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Gen Med > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Infectious disease S/S

A
  • fever-chills
  • malaise, sweating, nausea, vomiting
  • inc leukocyte reaction
  • Pain
  • rash/skin lesions
  • red streaks
  • inflammation lymph nodes/joints
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2
Q

Special consideration- elderly

A
  • aging immune system
  • chronic diseases
  • extrinsic factors
  • underreport symptoms- atypical symptoms
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3
Q

what do we see in the aging immune system?

A
  • decr naïve Tcells
  • incr memory Tcells
  • decr proinflammatory cytokines
  • decr cell mediated immunity
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4
Q

Infection

A

Process of organism forming a parasitic relationship wi the host

  • -organism invades, producing an immune response by host
  • -cellular damage results from production of toxins, competition with host’s metabolism
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5
Q

colonization

A

microorganisms live together in host’s tissues with the host being asymptomatic

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6
Q

transmission of infectious pathogen depends on:

A
  • pathogen
  • environment
  • susceptibility of host
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7
Q

successful transmission may lead to…

A
  • destruction of pathogen (first line of defense-intact skin/mucous membrane)
  • subclinical infection-rise in antibody titer, but no clinical symptoms
  • infectious disease with one or more clinical symptoms
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8
Q

incubation period

A
  • time between initial entrance of pathogen into host to appearance of disease symptoms
  • varies from few days –> several months
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9
Q

latent infection

A
  • replicated pathogen remains dormant in host

- may be up to years before becoming active

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10
Q

communicable period

A
  • Pathogen can be shed and passed from host to host
  • directly vs. indirectly
  • varies with pathogen and disease
  • usually before S/S appear and may continue through disease and even extend into convalescence stage
  • asymptomatic host can pass the pathogen
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11
Q

Types of organisms: Viruses

A
  • RNA or SNA nucleus with protein coat
  • host dependent
  • interferes with cell metabolism, growth & reproduction
  • latent response
  • antibiotics vs anti-virals
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12
Q

Types of Organisms: Mycoplasms

A
  • bacteria with no cell wall/ small size
  • sensitive to some antibiotics
  • very small genomes
  • host dependent
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13
Q

Types of organisms: Bacteria

A
  • single-cell microorganism with cell wall

- demonstrates independent growth from host

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14
Q

Types of organisms: Rickettsiae

A
  • Primarily animal host
  • transmitted to humans via bite from insect vector
  • host dependent
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15
Q

Types of Organisms: Chlamydiae

A
  • host dependent
  • DNA and RNA
  • susceptible to antibiotics
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16
Q

Types of Organisms: Prions

A
  • composed of proteins
  • redirects folding of proteins in CNS
  • transmitted animal –> human
  • usually long, latent period in host
  • rapidly progressive when active
  • mad cow disease
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17
Q

Pathogen

A
  • any microorganism that may cause disease
  • viruses, mycoplasms, bacteria, rickettsiae, chlamydiae, protozoa, fungi, prions, roundworms
  • principal pathogens
  • opportunist pathogens
  • pathogenicity-ability to induce disease
  • virulence-quantitative measure of pathogenicity
  • ***# people who die of disease/ #people who have disease
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18
Q

Reservoir

A
  • environment for organism to live & reproduce
  • Human, animal, plant, soil, food, water, equipment, &/or organic substance
  • Possibly more than one at different growth stages
  • carriers can provide environment for parasite and shed w/o showing S/S of disease
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19
Q

portal of exit

A
  • the site of leaving reservoir
  • Commonly secretions, fluids, excretions, open wounds, exudates
  • possibly more than one portal
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20
Q

Mode of transmission

A
  • infectious organism–> susceptible host
  • may travel by more than one route
    1. contact : direct or indirect
    2. airborne: <5 microns in size
    3. Droplet: >5 microns falling within 3ft of source
    4. : vehicle: common source
    5. Vector: intermediary reservoir and host
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21
Q

Portal of entry

A
  • site where organism enters host
  • GI tract
  • respiratory tract
  • mucous membranes
  • genitourinary tract
  • skin
  • trans placental
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22
Q

Susceptible Host

A
  • has characteristics and behaviors that incr probability of infectious disease
  • general health
  • age, sex, ethnicity, heredity
  • existing disease processes
  • environment
  • behaviors
  • anything that compromises body defense/integrity
  • risk of starting an infection in host varies also to number of organisms and duration of exposure
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23
Q

First Line of Defense

A

-external protection- goal is to remove organism before it multiplies

  • intact skin/ mucous membranes
  • oil &perspiration on skin
  • flushing of secretions
  • cilia in respiratory tract
  • Gag/cough reflexes
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24
Q

second line of defense

A
  • inflammatory process
  • local response to cell injury/prevention of further invasion. Walling off invader leading to destruction

-facilitate internal defenses: Lymphatic system, leukocytes, chemicals, proteins, enzymes to trigger defenses

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25
Q

third line of defense

A
  • immune response
  • shares action with inflammatory response
  • specific to invading organism’s antigenic character
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26
Q

Control Transmission: Goal

A

-to break chain of transmission for particular pathogen at link where most people can be protected

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27
Q

Control Transmission: Methods

A
  • use of barriers, isolation, immunizations, drugs, proper nutrition, incr sanitation, address environmental factors
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28
Q

Isolation & Barriers

A

Center for disease control and the hospital infection control Practices advisory committee developed the CSC Guidelines for Isolation Precautions in hospitals

  • two-tiered approach
  • – standard precautions
  • –transmission-based precautions: contact, airborne, droplet
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29
Q

Standard Precautions

A

-Based on the premise that every person is infected with an organism that could be transmitted in any healthcare environment

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30
Q

transmission based precautions

A
  • For the care of patients known or suspected to be infected or colonized with infectious pathogens
  • in addition to standard precautions to control transmission
  • may be based initially on patient symptoms aand then modified once diagnosis is confirmed or ruled out
  • three categories: contact, droplet, airborne
  • may be combined for diseases that have multiple transmission routes
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31
Q

Clostridium difficile (C diff)

A
  • anaerobic, spore-forming bacillus
  • Spores can survive for months
  • primarily fecal - oral route
  • a leading cause of nosocomial infections
  • manifests as diarrhea, but can lead to fatal inflammation of colon
  • contact isolation
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32
Q

risk group for C diff

A
  • antibiotic user
  • > 65 yo
  • residing in room which housed C diff pt 10-14 days prior
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33
Q

treatment of C diff

A

flagyl, vancomycin, probiotics

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34
Q

Staphylococcal Infections

A
  • Bateria that normally resides on skin
  • A leading cause of nosocomial and community acquired infections
  • direct contact transmission-not easily removed by scrubbing
  • most common location for colonization is nares
  • hand washing/education
  • manifests as local abscess filled with pus and bacteria.
  • may lead to infection anywhere via bloodstream
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35
Q

staphyloccal infections risk group

A

-surgical/ burn pts, IDDM, neutropenic, prosthetics, chronic skin disease, RA, catheter, corticosteroid Rx

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36
Q

staphylococcal infections Pathogenesis

A
  • usually by traumatic inoculation

- once invades, secretes membrane-damaging enzymes and toxins

37
Q

Staphylococcal infections clinical manifestations

A

-fever, chills, pain, swelling over affected area, cellulitis

38
Q

staphylococcal infections treatment

A

-find antibiotic to fight strain (MRSA-vancomycin)

39
Q

Streptococcal Infections- Group A

A
  • Group A streptococci (GAS)
  • usually transmitted via contact with respiratory droplets
  • S/S of GAS are dependent upon the location of infection
40
Q

streptococcal Pharyngitis

A
  • AKA strep throat
  • incubation 1-5 days
  • possible presentation: fever, sore throat, beefy red pharynx, swollen tonsils and lymph nodes, malaise, abdominal pain
  • post-strep secondary conditions include Rheumatic fever or acute glomerulonephritis
41
Q

streptococcal Pharyngitis treatment

A

antibiotics to avoid post strep syndromes

42
Q

Scarlet Fever (GAS)

A
  • usually follows untreated strep throat or wound infections
  • strep strain releases pyogenic exotoxin
  • common in 2-10 y/o
  • transmitted by inhalation or direct contact with oral secretions
43
Q

scarlet fever clinical manifestation

A

Fever
Sore throat
strawberry tongue
rash-sandpaper chest–> extremities

44
Q

streptococcal cellulitis

A
  • inflammation of skin and subcutaneous tissues.
  • usually at wound site, but entry site not always noted
  • may recur extremities with impaired lymph drainage
  • lymphangitis presents with red linear streaks from affected area toward tender, swollen lymph nodes
45
Q

Steptococcal Necrotizing Fasciitis (NF)

A
  • serious,rapidly progressive infection along fascial planes. hupotension, nausea, vomiting, delirium
  • type I-polymicrobial infection; p/o complication
  • type II- distal break in skin or transient bacteremia
  • initially, pain and fever present while skin looks unhealthy
  • infection rapidly spreads –> edema and tenderness
  • thrombosis of blood vessels –> dark red and indurated
  • ultimately, skin becomes ischemic
46
Q

treatment of NF

A

aggressive debridement with IV antibiotics
-culture and gram staining essential to determine antibiotics choice.
may need serial debridement

47
Q

streptococcus Pneumoniae

A
  • cause of pneumonia, sepsis, otitis media, meningitis
  • transmission via direct contact or inhalation of respiratory secretions
  • most common cause of community-acquired pneumonia
  • most common cause of death by preventable bacterial disease by vaccination
  • vaccination recommended for >65 y.o. individuals with chronic diseases or compromised immunity.
48
Q

streptococcus pneumonia clinical manifestations

A
  • present with fever, pleuritis with pain, dyspnea, productive cough, purulent sputum, elderly with delirium, slight cough
49
Q

Gas Gangrene

A
  • rare, painful; caused by anaerobic bacteria
  • muscles and subcutaneous tissues fill with gas and exudate
  • follows trauma or surgery
  • spreads rapidly and death ca follow within hours
  • growth uncommon in healthy human tissue unless devitalized tissue with severe trauma present
  • usually found in deep wounds
  • CO2 and H gases produced subcutaneously
50
Q

signs of gangrene

clinical manifestations

A
  • cool skin, pallor/ cyanosis; sudden severe pain, sudden edema, loss of extremity pulses
  • skin darkens- cutaneous necrosis and hemorrhage
  • thick discharge with foul odor
  • crepitation upon palpation of skin from gas bubbles
  • prevention is key to avoid gangrene by cleaning wound
  • surgical debridement and antibiotics
51
Q

Pseudomonas

A
  • causes pneumonia, wound infections, UTIs, sepsis
  • thrives on moist environmental surfaces
  • antibiotic resistant
  • aggressive growth often leading to sepsis in population with decr immunity
  • contact transmission: proper hand hygiene, proper cleaning of equipment, strict sterile techniques with wounds
52
Q

Blooodborne Viral Pathogens

A
  • hepatitis B, C, HIV
  • bloodborne pathogens standard
  • CDC Guidelines for infected HCWs treating patients
53
Q

Bloodborne pathogen standard

A
  • by occupational safety and health administration
  • to minimize exposure to HBV, HCV, HIV & other bloodborne pathogens
  • use of standard precautions to decr contact with potentially contaminated body fluids
54
Q

CDC Guidelines for infected HCWs treating patients

A
  • based on assumption that risk of transmission is greates when performing invasive procedures
  • avoidance of such procedures unless guided by expert panel on performance safety
  • must notify pt regarding infected status before performing invasive procedure
55
Q

Hepatitis B Virus

A
  • serious risk to HCWs
  • incr risk dependent upon: exposure to blood-degree of exposure, presence to HBV e antigen and hepatitis surface antigen

-transmitted via percutaneous injury or direct/indirect contact with infected blood and body fluids

  • HBV in blood survives up to one week on environmental surfaces
  • incubation period 45-180 days
56
Q

OSHA bloodborne pathogen standard mandates

A
  • HBV vaccine and immunoglobulin
  • strict adherence to hand ashing and standard precautions
  • use of barriers
57
Q

Hepatitis C

A
  • highest mode of transmission to HCWs via percutaneous injuries
  • incubation period 6-7 weeks
  • nearly infected will develop chronic HCV
  • no vaccine available
  • best route is prevention
58
Q

HIV

A

-nosocomial transmission from pt-> HCW via percutaneous or mucocutaneous exposure to blood/body fluids

-seroconversion after percutaneous exposure to infected blood depends on:
—visible blood on device prior to injury, involves needle placement into vein or artery, deep injury with contaminated device

59
Q

CDC recommends if HCW exposed to HIV:

A
  • Counseled
  • offered HIV baseline & follow-up blood testing ASAP
  • treated with antiviral therapy per protocol
60
Q

HIV postexposure

A
  • contact area immediately washed with antiseptic soap and rinsed
  • anti-retrovirals for four weeks
61
Q

Prevention HIV

A

Hand washing, standard precautions, barriers

62
Q

Herpesvirus

A

-eight types of herpeviruses
-usually subclinical primary infection vs symptomatic presentations
-may exist in latent state for life of host
-reactivation in compromised host
—widespread lesions in affected organs or CNS, severe illness in infants or immunocompromised, death

63
Q

Herpes Simplex Virus type 1 (HSV-1)

A
  • usually manifests as vesicles/sores in mouth and oral cavity
  • also infects genitourinary system
  • systemic symptoms-fever , malaise, myalgias
  • symptoms and lesions resolve 3-14 days
  • herpectic whitlow-infection of finger
  • some association with Bell’s palsy
64
Q

Herpes simplex virus type 2 (HSV-2)

A
  • principal cause of genital herpes via sexual contact
  • ulcers may also affect cervix, buttocks, rectum, urethra, and bladder
  • painful, small, grouped lesions with itching
  • sores usually heal in 1-3 weeks
  • women with genital hepes may pass virus to infant during birth
65
Q

HSV-1 and HSV-2

A
  • infect and visceral organ or mucocutaneous site
  • asymptomatic shedding usually immediately prior to sores appearing
  • transmission via contact through break in mucous membranes/skin particularyly if host is immunosuppressed
  • initial infection may be asymptomatic
  • virus typically remains latent with periodic reactivation
  • during primary infection, virus travels along axons of peripheral sensory nerves to nerve ganglia in CNS
  • Recurrences usually milder
  • may also cause meningitis, encephalitis
  • no available vaccines
  • diagnosis confirmed with cultures
66
Q

HSV-1 and HSV-2 treatment

A

Anti-virals, education

67
Q

HSV-1 and HSV-2 prevention

A

-hand washing, standard precautions, barriers

68
Q

Varicella Zoster Virus

A

Aka herpesvirus type 3

  • responsible for chicken pox/ shingles
  • most common complication is secondary bacterial skin infection
  • vesicles filled with high titers of infectious virus
  • airborne and contact transmission
69
Q

Varicella/chicken pox

A
  • virus is present in WBCs up to five days before rash
  • contagious one-two days prior to rash -> all lesions crusted
  • successive lesions continue to appear for several days
  • fever and malasie may precede rash
  • rash wwith “dewdrop ona rose petaal”
  • first appearance on scalp, then trunk, then extremities
  • c/o pain and itching
  • risk during pregnancy
70
Q

Varicella/chicken treatment

A
  • bed rest till afebrile; skin kept clean, itching creams or oral antihistamines
  • antivirals for adults and children with high risk for complications
71
Q

Herpes Zoster / shingles

A
  • presents as unilateral lesions erupting along dermatome
  • typically >50 yo or immunocompromised
  • contagious to those who have not had chicken pox or vaccination
  • complication is prostherpetic neuralgia
  • vaccine has been approved for adults >60 y/o
72
Q

Infectious mononucleosis

A
  • caused by herpes type 4 virus aka epstein barr virus
  • typically affects young adults and children
  • transmission mainly via oral secretions, lesss likely through blood
  • contagious before symptoms appear—> no fever and no lesions in mouth
  • serious complication are rare but include Guillain-barre syndrome and ruptured spleen
  • reactivation of virus may occur
73
Q

Infectious mononucleosis symptoms

A
  • fever, sore thorat, swollen cervical lymph nodes, malasie, left upper abdominal pain frm splenomegaly or heptomegaly
  • treatment of restt and supportive care
74
Q

Influenza virus

A
  • caused by influenza virus A or B
  • can cause serious illness, even death
  • transmission person -> person via inhalation or direct contact
  • secondary bacterial pneumonia could develop
  • vaccination is recommended for >6 mos y/o
75
Q

Influenza S/S:

A

Abrupt onset with high fever, malaise, myalgia, HA, dore throat, nasal congestion, nonproductive cough, nausea, vomiting, otitis media

76
Q

Influenza treatment

A

Antivirals given within 48 hours of onset
Supportive therapy
Droplet precautions
Prevention

77
Q

Respiratory syncytial virus

A
  • serious disease for infants and elderly, esp with lung/hear existing conditions & immunocompromised
  • recurrences = mild upper respiratory tract infections
  • droplet precautions
78
Q

respiratory syncytial virus S/S

A

low-grade fever, tachypnea, wheezing

79
Q

respiratory syncytial virus treatment

A

Hydration, humidifier, supportive therapy
no vaccine available
prevention

80
Q

Lyme disease

A
  • US most prevalent vector-borne infectious disease
  • caused by spirochete
  • tick larvae contact bacteria from infected rodents
  • bacteria can disseminate through blood stream or lymphatic system
81
Q

lyme disease S/S

A
  • erythema migrans
  • fever/chills
  • joint muscle pain
  • HA
  • fatigue
  • swollen lymph nodes
82
Q

Lyme disease stage 1

A

early , localized stage

-erythema migrans

83
Q

Lyme disease stage 2

A

Disseminated infection

- nervous system, heart, joints

84
Q

Lyme disease stage 3

A

Late , persistent infection

-intermittent arthritis, chronic neurological symptoms

85
Q

Lyme disease post infection syndromes

A

-Resembles fibromyalgia or chronic fatigue syndrome-debatable

86
Q

sexually transmitted disease

A
  • caused by bacteria, viruses, and parasites
  • chlamydia most reportable STD in US
  • contact precautions and hand washing while working with patients
87
Q

STD risk factors

A
  • multiple sex partners
  • history of blood transfusion
  • failure to use condom during sexual intercourse
  • sharing needles
88
Q

four most common types of infections

A
  • skin/soft tissue- MRSA
  • endovascular- endocarditis, sepsis, abscess
  • respiratory - pneumonia, lung abscess
  • musculoskeletal- osteomyelitis, septic arthritis

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