Infectious Disease Flashcards
What causes mononucleosis?
Epstein-Barr Virus (HHV 4)
Signs/symptoms of mononucleosis
- Fever
- Sore throat
- Posterior cervical lymphadenopathy
- Splenomegaly (+/-)
Also: malaise, myalgias, hepatomegaly
Petechial rash seen in 5% of mono, especially if given:
Amoxicillin
Diagnosis of mononucleosis
- Heterophile monospot Ab test
- Peripheral smear - 50% lymphocytes with > 10% atypical lymphocytes
- High LFTs
Management of mononucleosis
Supportive
Rest, analgesics, antipyretics
Symptoms may last for months
Avoid contact/trauma for at least 1 month
Borrelia burgdorferi
Lyme disease
Spread by deer tick
Lyme disease is most common in the:
Spring and summer
The highest likelihood of transmission for lyme disease is if the tick is engorged and/or has been attached for at least ____ hours
72
Expanding, warm, annular, erythematous rash. Classically seen with central clearing or “bulls eye” appearance within a month of tick bite
Lyme disease
Rash from lyme disease may be accompanied with viral-like syndrome, including:
HA
Fever
Malaise
Lymphadenopathy
Primary symptoms that can be seen with early disseminated lyme disease
- rheumatologic arthritis (esp at large joints)
- Neurologic symptoms - HA, meningitis, weakness, Bells palsy, neuropathy
- Cardiac - AV block, pericarditis
Diagnosis of lyme disease
- Clinical - pts with erythema migrans are often seronegative in early stage
- Serologic testing - ELISA followed by western blot if ELISA positive
False positive ELISA - syphillis
Management of lyme disease:
Early disease - doxycycline
Late/Severe disease - IV ceftriaxone
Lyme Dz prophylaxis
Doxycycline 200 mg x 1 dose within 72 hours of tick removal if tick is present for > 36 hours.
Signs/Symptoms of HIV
Fever
Malaise
Generalized rash
Generalized lymphadenopathy
AIDS is defined as a CD4 count < _______ cells/uL
200
HIV wasting syndrome
Chronic diarrhea and weight loss
Diagnosis of AIDS
- Antibody testing - ELISA followed by Western Blot (confirmatory test)
- Rapid testing - blood or saliva
- HIV RNA viral load - used to monitor treatment effectiveness
Treatment regimens for HIV
- NNRTI + 2 NRTIs or
- PI + 2 NRTIs or
- INSTI + 2 NRTIs
Post exposure prophylaxis for HIV
Raltegravir/Dolutegravir + Tenofovir + Emtricitabine
Influenza __ is associated with more severe, extensive outbreaks
A
Spreads primarily via airborne respiratory secretions
Influenza
Abrupt onset of a white range of symptoms: headache, fever, chills, malaise, URI symptoms, pharyngitis, pneumonia
Influenza
Diagnosis of influenza
- Usually clinical
2. Rapid influenza test (nasal swab)
Management of influenza
- Supportive is mainstay in healthy pts
2. Tamiflu in needed in pts with high risk of complications (best if initiated within 48 hours of onset of sx)
Signs/Symptoms of bacterial meningitis
- Fever/chills (95%)
- HA/nuchal rigidity, photosensitivity, N/V
- AMS, seizures
Kernig’s sign
Inability to straighten knee with hip flexion
meningitis
Brudzinski’s sign
Neck flexion produces knee/hip flexion
Meningitis
Diagnosis of menigitis
- Lumbar puncture - definitive diagnosis
2. Head CT scan - done to r/o mass effect before LP if high risk
LP results for bacterial meningitis
High neutrophils, low glucose, high total protein
For bacterial meningitis, do not wait to start
Empiric abx!
Treatment for bacterial meningitis if < 1 month old:
Ampicillin + Cefotaxime
Treatment for bacterial meningitis if 1 mo - 18 years
Ceftriaxone + Vancomycin
Treatment for bacterial meningitis if 18 y - 50 y
Ceftriaxone + Vancomycin
Treatment for bacterial meningitis if > 50 y/o
Ampicillin + Ceftriaxone
Meningitis post exposure prophylaxis
Ciprofloxacin 500 mg PO x 1 dose
Diagnosis of viral meningitis:
- CSF analysis - most important to differentiate
- MRI
- Serologies, viral cultures
Management of viral meningitis
Supportive care
Antipyretics, IV fluids, antiemetics
Most common source of salmonellosis
Poultry products (dairy, meat, eggs) Exotic pets (reptiles, turtles)
Salmonella gastroenteritis
Abdominal pain
Fever, cramping
Vomiting, mucus + blood diarrhea
Management of salmonella
Fluids
+/- fluoroquinolones, ceftriaxone if severe
Lower abdominal pain, high fever, tenesmus, explosive watery diarrhea (mucoid, bloody)
Shigellosis
Severe cases of shigellosis may lead to:
Toxic megacolon
Shigellosis can result in neurologic manifestations especially in young children, such as
Febrile seizures
Diagnosis of Shigellosis
- Stool cultures, fecal WBC/RBCs
- CBC (WBC > 50,000)
- Sigmoidoscopy - punctate areas of ulceration
Management of shigellosis
Fluids
TMP-SMX if severe, fluoroquinolones
