Infectious Disease Flashcards
Fever in Returning Traveller
Differential
Ddx: Malari, typhoid, Mening, Viral Hemorrhagic Fever
It is always important to ask where the patient went, their encounters, immunizations and prophylaxis.
Malaria:
P. Falciparum
P Vivax
Falciparum will usually present within the first two months of being home. and it is the most common
P. Vivax: Can remain dormant for years
Typhoid - Diagnosis
The most sensitive test is blood culture;
Vaccine is 50-70% effective
What is the initial work up for a new immigrant or adopted child?
Cbc and diff Liver Serologies: HBV, HCV, HIV, Syph TB and CXR Stool O and P U/A
What is a fever of unknown origin?
Classic: 2-3 weeks of fever and 3 or more outpatient visits OR 3 days in hospital with investigations
Nosocomial: Not present at admission; unsure with 3 days of investigations and 2 days of incubation
Neutropenia: 3 days of investigations, 2 days of incubation
HIV Associated: 4 weeks as outpatient or 3 days as inpatient with investigations and 2 days of cultures.
Congenital CMV
Characteristics: CNS, SKIN and EYES
Treatment: when and what
Microcephally, IUGR, calcifications and seizures; SNHL
Skin: Petichiae, purpura and jaundice
Eyes: Chorioretinitis, strabismus and optic atrophy
If confirmed CMV infection with chorioretinitis, Brain invovlement or SNHL then Gancyclovir IV x 6 weeks.
Need to ensure you are monitoring for Neutropenia.
Congenital Syphilis
Characteristics: Premature, IUGR, FTT HSM
Snuffles, Hands and soles have copper colour and desquamation.
Eyes: Salt and Pepper chorioretinitis
Bones- have bony changes
Late Changes: CNS manifestations, saddle nose, hutchinson teeth, mullberry molars and saber shins
Treatment and testing in suspected congenital Syphilis
Maternal Adequate treatment AND four fold drop: Test baby: If negative, follow up in 18 monts (RPR)
Inadequate treatment, unknown, not a four fold drop, infant rpr > mom: Full work up and treatment.
IV Crystalline Pen G 10-14 days
Congenital Toxoplasmosis
Triad: Hydrocephalus, calcifications and chorioretinitis
If the mom is infected in the first and second trimester the baby is going to be symptomatic; if in the third trimester, only likely to have chorioretinitis.
Treatment: Pyrimethamine + Sulfadiazine + leucovirin x 12 months
Steroids for eye disease
Intrauterine Varicella
Cicatrical Scars: There is new tissue forming that will develop into a scar. NO crossing midline for scars.
Findings: Scaring, hypoplasic limbs, microopthalmia, cataracts, chorioretinitis, seizures and microcephally.
Pregnancy Exposure to Varicella
Exposure =
- House hold exposure OR
- Face to Face x 5 minutes OR
- 15 minute indoor exposure
If mom Unsure or NO VZV History:
Stat IgG Serology.
Negative Result: VZIG in 96 hours
Acyclovir if Chickenpox develops
Parvo B19
If mom is exposed then you need to test IgM and IgG.
If negative, repeat in 2 weeks.
If IgM + and IgG negative - weekly ultrasounds x 12 weeks to monitor for the development of Non immune hydrops
Congenital Rubella Syndrome
IUGR, Blueberry Muffin Rash, HSM, Cataracts, Cardiac (PDA), SNHL and Bony Lesions
Presentations of the following:
Pertonsillar abscess
RPA
PTA: Trismus, muffled voice, uvula to the contralateral side
Lateral Pharyngeal Abscess: There is swelling under the mandible
RPA: infancy and early childhood. Insidious onset with torticollis
Secondary Infections with Varicella
Pneumonia
Nec Fasc - S. pyogenes and anaerobes
