Infectious Disease Flashcards
With cryptococcus think what 4 things
HIV CD4 less 100
Meningitis
Pigeon droppings
Pulmonary CNS sxs
What signs are often absent in cryptoccosis neoformans
Meningeal signs
What is the positive lab testing in cryptoccosis neoformans
Positive India ink = round encapsulated yeast
Because crytopcoccosis neoformans is yeast how can you think of treating it
FLUCONAZOLE
With cryptoccoal meningitis think what txm
Amphotericin
Location of histoplasmosis
Ohio and Mississippi River valley = inhaled SOIL or FECES
Describe histoplasmosis sxs
Flu sxs // headache // cough // night sweats
Histoplasmosis think what transmission
Bird droppings
Bats
Histo treatment
Itraconazole and severe = AMPHOTERICIN
Chlamydia can cause what 3 etiologies
Cervicitis / urethritis
PID
Lymphogranuloma Venereum
What type of discharge do you think with chlamydia
Watery in men // some to none in women — cervical mucopurulent discharge common
Chlamydia treatment // preg?
Doxy
Azithro in pregnancy
presumptive treatment of partners
With gonorrhea you’re thinking what kind of infections // 4
Conjunctivitis
Edpidymitis .. prostatitis
Pharyngitis
Urethritis
Lab staining for gonorrhea
Gram negative EXTRACELLULAR diplococci
Gonorrhea treatment
IM Ceftriaxone single dose
Lab findings in MRSA
Gram positive cocci in CLUSTERS
What drugs can treat MRSA
Bactrim
Clindamycin
Doxycycline
IV VANC
Rheumatic fever often presents in what age and how
5-14 years old
S/p untreated strep infection = INFLAMMATORY RXN in heart brain joints skin
Name the skin lesion associated with rheumatic fever
Erythema marginatum
What is spared in the rash of rheumatic fever
The face
What is the major criteria of rheumatic fever and how many do you need
1 and 2 minors or 2 majors alone.
Carditis
Polyarthritis
Sydenham Chorea
Eyrthema marginatum
Subq Nodules
Recent scarlet fever is indication of what
Recent strep infection
What valve is most effected in rheumatic heart disease
The mitral valve
Management of rheumatic fever
Penc G or Amox
ASA
What type of tick is involved in Rocky Mountain spotted fever
Dog tick
Wood tick
Describe Rocky Mountain spotted fever rash
Starts on palms and soles spreads towards the trunk
Blanching erythematous rash with macula and petechia
DOC for Rocky Mountain spotted fever
Doxy empirically
Lyme disease is caused by and lesion looks like ; must be attached for how long
Borrelia Burgodorferi
“Target” Bullseye lesion
24 hours or DONT TREAT
4 clinical manifestations of Lyme disease
Bilateral Bell’s palsy
Arthritis
Heart blocks
Erythema migrans
Talk about testing for Lyme Disease in the lab
ELISA OR IFA FIRST.
IgG for western blot if LESS 30 DAYS OF SXS
IgG and IgM western blot if GREATER 30 DAYS OF SXS
Lyme disease treatment ; if pregnant
Doxy
Amoxicillin if pregnant
When is doxy given prophylactically
Within 72 hours of tick REMOVAL
Syphillis primarily affects what heart structure
The aorta
Talk about serological testing for syphillis
Screen = RPR and VLDRL
Confirmatory = FTA -ABS ;; if positive this will remain positive for life.
you can also order direct visualization of T. Pallidum
Syphillis treatment and back up
Penc G ;; can even sensitize pregnant patients
All Others— with allergy = Doxy or Ceftriaxone
What rash is associated with rheumatic fever?
Erythema marginatum
What are the two ways of syphilis transmission?
Sexual contact
And vertical transmission
Describe the syphillis lesion
Chancre papule painless ; 1-2 cm ulcer with raised undurated edges
Where does syphillis have a predilection for on the body
Palms and soles
What type of STI really effects the aorta
Syphilis
What is the difference between syphilis lesion and H. Ducryei lesion
H. Ducreyi hurts; multiple painful inguinal Bubo
Syphilis is painless … that’s why its on the RIZE
Patient presents with syphilis like lesion and treated with antibiotics and gets a ridiculous reaction ; what are you thinking?
Jarisch Herxhiemer Reaction
High cyclical fever and what is the worst genus
Malaria falciparum
Best lab studies for malaria
Thick and thin Geimsa stain
What do you see on CT for toxoplasmosis
Ring enhancing lesions
3 combo of medications to treat toxoplasmosis if a patient is immunocompromised
Sulfadiazine + Pyrimethamine + Leucovorin
EBV affects what two types of cells?
B cells
Pharyngeal Epithelial cells
Classic triad of EBV
Fever
Sore throat
Cervical LAD
If MONO is treated with amoxicillin what happens>
Get a RASH
Peripheral blood smears positive in MONO
Atypical lymphocytes
Why do you avoid contact sports in EBV
Splenic rupture!
What is the smear for HSV and what does it show?
Tzanck Smear and Multi Nucleated Giant Cells
We give antivirals for what in HSV
Primary infection and suppressive therapy
Describe the timeline and stages of sxs in
HIV infection
Infected and then asxs for 8-10 years
Sxs = weight loss ; high infection ; uncommon fungal infections
“Kaposi Sarcoma”
“Hairy Leukoplakia”
What usually follows opportunistic diseases in HIV patients
Death
What is the time frame that western blot will be positive in HIV
31 days
Treatment for HIV is what class of medications?
2 NRTI’s = Nucleotide Reverse Transcriptase Inhibitors
+
1 NNRTI = Non Nucleotide Reverse Transcriptase Inhibitors
3 diseases with any CD4 count in HIV
Kaposi’s
Herpes Zoster
Lymphoma
CD4 count in HIV less than 100 what are 3 common diseases
Cerebral toxoplasmosis
Military Tuberculosis
HIV encephalopathy
What is the only type of animal that transmits rabies
Mammals
Rabies effects what part of the body
Encephalitis of gray matter
What is the name of the finding in postpartum tissue in a rabies infected patient
Negri bodies
What are two severe sxs that often lead to death in Rabies
Respiratory depression
Ascending paralysis
What is the post exposure prophylaxis for rabies in an unvaccinated individual
Rabies vaccine 4 doses 0, 3, 7, 14.
And a single does of RSIG.
Describe the lesions in chicken pox on a child
Crops of vesicles in various stages of healing
HEAD and TRUNK and EXTREMITIES
When are you contagious with chicken pox
2 days before lesions
And 5 days after vesicle appears.
7 DAYS TOTAL
What cranial nerve is affected in Ramsey hunt syndrome
CN 7
What is Hutchinson sign in reference to shingles
Eye Shingles
With bumps near the tip of the nose.
3 parts of Ramsay hunt syndrome
Facial paralysis on one side
Ear pain
Vesicles in the auditory canal and auricle
What is the reason most should not have chicken pox parties anymore (3)
Secondary skin infections
Viral PNA
Encephalitis
When do kids get the chicken pos vaccine
1 and 4 yrs old
When do adults eat the chicken pox vaccine
Over 50 yrs old they should
Rotavirus is transmitted how
Infected food contaminated by feces
What two viral infections cause fever vomiting and diarrhea
Norovirus = #1
Rotavirus
What is the treatment of choice for giardia
Tinidazole
What is the give away for giardia
Drinking water from a pond
What foods are associated with vibrio cholera
Street foods and Seafoods
What is the ABX of choice for moderate disease in vibrio cholera
Doxy
What two infectious agents can cause abrupt onset N/V
B. Cerues
Staph A.
Foods and type of abdominal sxs associated with C. Perfergins.
Reheated meats
Cramping abdominal pain
Saying for bloody diarrhea
Shiga Shiga Salmonella went Campylobacter C. Diff
What infectious agent can cause GBS
Campylobacter
Shigella can only be transmitted how>
Food or water ;; no animal reservoir
4 ways to transmit salmonella
Eggs
Milk
Dairy
REPTILES
Yersenia mimics what?
Appendicitis
What extraintentisinal sxs are common in yersenia
Erythema nodosum
Poly arthritis
E. Histolytica can cause what
Liver disease
2 drug types commonly associated with c. Diff
Clindamycin
Cephalosporins
EHEC 0157 : H7 can cause what in kids
Hemolytic uremic syndrome
Gray patches that coalesce into a pseudo membrane leaving a red space in the pharynx and flu like sxs are concerning for what ? And what is the treatment
Diphtheria
Erythromycin or PCN G
Describe the way intestinal helminths may present; treatment?
Pulmonary sxs + GI sxs with fecal blood positive + eosinophilia !!!
Travel to Guatemala
TXM = albendazole
What is the timeframe for rabies exposure
It usually takes about 1-3 months before experiencing myriad of sxs that last up to week ending in ascending paralysis.
Myriad of sxs : fever chills followed by mood changes, refusal to drink, grimacing.
When and how often do you give the herpes zoster vaccine?
Administered at 50 and after in 2 doses; 2-6 months apart
3 talking points for disseminated gonorrhea
Patient often has vague fever malaise and
1) migratory joint pain
2) tenosynovitis
3) vesicular non tender extremity lesions
is herpes associated with anogenital carcinoma
NO!
With blastomycosis think
Inhaled yeast that attacks the skin and then the bones
SKIN AND BONESSSSS
Cryptoccosu noeformans is what type of infection
Encapsulated yeast that is an opportunistic HIV infection
Talk about the syphilis rash
Begins on the TRUNK
Diffuse and Maculopapular
Spreads to the palms and soles
WIDESPREAD LAD
What is the name of the test for MONO
Monospot = heterotrophile antibbody
Common type of throat exudates seen in scarlet fever
Grey-white exudates
HHV 6 is associated with?
Roseola infantum
Epitrochelar LAD is pathaneumonic for what?
Syphilis infection ; on the arm above the elbow
What signifies adequate treatment for after syphilis infection
4 fold decrease in serologic titers at 6-10 months
What is the main complication of non bullous impetigo
Post strep glomerulonephritis
How can disseminated gonoccal infection affect one joint ?
Purulent mono arthritis
What 3 things do you think of with CMV
Newborn baby
Microcephaly
Sensorineural hearing loss/periventricualr calcifications
Is there a vaccine for hepatitis C?
NO! ONLY A and B.
Toxo usually affects folks with a CD4 count less than what?
100
3 ways to get Toxo
Eating undercooked meat
Cat feces
Contaminated soil
Best way to prevent HSV transmission
Daily antiviral therapy
Typhoid disease is spread how
Contaminated water or food, Typhoid Mary was NANNY that COOKED hella food
N. Meningitidis present with what smear
Gram positive cocci in pairs ;; prophylaxis is with rifampin = close contacts of someone infected
Funagal infection in immunodeficiency pt may express what
Neutropenia - PMNs
T cell suppression
MOA of azoles
Inhibits fungal cell wall formation
Amphotericin B is what type of medication
Polyene
Candiadiasis can cause what in men
Balanitis
Esophageal candida TXM
FLUCONAZOLE
Balanitis candida TXM
Topical nystatin
Cutaneous mild candidiasis txm
Nystatin ointment / Clotrimazole cream + 1% hydrocortisone
1st line for candidemia
IV echinocandin
Encapsulated budding yeast
Acquired by
Inhalation - pigeon droppings
Cryptoccous staining
Mucicarmine // INDIA INK
Cryptococcus TXM
FLUCONAZOLE 6-12 months = pulmonary
AMPHOTERICIN B x 14 d —> FLUCONAZOLE x 8 weeks
LP findings in crypt.
HIGH opening pressure
Incr Protein
Dec glucose
Type of histoplasmosis
Dimorphic fungus
OHIO MISS RIVER VALLEY
Both yeast and mold depends on location of growth
Acute = self limited —> Progressive :
-CD4 less than 100 ; adrenal insuff. / CNS involvement
Chronic:
-Elderly folks - cavities and nodules
Histoplasmosis Dx
Urine and serum antigen
Blood bone marrow culture
TXM histoplasmosis
Mild : Itraconazole x 6-12 weeks
*AIDS —> continue until CD4 over 150 ; 1 yr of txm ; 6 months ART
Severe : Amphotericin B [liposomal]
PJP transmission
Airborne ; can colonize the airway
CD4 less than 200! Increased in STEROID USERs
CXR findings in PJP
Diffuse interstitial infiltration ; nodules ; cavitations ; cystic changes
PJP TXM =
Bactrim perferred x 14-21 days
Botulism [4]
Gram positive ROD ; anearobic
Paralytic disease : blocks Acetycholine
Vacuum packed ; smoked ; canned food
Symmetric descending weakness —> paralysis/respiratory distress w/ NML sensorium
TXM Botulism
Antitoxin w/ 24 hours
Ventilate ; remove toxin from GUT
Campy [4]
Raw milk; contaminated food
Gastroenteritis ; fever ; abd pain
Immune compromised TXM = Azithromycin
Assoc with GUillen BArre
Cholera [4]
Gram negative rod ; intestinal epithelial cell target
Sudden RICE WATER ; water diarrhea
R2 fluids // PO—>IV
Severe illness= tetracycline
there is a vaccine
Diphtheria [4]
Exotoxin producing GRAM POS coccobacillus
TXM by respiratory secretions
Gray tenacious membrane MC
TXM = antitoxin ; PCN ; Azithromycin
Diphtheria prevention and isolation measures
Prevention : vaccination w/ Dtap = 6 weeks to 6 yrs old ; Tdap - over 6 yrs old ; Td- every 10 yr booster
—> can boost w vax if exposed
Isolation : until 3 negative pharyngeal cultures
Salmonellosis [4]
Gram neg rod Fecal to ORal
Enteric fever = typhoid
+/- bloody
TXM = immune compromised/sickle cell —> ciprofloxacin ; Ceftriaxone; Azithromycin
Bacteremic salmonellosis TXM
Cipro+ drain abscess + suppression
Salmonella typhi incubation
6-30 days
Pink blanching papules + pea soup diarrhea + fever
Typhoid fever
TXM of salmonella typhi for carrier and acute ; prevention
Carrier = CIPRO x 4 weeks ; cholecystectomy
Acute = cipro/levo x 10-14 days —> Ceftriaxone alternate
Prevention : immunize
Typhoid fever like to hide where
In the gallbladder
Shigellosis [4]
Gram negative rod
Oral anal sexual contact
Blood and mucous diarrhea ; ulceration ; engorged mucosa
TXM =
Cipro/Levo
3 complications assoc with shigellosis
Reactive arthritis = HLA b27 positive
HUS = kids rare
Disaccharide deficiency
Tetanus [4]
Gram positive rod ; spore forming
Uncontrolled spasms ; IVDU unvax ; migrant workers ; glottis spasms
Pain and tingling avg incubation 8-12 days
TXM = human tetanus IG IM in 24 hours +/- sedate and intubate
—> wound : metronidazole + debridement
LV incubation
5-21 days
Dx and TXM for LV
Dx : complement fixation ab testing
TXM = doxy
avoid doxy in pregnancy
MAC
Acid fast bacilli
Think chronic slow : bronchiectasis ; fibrocavitary
TXM = clarithro/azithro + rifampin + ethambutol
CRE = TXM
Disseminated MAC
CD4 less than 50
Dx = blood culture
Entamoeba
Histolytica MC in humans
Hyperparalystalsis + hepatomegaly + mucosal sloughing
Extra intestinal MC: Liver abscess // fever // pain // wt loss
Dx —> stool sample // TXM : luminal agent = diloxanide
Hookworms common in what regions
Tropical / Subtropical regions
Attach to small bowel and suck the blood
GI sxs 1 month after infection
Dx: stool sample ; microcytic anemia ; dec albumin
TXM : albendazole
1st line for non falciparum malaria
Chloroquine
Pinworms transmission
Fecal to oral route via ingestion of eggs
Pinowrms dx
Scotch tape in the AM —> microscope findings
Toxoplasmosis type of pathogen
Olbilaget intracellular protozoan
MC late presentation of congenital toxoplasmosis
Retinochorioditis
Painful photophobia
Vector Lyme disease
Ixodes : deer tick
Cardiac and Neuro findings with Lyme disease
Cardiac : myopericarditis with AV arrhythmias and heart block
Neuro : asepctic meningitis and Bell’s palsy
Paresthesia in Lyme disease
Stocking glove distro
Pregnant female Lyme disease treatment
Amoxicillin
Cefuroxime = if cant do doxy
3rd recurrence Lyme disease treatment
Prophylaxis
NSAIDs synovectomy
Pro = Tick attached for greater 36 hours —> TXM in 3 days doxy PO once
Rocky mounted spotted fever locations:
Think NC Oklahoma Tennessee Arkansas
NOTA
Rash for Rocky Mountain fever
Wrist ankle—> palms soles —> central spreading
Facial flushing —> conjunctival injection
SEVERE = DIC
Labs = incr LFTs / incr Bili / low Na+ ‘ low platelets
CSF = low glucose ; pleocytosis
TXM = doxy 3-5 days w/ 3 days past sxs
Pregn = doxy or chloramphenicol
Syphillis rash includes
Palms and soles
What is argyll robertson pupils
React poorly to light but accommodate to near focus
think Syphillis
CMV is
HHV - 5
MC congenital infection
CMV ; mono - like syndrome BUT. Heteropile ab negative
CMV disease treatment
IV ganciclovir —> PO valganciclovir
Resistant CMV disease treatment
IV foscarnet
EBV is
HHV - 4
LAD where for EBV
Posterior cervical chain
EBV airway obstruction can treat with
CC
EBV is associated with what in cancer
Burkitts ; Nasopharyngeal carcinoma ; T cell lymphoporliferative d/o
Third trimester HSV infection consider what
C section delivery
Encephalitis / meningitis TXM
IV acyclovir
Shingles is
HHV - 3
When is shingles disseminated
Greater than 3 dermatomes
Zostavax is
Live attenuated shingles vaccine
Pep for rabies
Rabies Ig around wound —> IM
[HRIG]
Then 4 injections with vaccine on days :
0 , 3 , 7 , 14 and 28if immune compromised.
*previous vac no need for HRIG and vaccine only day = 0 , 3.
HIV is
Retrovirus with reverse transcription requires reverse transcriptase for replication
Screen and confirmation HIV tests
Elisa —> western blot
PEP HIV
Counseling testing at 6 wks ; 3 mos ; 6 mos
ART : emtricicitabine/tenofovir/raltegravir within 72 hours
PrEP HIV
Emtricicitabine/tenofovir
[truvada/descovy]
Perinatal HIV concerns 2
ART : 3 drugs during preg L&D and x6 weeks for newborns
C -section if VL > 1000; avoid breast feeding
ART starting regimen
Dolutegravir + TAF + emctricitabine
Kaposi may consider what therapy
Chemo
Toxo with HIV CD4 count less 100 TXM
Bactrim
