Infectious Disease Flashcards
Active Hep B infection
- Start with surface antigen
- Then IgM CORE antibody becomes positive (actual infection)
- e-antigen POSITIVE–>indicates active viral REPLICATION (this is what determines vertical transmission to baby)
Chronic when surface ANTIGEN positive greater than 6 mo
Resolved past Hep B infection
- IgG CORE antibody positive (actual infection)
- Surface antiBODY positive (past infection
- e-antigen negative (viral replication no longer active)
- surface antiGEN negative–NO longer infectious
Hep B vaccination
-surface antiBODY positive
Treatment of n. gonorrhea
Cefixime/ceftriaxone PLUS azithromycin or doxycycline (also cover chlamydia)
same for urethritis, cervicitis (strawberry cervix), and PID
Treatment of chlamydia
azithromycin or doxycycline
same for urethritis, cervicitis, and PID
Primary syphilis
painLESS genital ulcer
painLESS lymphadenopathy
Tx: IM penicillin
Secondary syphilis
rash on PALMS and SOLES
alopecia areata
condylomata lata
Tx: IM penicillin
Tertiary syphilis
neurosyphilis-meningovascular stroke from vasculitis
tabes dorsalis (loss of position and vibratory sense, incontinence)
Argyll robertson pupil (loss of light rxn, but accomodates)
Aortitis
Gummas
Tx: IV penicillin
risk: Jarisch Herschheimer-fever/worse symptoms after tx-give apsipirn/antipyretic-it will pass
Treatment of crabs (pediculosis) or scabies
permethrin
Pregnant woman UTI or asymptomatic bacteriuria
Nitrofurantoin or amoxicillin (3 days if uncomplicated)
NOOOOOO!!!!! to bactrim and fluoroquinolones (cipro)
Strep bovis
endocarditis in person with colon cancer
Endocarditis
either abnormal valves (regurg/stenosis/prosthetic) OR injecting drug use (STAPH aureus)
fever + murmur or change in murmur and/or positive blood cultures
splinter hemorrhages, Janeway lesions (flat, painless), Osler nodes( raised, painful), mycotic aneurysms in brain, conjunctival petechiae, splenomegaly, septic emboli to lungs
best dx: blood culture, TEE more sensitive but also TTE
best empiric therapy: vancomycin + gentamicin
SURGERY only: valve rupture, chordae tendonae rupture, CHF, prosthetic
Culture negative endocarditis
most common-coxiella and bartonella
HACEK- Haemophilus aphrophilus, Haemophilus parainfluenzae, Actinobacillus, Cardiobacterium, Eikenella, Kingella
- oscillating vegetation on Echo
- prosthetic valve or injection drug use
- evidence of emboli
Tx: ceftriaxone
Prophylaxis with endocarditis
required if:
1- significant cardiac defect (prosthetic valve, unrepaired cyanotic lesion, transplant, previous endocarditis)
AND
2-Risk for bacteremia (dental work with BLOOD, resp tract surgery)
NOT for endoscopies, ob/gyn, prostate biopsy
NOT for mitral valve prolapse, mitral regurg, mitral stenosis, aortic stenosis, ASD
Lyme
Borrelia burgdorfi carried by Ixodes scapularis tick target lesion (erythema migrans), fever, oligoarthritis (esp knee), Bell palsy (7th CN), myocarditis, ventricular arrhythmia,
Dx: if rash consistent-no test, serolgy for other manifestations
Tx: doxycycline unless cardiac or more severe neuro–> ceftriaxone
Prophylaxis-single dose doxycycline ONLY when:
- endemic area
- tick attached for 24-48 hours
- definitely ixodes scapularis
Otherwise NO tx for asymptomatic tick
HIV- important CD4 levels
normal- 600-1000
start treatment: 200: TB HSV, varicella, Kaposi sarcoma
200-PCP
opportunistic infections-mostly at
Best initial HIV treatment
emtricitatbine, tenofovir, efavirenz
HIV transmission risk
anal>needle stick>oral>vaginal
25-30% maternal child without treatment
Prevention of Perinatal transmission
either continue existing treatment or start treatment (not teratogenic efavirenz)
mom may stop treatment following delivery if CD4 count high and viral load low
baby given intrapartum zidovudine and for 6 weeks following delivery
delivery: can do vaginal but MUST be C-section if
- CD4 below 350
- very high viral load (>1,000)
Disease prevention in HIV
New dx–> PPD with threshold of 5mm and chest x-ray if positive, if negative CXR–>latent–>INH 9 months
PCP prophylaxis with bactrim when
Meningitis-Bacterial Treatment
Treatment based on CELL COUNT
Thousand of neutrophils-start with ceftriaxone, vancomycin and steroids
add ampicillin for listeria if elderly/immunocompromised/pregnant etc
Meningitis-Viral treatment
suspect when lesions in temporal lobe, olfactory hallucinations, seizures
CELL COUNT–high lymphocytes in CSF
–>IV acyclovir
Rocky Mountain Spotted Fever
Rickettsia rickettsiae
fever, maculopapular rash on hands and feet, myalgias, headache, nausea
transmitted by dermacanter ticks-in US mostly south central and southeastern states
Most common overall cause meningitis (18-60 and 60+)
strep pneumo
other: n. meningitidis, listeria
gram - rods in elderly over 60
