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Clin Med I > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

suspected case

A
  • epidemiological exposure

- 2+ sx

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2
Q

probable case

A
  • relevant epidemiological exposure
  • no disease sx
  • positive IgM
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3
Q

confirmed case

A
  • viral RNA or antigen detected
  • IgM antibody
  • “tested positive for virus”
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4
Q

what causes zika

A
  • flavivirus

- single strand RNA virus

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5
Q

how is zika transmitted

A
  • mosquitoes
  • aedes aegypti and aedes albopictus strands
  • day and twilight feeders
  • breed in standing water
  • can be transmitted sexually, maternal-fetal
  • less frequently transmitted through blood transfusions, organ transplant, lab exposure
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6
Q

where did zika originate

A

uganda in rheusus monkeys

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7
Q

where are the more recent zika outbreaks

A
  • yap island- 2007
  • french polyesia- 2013-14
  • chile easter island - 2014
  • brazil- 2015
  • current- americas, caribbean, pacific islands, sub-saharan africa, asia
  • pregnant women/ attempting avoid travel below 6500 feet
  • cases in US related to travel
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8
Q

what fluids is zika detected in

A
  • blood
  • semen
  • saliva
  • female GU secretions
  • amniotic fluid
  • breast milk
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9
Q

clinical manifestations of zika

A
  • only in 20% of pts
  • mild in those with sx
  • low grade fever
  • pruritic rash
  • arthralgia - small joints
  • conjunctivitis
  • microcephaly in pregnant females
  • dx if 2+ sx
  • immunity after infection
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10
Q

what is the incubation period for zika

A
  • 2-14 days

- resolves in 2-7 days

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11
Q

less common sx of zika

A
  • HA
  • retro-orbital pain
  • myalgia
  • n/d
  • abd pain
  • mucus membrane ulceration
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12
Q

complications of zika

A
  • fetal loss
  • microcephaly
  • guillian barre syndrome
  • brain ischemia
  • myelitis
  • meningoencephalitis
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13
Q

diagnosis of zika

A
  • serum virus if sx onset < 14 days

- serum IgM if sx onset > 14 days

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14
Q

management of zika

A
  • supportive- rest, hydrate, APAP
  • NAIDS avoided until r/o dengue
  • ASA avoided in kids- Reye
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15
Q

prevention of zika

A
  • no vaccine
  • limit travel to certain areas
  • remove standing water
  • mosquito repellent
  • long sleeves/pants
  • environmental control
  • protected intercourse
  • must report zika cases to CDC
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16
Q

what causes chikungunya

A
  • alphavirus

- single strand RNA

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17
Q

where is chikungunya found

A
  • endemic to west africa
  • asia
  • europe
  • islands in indian and pacific oceans
  • americas
  • during rainy seasons
  • outbreaks have high attack rates
  • all US cases d/t travel
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18
Q

how is chikungunya spread

A
  • mosquitos
  • aedes aegypti and aedes albopictus
  • day feeder mosquitos
  • vertical transmission, blood donation, and organ transplant rare causes of transmission
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19
Q

clinical manifestations of chikungunya

A
  • abrupt fever (high grade) and malaise
  • polyarthralgia 2-5 days after fever in smaller joints bilaterally
  • pain is intense and disabling
  • maculopapular rash +/- pruritis
  • nonspecific lab changes
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20
Q

what is the incubation period of chikungunya

A
  • 3-7 days
  • acute phase lasts 7-10 days
  • majority of pts show sx
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21
Q

complications of chikungunya

A
  • death in pts >65 with comorbidities
  • persistent debilitating and immobilizing arthritis
  • resp, renal, and CV failure
  • can be persistent and relapsing up to 3 years
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22
Q

diagnosis of chikungunya

A
  • virus detected 1-7 days
  • antibodies detected > 8 days
  • IgM present after 5 days onset, persists for 3 mo
  • IgG present after 2 weeks, persists for years
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23
Q

management of chikungunya

A
  • supportive
  • NSAIDS
  • steroids, methotrexate, immune modulating agents for severe arthritis
  • no vaccine
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24
Q

prevention of chikungunya

A
  • minimize mosquito exposure
  • repellants
  • bed nets
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25
Q

what causes dengue virus

A
  • flavivirus
  • single strand RNA virus
  • four types DENV 1-4 with 46 strains
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26
Q

how is dengue spread

A
  • mosquito
  • aedes aegypti and aedes albopictus
  • maternal- fetal transmission
  • leading cause of death in tropics and subtropics
  • death most often in kids
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27
Q

current dengue classifications

A
  • dengue without warning sign
  • dengue with warning signs
  • severe dengue
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28
Q

where is dengue found

A
  • rio de janeiro
  • bolivia
  • argenita
  • brazil
  • peru
  • paraguay
  • mexico
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29
Q

dengue without warning signs symptoms

A
  • n/v
  • rash
  • HA
  • eye pain
  • muscle ache, joint pain
  • leukopenia
  • positive tourniquet test
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30
Q

dengue with warning signs sx

A
  • abd pain
  • persistent vomitting
  • fluid accumulation
  • mucosal bleeding
  • lethargy or restlessness
  • hepatosplenomegaly
  • increased HCT and decreased platelet
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31
Q

severe dengue sx

A
  • plasma leakage -> shock and fluid accumulation
  • respiratory distress
  • severe bleeding
  • severe organ failure
  • impaired consciousness
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32
Q

phases of dengue infection

A
  • febrile
  • critical
  • convalescent
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33
Q

febrile dengue phase

A
  • high grade fever
  • HA
  • rash
  • vomiting
  • myalgia
  • arthralgia
  • 3-7 days long
  • conjunctival injection
  • pharyngeal erythema
  • hepatomegaly
  • facial puffiness
  • petichiae
  • recover without complications
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34
Q

critical dengue phase

A
  • systemic vascular leak syndrome
  • plasma leak
  • bleeding
  • shock
  • organ failure
  • days 3-7 and lasts 34-48 hours
  • mod- severe thrombocytopenia
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35
Q

convalescent dengue phase

A
  • plasma leak and hemorrhage resolve
  • vital signs stabilize
  • usually lasts 2-4 days
  • rash may appear
  • profound fatigue, can take weeks to recover
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36
Q

diagnosis of dengue

A
  • viral antigen in first week

- IgM as early as four days after onset

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37
Q

management of dengue

A
  • supportive
  • APAP for fever
  • no NSAIDs bc of bleed risk
  • bleed management with blood replacement
  • volume replacement
  • shock tx
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38
Q

dengue prevention

A
  • mosquito control
  • vaccination- only for seropos or hx of dengue
  • limit travel
  • improve community participation
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39
Q

ebola virus cause

A
  • filoviridae
  • single strand RNA virus
  • resembles rabies, measles, mumps
  • has 5 species
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40
Q

how is ebola spread

A
  • direct contact with infected body fluids
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41
Q

what are the ebola species

A
  • zaire
  • sudan
  • tai forest (ivory coast)
  • bundibugyo
  • reston- only animal reservoir
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42
Q

where is ebola found

A
  • sub-saharan africa
  • guinea
  • liberia
  • sierra leone
  • nigeria
  • senegal
  • mali
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43
Q

how is ebola spread

A
  • contact with meat or body fluids of infected animals/ humans
  • virus can spread even after human/animal dies
  • lives on surfaces for hours- days
  • survives forever in immunologically privileged sites
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44
Q

what is the most infectious body fluid associated with ebola

A
  • vomit
  • feces
  • blood
  • less infectious in early stages
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45
Q

who is at the greatest risk of ebola

A
  • medical provider

- prep body for burial

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46
Q

ebola clinical symptoms

A
  • fever, chills, malaise (d 1-3)
  • rash
  • n/v/d abd pain (d 3-10)
  • shock (day 7-12)
  • hemorrhage not often seen
  • convalescence up to two years- arthralgia, weakness, fatigue, insomnia
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47
Q

when do ebola pts start to get better if they survive

A

during the second week

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48
Q

lab findings for ebola

A
  • leukopenia
  • thrombocytopenia
  • hematocrit increased or decreased
  • increased ALT and AST
  • coag abnormalities
  • renal abnormalities
  • electrolyte abnormalities
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49
Q

diagnosis of ebola

A
  • ID pt risk
  • viral RNA in serum
  • ReEbov available for rapid dx (15 min)
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50
Q

ebola management

A
  • supportive care
  • fluid/ electrolytes
  • anti-emetics
  • antipyretic
  • blood products
  • TPN
  • antivirals
  • compassionate use meds
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51
Q

prognostic factors for ebola

A
  • age- younger has less mortality
  • gender- slightly higher mortality in males
  • GI- higher rate of mortality with diarrhea
  • viral load
52
Q

ebola prevention

A
  • strict infection control
  • proper use of personal protective equipment
  • communication btwn government and health care works
  • no vaccine
  • considered cat A bioterror agent
53
Q

what makes up the sepsis continuum

A

infection -> bacteremia -> . sepsis -> septic shock -> MODS -> death

54
Q

what is the most common cause of bateremia?

A
  • staph aureus

- in community acquired and hospital acquired

55
Q

what is the most common cause of bacteremia d/t skin and soft tissue infections

A

stroup a streptococcus

56
Q

what is a common cause of bacteremia in immuncompromised

A

pseudomonas

57
Q

seeding for bacteremia

A
  • respiratory tract
  • UTI
  • abdominal infection
  • ENT
  • instrumentation i.e. catheter
  • surgery
  • prosthesis
58
Q

clinical signs of bacteremia

A
  • hypotension
  • tachycardia
  • fever
  • chills
  • malaise
  • SIRS possible
59
Q

treatment for bacteremia

A
  • empiric PO abx (staph and strep coverage)
60
Q

sepsis

A
  • life threatening organ dysfunction and infection

- dysregulated host response to infection

61
Q

septic shock

A

sepsis with circulatory cellular and metabolic abnormalities

62
Q

epidemiology of sepsis

A
  • higher in AA males
  • greatest during winter
  • > 65 is most cases
  • GP bacteria
63
Q

SIRS diagnosis

A
  • two or more of the following:
  • temp >38 C or < 36 C
  • HR > 90
  • RR > 20 or PaCO2 <32 mmHg
  • WBC >12,000, <4,000 cells, or >10% immature forms
64
Q

organ dysfunction assessment in sepsis

A
  • GCS score
  • BP
  • ventilator support
  • renal function
  • liver function
  • platelets
65
Q

risk factors for sepsis

A
  • ICU admission
  • bacteremia
  • advanced age
  • immunosuppression
  • diabetes and cancer
  • community acquired pneumonia
  • previous hospitalization
66
Q

septic shock clinical manifestations

A
  • vasodilatory or distributory shock
  • require vasopressors
  • cool skin
  • cyanosis
  • oligouria
  • altered mentation
  • elevated lactate
67
Q

multiorgan dysfunction syndrome (MODS)

A
  • progressive organ dysfunction
  • severe end of severe illness
  • primary or secondary
  • no universally accepted criteria for dx
68
Q

how is lyme disease transmitted?

A
  • tick bite

- mainly deer tick aka black legged ticks (l. scapularis)

69
Q

what causes lyme disease?

A
  • borrelia burgdorferi

- spirochete

70
Q

in what stage of life are most ticks in when they transmit lyme disease?

A
  • nymph stage

- adults are larger so are more easily seen/ removed

71
Q

risk factors for lyme disase

A
  • outdoor occupation
  • recreational activities in wooded area
  • live in an endemic area like new england
72
Q

when do deer ticks transmit lyme disease?

A
  • when feeding (look engorged)
  • if tick is easily removed or walking on surface it cannot transmit disease
  • if attached for > 72 hours likely to transmit disease
73
Q

what are the three phases of lyme disease

A
  • early localized disease
  • early disseminated disease
  • late disease
74
Q

clinical manifestations of early localized lyme disease

A
  • erythema migrans***
  • EM usually appears 7-14 days after bite
  • nonspecific viral sx
  • absence of rash means lyme is likely NOT your dx
75
Q

common characteristics of erythema migrans

A
  • painless
  • erythematous
  • circular
  • large diameter
  • central clearing may develop
76
Q

symptoms of early disseminated lyme disease

A
  • neurologic or cardiac involvement
  • occurs weeks to several months after bite
  • multiple EM lesions means disease is disseminated
  • uni/bilateral CN palsies (facial common)
77
Q

symptoms of late lyme disease

A
  • much less common
  • months to years after initial infection
  • usually arthritis in more than one joint (knees common)
  • neurologic subtleties
78
Q

diagnosis of early lyme disease

A
  • clinical dx
  • EM and/or viral symtpoms with hx of exposure is diagnostic
  • NO serology
79
Q

diagnosis of early disseminated or late lyme disease

A
  • hx and PE

- serologic testing as adjunct

80
Q

when do you perform serology testing on a suspected lyme disease case?

A 
- recent exposure to endemic area
AND
- risk factor for exposure
AND
- sx consistent with early disseminated or late disease
81
Q

who should not get serology testing for lyme disease

A
  • pts with EM rash

- screening of asymptomatic pts living in endemic areas

82
Q

what serological tests are used for lyme disease

A
  • ELISA then western blot
83
Q

when do antibodies for lyme appear

A
  • IgM- 1-2 weeks after infection
  • IgG- 2-6 weeks after infection
  • remain elevated even after treatment and resolution of sx for years
  • routine f/u serologic testing NOT recommended
84
Q

what is the DOC for lyme disease?

A
  • doxycycline
  • 100 mg orally twice daily X21 days
  • ** cannot be given to kids <8 or pregnant/ lactating women
85
Q

what are the second line agents for treating lyme disease?

A
  • amoxicillin 500 mg orally 3 times daily X21 days

- cefuroxime 500 mg orally twice daily X 21 days

86
Q

what is the treatment for early disseminated lyme disease?

A
  • IV antibiotics X 21-28 days
  • ceftriaxone
  • cefotazime
  • penicillin
  • caveat- if pt has facial palsy can treat with PO doxyxycline 100 mg twice daily
87
Q

treatment for late lyme disease

A
  • oral doxycycline or amoxicillin for 1 month

- usually to treat arthritis

88
Q

can you be infected with lyme more than once?

A

yes

89
Q

what is the prophylactic dose for lyme disease?

A
  • doxycycline 200 mg orally as single dose (so take two pills once)
90
Q

who should be treated prophylactically for lyme?

A
  • tick ID as deer tick
  • tick was attached > 36 hrs
  • must start within 72 hours of tick removal
  • high rate of local infection
  • doxycycline not C/I
91
Q

what causes rocky mountain spotted fever (RMSF)?

A
  • r. rickettsi

- GN bacteria

92
Q

what is the main issue with RMSF

A
  • bacteria causes increased vascular permeability

- clinical response varies from pt to pt

93
Q

who is most likely to die from RMSF?

A
  • kids < 4

- adults > 60

94
Q

how is RMSF transmitted?

A
  • tick bite
  • dock tick and rocky mountain wood tick
  • bacteria released 6-10 hours after bite
95
Q

symptoms of RMSF

A
  • usually start 2-14 days after bite
  • nonspecific viral sx
  • hallmark rash- blanching erythematous rash with macules that become petechial
  • rash usually begings on ankles and wrists -> trunk
  • rash seen on palms and soles
96
Q

diagnosis of RMSF

A
  • clinical diagnosis
  • serologic testing for confirmation
  • skin biopsy before or within 12 hours of abx
  • empiric therapy should be started within 5 days of sx onset
97
Q

what is the DOC for RMSF?

A
  • doxycycline
98
Q

what causes babesiosis

A
  • babesia protozoa
99
Q

how is babesiosis transmitted

A
  • tick bite
100
Q

what is the main concern with babesiosis

A
  • causes RBC lysis

- sx vary but can be fatal

101
Q

clinical manifestations of babesiosis

A
  • dev within 1-6 weeks of tick bite
  • associated with RBC lysis
  • fever, malaise, weakness
  • splenomegaly and hepatomegaly
102
Q

who is most at risk for a severe course of babesiosis

A
  • asplenism

- immunocompromised

103
Q

what are complications associated with babesiosis?

A
  • DIC
  • ARDS
  • CHF
  • renal failure
104
Q

diagnosis of babesiosis

A
  • blood smear
  • PCR
  • serology for acute infection (should not be sole diagnostic tool)
105
Q

what is the DOC for babesiosis?

A
  • atovaquone plus azithromycin

- 7-10 days of treatment

106
Q

what causes rabies?

A
  • rhabdoviridiae virus

- part of neuotropic viruses

107
Q

what determines susceptibility to rabies

A
  • bite location
  • virus varient
  • size of innoculation
  • degree of innervation at site of bite
  • host immunity and genetics
108
Q

what disease has the highest case fatality of any infectious disease?

A
  • rabies

- death primarily in developing countries

109
Q

how is rabies transmitted?

A
  • mainly exposure to saliva from animal bite
110
Q

types of rabies

A
  • prodrome- nonspecific viral sx
  • clinical rabies- either encephalitic or paralytic
  • once pt exhibits si/sx, often progresses to death
111
Q

encephalitic rabies

A
  • most common
  • death d/t respiratory and vascular collapse
  • hydrophobia and aerophobia
  • hyperactivity of facial, back and neck muscles
  • autonomic instability
  • agitation and combativeness
112
Q

paralytic rabies

A
  • ascending paralysis
  • starts in affected limb then spreads
  • little CNS involvement until later in course
  • death d/t respiratory muscles failure
113
Q

diagnosis of rabies

A
  • lab testing of several specimen
  • staining of skin biopsies
  • virus can be obtained from saliva
  • anti-rabies Ab obtained from CSF
  • most cases dx postmortem
114
Q

what occurs around the site of a rabies bite?

A
  • paresthesias
115
Q

rabies treatment

A
  • mainly focused on prevention
  • palliative treatment
  • aggressive treatment in ICU
116
Q

post exposure prophylaxis of rabies

A
  • can seek guidance from local public health authorities about who needs PEP
  • should be considered in bat bites/ bat exposure
  • can give immunoglobulin as passive immunization and vaccine as active immunization
117
Q

rabies and travel prophylaxis

A
  • give to people who may be working around rabid animals
  • kids who will be living in endemic areas
  • people who will be in areas where dog rabies is common
118
Q

pre-exposure prophylaxis

A
  • give 3 doses of vaccine
  • booster may be needed if ongoing risk of rabies
  • serologic testing can confirm protective levels
119
Q

how is malaria transmitted

A
  • mosquito bites
120
Q

who is most at risk for severe malaria infections?

A
  • young children
  • pregnant women
  • travelers to endemic regions
  • older kids and adults can dev immunity after repeated infections
121
Q

what causes malaria?

A
  • parasites

- p. falciparum causes severe illness

122
Q

symptoms of malaria

A
  • cyclic fever***
  • nonspecific sx
  • anemia
123
Q

how is malaria diagnosed?

A
  • giemsa stained blood smear

- rapid diagnositc tests available in endemic areas

124
Q

who requires hospitalization d/t malaria?

A
  • young kids
  • immunocompromised
  • no acquired immunity
  • pts with parasitemia but no sx
125
Q

what is the DOC for malaria

A
  • chloroquine

- other regimens available for chloroquine resistant strains

Clin Med I (16 decks)

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