Infectious Disease Flashcards by Kaylie Goldner

When should an emergently placed central catheter be removed?

Within 48 hours

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What test should you order to check for acute and disseminated histoplasma infection?

Histo urine Antigen

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Treatment for hot tub folliculitis

No antibiotics unless persistent infection, severe, or immunocompromised.

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What is the immune control phase of chronic Hep B?

DNA <2000
negative Hep B e antigen
normal LFTs

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If someone had Hep B, what is a consideration prior to starting immunosuppression?

Need to start antiviral before to prevent reactivation.

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What treatment is useful to prevent active Hep B in post exposure prophylaxis in susceptible person or in liver transplant where the host already had Hep B previously?

Hepatitis B immune globulin

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Patient with history of Hep B now inactive is preparing to receive liver transplant. How do you prevent the new liver from getting infected?

Hep B immune globulin

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What are 4 Ixodes infections?

Lyme, Anaplasmosis, Babesiosis, Powassan virus

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Which of the Ixodes infections are most likely to have meningoencephalitis?

A. Lyme
B. Babesiosis
C. Powassan virus
D. Anaplasmosis

C. Powassan virus

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What is the carrier for Japanese encephalitis?

Culex mosquito

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What is the presentation of Japanese encephalitis?

fever, Headache, encephalitis followed by focal neuro abnormalities (palsies, paralysis, Parkinsonian symptoms). May see aseptic meningitis.

will see IgM in CSF and later in serum

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What is the carrier for scrub typhus?

Chigger (orientia tsutsugamushi bacterium)

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What is the definition of disseminated Herpes Zoster?

any dermatomal involvement if immunocompromised. If immunocompetent, has to have at least 2 dermatomes or cross the midline.

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what is the difference in precautions needed between disseminated and focal Herpes zoster?

contact + airborne (can involve respiratory tract if disseminated) vs just contact

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What is the most common cause of fever in a returning traveler from South America?

Dengue

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What kind of fever is present in Dengue infection?

Abrupt onset of high fever with saddleback pattern (will go away then come back after a few days)

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What are distinguishing symptoms in Dengue fever?

Back pain (break bone fever), Retro-orbital pain, positive tourniquet test

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What disease do you think of with a positive tourniquet test? What does that mean?

Dengue
Petechiae develop distal to the BP cuff after it is deflated

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How is Chikungunya different from Dengue?

severe joint pain especially in the hands and feet, relapsing arthritis.

Can otherwise present similar to dengue, usually however this infection is asymptomatic.

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What symptoms are characteristic of Leptospirosis?

Conjunctival erythema, low back and calf pain. (may vary from just a fever to multisystem failure)

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What area of the world should you think of with typhoid fever?

South or Southeast Asia

(slow fever, longer lasting, GI sxs common, may have delayed rash over chest and abdomen)

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Why is vancomycin used in meningitis empiric coverage?

Double coverage due to high rates of ceftriaxone-resistant pneumococcus

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What exposure is Capnocytophaga canimorsus associated with?

cat or dog bite or scratch, exposure to dog saliva

(Gram negative rod) especially those with hypo- or a-splenia, cirrhosis, excessive alcohol use

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which bug classically presents with hemorrhagic bullae, nec fasc in immunocompromised people who had exposure to raw shellfish or skin trauma in sea water?

Vibrio

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Which bug is a Gram positive rod and is associated with fish/crustaceans/mollusks and painful localized violaceous cutaneous infection at trauma or previous wound?

Erysipelothrix rhusiopathiae

Resistance to oxy-beta-lactam substrates (cefotaxime, ceftazidime, ctx) means ESBL and even if lab says susceptible to cefepime this is likely false; go for _____.

Ertapenem

What antibiotic has great efficiency in the urine but limited systemic absorption and covers VRE?

Fosfomycin

What bug is the main cause of severe malaria and has increasing chloroquine resistance?

Plasmodium falciparum

What counts as severe malaria? (what criteria define it?)

>10% parasitemia w/ at least once clinical or laboratory criterion clinical: pulmonary edema, seizures, confusion, bleeding, jaundice, shock laboratory: severe anemia, AKI, hypoglycemia, metabolic acidosis, hemoglobinuria

Treatment for severe Plasmodium falciparum malaria?

Artesunate first then switch once stabilize

Which of the following types of malaria have a latent hepatic stage? Falciparum, vivax, ovale And, what is needed to prevent relapse for these?

Vivax and Ovale. Tx: include primaquine or tafenoquine to prevent relapse of erythrocytic stage

Does Campylobacter respond to azithromycin?

yes (resistance is common to amoxicillin and fluoroquinolone)

What are symptoms/signs of PTLD (posttransplant lymphoproliferative disorder)?

fever, pancytopenia, generalized lymphadenopathy, hepatosplenomegaly

What might EBV lead to in transplant patients presenting with fever, HSM, pancytopenia.

PTLD (posttransplant lymphoproliferative disorder)

when should you add on empiric coverage for Pseudomonal CAP?

Hospitalization AND parenteral antibiotics in the last 3 MONTHS (would also add vanc here) OR Growth on respiratory tract culture in the last YEAR.

What is considered severe C diff?

Cr > 1.5, WBC > 15k

what is the usual order of treatment preference in treatment of non-severe C diff?

oral fidaxomicin or vanc --> if you can't do these then can use oral metronidazole really only for mild c diff.

What is treatment for fulminant C diff?

oral vancomycin and IV metronidazole

if high suspicion for HSV encephalopathy but initial CSF PCR negative, what do you do?

repeat LP in 3-7 days and continue acyclovir in the meantime

What is associated with aerosolized excrement or birth byproducts?

Q fever (coxiella burnetii)

What does Q fever usually present like?

Mild self-limited febrile illness sometimes pneumonia and hepatitis, sometimes endocarditis

What bug is associated with an undulant fever, associated with direct contact with secretions/excretions from animals or contaminated food/milk?

Brucellosis (genus Brucella)

What condition presents with intermittent fever for weeks/months, HSM, arthralgias (back/joint), depression, LAD.

Brucellosis (Gram neg intracellular coccobacillus) Depression is often out of proportion to other symptoms. Fun fact: vaccination of cattle in US has virtually eliminated this reservoir, focus is international now.

What percentage of infections may the Legionella Ag miss?

up to 30% (only checks serogroup 1)

Which two viruses are carried by the Lone Star tick and have similar clinical presentation of fever, HA, myalgia, arthralgia? Only one responds to doxycycline.

Heartland Virus and Ehrlichia (may be other illnesses with similar clinical presentation and also carried by this tick).

You are treating a patient with early HIV who had significant risk factors for TB. CD4 is 127. TB test is negative. What should you do to ensure this is not a false negative?

Retest for TB screening when CD4 rises >200

How do you diagnose West Nile Virus encephalopathy?

CSF IgM (not PCR as this is not sensitive since viremia clears long before clinical presentation)

How do you diagnose HSV encephalopathy?

CSF PCR (IgM is not helpful because rise can take 10-14 days)

If two patients are respectively infected with West nile virus and HSV, who will present first with encephalopathy?

HSV

Which of the two viral causes of encephalopathy is detected best by IgM instead of PCR?

West Nile virus

What are the two ways someone might get a brain abscess?

Contiguous or Hematogenous spread

What size of brain abscess may be acceptable to just treat medically without surgical excision/aspiration?

<2.5 cm (if doing well GCS wise)

what should be considered if a brain abscess ruptures into ventricles?

emergent craniotomy and ventricular lavage

what is normal therapy for Latent TB (2 options)? what is second line therapy? What if you have HIV?

Isoniazid and Rifampin/Rifapentine 3 months OR Rifampin 4 months Second line: Isoniazid 6-9 months (higher toxicity and lower completion rates) In HIV: first option + pyridoxine also for 3 months

What syndrome includes zoster oticus or mouth lesions sometimes with vertigo/nystagmus?

Ramsay Hunt syndrome (VZV)

list 3 viral causes Bell palsy

HSV1, Lyme, VZV

What strange disease might you consider if someone has fever and hemolysis and has had a blood transfusion in the last 6 months?

Babesiosis

List some transfusion associated blood borne infections

HIV, Hep B and C, WNV, HTLV, Parvo B-19, Plasmodium, Trypanosoma

what tests have excellent sensitivity and specificity for Invasive pulmonary aspergillosis?

BAL and serum galactomannan assay. May need biopsy.

what might be pulmonary imaging findings in invasive aspergillosis? What are risk factors for this disease?

Infiltrates, thin-walled cavities, nodules, wedge shaped densities, ground glass around nodule (halo sign - can indicate any angioinvasive infection like fusariosis or mucor) Risk factors: SOT, long neutropenia

What is the halo sign in lung radiology

nodule with ground glass surrounding it, indicating hemorrhage into surrounding tissue (angioinvasive infection)

What organs can be impacted by invasive aspergillosis?

Lung, CNS, skin, eye

What kinds of organisms typically cause HCAVM (healthcare-associated ventriculitis or meningitis)? What is good empiric abx coverage?

Staph or enteric G neg Vanc/cefepime

What timeframe is testing good for PCR and IgM for Chikungunya?

PCR is good for about a week after symptoms first start then not reliable. IgM can be positive after 5-10 days then stay positive for 2-3 months.

Which infection can be described typically by the following: abrupt onset of severe, polyarticular arthralgia (usually 10 or more joints), high temperature, rash, and conjunctivitis and often with bilaterally symmetric polyarticular arthritis. May have lymphopenia/leukopenia and thrombocytopenia, elevated LFTs and Cr.

Chikungunya

If HIV presents in acute infection with joint pain, will it more likely be upper or lower extremities?

lower

what disease might you think of in a person with long-standing diabetes and diarrhea with bloating and fecal incontinence?

diabetic diarrhea with SIBO (hypomotility allows excessive colonization) Diagnosis of exclusion and needs endoscopy beforehand.

how do pap smears work in HIV?

Starting from HIV diagnosis or first intercourse, Pap smear annually until at least 3 normal then continue routine testing