Infectious Disease Flashcards
1
Q
Newborn with Sensorineural deafness, cardiac defects (PDA, PPS), cataracts, dermal erythropoiesis
A
Congenital rubella infection
- Other clinical signs: IUGR, pneumonia, encephalitis, HSM, jaundice, anemia, thrombocytopenia, blueberry muffin rash
2
Q
Hepatitis B serologies
A
- Hepatitis B surface antigen and antibody to hepatitis B core antigen = CHRONIC infection
- IgM hepatitis B core antibody = ACUTE infection
- Hepatitis B e antigen is suggestive of high viral replication and increased virus transmission
3
Q
Enterovirus meningitis
A
- MC in summer/early fall
- Transmission is fecal/oral
- CSF viral PCR is best way to detect it
- CSF: relatively low white count (can be neutrophil predominant early on), mildly elevated protein, normal glucose
- Other symptoms: GI/respiratory symptoms, nonspecific viral exanthem, hand/foot/mouth rash
4
Q
Pertussis treatment
A
5 day course of azithromycin for treatment and post-exposure prophylaxis
5
Q
Pertussis clinical presentation
A
- In < 3 month old can be severe - perioral cyanosis w/ coughing, gagging, apnea
- Catarrhal stage (5-7 days): mild upper respiratory symptoms
- Paroxysmal stage (7-10 days): whooping cough, post-tussive emesis, often afebrile
- Full duration is usually 6-10 weeks
- Complications: rib fractures, pneumonia, sleep issues, apnea, bradycardia, hypoxemia, hemorrhage, SIDS
6
Q
Bordetella pertussis micro
A
- Gram negative coccobacillus
- Droplet spread
- Incubation is 7-10 days
- Diagnose with PCR
7
Q
Immigrant child with eosinophilia
A
Test for Strongyloides stercoralis
8
Q
Adenovirus signs and symptoms
A
- Pharyngitis, conjunctivitis, fever, preauricular lymphadenopathy
- Outbreaks associated with swimming pools
9
Q
Coccidioidomycosis signs/symptoms and geography
A
- Soil from SW US (California, Arizona, New Mexico, Texas), Mexico, Central/South America
- Pulmonary: cough, fever, headache, effusions, lymphadenopathy
- Disseminated: skin lesions, bone lesions/pain, CNS meningitis
10
Q
Coccidioidomycosis micro
A
- Fungus with septate hyphae
- Airborne –> inhale spores
11
Q
Coccidioidomycosis diagonsis and treatment
A
- Serologic testing in urine, serum, plasma, or BAL
- Positive IGM at 1-3 weeks after infection
- Positive IgG –> complement fixation tests are HIGHLY SPECIFIC
- Tx with amphotericin B, fluconazole, or ketoconazole
12
Q
Bloody diarrhea from unpasteurized milk, undercooked poultry, or contaminated water
A
Campylobacter jejuni
13
Q
Campylobacter sign/symptoms
A
- # 1 cause bacterial foodborne GI in kids
- gram-negative, spiral, motile, non–spore-forming bacilli
- Bloody diarrhea, fever, crampy abdominal pain
- Complications: sepsis/meningitis in neonates,
- Guillain-Barré syndrome, reactive arthritis, Reiter syndrome, myopericarditis, and erythema nodosum
14
Q
Campylobacter treatment
A
3 days azithromycin to decrease duration and spread but often is just a self limited illness
15
Q
Neisseria meningitidis micro and treatment
A
Gram negative encapsulated diplococcus that colonizes in nasopharynx
- Transmission via droplets - higher rates of carriage in people in crowded living conditions
- Rocephin or penicillins
16
Q
Neisseria meningitidis signs/symptoms
A
- Rapid septic shock
- Purpuric rash, meningitis
- Endotoxin can cause cardiovascular collapse, DIC, respiratory failure
17
Q
Enterobius vermicularis transmission, symptoms, treatment
A
- Pinworms (roundworm)
- Transmission fecal-oral route with contaminated toys, bedding, clothing, or toilet seats
- MC in children age 5-10
- Symptoms: perianal pruritis, restless sleep, vulvitis with dysuria
- Tx: albendazole (treat everyone in the house) and sanitize everything
18
Q
Hepatitis C virus maternal to fetal transmission course
A
- Only 5% of infants born to moms with hep C get the virus (low transmission rate) –> need to get an antibody test at 18 months of age (or 6 months after breastfeeding)
- Chronic disease with slowly progressive liver fibrosis in childhood
19
Q
Listeria infection in neonate
A
- Risks: maternal GI illness prior to delivery, preterm
- Micro: Gram positive rods
- Symptoms: diffuse erythematous papular rash (granulomatosis infantisepticum), sepsis, meningitis
20
Q
Measles post exposure prophylaxis
A
Immune globulin for infants < 6 months of age if within 6 days of exposure
21
Q
Painless penile ulcers with indurated border
A
- Primary syphilis
- Definitive diagnosis: dark field microscopy
- Presumptive diagnosis: RPR or VRDL
22
Q
Painful penile ulcers
A
HSV, chancroid, non-STD infections (EBV)
23
Q
Common infections from developing worlds
A
TB, HIV, typhoid fever, invasive H. flu
24
Q
Most common STD in the US
A
Chlamydia
25
Complication from using erythromycin in newborns
Pyloric stenosis (if used for less than 6 week old)
26
Newborn in first 2 months, afebrile, staccato cough, tachypnea, w or w/o eye discharge
Chlamydia trachomatis
27
Diagnosis of Chlamydia
- Intracytoplasmic inclusion bodies in scrapings
| - PCR is definitive diagnosis
28
Treatment of chlamydia conjunctivitis
Oral erythromycin
| NOT TOPICAL
29
Chlamydia pneumonia symptoms
- Low grade fever with infiltrates in an adolescent
- Dx with immunofluorescent antiboides
- Tx: azithromycin for 5 days or erythromycin for 14 days
30
Epidemiology of Rocky Mountain Spotted Fever
- Rickettsia rickettsii is the bacteria
- Peak in spring/summer
- Incubation is 3-12 days
31
Purpuric macular rash that becomes petechial, starts on the wrists and ankles/palms and soles and spreads centrally 2-4 days after fever
Rocky Mountain Spotted Fever
- Also commonly have headaches and myalgias
- Labs: hyponatremia, can have pancytopenias
32
Diagnosis and treatment of RMSF
- Serologic testing at presentation and 2-4 weeks later - dx is based on 4 fold increase in titers
- TREAT prior to serologic testing results
- Tx: doxycycline
33
Differences between ehrlichiosis and RMSF
- Clinical symptoms very similar (headache, fever, myalgias)
| - Ehrlichiosis is more likely to present with leukopenia and elevated LFTs
34
Infections from H. flu type B
- Neonatal sepsis, childhood meningitis, periorbial cellulitis, pyogenic arthritis, epiglottitis
35
Gram negative cocci in pairs
H. flu and N. meningitidis
36
Treatment of H. flu
- Ceftriaxone or cefotaxime
| - OKAY to use IV steroids for this meningitis on initial presenation
37
Non-typeable H. flu infections
Otitis media and pneumonia
| - Tx for otitis media plus conjunctivitis is oral augmentin (because this is like H. flu)
38
Infections in asplenia patients
Encapsulated organisms
| - H. flu, Strep pneumo, N. meningitidis
39
Chemoprophylaxis following Hib exposure
Rifampin prophylaxis for:
- All household contacts if anyone in the house is not fully immunized (< 4 years old) or if they're immunocompromised
- ALL workers/attendees of daycare if there are more than 2 cases in a 60 day period
- Hib vaccine for all unimmunized or incompletely immunized (and then continue regular vaccine schedule)
40
Foods that salmonella comes from
- Chicken
- Eggs
- Red meat
- Unpasteurized milk and ice cream
- Contaminated unwashed raw fruits/vegetables
- Contaminated medical instruments
- Pets (turtles, snakes, hedgehogs)
41
Salmonella symptoms
- 1-2 days after ingestion
- Watery, loose stools
- Vomiting, abdominal cramps, fever
- Dx: stool culture/PCR
42
Indications for treatment of salmonella
- Younger than 3 months (to prevent invasive disease)
- Risk of invasive disease: hemoglobinopathies, malignancies, severe colitis, immunocompromised
Tx: ceftriaxone, azithromycin, quinolones
43
Generalized constitutional symptoms (HA, abdominal pain, malaise, high fever) with HSM, red/rose spots, fever pulse dissociation
Typhoid fever (Salmonella typhii)
44
Watery diarrhea with high fever that then becomes bloody diarrhea after fever stops
Shigella
- Also commonly have bandemia (left shift)
- Can also have seizures
- Commonly associated with daycare
- Tx: supportive unless severe (rocephin)
45
Pseudomonas infections
- Osteomyelitis/osteochondritis as a result of puncture wounds (nail through shoe)
- Otitis externa
- Infections from ventilators
- Sepsis (especially neutropenic kids)
- Pneumonia (especially in CF)
46
Treatment of pseudomonas
- Pip/tazo
- Gentamicin
- Carbapenems
- Ceftazidime/cefepime
- Ciprofloxain/levofloxacin
47
Brucellosis exposures
- Unpasteurized milk/cheese
- Exposure to cattle, sheep, goats (ZOONOTIC DISEASE!)
- Think about in fever of unknown origin
- Very nonspecific symptoms (malaise, fatigue, leukopenia, fever)
- Tx: Doxycycline or bactrim
48
Bloody mucous diarrhea after recent antibiotic
- C. diff --> can be heme positive and not grossly bloody
- Antibiotic: clindamycin or ampicillin
- Pseudomembranous colitis
49
Diagnosis of C. diff
- C. diff toxin using enzyme immunoassay
| - C. diff isolation from stool does not necessarily mean causation
50
Treatment of C. diff
- Metronidazole or oral vancomycin
| - Cleaning (soap and water), alcohol doesn't kill the spores
51
Strep pneumoniae infections
- Respiratory tract infections, otitis media
- Bacteremia and meningitis (in unimmunized kids)
- Risk of colonization with antibiotic resistant strains in kids less than 2, attending daycare, and recent antibiotic administration
52
Treatment of strep pneumoniae
- Penicillins and cephalosporins
| - Meningitis: vancomycin and cefotaxime/ceftriaxone
53
Strep pyogenes transmission
- Group A beta-hemolytic strep
| - Inhalation of organisms in large droplets or by direct contactw ith respiratory secretions
54
Strep pyogenes (GAS) infections
- Pharyngitis, cellulitis, necrotizing fasciitis, toxic shock
55
Rash that blanches easily and spares the face, palms, and soles - may mention pastia lines (red lines in skin folds of neck/axilla/groin/elbows)
```
Scarlet fever (GAS)
- Can also describe sunburn like sandpapery rash as well as perioral pallor
```
56
Treatment for GAS pharyngitis
- Dx with swab/culture
- ASO antibodies tell you about recent infection
- Tx: penicillin (can do amoxicillin) - erythromycin, clindamycin, first generation cephalosporin if allergic
- Prevents rheumatic fever, not PSGN
57
Arcanobacterium haemolyticum
- Catalase negative, acid fast, hemolytic, anaerobic, gram positive, bacillus
- Causes acute pharngitis but no palatal petechiae or strawberry tongue
- Commonly has a scarlatiniform rash (begins on extremities and then spreads to trunk)
- Can also cause pneumonia, sinusitis, sepsis, peritonsillar abscess, orbital cellulitis
- More common in teenagers
- Tx: erythromycin, azithromycin, clindamycin
58
Erysipelas
Strep cellulitis - commonly have red streaks associated with lymphangitis
59
Causes of toxic shock syndrome
Strep, staph, EBV, coxsackievirus, adenovirus
60
Acute and long term complications of bacterial meningitis in children
- Acute: seizures, empyema, cerebral edema, septic arthritis, vasculitis, cerebral hemorrhage/infarction, pericarditis
- Long-term: developmental delay, intellectual disability, hearing impairment, epilepsy, spasticity, and hemiparesis.
61
Coag negative staph infections
- Bacteremia from CVLs or indwelling IVs - Staph epi
| - If no foreign body, it's often a contaminant
62
MSSA treatment
- Oxacillin/nafcillin
| - If more invasive (bacteremia, endocarditis, meningitis), may need genatmicin or rifampin
63
Hospital acquired MRSA biggest risk factor
- Nasal carriage
| - Tx with vanc
64
Community acquired MRSA infection and treatment
- Often cause skin/soft tissue infections
- If abscess < 5 cm need only I&D, no abx
- Abx: bactrim or clinda
65
Infant < 6 months old with poor sucking, descending generalized weakness/hypotonia, loss of facial expression, loss of head control, weak cry, constipation
Infantile botulism
66
Botulism mechanism of action
- Food form (from poorly canned foods) - toxin is ingested
- Infantile form - spores are ingested and they germinate after ingestion (toxin is produced and absorbed in GI tract)
- Toxin blocks the release of acetylcholine into the synapse
67
Treatment of botulism
- Aminoglycosides can potentiate the paralytic effects of the toxin so DON'T GIVE ANTIBIOTICS
- Treatment is supportive care and maybe antitoxin for infantile botulism
- For wound botulism, use penicillin or metronidazole after antitoxin is given
68
Three stages of syphilis
- Primary: painless indurated ulcers (chancres) about 3 weeks after exposure
- Secondary: mucocutaneous rash/lesions (polymorphic maculopapular and INVOLVES PALMS/SOLES), lymphadenopathy, condylomata lata - usually 1-2 months later
- Tertiary: 15-30 years after initial infection --> gumma formation, cardiovascular involvement, neurosyphilis
69
Diagnosis of syphilis
- Nontreponemal tests (RPR and VDRL) may be positive with other viruses so are just a screening
- You should treat if this is positive while awaiting a confirmatory test
- Treponemal test is used for confirmation (FTA-ABS), 100% specific for syphilis but can be positive for life so aren't indicative of response to therapy --> This can be positive in lyme disease too so use the nontreponemal test to distinguish
- Definitive diagnosis is spirochetes in microscopic darkfield exam or DFA
70
Treatment of syphilis
IV Penicillin G
- Giving this to a pregnant woman with syphilis also treats the newborn (penicillin crosses the placenta) --> if mom has an allergy she has to undergo desensitization for treatment
71
When to treat a newborn born to a syphilis positive mom
- NO: if mom treated with penicillin > 1 month before delivery
- YES: if treated within last month, if treated with erythromycin (doesn't cross placenta), if baby's titers are higher than moms
72
Newborn with copious nasal secretions (snuffles), bullous lesions, osteochondritis, pseudoparalysis of the joints, poor feeding, hepatosplenomegaly
Congenital syphilis
Other sx: lymphadenopathy, mucocutanesou lesions, pneumonia, edema, thrombocytopenia, HSM, hemolytic anemia, jaundice, maculopapular rash
73
Hutchinson triad of untreated congenital syphilis
- Intestitial keratitis
- Eighth cranial nerve deafness
- Hutchinson teeth (peg shaped notched central incisors)
- Frontal bossing
74
Corynebacterium diphtheria infections
- Gram positive, nonspore forming, nonmotile, pleomorphic bacillus --> spread through respiratory tract droplets and contact with discharges
- Membraous nasopharyngitis (bloody nasal discharge with low grade fever), extensive neck swelling with cervical lymphadenitis, myocarditis, peripheral neuropathies
- Tx: equine antioxin
75
Risk factors for enterococci infections and treatment
- Recent antibiotic use, indwelling catheters (can cause bacteremia), recent surgery (part of normal gut flora)
- Tx: ampicillin and vancomycin (except VRE)
76
Kingella kingae infection
- Gram negative coccobacilli (HARD TO GROW FROM CULTURE)
- Frequently colonizes young children (toddlers)
- Can cause osteomyelitis, bacteremia, suppurative arthritis
- Often have respiratory or GI symptoms with the fever
- Tx: cephalosporins
77
Listeria monocytogenes infections
- Facultative anaerobic, nonspore forming, gram positive bacillus (multiple intracellularly)
- Common in pregnant women, immunocompromised, and neonates --> FOODBORNE
- Pregnant women often have influenza like illness
- Tx: ampicillin and gentamicin
78
Neisseria meningitidis symptoms
- Non-specific symptoms with myalgias, joint pain, petechial/purpuric rash, can have meningeal irritation
- Complications can occur rapidly: meningitis, limb ischemia, coagulopathy, pulmonary edema
79
Neisseria meningitidis micro and transmission
- Droplets and in close contact (dorms, military, etc) and terminal complement deficiency or asplenia
- Aerobic, nonmotile gram negative diplocci
- Grows best in chocolate or blood agar
- Dx with PCR or culture
80
Neisseria meningitidis treatment
Cefotaxime or cetriaxone
81
Neisseria meningitidis prophylaxis
All close contacts with invasive meningococcal disease regardless of immunization status
- Household contacts, child care/preschool contacts 7 days before illness, direct exposure to secretions 7 days before illness, anyone who slept in same area up to 7 days before illness, anyone with prolonged contact in close proximity during 7 days before illness, health care workers not wearing a mask
- Tx: rifampin (can turn secretions orange)
82
MCC of bacterial gastroenteritis inteh developed world
Campylobacter --> most in children younger than 4, common in daycares
83
Sources of campylobacter
- Ingestion of contaminated food (undercooked poultry, untreated water, unpasteurized milk)
- Fecal material from infected animals/people
84
Symptoms of campylobacter infection and treatment
Fever, abdominal pain, cramping, bloody diarrhea (dysentery)
- Sx can mimic appendicitis or intussusception
- Tx is hydration and azithromycin can shorten duration of illness
85
Yersinia infection sources and symptoms
- Swine --> unpasteurized milk or raw meat (pork) in a child younger than 5
- Sx bloody diarrhea with pseudoappendicitis (RLQ pain and elevated WBC)
- Can have bacteremia - tx with rocephin if immunocompromised
86
Treatment/complications of yersinia
- Supportive unless:
- Bacteremia (common in kids less than 1 or predisposing conditions including excessive iron storage or immunocompromised)
- Tx with bactrim, cefotaxime, aminoglycosides
87
Bartonella infections and treatment
Cat scratch disease
- Lymph nodes can become swollena nd tender
- Dx with serologic testing and enzyme immmunoassay or IFA test
- Tx is supportive unless HSM, large painful adenopathy, or immunocompromised
- IF treatment is needed use azithromycin, erythromcin, bactrim, or rifampin
- DON'T USE INCISION AND DRAINAGE OR SURGICAL EXCISION --> can lead to fistula formation or other complications
88
What do you do with a positive PPD or quantiferon
Get a CXR
- If xray is negative they have latent TB
- If xray is abnormal (perihilar adenopathy or cavitary lesions) then treat for pulmonary TB
89
Treatment of latent TB
- Isoniazid for 9 MONTHS
| - If INH resistant then can give rifampin for 6-9 months
90
Extrapulmonary TB symptoms
MAPD
- Meningitis
- Adenitis
- Pleuritis
- Disseminated (miliary disease)
91
PCP symptoms and prophylaxis
- Pneumonia with immunocompromised patient, ground glass appearance, general perihilar infiltrates that can evolve to intersitital infiltrates
- Bactrim prophylaxis - needs to be started at diagnosis or 4 weeks of age for infant born to HIV positive mother
92
Cryptosporidium symptoms and sources
- Contamination of water/pools, petting zoos, child care centers (poor hygiene after diaper changes)
- NON-BLOODY, watery diarrhea that lasts a long time
93
Aminoglycoside toxicity
- Ototoxicity from high trough levels
| - Effectiveness depends on high peak levels
94
Penicillins mechanism of action and uses
Bind to bacteria penicillin binding proteins and inhibit bacterial cell wall formation
- Strep throat, syphilis, meningococcal infections, otitis media, pneumonia, UTIs
95
First generation cephalosporin uses
Gram positive bacteria and useful for skin infections like MSSA
- DOES NOT penetrate CNS well
96
Second generation cephalosporin uses
Good for beta lactamase producing gram negatives (H. flu, moraxella, etc.) and some gram positives
97
Third generation cephalosporin uses
Excellent CSF penetration so good choice for meningitis
- Cefdinir for otitis media/sinusitis and GAS
- Cefixime for UTIs or respiratory infections
98
Fourth generation cephalosporin uses
Cefepime --> Gram positives and gram negatives including psuedomonas
99
Clindamycin mechanism of action
- BACTERIOSTATIC (not bactericidal)
| - Effective against aerobic GPCs, anaerobic GPCs, anaerobic GN cocci, chlamydia, protozoa
100
Macrolide side effects
- Use azithromycin more than erythromycin (less GI side effects)
101
Rifampin uses and contraindications
- Used for prophylaxis from meningococcal or Hib exposure and for invasive/resistant Staph infections
- NEVER for pregnant person, teratogenic
102
Side effects of bactrim
SJS, rash, neutropenia, anemia, thrombocytopenia
103
Vancomycin side effect
Red man syndrome --> rate dependent infusion reaction caused by histamine relase (not a true drug allergy)
- Slow infusion and give benadryl
104
Transmission and risk factors of entamoeba histolytica
- Transmitted via fecal oral route via contaminated food or water
- Increased risk people are immigrants, institutionalized people, MSM
105
Symptoms and diagnosis of entamoeba histolytica
- Dysnetery: 1-2 weeks of crampy abdominal pain, diarrhea, fever, tenesmus --> watery, bloody, mucus stools
- Complications: liver and brain abscess and lung disease
- Dx: trophozoites/cysts in stool, stool culture, enzyme immunoassay
106
Treatment of entamoeba histolytica
Symptomatic need metronidazole or tinidazole then a course of iodoquinol to clear cysts from intestines (only iodoquinol if asympotmatic)
- Need f/u stool studies and screening of household members
107
Symptoms/treatment of malaria
- Plasmodium species (ovale requires lifelong treatment)
- Found in tropical areas of the world --> female mosquito
- High fever with chills, rigor, sweats, headache -- fevers every 2-3 days
- Dx made by peripheral smear (thick and thin smears)
- Tx with quinidine
108
Toxoplasma symptoms/transmission in pregnancy
- Lower chance of fetal infection early in pregnancy but if it happens the consequences are more severe
- Lymphadenopathy may be the only symptom
- Transmission from changing cat litter, contaminated water/food (unwashed garden vegetables), inadequately cooked meat, unpasteurized goat milk
109
Congenital toxoplasmosis symptoms
- Microcephaly, hydrocephaly, chorioretinitis, diffuse cerebral calcifications, jaundice, HSM
- Later signs: deafness, impaired vision, seizures, learning/cognition issues
110
EBV serologies
- Heterophile antibody tests confirms diagnosis but not reliable in kids less than 4
- MC serology test is antibody against IgG viral capsid antigen that appears early in infection and persist for life
- Acute infection will have negative Epstein Barr nuclear antigen (appears several weeks to months after onset of infection) and positive IgM
111
EBV complications
- Can evolve to lymphoma in immunocompromised hosts
- Rash in patients who have mono and get ampicillin
- Splenomegaly (no contact sports for minimum of 4 weeks or until spleen is no longer enlarged)
112
Newborn with thrombocytopenia, petechia/purpura (blueberry muffin rash), periventricular calcifications, HSM, jaundice, SGA, microcephaly, hypotonia, sensorineural hearing loss
Congenital CMV ---> however it is usually clinically silent (think of this though in a baby with hearing loss or learning disability)
- Urine culture or PCR for CMV is definitive in first 3 weeks of life
113
Mono like illness but not EBV
Acquired CMV --> viral culture and PCR for testing
114
Human Herpesviruses
- HHV4 = EBV
- HHV5 = CMV
- HHV6 = Roseola
- HHV8 = Kaposi sarcoma
115
Infant/toddler with 3-5 days fever followed by generalized macular/papular rash
Roseola --> common to have febrile seizures with this too
116
Rubella symptoms
- Mild viral illness
| - Maculopapular rash, low grade fever, subactue clinical picture (underimmunized)
117
Confluent macular papular rash, Koplik spots, conjunctivitis, fever, cough, coryza
Rubeola (Measles)
118
Measles symptoms timeline
Transmitted by airborne droplets with incubation period of 8-12 days
- Prodrome first two days then Koplik spots
- Rash comes around day 5 then worse after abouta week and begins to resolve around day 10
119
Mesales post exposure management
- If exposure within 6 days: immune globulin should be given to infants < 12 months, pregnant women, and immunocompromsied individuals
- Giving vaccine to those not fully immunized within 3 days of exposure will prevent infection (so don't need immunoglobulin)
- Vaccination must wait 5 months after immunoglobulin was given and until the child is at least 12 months (for it to count as their normal vaccine)
120
Mumps outbreak management
- Kids fully immunized can stay in school
- Kids due for booster need to get booster
- Kids who never got vaccine need it before going back to school
- Parents who refuse to immunize: kid has to wait 26 days after last person in class developed symptoms
- If child had mums can go to school 9 days after onset of symptoms
121
Parotitis (difficulty opening mouth, unilateral swelling), fever, headache, malaise, meningitis/encephalitis, orchitis, pancreatitis
Mumps
- Epididymoorchitis is MC complication of mumps (impaired fertility in only 15% of cases)
- Tx is supportive
122
Differential of parotid swelling
- Mumps: low grade temp, non toxic
- Bacterial infection: high fever, toxic
- Salivary gland stone: intermittent swelling
123
Airborne transmission bugs
Aspergillosis, TB, measles, varicella, disseminated zoster
124
Parvovirus B19 infections
- Fifth disease: slapped cheek rash (often preceded by mild viral illness) --> lacey rash on extremities (can be pruritic) --> polyarthropathy (more in female adults)
- Hydrops fetalis
- Aplastic crisis in sickle cell
125
Neonatal HSV symptoms
- Sepsis, meningitis, seizures (temporal lobe), skin/eye/mouth lesions
- Most caused by HSV type 2 (PCR diagnosis)
- Delivery via C-section does not rule out transmission
- Tx: acyclovir
126
HIV symptoms
Chronic non-specific symptoms: weight loss, fever, night sweats
- Recurrent thrush
- LOW CD4 count
127
Perinatal modes of transmission for HIV
- Vertical through delivery (C/S decreases risk by 50%)
| - Breastfeeding
128
Diagnostic HIV test for infant < 18 months
- HIV DNA PCR is gold standard because antibody IgG can cross placenta from mom
- If > 18 months can use enzyme immunoassay to test for HIV antibody then need western blot analysis for confirmation
129
When to test if exposed to HIV
- Seroconversion happens within first 6 months
| - Test at exposure, 6 weeks, 12 weeks, and 6 months
130
Isolation for varicella infection
Airborne and contact for 5 days after onset of rash and until all lesions are crusted
131
Post exposure prophylaxis for varicella infection
Immunocompromised person exposed to varicella infection needs immune globulin
132
Most common complication of varicella infection
- Staph aureus superinfection involving the skin
| - Can also lead to pneumonia or osteomyelitis
133
Treatment for varicella
- Give immunoglobulin - considered a preventive measure more than a treatment (Needs to be given within 96 hours of exposure)
- Acyclovir for patients at increased risk of complications (unvaccinated people older than 12, people with chronic lung disease, children receiving steroids, immunocompromised)
134
Newborn exposure of chicken pox
- If mom develops symptoms (chickenpox) between 5 days before delivery to 2 days after delivery then the infant is at risk and should get immunoglobulin
- If mom has a zoster rash (in dermatome) - don't need any therapy
135
Enteroviral infection symptoms
- Vague complaints but can include high fever, rash, and viral meningitis (especially in summer)
- Kids often less than 5
- May have conjunctivitis/pharyngitis
- Dx with PCR, need contact precautions
136
Complication of coxsackie B virus
Myocarditis
137
Best way to prevent RSV spread
Good hand hygiene --> can live on environmental surfaces for several hours and for 30 minutes or more on hands
138
Indications for pavilizumab
- Infants with chronic lung disease, preemies, and congenital heart disease
- Doesn't decrease risk of getting RSV but decreases severity of the disease
139
Quickest and most useful way to test for influenza
Rapid antigen test
140
Treatment for influenza
Mostly supportive but can use antivirals (neuraminidase inhibitors - oseltamivir or zanamivir) if severe disease or at risk for complications
141
Infection caused by parainfluenza
Croup (laryngotracheobronchitis)
142
Rotavirus symptoms
- 1-2 days of fever, watery stools, intermittent vomiting, dehydration
- Dx with antigen testing of the stool
143
Animals that carry rabies
Bat, raccoon, possum, skunk, fox, coyote, bobcat
144
Treatment/prophylaxis of rabies and when to give it
- If animal is suspected of being rabid or if exposed to a bat (they can transmit without biting the human)
- Prophylaxis: 4 dose rabies vaccine and immunoglobulin infiltrating the wound (if prior vaccine just need 2 vaccine series)
145
Ascaris lumbricoides worm life
Most prevalent human intestinal roundworm
- Adult worms live in lumen of small intestine and produce 200,000 eggs/day that are then excreted in the stool and then incubate in soil for 2-3 weeks --> infection from ingestion of eggs in contaminated soil
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Ascaris lumbricoides infection symptoms and treatment
- Most are asymptomatic
- Can have nonspecific GI symptoms or symptoms of abdominal pain/obstruction
- Think of this with travel to a tropical region/endemic area
- Tx with albendazole or ivermectin
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Trichinella spiralis infection source
- Undercooked pork
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Necator americanus (hookworm) infection symptoms
- Often asymptomatic
- Chronic infection can lead to hypochromic microcytic anemia, growth delay, developmental delay
- Stinging/burning sensation --> pruritus --> papulovesicular rash for 1-2 weeks (on area that you stepped on it)
- Enters the body through the feet
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Tapeworm infection symptoms
- Taeniasis and Cysticerosis are the worms
| - Often asymptomatic but can have nausea, diarrhea, pain
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Toxocariasis infection symptoms
- GI symptoms or respiratory symptoms (wheezing, hepatomegaly, abdominal pain), vision problems
- Exposure to dogs/cats is risk factor or preschooler eating dirt
- Can have eosinophilia on labs
- Tx with albendazole or thiabendazole
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Enterobius vermicularius (pinworm) infection
- Perianal or perivulvar itching
- Transmission via fecal-oral route directly or via contaminated hands --> commonly have reinfection
- Diagnosis with adult worms in perianal region 2-3 hours after child is asleep
- Tx albendazole
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Treatment of candidiasis
- Oral in immunocompetent host: nystatin
- Oral in immunocompromised: fluconazole
- Invasive disease in neonate: IV amphotericin
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Cryptococcus symptoms and exposure
- Pulmonary disease, CNS disease/meningitis
- Associated with AIDS
- Exposure to bird droppings (pigeons)
- Tx: amphotericin B with oral flucytosine or fluconazole
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Aspergillosis symptoms, diagnosis, treatment
- Eosinophilis and infiltrates on CXR
- Dx with positive serum galacomannan
- Tx: voriconazole (ampho B in neonates)
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Histoplasmosis symptoms, geography, treatment
- Common in Missouri/Mississippi river valleys --> exposure to bird droppings
- Influenza like symptoms, respiratory symptoms, hepatosplenoemgaly
- Tx: supportive if immunocompetent, ampho B or fluconazole for disseminated disease/immunocompromised
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Workup for neonate with candidemia (secondary sites)
- Ultrasound of kidneys
- Echo for endocarditis
- LP for CSF
- Eye exam
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Measles complications
Otitis media, bronchopneumonia, laryngotracheobronchitis, diarrhea, acute encephalitis, subacute sclerosing panencephalitis (years down the road)
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Infection that requires you to stay out of daycare/school until 24 hours after starting therpay
Strep pharyngitis
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Symptoms of trichomonas
- Yellow/green/frothy smell vaginal discharge
- Vulvovaginal pruritis
- Strawberry cervix
- Diagnosed on wet mount
- Tx with metronidazole
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Symptoms of babesios
- Fever and hemolytic anemia
- Prodrome of malaise, anorexia, fatigue
- Tick bite transmission (same tick that transmits Lyme disease)
- Tx with clindamycin and quinine
- Will mention someone from Martha's vineyard in question stem
- On smear: maltese cross
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Mucormycosis appearance
Right angle septations
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Flesh colored, translucent, dome shaped papules
Molluscum contagiosum - viral rash
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Exposure to hay or rose garden --> nodules on forearm
Sporotrix - treat with itraconazole
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Staph scalded skin syndrome
- Toxin mediated disease by exfoliative toxins A and B
- Nikolsky sign (toxin mediated cleavage of the epidermis)
- Scarlitiniaform erruption and can have bullous lesions
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Prophylaxis for a dog bite in a child with penicillin allergy
- Clindamycin (covers anaerobes and skin flora)
| - Bactrim (covers pasturella)
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Prophylaxis for a dog bite in a child
- Augmentin
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Fever, weight loss, lymphadenopathy with negative mono spot in sexually active teen
Acute HIV
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Treatment of tularemia
Gentamicin (gentle rabbits)
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Types of tularemia
- Ulceroglandular
- Glandular
- Oculoglandular
- Respiratory
Associated with rabbites, hares, and rodents
- Diagnose with serology (but can also do with culture)
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Bacteria associated with brain abscess and infant formula
Citrobacter and Enterobacter
| - Gram negative meningitis (need imaging to rule out abscess)
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Erythematous papule that becomes pusule and erodes --> serpiginous border, painful in groin
Haemphilus ducreyi (chancroid)
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Empiric antimicrobial therapy for an asplenic patient with sepsis
- Vanc and rocephin
| - Risk for encapsulated organisms: S. pneumoniae, N. meningitidis, H. influenzae
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Empiric antimicrobial therapy for febrile neutropenic with beta lactam allergy
Cipro/vanc or aztrenoma/vanc
- Normally would do cefepime, pip/tazo, or meropenem (need to cover pseudomonas)
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Most common infections in a burn patient
- Staph aureus
- Pseudomonas
- Candida
- HSV1
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Indications for line removal with a CLABSI
- Infection with Staph aureus, fungi, or mycobacteria
- Severe sepsis
- Suppurative thrombophlebitis
- Endocarditis
- BSI continuing > 72 hours after initiating therapy
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At what age is a positive urine CMV indicative of a congenital CMV infection
Infant less than 3 weeks
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Diarrhea plus Haiti
Cholera
| - If mild dehydration just need oral rehydration
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Taenia solium infection
- Seizures with a single enhancing lesion in the soleus
| - Neurocystercosis
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Chagas disease bug and symptoms
- Trypanosoma cruzi
- Often asymptomatic
- Some can have swelling/inflammation at site of inoculation
- Romana's sign in the eye
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Antibiotic coverage for pott's puffy tumor
Ceftriaxone, vancomycin, metronidazole
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How do you interpret PPD
- If immunocompromised: > 5 is positive
- If born in endemic area, working/living in high risk area like jail or healthcare, or less than age 4: > 10 is positive
- If born in US and over age 4: > 15 is positive
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What CD4 count does PCP prophylaxis need to start in HIV patient
200 --> use bactrim
- < 100 concern for toxo
- < 50 concern for MAC (add on azithro)
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West Nile virus symptoms
- Arbovirus
- Often asymptomatic
- Can have fever, headache, myalgias, encephalitis (less than 1% develop neuroinvasive disease)
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Hepatitis A prophylaxis during a known outbreak
- Hep A vaccine if > 12 months and healthy
| - Immunoglobulin for < 12 months, immunocompromised, or chronic liver disease
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Hepatitis B prophylaxis for baby born to HBsAg positive mom
- Immunization and immunoglobulin within 12 hours of birth
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How long after IVIG infusion can patient receive MMR/varicella
11 months
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Bug and bacteria for lyme disease
- Ixodes deer tick (have to feed at least 36 hours to transmit Lyme disease)
- Borrelia burgdorferi
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Progression of lyme disease
- First 2 weeks: Erythema chronicum migrans (bullseye rash) at site of tick bite (but only in 25% of cases), vague arthralgias, fatigue
- Several months to years: CNS, cardiac, arthritic disease (pauciarticular), Bell's Palsy
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Arthritis associated with lyme disease
Pauciarticular in large joints (especially the knee)
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Labwork for Lyme disease
- Lyme enzyme immunosorbent assay (EIA) titer of fluorescent antibody (FA) test --> if positive or equivocal then do confirmatory Western blot test
- Detectable levels of serum antibodies don't build up until 4-6 weeks so false negatives can be common
- False positives: SLE< dermatomyositis, other rickettsial diseases
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Lyme treatment
- Doxycycline for > 8 years old
- Amoxicillin for < 8 years
- Treat for 14-21 days
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Child treated for lyme that then develops fevers, chills, hypotension, sepsis picture
Jarisch-Herxheimer reaction
| - Caused by lysis of organism and release of endotoxin
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Monospot limitations
- Not good in kids less than 4
- If negative initially, can become positive 2-3 weeks into illness
- Antibody titers can be detected for up to 9 months
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Fever, vesicular lesions in posterior pharynx
Coxsackie virus
| - Lesions usually spare the tongue and gingival surfaces
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Skeletal changes associated with congenital syphilis
- Pseudoparalysis (painful osteochondritis)
| - Multiple sites of osteochondritis at the wrists, elbows, ankles, knees, metaphysis/diaphysis of the long bones
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Time to keep home from school if hepatitis A infection
- Patient should stay home for 7 days if an acute infection
