Infectious disease 1B Flashcards by Cassandra Martinez

what are the two antibiotics to treat MRSA empirically before finding out culture results for a patient that has susceptibility to MRSA?

Bactrim DS and Doxycycline

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Cytomegalovirus is apart of what virus family?

herpes virus family

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Cytomegalovirus is a common cause of what type of infection?

Infectious mononucleosis
it is 2nd to Epstein Barr virus

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A mother can infect her unborn with cytomegalovirus, what are the 2 birth defects that the child could have?

Mental retardation and hearing deficit

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how is cytomegalovirus spread?

Saliva, breast milk, urine, blood

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what is the most common complication of cytomegalovirus?

CMV retinitis
requires immediate referral to ophthalmology and infectious disease specialist

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what are 4 common complications in immunocompromised patients with CMV?

GI ulcers, retinitis, pneumonitis, and dementia s/s

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Patients diagnosed with mononucleosis caused by cytomegalovirus, will have what symptom that differs from mono caused by Epstein Barr virus?

Patients with mono caused by cytomegalovirus will have a sore throat that is non-exudative.

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Although patients with cytomegalovirus are often asymptomatic, what symptoms can they present with?

Low-grade fever (99-100, recurrent)
non-exudative sore throat
fatigue
cervical lymphadenopathy
generalized body aches
skin rash–typically immunocompromised

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If EBV antibodies are negative, what is the next test?

CMV antibodies

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For CMV, IgM and IgG will be tested for. When will these labs be high?

IgM will be elevated in acute symptomatic phase

IgG will be elevated in later stage of infection

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A tissue biopsy from a skin rash of a person with suspected CMV will have what?

“Owl’s eye” inclusion bodies will be present

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what is the treatment for cytomegalovirus?

treatment is supportive therapy such as Tylenol, Motrin, fluids, rest.

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What is the treatment for HIV positive patient who has CMV?

IV antiviral medication given by infectious disease specialist

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what is the primary causative agent for infectious mononucleosis?

Epstein barr virus

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What is important to know about the Epstein Barr virus?

The virus becomes dormant after initial infection and can re-activate

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How long is the incubation period for the Epstein Barr Virus-Infectious mononucelosis?

4 to 6 weeks

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How is the Epstein Barr virus spread?

Spread through infected body fluids, such as saliva

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what are the triad of symptoms of the Epstein Barr Virus?

Fever, Sore throat (exudative), and posterior cervical lymphadenopathy

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What abdominal organ should you check for when a patient could possibly have Epstein Barr Virus-Infectious mononucleosis?

Spleen

Check for Splenomegaly

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what EBV antigen appears early and fades in 4-6weeks?

VCA IgM

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What EBV antigen peaks at 2-4 weeks? always present after exposure

VCA IgG

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What EBV antigen occurs 2-4 months after exposure and remains positive for life?

Epstein Barr Nuclear Antigen

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What EBV antigen is associated with reactivation or chronic disease? This disappears weeks to months after onset

Early antigen

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what is important education to parents of school-aged children with EBV?

Avoid contact sports due to possible risk of splenic rupture

what is the causative organism of Lyme disease?

Borrelia burgdorferi

in what areas are most common for Lyme disease infection to occur?

northeaster, mid-atlantic, and upper north central, northwestern california

in what areas are most common for Lyme disease infection to occur?

northeaster, mid-Atlantic, and upper north central, northwestern California

what months are common for lyme disease?

From May to November

How long is the incubation period for lyme disease?

3 to 31 days but can manifest months or years after infection

what is the goal of treatment for lyme disease?

to prevent progression of stages

what is the hallmark sign of stage 1--early localized stage of lyme disease?

Erythema migrans lesion that is at the site of the bite. it looks like a red macule/papule that enlarges over days to weeks

what is stage 2 of lyme disease called and why?

Stage 2 is the early disseminated stage There are multiple erythema migrans lesions that occur 3-5 weeks after the bite

Arthritis in large joints and encephalopathy/personality changes are associated symptoms of what stage of lyme disease?

stage 3, late disease

Headache, fever, fatigue, arthralgias, stiff neck occasionally occur in what stage of lyme disease?

stage 1, early localized

facial palsy, meningitis, conjunctivitis, headache, fatigue, heart block (rare) are symptoms of what stage of lyme disease?

stage 2, early disseminated

how is the diagnosis made of lyme disease?

Typically diagnosed through clinical presentation

what is the 2 laboratory diagnosis of lyme disease?

Western blot IgM, IgG test and Skin biopsy of ertyhema migrans

what is the 2 laboratory diagnosis of lyme disease?

Western blot IgM, IgG test and Skin biopsy of erythema migrans

What should you do as a provider when diagnosing lyme disease?

Report the disease, it is a reportable condition

what is first line therapy for lyme diesase?

Doxycycline 100 mg BID for 14 to 21 days

what are some restrictions for first line therapy of lyme disease?

Can't give to kids younger than 8 years of age or pregnant women

what is the second line therapy of lyme disease?

amoxicillin 500 mg TID for 14-21 days

If a patient has known exposure to Lyme disease and has no symptoms, what is the treatment?

one time dose of 200 mg doxycycline

what is the time frame to prescribe the one-time dose of Lyme disease exposure with no symptoms?

72 hours (3 days)

Is bacterial meningitis a reportable condition?

Yes

what are some of the common symptoms of bacterial meningitis?

headache, stiff neck, low grade fever, photophobia, nausea/vomiting, myalgias

what is the gold standard for diagnosis of bacterial/viral meningitis?

Lumbar puncture

What other labs should be done in addition to a lumbar puncture for the diagnosis of meningitis?

blood cultures CBC CT head if question of other etiology

What are some common symptoms of viral meningitis? list 2

Diarrhea Skin rash

what are some common causative organisms of bacterial meningitis?

Streptococcus pneumoniae Neisseria meningitdis Streptococcus agalactiae Listeria monocytogenes Haemophilus influenzae

what is the treatment for bacterial meningitis in infants/children?

Ampicillin or third generation cephalosporin, IV

what is the treatment for bacterial meningitis in adults up to age 50?

third generation cephalosporin

what is the treatment for bacterial meningitis in older adults over 50?

Ampicillin or third generation cephalosporin

Name some 3rd generation cephalosporins what is a tip to remember about 3rd gen cephalosporins

CefexIME CeftazidIME CefotaxIME CeftizoxIME CefpodoxIME CeftriaxONE CefoperazONE CeftibuTEN ends in IME or ONE

what is the treatment for viral meningitis?

Hydration Fever-Tylenol and Advil Anti-emetic Rest

how is hepatitis A transmitted?

fecal-oral route

which hepatitis is a cause of traveler's diarrhea?

Hepatitis A

what the two most common symptoms of hepatitis A?

jaundice and fever

What is the diagnosis of Hepatitis A?

IgM antibodies positive for anti-HAV

what patient education should be taught for patients with hepatitis A?

avoid alcohol cosumption limit use of hepatotoxic medications avoid contact sports for 2-4 weeks

For traveler's, when are they fully protected after receiving the hepatitis A vaccine?

4 weeks

What is hepatitis B method of tranmission?

spread through blood and body fluid exchange, and sexual contact blood, serum, wound exudate

what is the incubation period for hepatitis B?

60-90 days

what are the risk factors for contracting hepatitis B?

frequent blood transfusions, IV drug use, high-risk sexual behaviors

what is the dosing guidelines for hepatitis B?

1st dose upon birth 2nd dose at 1 month visit 3rd dose at 6 months

what are the 3 symptoms of hepatitis B?

fever, arthralgias, jaundice

what is the concern with children and acute hepatitis B?

In children it often progresses to chronic hepatitis B

what are the diagnostics for hepatitis B?

Hepatitis B serology LFTs CBC CMP

what is the treatment for acute hepatitis B ?

Usually self-limiting avoid hepatotoxic medications encourage hydration

what is the method of transmission for hepatitis C?

IV drug use is the most common mode of transmission

what are the diagnostics for hepatitis c staging?

Liver biopsy

what labs are apart of the hepatitis C diagnostics?

hepatitis c antibody panel liver function tests CBC CMP Consider referral for liver biospy

what is the treatment for hepatitis C?

Avoid hepatotoxic meds dose adjustment of meds if they are metabolized by the liver referral to a specialist for interferon therapy discourage alcohol use

what vaccine is the only FDA approved vector borne related disease?

yellow fever

How is CMV infection spread?

Direct contact with urine or saliva, (especially from baby and children), through sexual contact, and via breast milk

Epstein Barr virus is spread how?

Primarily through saliva

What is another name for the monspot test?

Heterophile antibody test

What immunoglobulin does the monospot test for?

IgM antibodies (acute infection)

Erythema migrans “bulls eye” rash is associated with what disease?

Lyme disease

Borrelia burgdorferi is associated with what disease?

Lyme disease

What is the diagnosis of Lyme disease to do treatment ?

The erythema migrans rash “bulls eye” rash

how is measles spread?

airborne and contact-droplet

what are common complications from measles?

otitis media diarrhea bronchopneumonia laryngotracheobronchitis

what are the three c's of measles?

cough, coryza, conjunctivitis children can have a high fever-up to 105

a person is considered infectious with measles when?

4 days of exposure and 4 days after onset of rash

what kind of rash does measles have?

maculopapular rash

the combination measles mumps rubella varicella vaccine can be used for children of what ages?

12 months to 12 years

when can the MMR be given?

at 12 months

what vaccine (MMRV or MMR) be given a 2nd dose within 28 days?

MMR

what is the minimal interval to give MMRV after the 1st dose?

at least 3 month interval

infants who are 6-11 months who are traveling should receive what vaccine?

MMR one dose

what vitamin should children be given if diagnosed with measles?

vitamin A

when do measles symptoms occur after exposure?

7 to 14 days after contact

what are the white spots in the mouth called? that is associated with measles, and when do they occur?

koplik spots occurs 2-3 days after symptoms begin

how does the rash of measles begin?

rash begins at the hairline with flat red spots that spread down to the trunk and the rest of the body

west nile virus is spread by what method?

mosquito

what are environment protection agency (EPA) registered insect repellents?

DEET Picardin IR3535 oil of lemon eucalyptus paramethane diol (PMD) 2-undecanone

what insect repellents can't be used on children ages 3 and under?

oil of lemon eucalyptus (OLE) PMD

what are the three most common symptoms of meningitis?

fever headache stiff neck

what are symptoms meningitis?

fever headache stiff neck nausea vomiting photophobia AMS-confusion

in babies with meningitis what is a physical sign that is an indicator?

bulging anterior fontanelle

at what age should the MenACWY vaccine be given?

at 11-12 years

how is hepatitis A transmitted?

fecal oral route

what are some risk factors for hepatitis A?

prisons, nursing homes, day care centers, poor sanitation. contaminated food or water, raw shellfish, foods, veggies, other uncooked foods that may have become contaminated in handling

what are some viral causes of hepatitis?

CMV,EPV, herpes virus, rubella, varicella-zoster, yellow fever virus, hep a-e

how is hep B transmitted?

through blood or body secretion sexual contact

how is hep C transmitted?

through IV drug use, needlestick injury

which hepatitis has the longest incubation period?

hepatitis B 12-14 weeks

when does the immunoglobulin IgM antibody occur?

appear at about 4 weeks

what is the diagnostic gold standard for acute hepatitis A?

IgM anti HAV

what is the first test to order when hepatitis B is suspected?

HBsAg (hepatitis B surface antigen)

Hepatitis A vaccine is available for children at what age?

At 1 year or 12 months

when is HBsAg elevated?

upon acute hepatitis diagnosis and chronic state if chronic state-refer to hepatologist