tetanus infxn
puncture
progression of tetanus
- tingling at inoculation site
- muscle spasms
- tetany/lockjaw
tx for tetanus
wound debridement
benzos
tetanus immune globulin + tetanus toxoid
metronidazole vs pcn
s/sx of TB
cough
night sweats
wt loss
post tussive rales
endemic area
immunocompromised
XR findings of TB
cavitary lesions
ghon complexes in lung apices
what is this showing
cavitary lesions -> TB
what is this showing
ghon complex: TB
dx for TB
gs: acid fast bacilli stain
bx: caseating granulomas
mantoux skin test positive parameters:
>5mm, >10mm, >15mm
> 5mm: CXR findings, past TB infxn, HIV, organ transplant, close contacts of known infected
> 10mm: IVDU, recent immigrants from endemic regions, communal living, myobacterial lab workers, comorbidities, kids < 4 yo,
> 15mm: no known rf
dx for TB
- PPD/IGRA
- if positive -> CXR
- if CXR is negative -> latent TB
- if CXR is positive -> active TB
tx options for latent TB
-isoniazid + rifapentine x 3 mos
-rifampin x 4 mos
-isoniazid + rifampin x 3 mos
tx options for active TB
-4 mos: rifapentine + moxifloxacin + isoniazide + pyrazinamide
-6 or 9 mos: RIPE -> rifampin + isoniazid + pyrazinamide + ethambutol
what TB drug causes orange body fluids
rifampin
what TB med causes peripheral neuropathy
isoniazid
give _ w. isoniazid for peripheral neuropathy
pyridoxine (B6)
what TB med causes hyperuricemia/gout
pyrazinamide
which TB med causes optic neuritis/red-green blindness
ethambutol
all TB meds are _toxic
hepato
pt’s w. active TB need _ for tx cessation
negative AFB smear + cultures x 2
prophylaxis for household contacts of TB
isoniazid x 1 year
when to d/c TB tx
transaminases > 3-5x UNL
varicella rash starts on the _
face
acute varicella zoster = _
and it lies dormant in the _
chickenpox
dorsal root ganglion
what is this showing
shingles
gs dx for varicella zoster
tzanck smear showing multinucleated giant cells
tzanck smear -> giant multinucleated cells -> varicella zoster
dendritic lesions on slit lamp exam
zoster ophthalmicus
zoster ophthalmicus involves CN
V
CN VII otalgia
lesions on the ear, auditory canal, TM
facial palsy
zoster oticus (ramsay hunt)
tx for shingles
acyclovir vs valacyclovir vs famciclovir w.in 72 hr
what is postherpetic neuralgia
pain/paresthesias/decreased sensation > 3 mos post zoster infxn
tx for postherpetic neuralgia
gabapentin
TCA
topical lidocaine/capsaicin
zoster vaccine is recommended for
all immunocompetent adults > 60 yo