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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
diphtheria - prevention
DTap: children < 7; 5 doses Tdap: older children, adults - booster every 10 yrs (usually Td but one Tdap)
26
diphtheria - 3 manifesations
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
27
diphtheria - tx
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
28
pertussis (bordetella pertussis) - characteristics
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"
29
pertussis - dx
culture nasopharynx: Bordet-Gengou agar OR PCR
30
pertussis - prevention
DTap: children < 7; 5 doses Tdap: older children, adults - booster every 10 yrs (usually Td but one Tdap)
31
pertussis - manifestations
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)
32
pertussis - tx
erythromycin x 7 days alternatives: azithromycin, clarithromycin, TMP-SMX contacts (any person in contact w/in 3 wks of start of cough): same tx
33
tetanus (clostridium tetani) - characteristics
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)
34
tetanus - manifestations
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
35
tetanus - treatment
tetanus immune globulin | PLUS: full course of immunization once recovered
36
tetanus - prophylaxis
includes Tdap or Td and/or immune globulin (TIG) | - depends on clean vs. dirty wound and vaccine hx
37
salmonella (S enterica) - characteristics
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
38
salmonella - treatment
self-limited = typically symptomatic care ABX for malnourished, severely ill, sickle-cell anemia pts - TMP-SMX, ampicillin, ciprofloxacin
39
salmonella - bacteremia (population and treatment)
can cause blood infection in immunosuppressed Sxs: prolonged or recurrent fever - distal seeding in bones, joints, pleura, pericardium, endocardium, lungs Tx: fluids and fluoroquinolone
40
salmonella (S typhi) - characteristics
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
salmonella (S typhi) - treatment
fluids fluoroquinolones Note: if exposed, can become a carrier (tx: cipro)
42
shigella (S. sonnei, S. dysenteriae) - characteristics
gram-negative non-spore forming rod | trasmission through fecal-
43
shigella - manifestations
``` abrupts onset diarrhea with blood and mucous lower abd cramps tenesmus fever, chills, malaise, anorexia, H/A temporary reactive arthritis (Reiter's) ```
44
shigella - diagnosis
stool: WBC, RBC blood: culture sigmoidoscopy: inflamed mucosa with punctate lesions and ulcers
45
shigella - treatment
ABX: fluoroquinolones (Cipro), ceftriaxone, TMP-SMZ
46
rocky mountain spotted fever (rickettsia rickettsia) - characteristics
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
rocky mountain spotted fever - manifestations
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
rocky mountain spotted fever - labs
thrombocytopenia (low platelets) with hyponatremia (low Na) | - immunohistology and serology to confirm
49
rocky mountains spotted fever - treatment
doxycycline (ABX): all ages except pregnant - continue 3 days after fever ends Pregnant: chloramphenicol Note: prognosis good with treatment
50
lyme disease (borrelia burgdorferi) - characteristics
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
lyme disease - clinical stages
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
lyme - treatment
doxycycline (2-3 wks) preg: penicillin IM peds: amoxicillin Prevention: chemoprophylaxis with doxycycline if met criteria
53
syphilis (treponema pallidum) - characteristics
spirochete bacteria | ONLY transmitted through sexual contact
54
syphilis - clinical manifestations
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
syphilis - treatment
penicillin (any stage)
56
syphilis - pregnancy
screen all pregnant patients, repeat in 3rd trimester - any + serology = tx with penicillin - goal: prevent congenital syphilis
57
congenital syphilis
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
cytomegalovirus (CMV) - general info
common infection most asymptomatic - virus remains latent and can effect once host becomes immunocompromised
59
CMV - primary disease (perinatal and healthy host)
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
CMV - reactive disease (immunocompromised host - CD4<100)
retinitis: neovascular lesions in back of eye GI/biliary: esophagitis, IBD-like syndrome pulmonary: pneumonitis, high mortality neurologic: encephalitis
61
CMV - diagnosis
tissue confirmation: "owl's eye" intracytoplasmic inclusions atypical lymphs (like EBV)
62
CMV - treatment
ganciclovir IV +/- focscarnet maintenance: ganciclovir + foscarnet daily
63
CMV - prevention
HIV: HAART, ganciclovir or valganciclovir Post-transplant: antiviral agents and CMV immunoglobulin
64
epstein barr virus (EBV) - general information
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
EBV - clinical manifestations
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
EBV - labs
heterophil antibodies (monospot)
67
EBV - treatment
symptomatic, supportive acyclovir: decrease viral shedding (no effect on course of illness) steroids: only if - impending airway obstruction - hemolytic anemia - severe thrombocytopenia
68
EBV - prognosis
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
rabies - general information
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
rabies - manifestations
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
rabies - prevention
immunization of domestic animals local bite care prophylaxis: rabies immune globulin and human diploid cell rabies vaccine
72
rabies - treatment
note: almost ALWAYS fatal - ICU, ventilation, multi-drug approach
73
HIV (human immunodeficiency virus) - general information
first recognized in 1981 human retrovirus (requires reverse transcriptase for replication) targets all cells with T4 antigen, primarily CD4 helper lymphocyte
74
HIV/AIDS - transmission
sexual contact, parenteral exposure, perinatal transmission
75
HIV - diagnosis
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
HIV - clinical manifestations
acute HIV: tough to identify - flu or EBV-like illness - persistent lymphadenopathy HIV disease: - fever, night swats, weight loss, dementia - opportunistic infections, malignancies
77
AIDS - manifestations (indicator conditions)
there are many, including: - recurrent bacterial pneumonia - candidiasis of respiratory tract - Kaposi sarcoma - wasting syndrome (wt loss, diarrhea, fever > 1 month)
78
HIV/AIDS - prevention
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
HIV/AIDS - treatment
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
anti-HIV drugs - 6 categories and major side effects of each
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
helminths - general information (3 categories)
parasites, all hermaphroditic (have both male and female reproductive parts) 3 categories: - nematodes (roundworms) - trematodes (flukes) - tapeworms
82
helminth infections - manifestations
``` 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
helminth infections - treatment
albendazole deworming programs: STOP transmission
84
malaria - two types to know about
parasite plasmodium vivax: most common P falciparum: most deadly
85
malaria - characteristics
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
malaria - clinical manifestations
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
malaria - labs / diagnosis
peripheral smear - fresh blood (look for parasitemia - see them within RBCs)
88
malaria - treatment
chloroquine | - safe in pregnancy, well tolerated
89
malaria - prognosis
2-4 weeks uncomplicated, untreated good prognosis (if treated) P falciparum: 15% mortality rate despite tx
90
malaria prevention
chemoprophylaxis: chloroquine, malorone, mefloquine, doxycycline education / mosquito control: bed nets, screens, clothing, DEET
91
toxoplasmosis (toxoplasma gondii) - characteristics
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
toxoplasmosis - transmission
ingest cysts (raw or uncooked meat) ingest oocysts (food, water, cat littler, soil) transplacental transmission
93
toxoplasmosis - 4 clinical syndromes
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
toxoplasmosis - diagnosis
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
toxoplasmosis - treatment
immunocompetent: tx only if severe dz immunocompromised: pyrimethamine PLUS folic acid - treat 4-6 wks, then prophylaxis (TMP-SMX, dapsone)
96
toxoplasmosis - prevention
fully cook meat protect from cat feces (clean litter box) screen all pregnant women - if no antibodies, avoid cats
97
pinworms (enterobius vermicularis) - characteristics
humans only host fecal-oral trasmission adult worm in colon, eggs deposit in perianal area (night-time)
98
pinworms - diagnosis
see at night; scotch tape test (see eggs and worms)
99
pinworms - treatment
albendazole, mebendazole, pyrantel treat all household members; repeat tx in 2 weeks hygiene, linens, etc.

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