Infectious disease Flashcards
How do you dx CMV and treatment?
Inclusion bodies on smear and pos IgM. Symptomatic treatment. Gancyclovir tx but side effect neutropenia.
What is cytomegalovirus?
A mono like virus (fever, malaise, leukopenia, increased lymphs) WITHOUT pharyngitis. Member of the herpes family. Leading cause of blindness in AIDS patients.
What is EBV?
Member of the herpes family. Transmitted by saliva. Fever, pharyngitis, malaise, lymphadenopathy, fine lacy rash, splenomegaly.
Lab testing and treatment of EBV?
Lymphocytosis with atypical lymphs. Screening test…. Positive herterophile antibody or mono spot. VCA-IgM is best test for primary infection. Treat with supportive care.
Describe erythema infectiosioum. Cause, presentation, treatment.
Fifth disease. Caused by parvovirus B19. Malaise, headache, slapped cheek rash and macular papular rash on trunk, no palms or soles. Treatment supportive care.
What is a rash of grouped small vesicles on an erythematosus base?
Herpes simplex.
Describe the process of herpes type 1.
Any mucosal surface. Painful lasts 5-10 days. Burning then lesions.
Describe herpes type 2.
Genital herpes. 5 day incubation after exposure. Painful multiple lesions. Paresthesias noted 12-24 hrs before lesions.
What is the lab test for herpes?
Tzank smear.
Treatment for herpes simplex?
Acyclovir. IV for encephalitis.
Describe influenza and the clinical presentation.
RNA virus. Spread by respiratory droplets. Incubation is 1-3 days. Patient presents with abrupt fever, myalgia, headache, nonproductive cough. Look sick but exam normal. WBC may be low.
Where is influenza A found?
Institutional settings.
Where is influenza B found?
Schools and military.
What is the treatment for influenza A?
Rimantadine or zanamivir. Antivirals MUST be given within 48 hrs!!! No later.
What is Reye’s syndrome?
Side eft of giving a child aspirin. No ASA for kids with viral infections!
Describe mumps.
Painful swollen parotid glands, fever, headache, malaise. Incubation 12-24 days, may have orchitis, oophoritis, pancreatitis. Dx with viral culture in saliva. Treat supportive or vaccine to prevent.
Describe rabies.
Rhabdovirus, transmitted by infected saliva. S/S: paresthesias, hydrophobia, rage. Convulsions, paralysis, thick muscle spasm, saliva.
Treatment for rabies exposure?
Wash and clean wound. Post rabies exposure immunization. RIG -full dose around wound (don’t give if previously immunized) then vaccine on day 0,3,,7,14,28. If previously immunized then vaccine on day 0,3.
What is roseola?
From herpes virus 6 & 7. Under age 5. High fever x 3 days then rash on trunk. Supportive care and fever control.
Roseola?
High fever x 3 days then rash on trunk.
What is rubella?
Systemic illness with lymphadenopathy 5-10 days before rash. Fever, then macula papular rash to face then trunk then extremities. May have Forcheimer spots. Complication include cataracts and deafness in congenital rubella. Treatment is immunization.
What are forchheimer spots?
Petechial lesions on the soft palate found in rubella
Rubella?
Lymphadenopathy then fever and rash on face then trunk then extremities.
Describe rubeola? (Measles)
Transmitted by infects droplets, prodrome of coryza, cough, conjunctivitis then fever AND rash. Brick red macula papular rash on face the trunk then limbs. Treatment is symptomatic and isolate 1 week after rash gone. Has koplik’s spots.
What s a koplik’s spot?
White or blue grey lesions on a red base opposite a molar, found in rubeola ( measles)
Describe acute varicella (chicken pox).
Starts with fever and malaise, then a puritic papular rash appears. First lesions is dewdrop on a rose petal. lesions at any stage at any given time
What is the most common complication of varicella?
Bacterial infection.
Treatment for varicella?
Supportive, antivirals, immunoglobin in a pregnancy or immunocompromised.
Who get the zoster vaccine?
Anyone I’ve the age of 60 gets vaccine once.
What is the most common opportunistic fungal infection?
Candida
What is thrush?
Oropharyngeal candida infection. White plaques on buccal mucosa with. Erythematous base.
Describe a cutaneous candida infection.
Erythematous lesions with distinct borders and satellite lesions.
How do you diagnose candida infection?
KOH
Treatment for candida infections?
Azoles….. Fluconazole in AIDS. Bad fungal infection? Amphotericin B.
What causes the most fungal meningitis?
Cryptococcosis.
Describe cryptococcosis.
Most common in immunocompromised patients. Fungal meningitis. Looks like bacterial meningitis with headache, mental status changes, meningismus, visual abnormalities.
What does cryptococcosis look like on lab tests?
CSF: decreased glucose, increased WBC. India ink prep.
Treatment for cryptococcosis?
Amphotericin B plus flucytosine.
Histoplasmosis buzz words?
Mississippi and Ohio river valley, bird or bad dropping, caves, causes respiratory illness.
What does the CXR look like in histoplasmosis?
Pneumonia with miliary pattern,
Torment of histoplasmosis?
Itraconazole - mild to mod
Amphotericin B - severe
Buzz words for coccidioidomycosis?
SoCal to Texas, pulmonary sx and arthralgias. Dx by culture. Tx: fluconazole or Amphotericin B
What is the most common vector borne infection in the US and the bug that causes it?
Lyme disease caused by borrelia burgdorferi.
Lyme disease is common when and where.
New England and Wisconsin in summer months hiking or camping.
Describe stage 1 of Lyme disease.
3-30 days after tick bite. Flu like symptoms, headache, malaise, classic rash of target lesion (erythema migrans).
Describe stage 2 of Lyme disease.
Weeks to months later: Bell’s palsy, AV block, meningitis
What happens in stage 3 of Lyme disease?
Migratory polyarthritis.
What is the lab test for Lyme disease?
ELISA
Treatment for Lyme disease?
Doxycycline. If serious heart or neuro sx the IV rocephin
What causes Rocky Mountain Spotted Fever?
Tick infected with rickettsia rickettsii.
What is the classic triad of RMSF?
Abrupt headache, fever, rash.
Describe the rash of RMSF.
Red macular rash on palms and soles, then moves center.m
What is the treatment of RMSF?
Doxycycline
What does treponema pallidum cause?
Syphilis
Describe the sx of primary syphilis.
PAINLeSS ulcer on genitalia resolves after 3-6 weeks. Enlarged regional lymph nodes.
What is the best lab test to detect syphilis?
FTA-ABS, then RPR.
Treatment for syphilis?
Penicillin, second is doxy.
Describe secondary syphilis.
4-8 wks after chancre. Generalized maculopapular rash on palms and soles. Fever, malaise, arthritis. Treat with PCN.
Describe tertiary syphilis.
Tumors of the skin, bones, liver. Aoritis, aneurysms, CNS dosirders. Treat with PCN.
What is neuorsyphilis?
Can be noted at any time during course of disease. Meningitis may present with HA, nausea, stiff neck, cranial nerve palsy, hearing loss. May also have seizures. Argyll Robertson pupils common. Treat with PCN.
What are argyll Robertson pupils?
Small irregular pupils that react to accommodation but not to light. Common in neuorsyphilis.
What are the clinical features of Tb?
Fever, chills, night sweats, anorexia, wt loss, fatigue, chronic nonproductive cough, hemoptysis.
Gold standard lab for TB?
Acid fast bacillus culture! (AFB culture)
Treatment for latent TB?
INH x 2/wk for 9 months, rifampin Qday x 4 months
INH side effects?
Hepatitis, peripheral neuropathy….. Give with Vitamin B6!!!
Rifampin side effect?
Orange body secretions
What is MAC? (Mycobacterium Adium complex)
Seen in HIV patients. Causes dissiminated and pulmonary dz. fever, wt loss, anorexia, diarrhea. Dx: blood cx.
Treatment: TB tx plus macrolyde (azithromycin)
What does mycobacterium leprae cause?
Leprosy. Skin lesions and peripheral nerve involvement. Treat with rifampin for months to years.
What causes amebiasis (amebic dysentery) ?
Entamoeba histolytica. Fecal to oral transmission, travel to Central America. Causes colitis, abdominal pain, BLOODY diarrhea. Lab: PCR and O&P.
Treat with metronidazole
How is giardia spread and how do you treat it?
Contaminated water, fecal to oral. Sx: foul smelling, green diarrhea, abdominal pain.
Dx: O&P, serology
Tx: metronidazole
Metronidazole GETS parasites.
Giardia, entamoeba, triconoma
Where is the hook worm found?
Moist tropics and southeast US.
Life cycle of a hook worm?
Penetrates skin. Migrates to lung, ciliary action brings to mouth and swallowed. Moves to upper bowel, matures and releases eggs.
Symptoms of hook worm infection?
Skin: itch
Lungs: dry cough, blood tinged sputum
GI: anorexia, diarrhea, abdominal pain
Treatment for hook worm.
Albendazole.
Describe infection of round worm (ascaris).
From contaminated soil, reside in small intestine. Usually asymptomatic,, may have fever , cough, GI distension.
Treat with albendazole or mebendazole.
Signs and symptoms of malaria?
Fever, chills, sweating, headache, myalgias, splenomegaly, anemia and leukopenia.
How do you diagnose malaria?
Parasite in blood, thick then thin smear.
Malaria types by fever?
Fuck - falciparum continuous
My - malariae every 72 hrs
Oven - ovale every 48 hrs
Viv - vivax every 48 hrs
Treatment for malaria?
Varies with plasmodium species…. If they don’t say chloroquine resistant then PICK IT! ( or hydroxychloriquine)
Mefloquine is an option for resistant.
Life cycle of a pin worm?
Adults inhabit the cecum, females migrate to anus to lay eggs, patient. Auto infects, eggs hatch I. Duodenum.
S/s of pin worms!
Perianal pruritus especially at night. No eosinophilia cause not invasive. Scotch tape test.
Treatment: mebendazole single dose, repeat in two weeks and treat entire family.
What is the host of toxoplasmosis?
Cats!
S/s of toxoplasmosis?
Asymptomatic in immunocompetent patients.
Fever, malaise, headache, cervical lymphadenopathy, arthralgias, stiff neck, sore throat.
Labs for toxoplasmosis?
IgM antibodies and ring enhanced lesions with contrast on Brain CT.
Treatment for toxoplasmosis?
Pyrimethamine + folic acid + sulfa diazinon or clinda…. Avoid cat litter!
Who gets pneumocystis jirovecii infections?
AIDS patient s with CD4 count less than 200.
Symptoms of Pneumocystis jirovecii?
Fever, chills, sweats, fatigue, dyspnea, nonproductive cough.
CXR for patient patient with p. Jirovecii?
Bilateral diffuse interstitial disease without hilar adenopatny, apices spared.
How do you dx and treat pneumocystitis jirovecii?
Bronchoalveolar lavage and special lung tissue stains. Bactrim
Buzz word: cholera.
Acute grey rice water diarrhea. Crowding famine. Stool cx, treat with fluids and doxy.
Young patient with single red hot joint consider…..
Gonococcal infection
Describe s/s of gonococcal infection.
Purulent urethral/cervical discharge, fever, Monoarticular arthritis (knee, ankle, wrist)
Lab test and treatment for gonorrhoeae.
Gram stain and culture, don’t forget HIV and RPR.
Treat with IM rocephin and treat for chlamydia (azithromycin or doxy)
Salmonella buzz words:
Contaminated eggs, milk, reptiles. Pea soup diarrhea (no blood) 12-48 hrs after ingestion Rose spots on trunk Stool cx pos Tx: fluids, fluroQuinolones
Watch for this in sickle cell patients with salmonella.
Osteomyelitis.
Shigella buzz words:
Causes infectious colitis Fecal to oral - day cares Toxic appearing with bloody diarrhea Stool culture pos Tx: ciprofloxacin
E. Coli o157:H7 buzz words:
Undercooked hamburger, milk, bean sprouts
Bloody diarrhea and HUS (schistocytes)
Supportive care…. No ABX!
What causes botulism and what are the signs and symptoms?
Ingestion of home canned foods, honey in kids.
Sudden onset of cranial nerve paralysis
4 D’s: diplopia, dysarthria, dysphagia, dysphonia.
Floppy baby syndrome. Fixed and dilated pupils.
Children: irritability, weakness, hypotonicity
Diagnosis and treatment of botulism?
ID toxin in serum or food.
Tx: remove toxin from gut via lavage, antitoxin.
What is diptheria and how does it spread?
Gram pos bacillus, spreads via respiratory droplets.
S/s of diptheria?
Sore throat, fever, discrete white exudate in throat that bleed when removed. Marked cervical adenopathy with bull neck appearance.
Treatment of diptheria?
Antitoxin, penicillin or erythromycin
What causes tetanus and the symptoms of infection?
Clostridium tetani in the soil, incubation 5 days to 15 wks… They will have hx of a wound. Affects neurotransmitter. Symptoms are stiff neck and other muscles (trismus), dysphagia, irritability, hyper reflexes.
What is the treatment for tetanus?
Supportive care and would cleaning.
Immunization, penicillin,
Benzos for muscle spasm.
Tetanus wound management:
Unknown status or = 3 doses:
Clean wound: Tdap, dirty Tdap and TIG
None.
How does HIV work?
Retrovirus that changes viral RNA to viral DNA with the aid of reverse transcriptase. Acute infection is like the flu.
What is the conformation test for HIV?
Western blot
What is the screening test for HIV?
eLISA
What is a normal CD4 count?
1,500-700
Infection at CD4 count less than 500?
Lymphadenopathy
Infection of HIV in CD4 between 500-200?
TB! Thrush, zoster, lymphoma, kaposi
HIV infection at 200-100 CD4?
PCP, histoplasmosis
HIV infection at Cd4 of 50-100?
Toxoplasmosis, cryptococcus
Infection of HIV with CD4 less than 50?
MAC, PML, CMV retinitis
What are the guidelines for starting HIV treatment?
CD4 less than 350 or viral load greater than 55,000
Never start an agent by itself!!
What is zidovudine?
HIV NRTI drug (AZT) with side effect of bone marrow suppression.
Common NNRTI in HIV treatment?
Nevirapine, causes rash
Common protease inhibitor drug for HIV treatment?
Atazanavir, ritoavir
All cause nausea, vomiting diarrhea
List the gram positive cocci.
Staph
Strep,
pepto streptococcus
List the gram positive rods.
Corny bacterium Listeria Anthrax Lactobacillus Bacillus Propionibacterium
Los the gram negative cocci.
Neisseria
List the gram negative rods.
E. Coli, salmonella, shigella, moraxella, h. Flu Klebsiella Enterobactor Pseudomonas Proteus
