Infectious disease Flashcards
Blastomycosis
Soil exposure along Ohio River Valley
Asymptomatic or pulmonary sxs
Dx: Biopsy
Tx: itraconozole / amphotericin B
Cocciodiomycosis
“San Joaquin Valley Fever”
Flu like illness, cough, night sweats
Tx: generally none unless severe
Pneumocystosis
Pneumocystis jirovici (carinii)
AIDS/ immunocompromised
Fever, cough, hypoxia out of proportion to exam
Cxr: interstitial infiltrates
Tx: TMP-SMX
Cryptococcosis
AIDS/ immunocompromised
Fungal meningitis
INDIA INK STAIN
Refer
Candidiasis
Vulvar itching and erythema with white curdy discharge
KOH : Hyphae
Tx: -conozole cream
Malaria
Chills, fever, sweats
Thick and thin blood smears
Travel hx
Mefloquine (malarone) prophylaxis
Toxoplasmosis
Pregnant lady handling cat litter
HA, AMS, seizure
Head CT w ring enhancing mass lesions
Tx: refer
Varicella zoster
Transmit w/ Respiratory secretions and not so much by contact w vesicles
First exposure : chicken pox
Reactivation: shingles (herpes zoster)
Herpes zoster tx: valcyclovir. /
IV acyclovir if serious
Ebstein Barr Virus
Mono
Rash when given amoxicillin
+monospot
Tx: supportive, no contact sports due to risk of splenic rupture
Cytomegalovirus
Similar to Mono!
Transmitted sexually usually or respiratory secretions
#1 cause for AIDS associated blindness Igm/IgG testing
Tx: ganciclovir
Herpes virus 8
Kaposi’s Sarcoma
Red purple Macules papules nodules
AIDS pts
Rabies
Bite wounds from bats
99% fatal if not treated
Tx: clean wound, infiltrate human rabies immune globulin (HRIG) around wound , then give rabies Vaccine 4 injections
HIV
“Mono like illness”
Rash 40-80%, mucocutaneous ulceration distinctive feature
Screening test : ELIZA
Confirmatory test: Western Blot
Tx: combo of at least 3 drugs emtricibine, tenofivir, efavirenz anything ending in –navir like lopinavir
HIV
opportunistic infections and treatment
Pneumocytosis CD4
Tetanus
Hyper-reflexia
Trismus – “lock jaw”
Tx: supportive care
—–Beta blocker can help
Botulism
Home canned foods
Honey
Wounds - black tar heroin
Tx : admit. Intubation if needed. Needs Botulinum Antitoxin
Lyme disease
Stage 1 : Erythema migrans, Bell’s palsy
Stage 2: AV block 5%
Stage 3: Chronic arthritis
Doxycycline 14-21 days
Rocky Mountain Spotted Fever
Flu like illness prodrome
Red macular rash on wrists / ankles and spreading centrally, then turns petechiael
Tx: doxycycline
Ehrlichiosis // anaplasmosis
Fever / chills, HA, myalgias
Hallmark:: Leukopenia and thrombocytopenia
Rash—- typically involves trunk, spares hands / feet and not associated with tick bite area
Tx: doxy (even KIDS)
Trichomoniasis
Frothy green discharge
colpitis macularis =Strawberry cervix
Tx: metronidazole
Gonorrhea
Gram negative diplococci
Dx: DNA - nucleus acid testing NAAT
Tx: ceftriaxone 250 IMx 1
Plus Azithromycin 1G po x 1
Chlamydia
Asymptomatic usually
Can have reactive arthritis
Tx : Azithromycin 1g PO x 1
Syphillis
Painless ulcer - chancre
Generalized rash + palms and soles
Dx: VDRL / RPR –> confirm FTA-ABS
Tx: benzathine PCN x 1 dose
Chancroid
Painful “ragged” ulcer with fluctuant inguinal adenitis “bubo” is pathognomonic
Tx: ceftriaxone 250mg IM x 1or Azithromycin 1g po x 1
HSV 1 associated with what neurological problem ?
Bell’s palsy , CN VII
HSV 2
Dx: PCR
Tx: acyclovir
> 6x / yr. –> valcyclovir
HPV 6 / 11
Genital warts
Anorectal warts- condylomata acuminata – associated with cancer
HPV 16 and 18
Most common world wide 70%
Risk of cervical cancer
Also associated with other cancer
Vaccine : gardasil 6/11/16/18
Cervarix 16/18 only girls
Osteomyelitis
Staph aureus
Blood cultures / bone biopsy if needed
Tx: IV antibiotics for 4-6 weeks
Infectious arthritis
Joint infection
Common: Staph aureus
Common in young sexually active F»M : gonorrhea
Tx: ceftriaxone + doxycycline together
Infective endocarditis pathogens
Left sided: most common
Right sided: staph aureus with IV drug use usually
Native valve :: strep viridans, enterococcus, staph aureus, HACEK can cause false negative culture
Prosthetic valves: staph aureus -septic
Strep if subacute
Infective endocarditis diagnosis
Blood cultures
Echo is gold standard
DUKE criteria : oslers nodes (ouch), janeway lesions, splinter hemorrhages
Infective endocarditis treatment
Vanco + ceftriaxone
Vanco + gentamicin
Infective endocarditis prophylaxis
Amoxicillin 2g PO x 1 30 min prior to procedure
Allergy: cephalexin 2g PO
Meningitis
Acute, life threatening CNS infection
—-Bacteria in Subarachnoid space causing inflammation of brain
Bacterial:: Strep pneumoniae is the worst with high mortality
Aseptic:: enterovirus like coxsackievirus summer and fall
Meningitis pathogens in baby
S. Agalactiae
E. coli
Meningitis pathogens
1month -50years
Treatment??
S. Pneumo
N. Meningitidis
H. Flu (less common now)
Tx: ceftriaxone + vanco +/- ampicillin
** give with dexamathasone
Meningitis pathogens
> 50 years
Strep pneumo (bad with high mortality)
Meningitis CSF
High opening closure High cell count (100-1000s) Usually + PMNs Low glucose High protein
***basically high everything, but glucose (eaten by bacteria)
Erysipelas treatment
Streptococcal spp. (Group A,B, or C) more likely than staph
Tx: mild: Pen VK
mod-severe: cefazolin 1-2g q8 IM/IV or ceftriaxone 1g IV/IM
Cellulitis
Strep more common than staph
Tx: penicillin, cephalexin, cefazolin,
Folliculitis
Staph aureus hair follicle infection and apocrine glands
Tx: warm compress and mupiricin
Hot tub : pseudomonas
Tx: warm compress and anti-pruritis meds, no antibiotics needed surprisingly
Furuncle
Boils
Staph / MRSA
I&D and anti-staph abx
Carbuncle
Multiple abscesses together separated by connective tissue in thick inelastic areas like thighs
Staph
Surgical I&D and abx
Necrotizing fasciitis
Cellulitis but with systemic symptoms out of proportion to exam
Tx: surgery!! Then abx.
Gas gangrene
What pathogen?
Usually cause from traumatic wound
*C. Perfringens
Has crepitus
Tx: surgical emergency
Cat bite
pathogen?
Tx?
Pasteurella multocida
Amoxicillin / clavulanate
(Or clindamycin or metronidazole )
Human bite
pathogen
Tx?
Eikenella
Amoxicillin / clavulanate
Most common viral gastroenteritis ?
Norovirus
Food poisoning pathogen ?
Staph aureus
Cholera
Rice water stool
Vibrio cholerae
Tx: IV fluids–hit hard!
Giardia
Most common parasitic infection causing diarrhea in US
Travel and camping
Shiga-toxins
E.coli 0157:H7
E.coli 0157:H7
Undercooked hamburger and almost any fresh food
Bloody diarrhea and severe abdominal pain , shiga-toxins
***HUS -hemolytic uremic syndrome and ARF
Antibiotics controversial
Treatment of C. diff
Metronidazole
Bloody diarrhea, abdominal pain, systemic toxicity
Associated with daycare
Shigellosis
Most common bacterial cause of infectious diarrhea
Watery, bloody diarrhea
Associated with raw chicken
Campylobacter jejuni
Treat with Azithromycin
Salmonella
Tx:
Undercooked eggs
Tx: fluoroquinolone
Histoplasmosis
Bird dropping / bat guano along Ohio River Valley
Asymptomatic or pulmonary sxs
Dx: biopsy
Tx: itraconozole / amphotericin B
