infectious disease 2 Flashcards
rocky mountain spotted fever vector
Dog ticks
clinical features + lab features of rocky mountain spotted fever
- fever, headache, rash
- rash beginning in ankles and wrists
- thrombocytopenia, mild transaminitis, ***hyponatremia
rocky mountain spotted fever treatment
doxycycline
rocky mountain spotted fever geography
South central and southeast states
most all tic borne diseases are treated with
doxycycline
treatment of complete heart block from lyme disease
CTX
- NOT pacemaker
only tic borne disease not treated with doxy
babesia (parasite, not TIC)
treatment of babesiosis
azithromycin + atovaquone
most common cause of transfusion related infection in US
Babesiosis
anaplasmosis lab features
- thrombocytopenia + elevated liver enzymes + leukopenia
* morulae in granulocytes
diseases with black legged tick as vector
- Babesiosis
- Anaplasmosis
- Lyme disease
ehrlichiosis lab features
- Thrombocytopenia + elevated liver enzymes
- morulae in monocytes
anasplasmosis vs. ehrlichiosis
murulae are in monocytes in ehrlichiosis, granulocytes in anaplasmosis
Unique clinical features of dengue fever
- after inflating BP cuff, petechia are present
- headache localized behind the eyes
Chikungunya clinical features
- severe polyarthralgia affecting small distal joints
other clinical + lab features of dengue
- joint pain
- macular rash sparing palms and soles
- leukopenia
- elevated liver enzymes
norovirus clinical features
- outbreaks in nursing home
* *Vomiting predominant, rather than diarrhea predominant
most common cause of traveler’s diarrhea
ETEC
deli meats, unfermented
listeria
reheated rice syndrome pathogen
bacillus
rapid onset vomiting after eating potato salad
staph aureus
swimming in recreational facility with treated water with treated water
cryptosporidium (not killed by chlorine)
unpasteurized milk pathogen
brucellosis
direct exposure to TB or recent TB contact cutoff
greater than 5 mm
Caveat about treating TB for patients on warfarin
Can’t use rifampin or rifapentine
TB drug least likely to cause LFT elevation
ethambutol
organisms requiring airborne precautions
TB
VZV
measles
SARS
hanta virus clinical features
see memory palace
francissela tularemia clinical features
- Francis has wings on + is sweating profusely + has a ulcer like below on his hand/variable presentation severe febrile pulmonary infection OR ulcerative disease at inoculation site).
cutaneous larva migrans clinical features
parasite living in intestines of dogs + larvae in sandy soil + red intensely pruritic eruption that looks like twirling lesions
Lyme disease treatment
doxycycline
Lyme disease treatment if neurologic or cardiac involvement
CTX
Management of patient testing PCR positive for anaplasmosis and treated with doxy but fails to improve
- likely has babesiosis, treat or babesiosis
babesiosis treatment
azithromycin + atovaquone
Cryptosporidium watery or bloody diarrhea
watery
salmonella watery or bloody diarrhea
bloody
campylobacter watery or bloody diarrhea
bloody
cyclospora watery or bloody diarrhea
watery
Shigella watery or bloody diarrhea
bloody
Enterobacter watery or bloody diarrhea
bloody
Chitlins (chitterlings) + association
- pork intestines
- yersinia
Yersinia watery or bloody diarrhea
bloody
yersinia clinical features
Ben is there in a bathtub next to her dancing around/causes acute diarrhea or pseudoappendicitis (right lower abdominal pain due to mesenteric adenitis and/or terminal ileitis). + bloody diarrhea
Yersinia treatment
supportive care
Shigella clinical features
Shitting into bucket + Spenser’s sweating profusely + eyes super sunken in/causes bloody diarrhea + abdominal pain + high fever + severe dehydration.
Other clinical associations of anthrax
- exposure to animal hair, hides
- mediastinal widening on CXR
Parapneumonic effusion vs. empyema or complicated parapneumonic effusion
Parapneumonic effusion = effusion in pleural space.
*Complicated parapneumonic effusion and empyema occur when bacteria infect the pleural space
Empyema definition
Collection of pus within the pleural space
Complex effusion definition
effusion with internal locations
initial treatment of invasive aspergillosis
voriconazole
Other distinguishing features of conjunctivitis
Bacterial = purulent discharge Viral = viral prodrome, other viral URI symptoms Allergic = itching of eyes, nasal congestion, sneezing, wheezing
botulism presentation
Gram is stuffing sword down throat + he has big headphones on + he has eyes in is forehead/is four-eyed (diplopia code) + duck tape over his mouth + darts all over his body/classic presentation = 3 D’s: diplopia + dysphagia + dysphonia + skeletal muscle weakness + dysarthria (*key to differentiating presentation from anticholinergic effects). Also, dry mouth + mydriasis.
Treatment of botulism
Antitoxin
Timing of antiviral therapy for VZV
- Start therapy within 72 hours of onset
- IF after 72 hours, only start antiviral therapy if new lesions are appearing (indicating ongoing viral replication)
Treatment of varicella
acyclovir, valacyclovir, famciclovir
HPV vaccination age
11-26 (can be administered starting at age 9)
*after age 26 on individual basis, recommended if new sexual partners.
Chagas disease presentation
massive colon hanging across top of courtyard + huge Mr. Farrington with the top of his head cut off + Massive head with esophagus + huge ureters hanging from courtyard and dripping piss/presentation = dilated cardiomyopathy with apical atrophy + megacolon + megaesophagus + megaureter (all by below pathophys mechanism) + achalasia. His right eye is swollen like below/unilateral periorbital swelling (Romana sign) characteristic of acute stage.
Haemophilus ducreyi (Chancroid) presentation
Walls of room covered in grey and yellow exudate + shenk with a painful, draining abscess on his dick/multiple and deep ulcers + base may have gray to yellow exudate. Draining buboes.
Pasteurella multocida clinical features
- Location: kitchen at M&D’s house
- Picture the nipper/kuma with eye glasses on/looking like louie Pasteur + he’s biting dad in the calf causing a large skin abscess + an eel in dad’s leg/part of normal flora in cats and dogs and bits cause skin abscesses + cellulitis + osteomyelitis.
Pasteurella multocida treatment
Terry is fucking kuma in the butt/treat with penicillin.
leprosy treatment
Nate at the top of a ramp + daphne doing a dab + chloe from Dartmouth as a centar/treatment = dapsone + rifampin AND add clofazimine.
Nocardia treatment
- Location: asteroid
- Jan playing a DJ set/treat with sulfonamides (TMP-SMX).
Nocardia clinical features
- Big caves all around asteroid with Neil walking out of them + magic Johnson with wings flying next to helicopter/pulmonary nocardiosis occurs in immunocompromised + can present as cavitary pneumonia and is commonly confused with TB.
- Big holes/depressions in her head + circular rays of light coming out of her head/imaging reveals abscesses in brain (ring-enhancing focal lesion).
presentation of MAC + imaging
- similar to TB (cough, fever, *weight loss)
- typical occurs in patients with underlying lung disease but can also occur in absence of prior lung disease
- nodular or cavitary opacities
- HRCT: multifocal bronchiectasis + small nodules
Treatment of pulmonary MAC
combination therapy with clarithromycin + ethambutol + rifampin
pulmonary MAC diagnosis
2 positive sputum cultures
OR
1 bronchial lavage wash with positive culture
OR
bronch with lung biopsy with histopathological features of mycobacterial infection and positive culture
Differential + management of patient with positive RPR titer after treatment for syphilis
- reinfection vs. inadequate treatment vs serofast reaction
- IF titer significantly decreased –> prob serofast reaction, so repeat RPR in 6 months to make sure its stable and not rising + check HIV
- IF failure to fall 4 fold or persistent symptoms – LP to rule out neurosyphilis
IF reinfection (new parters or new symptoms) – treat again
epidemiology of blastomycosis and histoplasmosis
Both in Mississippi and Ohio River Valley
- Blasto more in Midwestern US
Blastomycosis clinical features
- cutaneous plaques/ulcerations
- bone lesions with sinus tracts
- pulmonary involvement (cough, dyspnea)
- GU involvement (epididymo-orchitis)
Coccidioidomycosis clinical features
- skin lesions
- lymph node involvement
- meningitis
Treatment of blastomycosis
IF mild to moderate – itraconazole
If severe – amphotericin B
Other clinical feature of histoplasmosis
Pulmonary involvement with hilar or mediastinal adenopathy
antibiotic regimen for patient who is flu positive with superimposed PNA
Azithro + CTX + vanc
(cover for strep and staph)
*just add vanc
Treatment of jarisch-herxheimer reaction
- supportive (tylenol, NSAIDS, IV fluids) (self-limiting)
Management of bell palsy
- prednisone ASAP
clinical features of meningococcal meningitis
- severe myalgia
- rapid deterioration within 22 hours of symptom onset
- nonspecific: fever/HA/vomiting
- specific: petechia, meningeal signs, AMS
treatment of meningococcal meningitis
CTX
*chemoprophylaxis for close contacts
isolation precautions for meningococcal meningitis
droplet precautions
chemoprophylaxis for contacts of meningococcal meningitis infected patients
Rifampin + cipro + CTX
P jirovecii pneumonia presentation + imaging
- subacute: dyspnea, dry cough, fever
- similar to TB: weight loss, headache, night sweats
- immunocompromised patient
- high LDH
- imaging = interstitial infiltrates + can have cavitary lesions
- can have spontaneous PTX
parvovirus presentation
- asymptomatic or flulike
- acute symmetric arthralgia (hands, wrists, knees and feet (resembling RA)
syndrome caused by parvovirus in SCD patients
- pure red cell aplasia
parvovirus diagnosis
*IgM (a lot of people have IgG from previous infection, which documents immunity)
acute rheumatic fever presentation
- fever + migratory arthritis involving large joints + chorea + erythema marginatum + pancarditis + subcutaneous nodules
mono presentation
fever + pharyngitis + LAD + atypical lymphocytosis
Toxo plasmodia treatment in HIV patients
pyrimethamine + sulfadiazine + *leucovorin (pyrimethamine is a folic acid antagonist)
Drugs that interfere with folic acid metabolism
- MTX
- phenytoin
- pyrimethamine
- trimethoprim
west-nile encephalomyelitis presentation
- patient in hot, humid weather in summer
- *Asymmetric flaccid paralysis
- Extrapyrimidal symptoms
- maculopapular rash (20-50%) in chest, arms, back
- can have parkinsonism symptoms (rigidity)
Post-polio syndrome clinical features
- history of paralytic polio, then develop worsening of previous weakness later in life
- weakness, fatigue, muscle, or joint pain (no infectious symptoms)
lung abscess clinical features + CXR findings
- fever, night sweats, weight loss, cough with foul-smelling sputum
- *weeks or months of above symptoms
- cavitary lesion with air-fluid level
first-line treatment of lung abscess
Ampicillin-sulbactam
OR
carbapenem
*clinda no longer recommended due to risk of treatment-associated Cdiff
*bronch not required (unlike other abscesses, lung abscesses don’t require drainage and frequently respond to antibiotics)
*treat until repeat CXR is clear or shows small, stable residual lesion
