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PANCE Review > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

fungal infections

A

opportunistic infections: attack weak immune systems (immunocompromised patients)

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2
Q

fungal infections - risk factors

A 
neutropenia (cellular immunodeficiency)
DM
renal failure
post-transplant
IVDU
chemotherapy, corticosteroids
parenteral nutrition
recent surgery
broad spectrum ABX use
ICU stay
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3
Q

candida, mucous membranes

A

fungal infection
oral: most common (angular cheilitis - corner of mouth, white plaque, red plaques w/ dentures)
GI tract/esophagus: odynophagia (pain w/ swallowing), GERD, biopsy to confirm (think immunocompromised)
GU: white, curd-like discharge, irritation and pruritus (balanitis in males)
- KOH: pseudo-hyphae (dx)

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4
Q

candida, skin infections

A

likes moist, dark, warm places

features: red, pruritic lesions, distinct borders, satellite lesions (pustules)
nails: onychomycosis, paronychia (chronic)

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5
Q

candida, disseminated

A

see in very sick people; often deadly
candidemia (in blood stream): from catheters or invasive instrumentation)
endocarditis: IVDU (large vegetations on eco)
chronic disseminated (aka hepatosplenic): occurs w/ leukemia pts (kids) undergoing aggressive chemo; see punched out lesions on liver via CT
dx: positive blood culture

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6
Q

candida treatment

A

remove cause (invasive instrument) and then tx underlying dz:

  • most anti-fungals interfere with fungal cell membrane or wall formation
  • fungus grow slowly and die slowly, so tx for long time

Azoles:

topical: clotrimazole, miconazole
systemic: fluconazole, itraconazole

Terbinafine: dermatophytes (paronychia, onychomycosis)

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7
Q

cryptococcus

A

encapsulated budding yeast
found in soil, pigeon feces
transported to immunocompromised people via inhalation:
- pulmonary infection (COPD, chronic steroid use, post-transplant)
- meningitis (very sick pts with CD4<50… AIDS pts)

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8
Q

cryptococcus: pulmonary

A

sxs: fever, cough, dyspnea, pneumonitis
dx: culture, staining (india ink or methenamine silver)
tx: fluconazole (10 wks)

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9
Q

cryptococcus: meningitis

A

sxs: H/A, N/V, confusion, fever, vision changes, see access on CT scan (cryptococcomas)
dx: CSF (inc. protien, WBC, dec. glucose); CT or MRI (cryptococcomas, hydrocephalus)
tx: fluconazole (mild dz), induction with amphotericin B than lifelong fluconazole

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10
Q

histoplasmosis

A

fungus
found in: soil, bird and bat droppings
transported to immunocompromised via inhalation

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11
Q

histoplasmosis - 3 types of disease

A
  1. chronic progressive pulmonary dz (elderly, COPD)
    - patchy cavitations, calcified hilar nodes, pericarditis
  2. progressive disseminated dz (HIV, CD4<300)
    - fever, dyspnea, cough, ulcers, hepatosplenomegaly, adrenal insufficiency
  3. disseminated dz (severe immunocompromised, AIDS, CD4<100)
    - fever, septic shock, multiplee organ involvement, miliary pattern on CXR
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12
Q

histoplasma - labs, dx, tx

A

labs: anemia of chronic dz, bone marrow failure, inc. all phase, LDH, ferritin

Dx: bronchoalveolar lavage, serum antibody titers, blood culture

Tx: itraconazole (mild dz), amphotericin and lifelong itraconazole (severe)

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13
Q

pneumocystis

A

fungus, ubiquitous, airborne

effects premature or debilitates infants and immunodeficiency states

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14
Q

pneumocystis - sxs

A

sxs: abrupt onset, fever, tachypnea, dyspnea, cough (nonproductive), bibalilar crackles

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15
Q

pneumocystis - dx

A

CXR: diffuse interstitial infiltrates

PFT: dec. in vital capacity and total lung capacity; hypoxemia, hypocapnea
- HINT: rapid desaturation following removal of oxygen

Dx: get a sample (sputum or bronchoalveolar lavage) and stain

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16
Q

pneumocystis - tx

A

TMP-SMX (bactrim)

steroids: only in early tx
prophylaxis: TMP-SMX daily for pts w/ CD4<200 (very immunocompromised)

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17
Q

botulism (clostridium botulinum) - characteristics

A

gram-positive rod
found in soil, anaerobic, spore-forming
release toxin A, B
inhibits release of acetylcholine (neuro-muscular junction)

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18
Q

botulism - how contracted

A

food-borne (ingest toxin - home canning)

infant (honey - ingest spores)

wound (farmers, migrant workers; toxin produced in wound)

bioterror potential

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19
Q

botulism: manifestations

A

12-26 hrs after ingestion

  • N/V
  • vision changes (diplopia, loss of accommodation)
  • dry mouth, dysphagia, dysphonia
  • respiratory paralysis

baby: flaccid, weak
note: no sensory changes or fever

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20
Q

botulism: treatment

A

botulinum antitoxin (w.in 24 hrs)
manage respiratory failure
parenteral fluids

report to health department, CDC

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21
Q

cholera (vibria cholerae) - characteristics

A

gram-negative flagellated rod

ingested through fecal/oral route; contaminated water or food (epidemics, natural disasters)

activated adenylyl cyclase in intestinal epithelia = hyper secretion of water and chloride

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22
Q

cholera - manifestations

A

acute onset
“rice water” stool (gray turbid)
leads to dehydration and hypotension

diagnostics rarely indicated (usually clinical dx): can do stool culture

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23
Q

cholera - tx

A

fluid replacement - PO is best but IV if PO not tolerated

prevention: vaccine (short-lived for workers going into contaminated areas)

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24
Q

diphtheria (corynebacterium diphtheria) - characteristics

A

gram-positive bacillus
respiratory transmission

develops exotoxin that inhibits elongation factor required for protein synthesis
- see respiratory secretions

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25
Q

diphtheria - prevention

A

DTap: children < 7; 5 doses

Tdap: older children, adults
- booster every 10 yrs (usually Td but one Tdap)

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26
Q

diphtheria - 3 manifesations

A
  1. nasal: discharge (minor)
  2. laryngeal: obstruction (minor)
    3: pharyngeal: gray membrane that continues to grow and block airway (serious)
    - mild sore throat, lymphadenopathy, fever malaise
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27
Q

diphtheria - tx

A

reportable dz
antitoxin: give to anyone w/ possible exposure
remove membrane

ABX: erythromycin (tx until 3 consecutive negative cultures)
- contacts tx with erythromycin for 7 days

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28
Q

pertussis (bordetella pertussis) - characteristics

A

gram-negative aerobic coccobacillus
respiratory transmission
- incubation of 7-17 days
- most cases in kids <2 yrs (un-vaccinated)
- no lasting immunity (from getting dz or immunization)
- “whooping cough”

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29
Q

pertussis - dx

A

culture nasopharynx: Bordet-Gengou agar OR PCR

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30
Q

pertussis - prevention

A

DTap: children < 7; 5 doses

Tdap: older children, adults
- booster every 10 yrs (usually Td but one Tdap)

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31
Q

pertussis - manifestations

A

3 stages:

  1. catarrhal: sneezing, anorexia, malaise, hacking cough
  2. paroxysmal: bursts of rapid coughs follow by “whoop”
  3. convalescent: 4 wks after onset; dec. in frequency and severity of cough

non-specific lab finding: lymphocytosis (high WBC)

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32
Q

pertussis - tx

A

erythromycin x 7 days

alternatives: azithromycin, clarithromycin, TMP-SMX

contacts (any person in contact w/in 3 wks of start of cough): same tx

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33
Q

tetanus (clostridium tetani) - characteristics

A

gram-positive anaerobic rod
found in soil
local inoculation of wounds - spore germinate within wounds
neurotoxin - results in uncontrolled spasms

At risk: elderly, migrant workers, IVDUs

Most due to puncture wounds (stepping on nail)

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34
Q

tetanus - manifestations

A

progressive:

  • pain and tingling at site
  • muscle spasms
  • stiff jaw, neck, dysphagia, irritability
  • painful, toxic convulsions (trismus = lock jaw)
  • remain conscious, no sensory deficits or fever
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35
Q

tetanus - treatment

A

tetanus immune globulin

PLUS: full course of immunization once recovered

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36
Q

tetanus - prophylaxis

A

includes Tdap or Td and/or immune globulin (TIG)

- depends on clean vs. dirty wound and vaccine hx

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37
Q

salmonella (S enterica) - characteristics

A

gram-negative facultative anaerobic rod
transmission though fecal-oral route
incubation: 8-48 hrs
sxs: fever, chills, N/V, crampy abd pain, diarrhea (+/- blood) for 3-5 days

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38
Q

salmonella - treatment

A

self-limited = typically symptomatic care

ABX for malnourished, severely ill, sickle-cell anemia pts
- TMP-SMX, ampicillin, ciprofloxacin

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39
Q

salmonella - bacteremia (population and treatment)

A

can cause blood infection in immunosuppressed

Sxs: prolonged or recurrent fever
- distal seeding in bones, joints, pleura, pericardium, endocardium, lungs

Tx: fluids and fluoroquinolone

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40
Q

salmonella (S typhi) - characteristics

A

gram-negative facultative anaerobic rod
transmission through fecal-oral route

sxs: malaise, H/A, cough, fever plateaus (7-10days) then become more ill
- abd pain, distention, constipation or diarrhea (“pea soup”)
- rash: rose spots

41
Q

salmonella (S typhi) - treatment

A

fluids
fluoroquinolones

Note: if exposed, can become a carrier (tx: cipro)

42
Q

shigella (S. sonnei, S. dysenteriae) - characteristics

A

gram-negative non-spore forming rod

trasmission through fecal-

43
Q

shigella - manifestations

A 
abrupts onset
diarrhea with blood and mucous
lower abd cramps
tenesmus
fever, chills, malaise, anorexia, H/A
temporary reactive arthritis (Reiter's)
44
Q

shigella - diagnosis

A

stool: WBC, RBC
blood: culture
sigmoidoscopy: inflamed mucosa with punctate lesions and ulcers

45
Q

shigella - treatment

A

ABX: fluoroquinolones (Cipro), ceftriaxone, TMP-SMZ

46
Q

rocky mountain spotted fever (rickettsia rickettsia) - characteristics

A

bacteria
found in middle/southern Atlantic, Mississippi Valley (not Rocky Mountains)
spread by wood tick, dog tick
late spring or summer

Prevent: avoid ticks

47
Q

rocky mountain spotted fever - manifestations

A

progressive:

  • fever, chills, H/A, N/V
  • restless, insomnia, irritable
  • rash (macules to papules): starts at wrists/ankles (includes palms and soles), spreads inward

severe dz: cough, pneumonitis, delirium, lethargy, seizure

48
Q

rocky mountain spotted fever - labs

A

thrombocytopenia (low platelets) with hyponatremia (low Na)

- immunohistology and serology to confirm

49
Q

rocky mountains spotted fever - treatment

A

doxycycline (ABX): all ages except pregnant
- continue 3 days after fever ends

Pregnant: chloramphenicol

Note: prognosis good with treatment

50
Q

lyme disease (borrelia burgdorferi) - characteristics

A

spirochete bacteria
most common tick-borne illness in US (deer tick)
tick must feed for 24-36 hrs to transmit dz (KEY); drops off in 2-4 days
- best removal: fine tipped tweezer
- nymph tick most likely to transmit dz

51
Q

lyme disease - clinical stages

A

stage 1: 3-30 days

  • flu-like sxs
  • erythema migrans (flat or raised), bull’s eye clearing, single or multiple

stage 2: days to weeks (early disseminated)

  • fatigue, malaise
  • smaller, multiple lesions
  • H/A, neck pain
  • migratory arthritis

stage 3: mos to yrs (late persistent infection)
- MSK: arthritis, synovitis

52
Q

lyme - treatment

A

doxycycline (2-3 wks)

preg: penicillin IM
peds: amoxicillin

Prevention: chemoprophylaxis with doxycycline if met criteria

53
Q

syphilis (treponema pallidum) - characteristics

A

spirochete bacteria

ONLY transmitted through sexual contact

54
Q

syphilis - clinical manifestations

A

primary: painless chancre (ulcer) - clean lesions

secondary: fever, maculopapular rash (includes palms and soles)
- highly contagious

tertiary: inflammation of CNS (presents in bones, eyes, lungs, GI, etc.)
- neurosyphilis: + CSF, meningovascular, general paresis
- tabes dorsalis: slow degeneration of neural tracts in dorsal columns of spinal cord - loss of proprioception, reflexes, general tone

55
Q

syphilis - treatment

A

penicillin (any stage)

56
Q

syphilis - pregnancy

A

screen all pregnant patients, repeat in 3rd trimester

  • any + serology = tx with penicillin
  • goal: prevent congenital syphilis
57
Q

congenital syphilis

A

first signs:

  • maculopapular rash, mucous membrane patches
  • “snuffles” - serious nasal d/c
  • hepatosplenomegaly

If untreated:
- interstitial keratitis (blindness), Hutchinson teeth, saddle nose, saber shins, deafness, CNS defect

Treatment: penicillin

58
Q

cytomegalovirus (CMV) - general info

A

common infection
most asymptomatic
- virus remains latent and can effect once host becomes immunocompromised

59
Q

CMV - primary disease (perinatal and healthy host)

A

perinatal (in utro or breast milk):

  • jaundice, hepatosplenomegaly
  • microcephaly, CNS calcifications, mental retardation
  • motor disability, hearing loss

immunocompetent host:

  • fever, malaise
  • myalgias, arthralgias
  • complications: GI issues, encephalitis, pericarditis, myocarditis, Guillain Barre syndrome
60
Q

CMV - reactive disease (immunocompromised host - CD4<100)

A

retinitis: neovascular lesions in back of eye

GI/biliary: esophagitis, IBD-like syndrome

pulmonary: pneumonitis, high mortality
neurologic: encephalitis

61
Q

CMV - diagnosis

A

tissue confirmation: “owl’s eye” intracytoplasmic inclusions

atypical lymphs (like EBV)

62
Q

CMV - treatment

A

ganciclovir IV +/- focscarnet

maintenance: ganciclovir + foscarnet daily

63
Q

CMV - prevention

A

HIV: HAART, ganciclovir or valganciclovir

Post-transplant: antiviral agents and CMV immunoglobulin

64
Q

epstein barr virus (EBV) - general information

A

human herpesvirus 4
any age (most common 10-35)
sporadic cases or epidemics (high schools)
transmission: likely saliva

NOTE: associated with many chronic dzs - Burkitt’s lymphoma, nasopharyngeal carcinoma, chronic fatigue, oral hairy leiloplakia, Hodgkin’s, SLE, MS, rheumatoid arthritis

65
Q

EBV - clinical manifestations

A

most common: fever, sore throat, malaise, anorexia, myalgias

common: posterior lymphadenopathy, splenomegaly, maculopapular rash (NOTE: 90% if give ampicillin), exudative pharyngitis, soft palate petechiae

less common: hepatitis, gall bladder, mononeuropathy, meningitis, etc.

66
Q

EBV - labs

A

heterophil antibodies (monospot)

67
Q

EBV - treatment

A

symptomatic, supportive

acyclovir: decrease viral shedding (no effect on course of illness)

steroids: only if
- impending airway obstruction
- hemolytic anemia
- severe thrombocytopenia

68
Q

EBV - prognosis

A

95% recover w/o specific tx

fever ends in 10 days; lymphadenopathy and splenomegaly ends in 4 weeks; debility may last 2-3 months

69
Q

rabies - general information

A

transmitted from: raccoons, skunks, bats, foxes, coyotes (not bunnies)

incubation 3-7 wks

virus travels along nerves, multiplies in brain, migrates to salivary glands

70
Q

rabies - manifestations

A

pain at site, fever, malaise, N/V

CNS stage: relentless progression

  • “furious” encpehalitis: delirium, spasm, hydrophobia
  • “dumb” paralytic”
  • ascending paralysis (looks like guillain barre)

Note: fatal dz

71
Q

rabies - prevention

A

immunization of domestic animals

local bite care

prophylaxis: rabies immune globulin and human diploid cell rabies vaccine

72
Q

rabies - treatment

A

note: almost ALWAYS fatal - ICU, ventilation, multi-drug approach

73
Q

HIV (human immunodeficiency virus) - general information

A

first recognized in 1981

human retrovirus (requires reverse transcriptase for replication)

targets all cells with T4 antigen, primarily CD4 helper lymphocyte

74
Q

HIV/AIDS - transmission

A

sexual contact, parenteral exposure, perinatal transmission

75
Q

HIV - diagnosis

A

screening:
- ELISA, confirmatory Western blot or HIV antigen assay
- Rapid HIV testing

viral load:
- measures actively replicating virus

CD4 count:
- how well body is fighting virus (CD4<200 = risk of poor outcome = opportunistic infections and malignancies)

Labs: pancytopenia

76
Q

HIV - clinical manifestations

A

acute HIV: tough to identify

  • flu or EBV-like illness
  • persistent lymphadenopathy

HIV disease:

  • fever, night swats, weight loss, dementia
  • opportunistic infections, malignancies
77
Q

AIDS - manifestations (indicator conditions)

A

there are many, including:

  • recurrent bacterial pneumonia
  • candidiasis of respiratory tract
  • Kaposi sarcoma
  • wasting syndrome (wt loss, diarrhea, fever > 1 month)
78
Q

HIV/AIDS - prevention

A

primary: safe sex, harm reduction, drug rehab, screen blood products
secondary: screening at risk pts, prevent opportunistic infections and malignancies in those infected

post-exposure: counseling, testing now, 6wks, 3mos, 6mos; anti-viral therapy (3 drug combo) - begin w/in 72 hrs for best outcome (continue 4-6 wks)

perinatal: antivirals during pregnancy, L&D, and to newborn; avoid breast feeding

79
Q

HIV/AIDS - treatment

A

HAART (antiretroviral therapy) - combo therapy preferred
tx or prevent opportunistic infections and malignancies
goal: suppress viral load
monitor: CD4, viral load, overall pt health status

obstacles: adherence, effectiveness, resistance, adverse effects

80
Q

anti-HIV drugs - 6 categories and major side effects of each

A

NRTIs (nucleoside reverse transcriptase inhibitors)
- SEs: anemia, neutropenia, GI distress, hepatitis, pancreatitis

NNRTIs (non-nucleoside reverse transcriptase inhibitors)
- SEs: rash, near manifestations, anxiety

fusion inhibitor
- SEs: injection site pain, pruritis, allergic rx

CCR5 antagonist
- SEs: cough, fatigue, abdominal pain, dizziness

protease inhibitors
- SEs: H/A, GI upset, peripheral paresthesias, renal calculi, depression, arrhythmias, lipid abnormalities

INSTIs (integrase strand transfer inhibitors)
- SEs: H/A, dizziness, nausea, insomnia

combination drugs:
- preferred

81
Q

helminths - general information (3 categories)

A

parasites, all hermaphroditic (have both male and female reproductive parts)

3 categories:

  • nematodes (roundworms)
  • trematodes (flukes)
  • tapeworms
82
Q

helminth infections - manifestations

A 
intestinal infestations (mild to severe)
malnutrition, growth disruption
skin signs: red, pruritic (hookworm)
try to get into blood or lymph systems (can cause lymph obstruction)
renal dz, splenic infarction

absenteeism: miss work and school b/c of diarrhea

83
Q

helminth infections - treatment

A

albendazole

deworming programs: STOP transmission

84
Q

malaria - two types to know about

A

parasite

plasmodium vivax: most common

P falciparum: most deadly

85
Q

malaria - characteristics

A

endemic in tropics
1 million deaths/year
most cases in US are imported

anopheles mosquito inoculates human –> sporozoites travel to liver and released into bloodstream and enter RBCs

86
Q

malaria - clinical manifestations

A

attacks consist of shaking chill (cold stage), fever (hot stage), and diaphoresis (sweating stage)
- last 4-6 hrs, reoccur every other day or every 3rd day

P falciparum: CNS manifestations and renal insufficiency - poor prognosis

87
Q

malaria - labs / diagnosis

A

peripheral smear - fresh blood (look for parasitemia - see them within RBCs)

88
Q

malaria - treatment

A

chloroquine

- safe in pregnancy, well tolerated

89
Q

malaria - prognosis

A

2-4 weeks uncomplicated, untreated

good prognosis (if treated)

P falciparum: 15% mortality rate despite tx

90
Q

malaria prevention

A

chemoprophylaxis: chloroquine, malorone, mefloquine, doxycycline

education / mosquito control: bed nets, screens, clothing, DEET

91
Q

toxoplasmosis (toxoplasma gondii) - characteristics

A

only in humans, cats, and birds

80% of primary infections are asymtomatic

cysts: latent form, press indefinately in muscle and nerve tissue
oocysts: passed in feces, remain infective for wks-yrs

92
Q

toxoplasmosis - transmission

A

ingest cysts (raw or uncooked meat)

ingest oocysts (food, water, cat littler, soil)

transplacental transmission

93
Q

toxoplasmosis - 4 clinical syndromes

A

healthy person: acute, mild, febrile, multi-system (mono-like)

congenital (maternal primary infection during pregnancy): still birth, eye (blindness) or brain damage (either at birth or within a week of birth)

immunocompromised: focal infection, encephalitis (brain), disseminated infection (multi-system)

94
Q

toxoplasmosis - diagnosis

A

histology: look for cysts, trophozoites
serology: look for antibodies with ELISA, Western blot, PCR, IgG

CT: ring enhancing lesions (on periphery and multiple vs. lymphoma where lesions are central and single)

95
Q

toxoplasmosis - treatment

A

immunocompetent: tx only if severe dz

immunocompromised: pyrimethamine PLUS folic acid
- treat 4-6 wks, then prophylaxis (TMP-SMX, dapsone)

96
Q

toxoplasmosis - prevention

A

fully cook meat
protect from cat feces (clean litter box)
screen all pregnant women - if no antibodies, avoid cats

97
Q

pinworms (enterobius vermicularis) - characteristics

A

humans only host
fecal-oral trasmission
adult worm in colon, eggs deposit in perianal area (night-time)

98
Q

pinworms - diagnosis

A

see at night; scotch tape test (see eggs and worms)

99
Q

pinworms - treatment

A

albendazole, mebendazole, pyrantel

treat all household members; repeat tx in 2 weeks

hygiene, linens, etc.

PANCE Review (16 decks)

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