Infectious disease Flashcards
IgM role in immunity
IgM = the first antibodies made against an infection
IgG = most prevalent immune globulin in the bloodstream - phagocytosis of invading pathogens & transplacental immunity
IgA = found in mucosal surfaces & secretory immunity
IgE = present in allergy & anthelminthic immunity
Candidial esophagitis - CP, DX, TX
Odynophagia, GERD, epigastric pain, nausea, vomiting, +/- thrush
Endoscopy - white linear plaques/erosions
KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)
Tx: Fluconazole PO
Oral thrush
CP - friable white plaques - leave erythema/bleed if scraped
KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)
Tx: Nystantin S&S
VAGINAL CANDIDIASIS
Vulvar pruritis, burning, vaginal itching
KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)
Tx: Mizonazole, clotrimazole
Intertrigo - what is it? CP? TX?
Pruritic red beefy rash w/ discinct scalloped borders & satellite liesions
KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)
Tx: Topical clotrimazole
Fungemia, endocarditis
Seen in immunocompromised pt +/- indwelling catheters
Tx:
IV amphotericin B
Caspofungin if severe
Cryptococcosis - etio, transmission
Cryptococcus neoformans or C. gattii - encapsulated budding round yeast
Found in PIGEON / IRD DROPPINGS
MC in immunocompromised pt
Cryptococcosis - CP
CP:
1. Meningoencephalitis - HA meningeal si (neck stiffness, N/V, photophobia)
or
- Pneumonia
Cryptococcosis - DX & TX
Dx:
LP - inc WBC (lymphocytes), dec glucose, inc protein, india ink stain = encapsulated yeast , cryptococcal antigen in CSF
Tx:
Amphotericin B + Flucytosine x 2 weeks followed by oral fluconazole x 10 weeks
Histoplasmosis - etio? a/w? where found? CP?
Etio: Histoplasma capsulatum = dimorphic oval yeast
A/w: Soil contaminated w/ bird/bat droppings in OH/MI river valley
CP: ASX, atypical PNA (fever, non-productive cough, myalgias)
Disseminates if immunocompromised = hepatosplenomegaly, fever, ulcers, blood diarrhea, & adrenal insufficiency
Dx - labs, imaging histoplasmosis
Labs - Inc ALP, LDH, pancytopenia
CXR - pulmonary infiltrates & hilar/mediastinal lymphadenopathy
Tx histoplamosis
Mild- mid: IV Itraconazole
Severe dz: Amphotericin B
Pneumocystis PNA - etio, CP,
Etio: pneumocystis jiroveccii
CP:
O2 desat w/ ambulation, fever, DOE, nonproductive cough
Dx:
CXR - diffuse b/l interstitial infiltrates - may be normal, increased LDH
w/ Pneumo, PaO2 drops w/ ambulation P=P
Tx:
BACTRIM x 21 days - prednisone if hypoxic
Dapsone if sulfa allergy
CD4 count less than ? you PPX for PCP
< 200
PPX w/ Bactrim
PPX b/c PCP is most common opportunistic infection
Aspergillus found in? MC affects which parts of body?
Garden & house plant soil & compost - transmission via inhalation
Mc affects lungs, sinuses, & CNA
Aspergillus releases which substance which increases risk of which cancer?
Releases alfatoxin B1 which is a/w inc risk of hepatocellular carcinoma
Allergic bronchopulmonary aspergillosis - MC in who? CP?
MC in asthma & CF
Airway type I hypersensitivity rxn to fungus (eosinophilia & inc IgE)
CP: Asthma sx, cough, thick brown sputum (mucus plugs), fever, pulmonary infiltrates
“Fungal ball” on CXR = ?
Aspergilloma - when fungus colonizes a pre-existin pulmonary cavitary lesion - can be asx or have couth + hemoptysis
Chronic sinusitis treated with several courses of abx that didn’t go away should make you think what?
FUNGAL infection like acute invasive aspergillus - fever, HA, toothache, epistaxis,
INVASIVE CHRONIC SINUSITIS - often fatal - pull out the big guns (voriconazole)
Tx allergic bronchopulmonary aspergillosis
Tapered corticosteroids - chest PT, itraconazole
Severe or invasive aspergilus sinusitis tx
Voriconazole
Symptomatic aspergilloma tx
Surgical resection
Infection found in men who work outdoors with decaying wood or around soil in close proximity to waterways
Blastomycosis - fungal infection caused by blastomyces dermatitidis = pyogranulamatous fungal infection
Tx: Itraconazole
What does disseminated blastomycossis look like?
Pulmonary = MC site –> MOST ARE ASYMPTOMATIC - if chronic - like the flu- cough with or without sputum, dyspnea, headache, fever,
Also cutaneous - verrucous crusted ulcerated lesions which expand - skin = MC extrapulmonary site
Look like little meteor blasts on the skin
Coccidiodomycosis - who gets it? CP?
FOund in arid/desert regions in SOUTHWEST US, me
Primary pulmonary dz = asx in 65%
If not sx = mild flu-like sx or valley fever
Disseminated =CNS Meningitis
Valley fever clinical syndrome
Fever, arthralgias (pain & swelling in knees & ankles), erythema nodosum, erythemamultiform, macropapular rash, flu-like sx
Kind of generic - hopefully will give hx of being in southwest - arid climates where coccidiodomycosis is (southwest US, mexico) or being in dirt
Tx coccidiodomycosis - “valley fever”
Most cases are asx and don’t need tx
Localized lung dz treated symptomatically
Fluconazole for CNS disease
Reiter’s syndrome
Is reactive arthritis 2/2 chlamydia infection - urethritis, uveitis, arthritis
+ HLA - B27
Cant see, pee, climb a tree or “B”e
Disseminated gonorrhea = ?
Arthritis & dermatitis
Septic arthritis of the knee!
Cat scratch disease - etiology, CP, tx
Bartonella henselae - after scratch or bite from flea-infested cat (2-4wk incubation )
Brown/red/papule - ulcer at inoculatio site - 1-7 weeks after = fever, headahe, malaise, LYMPHADENOPATHY!!
Etiology meningococcal meningitis
Neisseria meningitidis
CP meningiococcal meningitis
+ kernig sign (can’t straignten leg when knee flexed - stretching meninges hurts)
+ Brudzinski - neck flexion -= involuntary hip/knee flexion
Fever, headache, visual changes, photophobia, AMS, neck stiffness, purpuric rash (DIC)
Treatment meningococcal meningitis
Most people are treated empirically:
Adults: ceftiraxone & vanco Infant:Ampicillin & cefotaxime
Penicillin G is TOC if susceptible
Prevention of meningococcal meningitis
Meningococcal vaccine - given to patients > 55 YO & high risk patients (asplenia)
Chancroid etiology, characteristics
Etio: Haemophilus ducreyi
ChancO = Haem-O
STD - PAINFUL ulcer(s) - irregular border, erythema, fever, painful inguinal LAD
Treat H. flu w/ azithro, treat this with azithro! 1g x 1 dose
MCC epiglotitis
Haemophilus influenzae
Also 2nd MCC CAP
Which cause of CAP is a/w otitis media & sinusitis?
H. flu
Diseases with eschar formation
Tularemia, anthrax, leishmaniasis, coccidiomycosis, mucormycosis
Hot tub folliculitis - etio, description of rash, tx
Etio - Pseudomonas
CP - smal pink to red bumps - filled with pus or covered w/ scap - 1-4 d after exposure - itchy tender red bumps located around hair follicles
Management - Usually spontaneously resolves WITHOUT treatment
Ciprofloxacin orally if persistent
Bubonic plague presentation
Etio - yersinia pestis (GNR)
Acutely swollen extermely warm red painful nodes (buboes) - 2-10 cm in diameter int eh groin, axilla & cervical regions
Tx Streptomycin or gentamycin
PEP - doxy or tetra
Fournier’s gangrene - etio, pt it happens in, tx
Etio - MC GABHS (often polymicrobial)
Happens in MALES w/ impaired immunity or after trauma to the area
EXTREME PAIN OUT OF PROPORTION TO PHYSICAL EXAM - blue, hemorrhagic bullae (blisters) at site –> gangrene –> shock
Tx - surgical debridement and broard spectrum antibiotics (carbepenem, zosyn, unasyn etc)
Diptheria etio
Corynebacterium diptheriae
Clinical manifestations diptheria
Tonsillopharyngitis w/ PSEUDOMEMBRANE - friable gray/white membrane on pharynx that bleeds if scraped
Myocarditis rarely = arrhythmias & heart failure
Tx diptheria
Diptheria antitoxin - horse serum and erythromycin & Penicillin x 2 weeks
Prevention of diptheria
DTAP vaccination
Tetanus - how do you get it, patho, CP
Clostridium tetani (Gram positive rod) - anaerobe found in soil - germinates easily in crush and puncture wounds - make s
Make sure anyone w/ wound has had tetanus shot esp if dirty
Patho/CP: Tetanospasmin = neurotoxin that = severe muscle spasm = local muscle spasms, jaw & neck stiffness, TRISMUS (lock jaw) = MC presenting sx, dysphagia
PE: Inc DTR! autonomic dysfunction = tachy, hyperpyrexia
Tetanus = trismus!!!
Tx tetanus
Metronidazole - against the clostridium tetani anaerobe!
PLUS teatnus immunoglobulin
Benzos for spasms
Tetanus PPX - never previously vaccinated
Tetanus immunoglobulin (250)
Tetanus vaccine - first dose right away, 2nd in 4-8wk, 3rd in 6-12 mo
IF previously vaccinated - TDAP or Td vaccine q10 years or given again if major cut > 5 years since last booster
Gas gangrene (myonecrosis) - etio, MC scenario it happens in, CP, tx
Etio - Clostridium perfringens
Happens after traumatic injury, IV drug use - (where clostridium anaerobes get into anaerobic environment)
CP - sudden onset pain & edema in area of wound w/ systemic toxicity (shock)
Brown to blood-tinged watery exudates with skin discoloration of surrounding area
Crepitus / gas in the tissue palpated on physical exam
Dx gas gangrene (myonecrosis)
Radiographs - air in the soft tissues
Culture of smear of exudates = gram positive rods/bacilli that are spore-forming
Tx gas gangrene
IV penicillin + IV clinda + wound debridement
Botulism - etio, who gets it/how
Etio: Clostridium botulinum
Adults: from canned, smoked or vacuum-packed foods
Infants: Honey or dust w/ spores = active toxin in gut
CP Botulinism
Sx onset 12-36 hrs after ingestion, 6-8 hrs if <1YO
8D’s of botulism - 8 letters & 8 D’s =
Dilated, fixed pupils Dry mouth Dysphagia Dysarthria Dysphonia Descending, decreased muscle strength = flaccid paralysis
(think of botox freezing muscles)
Infants = floppy baby syndrome - lethargy, weakness, flaccid paralysis, weak cry, FTT
Tx botulism
Antitoxins (<1 human, >1 equine)
Intubation if respiratory failure
NO ANTIBIOTICS in food-borne type = more bacterial lysis = more toxin release!
Only abx in wound type (rare)
Where is listeria found? Who does it cause significant disease burden in? Treatment?
Found in contaminated deli meats and unpasteurized dairy products (soft cheeses)
Infects: Children, elderly, pregnant patients
CP: Bacteremia (esp newborns), 3rd MCC meningitis
Tx: IV ampicillin
Anthrax - found in? causes which manifestations?
Bacillis anthracis - found in livestock
Manifestations - on skin = painless black eschar = MC type.
Also if inhaled - flu-like sx –> dyspnea–> pleural effusions, hypoxia, shock –> think bioterrorism
Dx inhaled anthrax on CXR
WIDENED mediastinum - b/c of hemorrhagic lymphadenitis
Tx anthrax
CIpro for tx & exposure
Syphilis etiology, transmission
Etio: Spirochete treponema pallidum - known as the “great immitator” b/c can present in many ways similar to other diseases
Transmission: Direct contact - sexual activity - forms chancre at innoculation site –> LN then disseminates
Clinical manifestations syphillis
Primary - (3 days - 3 months after infection)- single pailnless chancre at innoculation site - raised, indurated edges w/ non-tender regional LAD
Secondary - (6 weeks to 6 months after initial sx)- think of it disseminating = systemic sx (fever, malaise, LAD, arthritis, HA), maculopapular rash on palms, soles, also - CONDYLOMATA LATA - wart-like lesions involving mm
Tertiary - (years after primary infection) = granulomatous gummas and spreads to brain = neurosyphilis (HA, dementia, vision & hearing loss, TABES DORSALIS, ARGYLL ROBERTSON PUPIL, AORTITIS
Each one has skin manifestations - chancre –> condylomata lata –> gummas
Secondary is spreading to body - so systemic sx, then tertiary spreads up to brain =
Tabes dorsalis
Demyelination of posterior column leading to ataxia, areflexia, burning pain, weakness
Occurs in tertiary syphilis
Argyll- robertson pupil - what is it? when does it occur?
Small irregular pupil that constricts normally to near accommocation but does not constrict/react to light
Occurs in tertiary syphilis
Congenital syphilis causes….
Hutchinson teeth (notches on teeth)
Saddle-nose deformity
ToRCH syndrome
ToRCH syndrome
TORCH syndrome is a cluster of symptoms caused by congenital infection with toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other organisms including syphilis, parvovirus, and Varicella zoster.
Zika virus is considered the most recent member of TORCH infections
Sx: Hepatosplenomegaly (enlargement of the liver and spleen), fever, lethargy, difficulty feeding, anemia, petechiae, purpurae, jaundice, and chorioretinitis
Dx of syphilis
Darkfield microscopy to directly visualize if have a chancre or condyloma lata
RPR - non-treponomal test - non-specific & must be confirmed if positive w/ treponemal test =
FTA-ABS - fluorescence treponemal antibody absorption (FTA-ABS) or microhemagglutinatino test for T. pallidum antibodies
Tx syphilis
PENICILLIN G = ALWAYS THE TOC - even in penicillin allergic pt - try desensitizing
Primary, secondary, or early latent:
Pen G 2.4 mil units x 1 dose
Tertiary or late-latent:
If tertiary or late-latent then Pen G 2.4 mil units IM every week x 3 doses
If bad PCN allergy - can try doxy - but none are as effective as PCN
All pt follow up at 6 months & 12 months to see if cured - 4-fold dec in RPR titer = adequate management
Lyme disease - etio, transmitted via?
Borellia burgdorferi - gram negative spirochete
Transmitted via lxodes scapularis tick in nymphal phase - MC source = white-tailed deer & white-footed mice - in SPRING, SUMMER (when the nymphs feed) - MC in northeast, midwest, id-atlantic
Highest rate of trans if tick engorged & has been attached for > 72 hours
Clinical manifestations of early localized lyme
Erythema migrans
Expanding, warm, annular, erythematous macular rash - classically seen w/ central clearing but not always - appearance w/in 1 month of & around area of tick bite
May also have viral-like syndrome - headache, fever, malaise, LAD
Clinical manifestations of early disseminated lyme
1-12 weeks after infection - rheumatologic - ARTHRITIS (large joints)
Neurologic - HA, meningitis, weakness, CN palsies (CNVII palsy!!! - think bells! Lyme = common cause! )
Cardiac - AV block, pericarditis
Late lyme disease clinical manifestations
Persistent synovitis
Persistent neurological sx
Subacute encephalitis
Acrodermatitis chronic atrophicans - bluish discoloration of extremities seen in europe
Lyme dx
Lyme = CLINICAL dx !!! - esp w/ early lyme - this is because people in erythema migrans rash stage are often SERONEGATIVE so no reason to test!!!
Serology testing for lyme - when done, how?
ELISA –> if positive, or equivocal, it is followed up by a western blot
**Note - during time pt has erythema migrans rash, the serologic testing is often negative - that’s why it’s mainly a clinical diagnosis based on the rash & classic lyme sx along with hx exposure
False positive for lyme- ELISA occurs in?
If have another spirochetal disease like syphilis
Lyme tx
Early disease - doxy BID x 10-21 days - early disseminated do at least 14 days, if not 28
Amoxicillin = TOC in pregnancy, children <8 YO x 14-21d
Late/severe disease (AV heart block, sycnope, dyspnea, CP, CNS disease - other than CNVII palsy) –> IV ceftriaxone
Which two diseases that the PANCE loves commonly cause CNVII palsy?
Lyme disease
Sarcoidosis (Sarco-NM = 7 letters)
Lyme PPX
Doxycycline 200 mg x 1 dose within 72 hours of Ixodes tick removal that was on > 36 hours & > 20% of ticks in area infected
RMSF
RMSF =
M - W = wood dog tick
S - seizures, V SICK (fever, chills, arthralgias, myalgias, HA, lethargy, N/V, seizures)
Rash
Fever, maculopapular rash, tick bite =
Rocky mountain spotted fever = clinical dx based on fever, rash, hx tick bite = DX = TREAT
Tx RMSF
Doxy (even in children) x 5-14 days - ideally w/in 5 days of sx onset to reduce mortality
Chloramphenicol = 3rd line = TOC in pregnancy (not in pregnancy)
Describe the rash of RMSF
Maculopapular Erythematous BLANCHING FIRST on wrists/ankles --> then palms/ soles --> then centrally
Think of tick biting on wrist & crawling towards your center- rash spreads towards center
Dx RMSF
CLINICAL - fever, rash, tick bite = dx right there- treat w/ doxy
Can do serologies - indirect immunofluorescent Av test for IgM and IG against rickettsia ricketsii - 4x increase in titers = acute disease
CSF - low glucose & pleocytosis (increased cell count)
Amebiasis - etio, CP, dx, TX
Etio: Entamoeba histolytica - protozoan spread by fecal contamination of soil, water
CP: GI colitis, dysentery (bloody diarrehea), amebic liver abscess
Dx: Stool O&P, positive serologic tests (ELISA)
Tx:
Colitis - metronidazole followed by paromomycin (anti-parasitic aminoglycoside)
Abscesss - metronidazole, paromomycin, chloroquine +/- IR drainage if no improvement in 3 days
Malaria - etio, who gets it, who **doesn’t get it
Etio: Plasmodium spp. - falciparum = worst
Anyone bit by anopheles mosquito w/ the protozoa in it
Sickle cell trait & thalassemia trait are protective vs malaria
CP Malaria
CYCLICAL fever (2/2 cyle of plasmodium infecting RBC –> RBC lysis –> Fever)
Also chills –> fever –> diaphoresis –> chills –> fever –> etc
Hemolytic anemia
Thromgocytopenia
Leukopenia
P. falciparum = most dangerous b/c can cause cerebral malaria = coma and severe hemolysis + hemoglobinuria (dark urine) –> renal failure
Dx malaria
Geisma stain peripheral smear (thin & thick) - parasites in RBCs, thrombocytopenia, increased LDH
Tx malaria
Chloroquine - 1st line in sensitive areas
MDR area = atovaquone with doxy or clinda
Babeiosis - etio, transmission, CP
Etio - babesia microti - malaria-like protozoa that attacks RBCs
CP: fever, chills, hemolytic anemia & jaundice, arthralgias, myalgias
Like the malarial version of lyme diease - b/c caused by same tick (Ixodes) & in same area (northease - LONG ISLAND, MASS), bite but infects RBC (it’s a protozoa) & = hemolysis like malaria
LYME FUCKED MALARIA = BABY- OSIS
Dx babeiosis
Peripheral smear shows:
Pathognomonic TETRADS = MALTESE cross = the parasite that has infected the RBC
Tx babeiosis
Atovaquone plus azithromycine or quinine plus clinda
Toxoplasmosis - etio, CP, Dx, Tx
Etio: Toxoplasma gondii (protozoan) - transmitted by cats
Primary inf - usu asx in immunocompetent pt or may develop mono-like illness w/ cervical LAD
Immunocompromised pt (CD4 < 100) = ENCEPHALITIS & chorioentinitis - fever, cervical LAD, malaise, myalgias, headache, arthritis
Dx: PCR, Head CT/MRI w/ RING-enhancing lesions
Tx: Sulfadiazene (or clinda) + pyrimethamine (w/ folic acid/leucovorin) to prevent bone marrow suppression - spiramycin if pregnant
Toxoplasmosis - PS - pyrimethamine & sulfadiazene
Contenital toxoplasmosis
One of ToRCH infections = BLUEBERRY MUFIN RASH (from TTP - thrombotic thrombo-cytopenic purpura), hepatosplenomegaly, hearing loss, mental development delays
Pinworm - etio, transmission, tx
Etio: Enterobius vermicularis (sounds like worm)
Tranmission: Fecal-oral (esp in school-aged children!)
Dx: Scotch tape test
Tx: Albendazole - bend over to check & then give you albendazole
African trypanosomiasis (african sleeping sickness)
Etio: Protozoa T. brucei rhodesiense & gambiense
Vector: Tsetse fly
Prevalent in: Sub-sarahan africa & central america
CP:
Early: Painless shancre at bite site - generalized LAD, fever, malaise, HA, joint pain, WINTERBOTTOM sign - POSTERIOR cervical LAD
Late: CNS infection = daytime sleepiness followed by nighttime insomnia
Dx: Peripheral blood smear or aspiration of an affected LN
Tx: Infectious disease consult
Mycobacterium avium complex
Causes bronchiectasis/pulm infection in immunocompetent pt - cough w/ sputum, fever, weightloss
In immunocompromised (HIV) = disseminates = FUO, sweating, weight loss, fatigue, diarrhea, dyspnea, RUQ Pain
Dx: Acid fast bacillus staining & culture
Tx: Clarithromycin & Ethambutol for TWELVE MONTHS
Leprosy - etio, where found, tx
Eito: Mycobacterium leprae
Affects: Superficial tissues (skin, peripheral nerves)
Dx: Acid fast bacillus smear on skin bx
Tx: Dapsone & rifampin & clofazimine x 2-3 years
CMV = HHV#?,
Cytomegalo = 5 sylab = HHV 5
One of ToRCH infections
Most people have it (70%) but only causes disease in immunosuppressed pt
CP:
Primary dz - moast ASX, or mono-like illness
Reactivation (CD4<50)- retinitis (scrambled eggs/ketchup appearance), esophagitis (large superficial ulcers on endoscopy)
Tx: Gancyclovir
Congenital CMV
One of ToRCH infections - cause blueberry muffin rash (TTP) & petechiae, sensorineural hearing loss, hepatosplenomegaly
Dendritic ulcers on slit lamp exam =
Herpes keratitis
Tx: antiviral eye drops (trifluridine, vidarabine, ganciclovir) AND oral acyclovir
HSV esophagitis on endoscopy?
SMALL DEEP ULCERS
CMV = large shallow ulcers
Usual description of herpes ulcers on a test
Painful, grouped vesicles on an erythematous base
Bells palsy a/w which herpes virus?
HSV 1
MCC encephalitis? Tx?
HSV
Tx: IV acyclovir
Dx HSV 1/2 in all forms
PCR is most sensitive & specific test, also a clinical dx
What would a KOH for herpes show? What would a tzanck smear show?
KOH - show NOTHING - used for FUNGAL infections DUH
Tzanck smear - would show multinucleated giant cells & intranuclear inclusion bodies
Varicella zoster virus - HHV#? clinical manifestations? management?
HHV3 - 3 words, #3
Clinical manifestations:
1. Chicken pox:
Primary inf - fever, malaise, begins on face, spreads down - in different stages of healing, vesicles on erythematous base (dew drops on rose petal)
- Herpes zoster (shingles) - VZV reactivation along ONE dermatome - UNILATERAL, can disseminate in HIV
- Herpes zoster ophthalmalicus- HHV3 infects first division of CN 5 (trigeminal). + HUTCHINSON’s SIGN - lesions on nose usu mean ocular involvement!!! + dendritic lesions on slit lamp if keratoconjunctivitis present
- Post-herpetic neuralgia - pain > 3 months, hyperesthesias, decreased sensation - GIVE antivirals w/ in 72 hours of sx onset in zoster to prevent PHN
Epstein barr virus (mono) caused by HHV#? CP, Dx, Tx
Etio: HHV4 - mono = 4 letters, & is #4
“kissing disease” 80% adults are seropositive
CP: Fever, sore throat, & POSTERIOR cervical LAD, malaise, myalgias, splenomegaly
Dx: Heterophile (monospot) Ab test (positive w/in 4 weeks)
CBC w/ diff (or smear) will show > 10% atypical lymphocytes
Tx: Supportive, avoid trauma & contact sports
Rabies
Def = life-threatening infection of the CNS (encephalitis of grey matter)
Infected saliva from bites of rabid animals - raccoons, bats, skunks, foxes, wolves dogs (NOT RODENTS)
If person slept in room where later discovered a bat - do they receive rabies PPX?
YES - even if no visible bite mark seen - goes thru axons from peripheral to central nervous system w/ incubation 3-7 weeks so too late if don’t get PPX
CP Rabies
- Prodrome - pain, itching, paresthesisas at initial site of bite is pathognomonic
- CNS phase - encephalitis, arophobia, hydrophobia, numbness, paralysis
- Respiratory phase - respiratory muscle paralysis = death
RABIES = PCR - prodrome, CNS infection, RESP paralysis
Dx rabies
Quarantine the animal for 7-10 days if you can - NEGRI bodies in brain of dead animals
Tx rabies
Once sx occur, you’re fucked - induce coma & give amantadine & ribavirin
PEP Rabies, first episode
PEP rabies = Rabies vaccine (HDCV) on days 0, 3, 7, 14 - HDCV = 4 letters, need 4 doses (immunocomp add one dose on day 28)
AND
Rabies immunoglobulin (1/2 in wound, 1/2 IM)
This is all ideally started w/in 6 days of exposure
PEP for rabies if have already been bitten in past & received PEP once
Only need rabies vaccine, two doses, no immunoglobulin needed
Smallpox classic presentation
Flu-like prodrome with SIMULTANEOUS SKIN eruptions - palmar and plantar lesions common - spreads TRUNK to extremities (varicella spreads head down & spares palms/soles)
Tx: supportive, isolate & vaccinate all contacts
West nile fever - etio, CP, tx
Etio: Flavivirus (type of arbovirus)- birds = reservoir, mostquitos transmit to humans, homeless at increased risk
CP: Most ASX, flu-like - HA, fatigue, nausea, vomiting, stiff neck, AMS
Tx: Supportive
SARS (severe, acute, respiratory syndrome) - etio, CP, tx
Coronavirus - respiratory droplet transmission
Causes: atypical PNA, non-specific flu-like symptoms, pharyngitis
Dx: TR-PCR for CARS-CoV in urine, stool & nasal secretions - STOOL is the first to be positive
Management: aggressive supportive management
Creutzfeldt-jakob disease - etio? CP?
PRION - mediated degenerative grain disease that leads to rapidly-progressing dementia - fatal w/in 1 year
Patho: Prion enters cells = misfolding = holes in tissues = spongioform cortex
Myoclonus, marked gait abnormalities
HIV acute seroconversion CP
Flu-like illness, fever, malaise, generalized rash, generalized LAD
AIDS CP
Defined as CD4 count < 200 or the development of aids-defining illness with or without HIV testing
Recurrent & potentially severe life-threatening opportunistic infections or malignancies
HIV wasting syndrome (chronic diarrhea & weight loss)
AIDS-associated neurologic changes - encephalopathy or dementia
Dx HIV
Antibody testing:
- ELISA (screening test) - if reactive, confirmed w/ western blot - person usu reactive w/in 3-6 mo
- Rapid testing: blood or saliva
HIV RNA VIRAL LOAD - used mainly to monitor infectivity & treatment effectiveness in pt already dx w/ HIV
CD4 200-500 HIV - opportunistic infections that start causing an issue
Tuberculosis!!! - treat w/ INH if latent TB
Kaposi sarcoma, thrush, lymphoma, zoster
CD4 count < 200 in HIV ….worry about?
PCP - can initiate PPX with bactrim
CD4 count < 150 in HIV …worry about?
HIstoplasmosis - PPX with Itraconazole
CD4 count < 100 in HIV..worry about?
- Toxoplasmosis - PPX w/ bactrim
(Note: **Different than tx - tx = sulfaziazene w/ pyrimethazine - causes then ring-enhancing lesions on MRI) - Cryptococcus - PPX w/ fluconazole
CD4 count < 50 in HIV…worry about?
MAC - Azithromycin
CMV retinitis - valganciclovir
PEP to HIV
Used in pt w/ high risk of infection (occupational exposure) - best if started w/in 72 hours - earlier the better
We offer PEP to HCP with a percutaneous mucous membrane or nonintact skin exposure to blood or bloody body fluids of a patient with known HIV infection. If the HIV status of the source patient is unknown, we offer PEP while awaiting HIV testing, particularly if the source patient is at high risk for HIV infection (eg, injection drug users, men who have sex with men) or has symptoms suggesting HIV infection. If the source patient cannot be identified (ie, HIV testing not possible), we offer PEP if the exposure occurred in a high-risk setting (eg, a needlestick from a sharps container in an HIV clinic or a needle exchange program)
HIV ARV treatments for naive patients
NNRTI + 2 NRTI or…
PI + 2 NRTI or…
INSTI + 2 NRTI
NRTI =
Zidovudine, Emtricitabine, abacavir, tenofivir
NNRTI =
Efevirenz, delavirdine, etravirine, nevirapine, rilpivirne
Proteas inhibitors (PI) - all end in - NAVIR: Atazanavir, indinavir
INSTI = integrase inhibitor =
Raltegravir, dolutegravir
Measles vs German measles
O looks like a C & its in RubeOla - one L, measles = one word
Rubella = two L’s = two words (german measles) - german’s are tough, not as bad of an infection - just some post-cervical & post-auricular LAD & LIGHT pink rash. Measles you turn into a red brick as maculopapular rash convalesces
3 C’s - cough, conjunctivitis, coryza & Koplick spots - rubeOla - measles
Rubella - german measles - two LL’s = light pink rash, lighter sx - 3d rash & no long term sequelae - BUT congenital rubella = teratogenic (ToRCH infection)
Rubeola - measles = can have significant M&M if it causes PNA or encephalitis in kids
Roseola - CP
Fever and rash, surprise surprise..
However Roseola = HIGH fever for 3 days - child is well-appearing during this time - pink maculopapular BLANCHING rash
Only childhood rash that STARTS ON TRUNK - then goes to face
Measles = starts on hair line & spreads to face extremities
Chicken pox - starts on face & descends - spreads down
RMSF - starts on wrists & spreads centrally
Erythema infectiosum
AKA 5th disease - caused by PARVO (5 letters) virus
Red flushed face - “slapped cheek” like been slapped by hand w/ 5 fingers - also lacy reticular rash on the body - ALL OTHERS ARE maculopapular - so if see “lacy reticular” then think erythema infectiosum
Hand, foot & mouth disease
Coxsackie A virus
Fever, URI - vesicular lesions w/ erythematous base w/ an erythematous halo in oral cavity - vesicles on hands, feet, mouth, genitals
Seen more in summer
Scalded skin syndrome
S. aureus exotoxin
Kids < 6 YO
+ NIKOLSKY SIGN = sloughing of skin with gentle pressure
PAINFUL diffuse red rash begins centrally
