Infectious Disease Flashcards
1
Q
ABECB
A
acute bacterial exacerbations of chronic bronchitis
2
Q
candidiasis
A
MC opportunistic pathogen
-DX: KOH SMEAR - BUDDING YEAST + PSEUDOHYPHAE
ESOPHAGITIS:
- MC MANIFESTATION, reflux, epigastric pain, N/V +-thrush
- ENDOSCOPE: LINEAR PLAQUES/EROSIONS
- TX: FLUCONAZOLE PO 1ST LINE
ORAL THRUSH:
- FRIABLE WHITE PLAQUES, BLEED/RED WHEN SCRAPED
- TX: NYSTATIN, swish + swallow
VAGINAL:
- itching, burning, discharge
- TX: MICONAZOLE, CLOTRIMAZOLE, fluconazole/weekly if persistent
INTERTRIGO:
- cutaneous infx mc in moist, macerated areas, ITCHY, BEEFY RED, w/ DISTINCT, SCALLOPED BORDERS + SATELLITE LESIONS
- TX: CLOTRIMAZOLE TOPICAL, keep dry
FUNGEMIA, ENDOCARDIDITS:
- seen in immunocomp +/- indwelling catheters
- TX: IV AMPHO B, CASPOFUNGIN IF SEVERE
3
Q
cryptococcosis
A
- cryptococcus neoformans or C.gatti
- ENCAPSULATED, BUDDING ROUND YEAST
- MC IN IMMUNOCOMP; AIDS-defining illness
-TRANSMISSION: PIGEON/BIRD DROPPINGS
- sx-
- MENINGOENCEPHALITIS: MC CAUSE FUNGAL ENCEPH
- headache, meningeal signs, N/V, photophobia
- PNEUMONIA
- dx-
- LP: FUNGAL CSF PATTERN: inc WBC, dec GLUCOSE + PROTEIN
- INDIA INK STAIN –> ENCAPSULATED YEAST
- CRYPTOCOCCAL ANTIGEN IN CSF
- tx-
- AMPHO B + FLUCYTOSINE X2 WKS, THEN PO FLUCONAZOLE X10 WKS
- Pneumonia if immunocomp –> Fluconazole x3-6mo
4
Q
Histoplasmosis
A
- histoplasma capsulatum
- AIDS-defining illness
- ASSOC W/ SOIL CONTAINING BIRD/BAT DROPPINGS IN MISSISSIPPI + OHIO RIVER VALLEYS, spelunkers
- once inhaled, ingested by alveolar macrophages
- sx-
- asymptomatic mc, PNEUMONIA
- DISSEMINATION IF IMMUNOCOMP: hepatosplenomegaly, F, oropharyngeal ulcers, bloody diarrhea, +/-adrenal insufficiency
-dx-
-INC ALP, LDH, pancytopenia
-CXR: pulmonary infiltrates, hilar/mediastinal lyphadeno
+cultures if disseminated/HIV
- tx-
- MILD-MOD: ITRACONAZOLE 1ST LINE
- SEVERE: AMPHO B
5
Q
Pneumocystis (PCP pneumonia)
A
- pneumocystis jirovecii - yeast-like fungus (doesn’t respond to anti-fungals)
- transmission: inhalation
- MC OPPORTUNISTIC INFX IN HIV
- sx-
- F, syspnea on exertion, nonproducitve cough, 02 DESATURATION W/ AMBULATION
- dx-
- CXR: BILATERAL DIFFUSE INTERSTITIAL INFILTRATES
- INC LDH
- BRONCHOALVEOLAR LAVAGE SPECIMEN OR INDUCED SPUTUM - DEFINITIVE DIAGNOSIS
-tx-
-BACTRIM - DOC x21 days
+/- PREDNISONE IF HYPOXIC
-sulfa allergy –> DAPSONE
-HIV PROPHYLAXIS IF CD4<200 –> BACTRIM
6
Q
aspergillosis
A
- common in GARDEN + HOUSEPLANT SOIL + COMPOST
- transmission: inhalation
- MC AFFECTS LUNGS, SINUSES + CNS
- produces AFLATOXIN B1 - ASSOC W/ INC RISK HCC
-sx- ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS -MC INPT W/ ASTHMA + CYSTIC FIBROSIS -Type 1 hypersensitivity: EOSINOPHILIA + IGE -thick brown sputum (mucus plugs)
ASPERGILLOMA
-fungus colonizes a preexisting pulmonary cavitary lesion
+HEMOPTYSIS
-“FUNGAL BALL” ON CXR
ACUTE INVASIVE ASPERGILLUS
-F, HA, toothache, epistaxis, INVASIVE CHRONIC SINUSITUS, commonly involves lungs, often fatal
CHRONIC INVASIVE (DISSEMINATED)
- immunocomp/neutropenic pt
- pleurtic chest pain, cough, necrotizing skin lesions, wound infx, brain abscesses
Chronic Necrotizing Pulmonary - rare
- dx-
- Galactomannan levels (found in walls of aspergillus), B-D glucan assay, culture
- inc IgE and eosinophils in allergic
- BX: DUSKY, NECRTOIC TISSUE (NOSE); SEPTATE HYPHAE W/ REGULAR BRANCHING AT WIDE ANGLES
- tx-
- ALLERGIC: TAPERED CORTICO, +/- ITRACONAZOLE
- SEVERE/INVASIVE: VORICONAZOLE DOC +/- sx debrid
- ASPERGILLOMA: SX SURGICAL RESECTION
7
Q
mucormycosis
A
- MC RHIZOPUS, mucor + rhizomucor
- MC in DM, immunocomp, hyperglycemic acidosis
- sx-
- RHINO-ORBITAL-CEREBRAL INFX: SINUSITIS that spreads to the orbits, palate + brain
- BLACK ESCHARS of nasal mucosa, palate + cyanosis
-dx-
BX: NON-SEPTATE BROAD HYPHAE W/ IRREGULAR RIGHT-ANGLE BRANCHING
-tx-
IV AMPHO B 1ST LINE; may need sx debridement
8
Q
blastomycosis
A
- blastomyces dermatitidis: pyogranulomatous fungal infx
- occurs MC IMMUNOCOMPETENT MEN
- OUTDOOR ACTIVITIES (AROUND SOIL OR DECAYING WOOD) IN CLOSE PROXIMITY TO WATERWAYS (great lakes, Ohio, Mississippi river valley)
-sx-
PULMONARY: mc site; MANY ASYMPTOMATIC, chronic:
-FLU-LIKE: cough, dyspnea, ha, fever
-PNEUMONIA: high fever, chest pain, productive cough
CUTANEOUS:
-papules –> VERRUCOUS, CRUSTED OR ULCERATED LESIONS that expand and may leave central scar
DISSEMINATED: MC IN LUNGS, SKIN, BONE + GU (prostatitis or epididymitis)
- dx-
- Sputum/Pus/CSF or Urine Cultures: round, broad-based budding yeast w/ thick, refractile double walls
- CXR: consolidation, nonspecific leukocytosis
- tx-
- ITRACONAZOLE 1ST LINE
- AMPHO B IF SEVERE
9
Q
coccidioidomycosis “valley fever”
A
- coccidioides immitis grows in SOIL IN ARID/DESERT REGIONS OF SOUTHWESTERN US, MEXICO, SOUTH + CENTRAL AMERICA
- transmission: inhalation of spores
-sx-
PRIMARY PULMONARY DISEASE (60% a-sympto)
-MILD FLU LIKE: fever, chills, nasopharyngitis, cough
VALLEY FEVER:
-FEVER, ARTHRALGIAS (KNEES + ANKLES), ERYTHEMA NODOSUM, ERYTHEMA MULTIFORME, maculopap rash
DISSEMINATED/EXTRAPULMONARY/PERSISTENT DZ:
- CNS (MENINGITIS) IN 50%
- can effect any organ, esp lungs, skin, soft tissue, lymphs, jts
- dx-
- Early: enzyme-linked immunoassays for IgM + IgG ANTIBODIES 1ST TEST USUALLY ORDERED; CULTURES MOST DEFINITIEVE
- meningitis: CSF
- pulmonary: CXR
- histology: SPHERULES IN TISSUES
- tx-
- MOST CASES ASYMPTOMATIC/MILD AND SELF LIMITED
- FLUCONAZOLE FOR CNS DISEASE (AMPHO B IF SEVERE)
10
Q
FUNGAL INFX
A
CANDIDIASIS CRYPTOCOCCOSIS HISTOPLASMOSIS PNEUMOCYSTIS ASPERGILLOSIS MUCORMYCOSIS BLASTOMYCOSIS COCCIDIOIDOMYCOSIS
11
Q
GRAM NEG BACTERIAL DZ
A
CHLAMYDIA GONORRHEA CAT SCRATCH DISEASE (BARTONELLA HENSELAE) MENINGOCOCCAL MENINGITIS CHANCROID (HAEMOPHILUS DUCREYI) HAEMOPHILUS INFLUENZAE TULAREMIA (FRANCISELLA TULARENIS) BRUCELLOSIS HOT TUB FOLLICULITIS (PSEUDOMONAS) Q FEVER (COXIELLA BURNETII PLAGUE (YERSINIA PESTIS)
12
Q
GRAM POS BACTERIAL DZ
A
NECTROTIZING FASCIITIS (GABHS) DIPHTHERIA (CORYNEBACTERIUM) ERYSIPELOID (ERYSIPELOTHRIX RHUSIOPATHIAE) TETANUS (CLOSTRIDIUM TETANI) GAS GANGRENE (CLOSTRIDIUM PERFRINGENS) BOTULISM (CLOSTRIDIUM BOTULINUM) LISTERIOSIS ANTHRAX (BACILUS ANTHRACIS)
13
Q
SPIROCHETAL DZ
A
SYPHILIS (TREPONEMA PALLIDUM)
LYMES (BORRELIA BURGDORFERI)
ROCKY MT SPOTTED FEVER (RICKETTSIA RICKETSII)
14
Q
PARASITIC DZ
A
AMEBIASIS (ENTAMOEBA HISTOLYTICA) ACANTHAMOEBA KERATITIS MALARIA (PLASMODIUM) BABESIOSIS (BABESIA MICROTI) TOXOPLASMOSIS (TOXOPLASMPA GONDII) ENTEROBIASIS (PINWORM - E. VERMICULARIS) CHAGAS DZ (TRYPANOSOMA CRUZI) AFRICAN TRYPANOSOMIASIS / SLEEPING SICKNESS TRICHINOSIS ASCARIASIS LEISHMANIASIS
15
Q
chlamydia**
A
-MC CAUSE OF STD IN US
- sx-
- URETHRITIS, PELVIC INFLAM DZ
- REACTIVE ARTHRITIS (REITERS SYND): URETHRITIS, UVEITIS, ARTHRITIS
- LYMPHGRANULOMA VENEREUM (genital/rectal lesion)
- dx-
- NUCLEIC ACID AMPLIFICATION
-tx-
AZITHROMYCIN 1g x 1 dose (also tx GONO 250mg IM)
alt: DOXY 100mg x 10d
16
Q
gonorrhea**
A
-neisseria gonorrhoeae
- sx-
- URETHRITIS + CERVICITIS: anal, vaginal, penile or pharyngeal discharge
- DISSEMINATION: ARTHRITIS-DERMATITIS SYNDROME (tendon pain, arthralgias, rash) –> SEPTIC ARTHRITIS
-tx-
CEFTRIAXONE 250mg IM (+ azithro or doxy for clam)
17
Q
cat scratch disease*
A
-BARTONELLA HENSELAE - after scratch or bite from flea-infested cat; 2-4 wk incubation period
- sx-
- brown/red papule/ulcer at site; 1-7 wks later –> FEVER, ha, malaise –> LYMPHADENOPATHY FOR 2-4 MO
- tx-
- mild: SYMPTOMATIC
- MOD: AZITHRO 1ST LINE OR DOXY
- sev: rifampin, genatmicin, cipro
18
Q
meningococcal meningitis
A
-neisseria meningitidis
-sx-
-fever, headache, photophobia, NECK RIGIDITY, AMS, RURPURIC RASH (DIC)
+KERNIG’S SIGN - inability to straighten leg when hip flexed at 90 deg
+BRUDZINSKI’S SIGN - neck flexion causes involuntary hip/knee flexion
-tx-
-MOST PEOPLE TREATED EMPERICALLY
(Adults: Ceftriaxone + Vanc; Infants: Amp + Cefotaxime)
-PCN G DOC IF SUSCEPTIBLE
- prophylaxis for pt exposed: CIPRO 500mg x 1 dose or RIFAMPIN
- vaccine given in pt >55y and high-risk pt
19
Q
chancroid**
A
- HAEMOPHILUS DUCREYI
- 10% co-infx w/ HSV or syphilis in US
- STD MC transmitted after break in skin
- sx-
- PAINFUL GENITAL ULCERS –> BOBO FORMATION (enlarged lymph nodes, may rupture + form abscess), PAINFUL LYMPHADENOPATHY
- dx-
- clinical; hard to culture –> PCR
-tx-
AZITHROMYCIN 1g x 1 dose
-alt: Ceftriaxone 250 IM, Erythromycin, Cipro
20
Q
haemophilus influenzae
A
- MC CAUSE EPIGLOTTITIS, 2ND MC CAUSE CAP
- often assoc w/ sinusitis, otitis media
- RF: underlying pulm dz; COPD, BRONCHIECTASIS, CYSTIC FIBROSIS, ETOH, DM, children <6 + elderly
-tx-
AMOXICILLIN
-Augmentin if positive for beta-lactamase
-alt: FQ, Bactrim
IV CEFTRIAXONE FOR EPIGLOTITIS, PNM, MENINGITIS
21
Q
tularemia
A
- FRANCISELLA TULARENIS - mc rodents + RABBITS
- transmission: tick/insect bite or handling animal tissues
-sx-
ULCEROGLANDULAR - MC TYPE
-fever, headache, nausea –> SINGLE PAPULE AT SITE OF INOCULATION –> ULCERATION OF PAPULE W/ CENTRAL ESCHAR + TENDER REGIONAL LYMPHADENOPATHY
- Glandular: tender regional lymphadenopathy
- Oculoglandular: if splashed in eye –> pain, photophobia
- Pharyngeal: due to ingestion –> fever, sore throat
- Typhoidal: ingest infected meat (UNDERCOOKED RABBIT)
- dx-
- Serologies, blood cultures
- tx-
- STREPTOMYCIN DOC, gentamicin, doxy
22
Q
brucellosis
A
- MC lab acquired infection
- GOAT, SHEEP, CATTLE HOGS MC ANIMAL VECTOR
- ENDEMIC IN MEXICO
- transmission: handling infected tissues or INGESTION OF INFECTED UPASTEURIZED MILK + CHEESE
- sx-
- NONSPECIFIC ABSENT OF LOW-GRADE FEVER
- weakness, arthralgias, headache, weight loss
- dx-
- culture, serologies, lymphocytosis
- tx-
- RIFAMPIN + DOXYCYCLINE (BACTRIM IN KIDS)
23
Q
hot tub folliculitis
A
-PSEUDOMONAS AERUGINOSA
- sx-
- SMALL, PINK TO RED BUMPS, +/- filled w/ pus or scab
- 1-4 days after exposure
- tx-
- USUALLY RESOLVES 7-14d w/out tx
- CIPRO PO IF PERSISTS
24
Q
Q fever
A
- COXIELLA BURNETII - inhalation or ingestion
- EXPOSURE TO SHEEP, GOATS, CATTLE AND THEIR PRODUCTS (WOOL)
- sx-
- ACUTE: PNEUMONIA MC –> flu-like illness
- CHRONIC: CULTURE-NEG ENDOCARDITIS MC - vascular infx of aorta, persistent low-grade fever, rash
- dx-
- Acute: IMMUNOFLUORESCENCE IFA MC TEST USED
- Chronic: phase I IgG immunoglobulins
- Leukopenia, inc LFTs
- tx-
- DOXY DOC
- fluoroquinolones, macrolides, bactrim
- Rifampin may be used in chronic
25
plague
- YERSINIA PESTIS
- transmission: VIA INFECTED RODENTS + FLEAS, PERSON TO PERSON VIA DROPLETS; rare in US
- sx-
- rapid onset of F/C, malaise, myalgias, tachy, AMS
BUBONIC: MC FORM (95%)
-ACUTELY SWOLLEN, EXTREMELY WARM, RED PAINFUL NODES (BUBOES) IN GROIN, AXILLA, CERVICAL
```
SEPTICEMIC:
-subsequent, advanced dz w/out boboes
-DIC: EXTENSIVE PURPURA "BLACK DEATH"
-ACRAL GANGRENE: DISTAL EXTREMITIES, NOSE, PENIS
(often die from pneumonia or meningitis)
```
PNEUMONIC:
-tachypnea, productive cough, frothy, BLOOD-TINGED SPUTUM "RED DEATH"
- dx-
- gram stain --> bipolar staining, SAFETY PIN APPEARANCE OF ORGANISMS
- tx-
- STREPTOMYCIN OR GENTAMICIN 1ST LINE
- doxy as alternative; strict respiratory isolation for 48 h min
-POST-EXPOSURE PROPHYLAXIS: DOXY OR TETRACYCLINE
26
necrotizing fasciitis
- MC GABHS (OFTEN POLYMICROBIAL) - rapid progression of infx through fascia
- FOURNIER'S GANGRENE: NECTROTIZING FASCIITIS OF PENIS/SCROTUM ESP SEEN W/ IMPAIRED IMMUNITY (DM) OR AFTER TRAUMA TO AREA
- sx-
- EXTREME PAIN OUT OF PROPORTION --> devo BLUE, HEMORRHAGIC BULLAE AT SITE --> GANGRENE --> septic shock
-tx-
-SURGICAL DEBRIDEMENT + BROAD SPECTRUM ABX
(Amp/Sulbactam, Pip/Tazo, Imipenem)
27
diphtheria
- CORYNEBACTERIUM DIPHTHERIAE (rare in US --> vac)
- transmission: inhalation of respiratory secretions
-sx-
TONSILLOPHARYNGITIS OR LARYNGITIS - CLASSIC
-PSEUDOMEMBRANES - FRIABLE GRAY/WHITE MEMBRANE ON PHARYNX THAT BLEEDS IF SCRAPED
-BULL NECK: swelling due to enlarged cervical nodes
-fever, nasopharyngeal sx, neuropathy
-MYOCARDITIS, arrhythmias or heart failure
- dx-
- clinical, PCR, culture to confirm; isolate until 3 neg throat cultures
- tx-
- DIPTHERIA ANTITOXIN (HORSE SERUM) MOST IMPORTANT + ERYTHROMYCIN OR PCN X2 WKS
- antitoxin reduces sequelae and inc recovery (from CDC)
- abx to reduce spread
PROPHYLAXIS: ERYTHROMYCIN 7-10D OR PCN G X1 DOSE
28
ersipeloid
- erysipelothrix rhusiopathiae
- OCCUPATIONAL DZ FOLLOWS SKIN ABRASION, PUNCTURE WOUND FROM RAW FISH, SHELLFISH, RAW MEAT/POULTRY
-sx-
LOCALIZED CUTANEOUS: limited to hands/fingers/webspaces: pain, burning, tingling
-NON-PITTING EDEMA, PURPLE ERYTHEMA W/ SHARP IRREGULAR MARGINS EXTENDING PERIPHERALLY BUT CLEARING CENTRALLY
DIFFUSE CUTANEOUS: may be associated w/ fever
GENERALIZED: low grade fever, endocarditis + bacteremia uncommon but possible sequelae
- dx-
- usually clinical, culture from material bx
-tx-
PCN G OR V, cephalosporins, clindamycin
29
tetanus
- CLOSTRIDIUM TETANI
- ubiquitous in soil germinates ESP PUNCTURE + CRUSH WOUNDS
- neurotoxtin blocks neuron inhibition (blocks acetylcholinesterase) --> severe muscle spasm
-sx-
GENERALIZED TETANUS:
-early: LOCAL MUSCLE SPASMS, NECK/JAW STIFF, TRISMUS MC --> RISUS SARDONICUS (FACIAL CONTRACTIONS), OPISTHOTONUS (ARCHED BACK), muscle rigidity in descending fashion, spares hands/feet
-MAY AFFECT RESPIRATORY MUSCLES, SPASM W/ MINOR STIM, INC DTR
- NEONATAL TETANUS: usually transferred from mom or unsanitary practices (instruments cutting cord)
- LOCALIZED: uncommon, just local muscles and wound affected
- CEPHALIC: cranial nerve involvement only
-tx-
METRONIDAZOLE (OR PCN G) AND IM TETANUS IMMUNE GLOBULIN (5K UNITS)
-benzos to reduce spasms ex Diazepam
-Prophylaxis: TDAP, if never vaccinated (tetanus immune globulin 250u + initiation of tetanus toxoid vaccine)
30
gas gangrene (myonecrosis)
- CLOSTRIDIUM PERFRINGENS
- TRAUMATIC INJURY + IV DRUG USE MC CAUSES (anaerobic conditions)
- sx-
- sudden onset pain/edema w/ wound contamination --> SYSTEMIC TOXICITY (SHOCK)
- BROWN TO BLOOD-TINGED WATERY EXUDATES
- CREPITUS/GAS IN TISSUE PALPATED ON EXAM
- dx-
- XRAY: AIR IN SOFT TISSUES (CT/MRI more detail)
- CULTURE OR SMEAR OF EXUDATES
- tx-
- IV PENICILLIN + IV CLINDAMYCIN, DEBRIDEMENT
- may need amputation
- alt: Tetracycline + Metronidazole
31
botulism
- CLOSTRIDIUM BOTULINUM
- neurotoxin inhibits acetylcholine release at neuromuscular jx --> WEAK, FLACCID PARALYSIS, RESP ARREST
- transmission:
- ADULT: CANNED/SMOKED/VACUUM-PACKED FOODS
- INFANT: INGESTION OF HONEY OR DUST SPORES
- WOUND: rare, mc traumatic injury w/ contaminated soil
- sx-
- about 12-36 hrs after ingestion (6-8 if <1y)
- sudden onset of D's: DILATED, FIXED PUPILS, DRY MOUNT, DYSPHAGIA, DYSARTHRIA, DYSPHONIA
- DESCENDING, DECREASED MUSCLE STRENGTH --> flaccid paralysis
- "FLOPPY BABY SYNDROME" newborn
- tx-
- ANTITOXINS IN ALL CASES!
- if >1yo --> EQUINE-DERIVED BOT ANTITOXIN
- if <1yo --> HUMAN-DERIVED BOT IMMUNE GLOBULIN
- intubate if respiratory failure
- no abx in foodborn type (may worsen dz via toxin release from bacteria lysis)
- abx only in wound botulism --> PCN G
32
listeriosis
- LISTERIA MONOCYTOGENES - non-spore forming, endotoxin-producing
- MC FOUND IN CONTAMINATED FOOD: COLD DELI MEATS, UNPASTEURIZED DAIRY
- highest: children, elderly, pregnant pt
- sx-
- LISTERIOSIS: BACTEREMIA, 3rd mc cause of meningitis
- PREGNANCY: 3RD TRI --> FEBRILE ILLNESS ASSOC W/ PREMATURE LABOR + STILLBIRTH
```
-tx-
IV AMPICILLIN (allergy: Bactrim)
-add Gentamicin in meningitis, endocarditis, immunocomp
```
33
anthrax
- BACILLUS ANTHRACIS
- NATURALLY FOUND IN LIVESTOCK
- transmission: inhalation, ingestion of spores, direct contact
-sx-
CUTANEOUS: 5-14 days after --> erythematous papule at inoculation site, ulcerates --> PAINLESS BLACK ESCHAR . w/ marked surrounding edema + vesicles - MC TYPE
INHALATION: nonspecific flu-like sx rapidly progressing to dyspnea (pleural effusions), hypoxia + shock
-DX- WIDENING OF MEDIASTINUM ON CXR
GI ANTHRAX: rare in US
-ingestion of meat spores --> GI bleed, ab pain, n/v
-tx-
CIPRO FOR TX + EXPOSURE (alt Doxy)
34
syphilis**
- TREPONEMA PALLIDUM
- transmission: direct contact of infected lesion during sex and contact w/ lesions (includes mucus memb); can also be transmitted to fetus via placenta
- organism enters tissues, formes chancre at inoculation site and goes to regional nodes before disseminating
-sx-
PRIMARY:
-CHANCRE - PAINLESS ULCER AT INOCULATION SITE w/ raised indurated edges; heal in 3-4 weeks, non-tender lymphadenopathy
SECONDARY:
- occur few weeks to 6 mo after initial sx
- MACULOPAPULAR RASH - INVOLVES PALMS/SOLES
- CHONDYLOMA LATA - wart-like, moist lesions involving mucous memb, esp near chancre site - contagious!
- systemic sx: fever, lymphadenopathy, arthritis, meningitis, ha, hepatitis
TERTIARY (LATE):
- may occur 1 to >20 years after infx
- GUMMA: noncancerous granulomas on skin/body tissues
- NEUROSYPHILIS: ha, meningitis, dementia, vision/hearing loss, TABES DORSALIS (demyelination of posterior columns)
- ARGYLL-ROBERTSON PUPIL: small, irregular pupil that constricts normal to near accommodation but doesn't constrict/react to light
- CARDIO: AORITIS, aortic regurge, aortic aneurysms
CONGENITAL SYPHILIS:
-HUTCHINSON TEETH (notches), sensorineural hearing loss, SADDLE-NOSE DEFORMITY, ToRCH SYND
- dx-
- DARKFIELD MICROSCOPY to see spirochete (used in pt w/ chancre or condyloma)
- SCREEN: RPR, VDRL
- CONFIRM: FTA-ABS
-tx-
PCN DOC FOR ALL STAGES (EVEN IF ALLERGIC)
-primary, secondary or early-latent: PCN G IM 2.4 million units x 1dose
-tertiary or late-latent: PCN G IM 2.4 million units q week x3
SE: JARISCH-HERXHEIMER RX
PCN allergic: Doxy or Tetracycline
-all pt should be reexamined clinically and serologically at 6 mo and 12 mo after + tested for HIV
35
lyme disease**
- BORRELIA BURGDORFERI
- transmitted by IXODES DEER TICK - MC SOURCES white-tailed dear and white-footed mice; spring/summer
-highest likelihood of transmission if tick engorged and attached for at least 72 hr
-sx-
EARLY LOCALIZED:
-ERYTHEMA MIGRANS (90%) - EXPANDING, WARM, ANNULAR, ERYTHEMATOUS RASH W/ CENTRAL CLEARING OR "BULL'S EYE" w/in month ob bite
+/- viral-like sx: ha, fever, malaise
EARLY DISSEMINATED: 1-12 WKS
- RHEUMATOLOGIC: arthritis, esp large joints
- NEUROLOGIC: ha, meningitis, weakness, CN 7/FACIAL PALSY, neuropathy
- CARDIAC: AV BLOCK, pericarditis
LATE DISEASE:
-persistent synovitis, neuro sx, subactue encephalitis
- dx-
- CLINICAL, esp early (pt w/ bull's eye often seronegative in early stage)
- SEROLOGICAL: ELISA followed by WESTERN BLOT IF ELISA POS/EQUIVOCAL
- tx-
- Early:
- DOXYCYCLINE BID X 10-21 DAYS (alt: azithro or erythro)
- AMOX - DOC FOR CHILDREN <8 OR PREGNANCY
- Late/Severe:
- IV CEFTRIAXONE IF 2ND/3RD AV HEART BLOCK, SYNCOPE, DYSPNEA, CHEST PAIN, CNS DZ
-Prophylaxis: DOXY 200mg x 1 dose w/in 72 hr of tick removal if tick is present for >36h + >20% ticks infected in area
36
rocky mountain spotted fever**
- RICKETTSIA RICKETSII - pot'l fatal but curable tick-borne
- affinity for vascular endothelial cells --> vascular injury, microhemorrhages and microinfarcts
-vector: DERMACENTOR ANDERSONI/VARIABILIS (WOOD/DOG TICK) - mc in south-central and southeast US
- sx- 2-14d after tick bite
- F/Ch, myalgias, arthralgias, HA, N/V, lethargy, seizures
- BLANCHING, ERYTHEMATOUS MACULAR RASH FIRST ON WRISTS/ANKLES --> PALMS/SOLES, SPREADS CENTRAL OVER 2-3 DAYS +/- PETECHIAE
- pt may devo encephalitis, ARDS, cardiac or bleeding disorders
- dx-
- CLINICAL, DON'T WAIT FOR SEROLOGY - fever, rash, history of tick bite
- Serologies: indirect immunofluorescent AB test for IgM/IgG
- 4-fold rise in titer indicates acute disease
- Skin biopsy
- CSF: low glucose and inc cell count
-tx-
DOXY (EVEN IN CHILDREN) X 5-14 DAYS - start w/in 5 days
Chloramphenicol 2nd line (and in pregnancy)
37
amebiasis
-ENTAMOEBA HISTOLYTICA (protozoan spread by fecal contamination of soil, water)
- sx-
- GI COLITIS, DYSENTERY (BLOODY), AMEBIC LIVER ABSCESS
- dx-
- STOOL O+P, positive ELISA
- dx-
- COLITIS --> METRONIDAZOLE (alt Tinidazole) + intraluminal agent (paromomycin, diloxanide or diiodohydroxyquin)
- ABSCESS --> Metronidazole or Tinidazole + intraluminal agent followed by Chloroquine
38
acanthamoeba keratitis
-transmission: minor ocular trauma --> swim w/ contacts, infected contact solution
- sx-
- KERATITIS (ESP W/ CONTACT LENSES), ocular pain, photophobia, tearing, blurred vision, conjunctival injection
- exam --> CORNEAL STROMAL RING INFILTRATE, hypopyon
- encephalitis + granulomatous disease in imunocomp
- tx-
- combo: BIGUANIDE-CHLORHEXADINE +/- PROAMIDINE OR HEXAMIDINE
39
malaria
- RBC DISEASE CAUSED BY PLASMODIUM (falciparum, vivax, ovale, malariae)
- infects RBC --> RBC lysis --> cyclical fever
- protozoa transmitted by FEMALE ANOPHELES MOSQUITO
- FALCIPARUM MOST DANGEROUS TYPE
- sx-
- CYCLICAL FEVER (cold/chills --> hot/fever --> diaphoretic stage every other or 3rd day)
- LEUKOPENIA, HEMOLYTIC ANEMIA, THROMBOCYTOPENIA, ha, myalgias, GI sx, splenomegaly
- P.FALCIPARUM: CEREBRAL MALARIA (COMA due to lysed RBCs occluding cerebral flow)
- BLACKWATER FEVER = sev hemolysis + hemoglobinuria + renal failure
- dx-
- PERIPH SMEAR: GIEMSA STAIN --> PARASITES IN RBC
- tx-
- CHLOROQUINE 1ST LINE IN SENSITIVE AREAS
- mulit-drug-resistant area: Atovaquone (w/ doxy or clinda)
40
babesiosis
- BABESIA MICROTI
- malaria-like PROTOZOA that ATTACKS RBCs
- hx of TICK BITES (ixodes); NORTHEAST US
- sx-
- fever, chills, HEMOLYTIC ANEMIA + JAUNDICE, arthralgia, myalgia
- dx-
- Periph Smear: parasites w/in RBC, esp PATHOGNOMONIC TETRADS (MALTESE CROSS)
-tx-
ATOVAQUONE AND AZITHROMYCIN
OR
QUININE AND CLINDAMYCIN
41
toxoplasmosis
- TOXOPLASMA GONDII (PROTOZOAN)
- TRANSMITTED BY CATS (INCLUDING LITTER)
-sx-
PRIMARY INFX: usually asymptomatic w/ normal immune system; may devo mono-like illness
ENCEPHALITIS + CHORIORETINITIS:
-IN IMMUNOCOMPROMISED (CD4 <100), fever, lymphadenopathy (esp cervical), malaise, myalgias, ha
CONGENITAL: part of ToRCH syndrome: Toxoplasmosis, Rubella, Cytomegalovirus, Herpes 2: BLUEBERRY MUFFIN RASH (TTP), HEPATOSPLENOMEGALY, HEARING LOSS, MENTAL DEVO DELAYS
- dx-
- PCR, Head CT/MRI +/- show RING-ENHANCING LESIONS
- tx-
- SULFADIAZENE (OR CLINDA) + PYRIMETHAMINE
- W/ FOLINIC ACID/LEUVOCORIN to prevent bm suppression and reduce nephrotoxicity
- Spiramycin if pregnant
Prophylaxis: CD4 <100 --> BACTRIM
42
enterobiasis (pinworm)
- ENTEROBIUS VERMICULARIS
- transmission: FECAL-ORAL, esp kids
- sx-
- PERIANAL ITCHING, ESP @ NIGHT (eggs laid at night)
- dx-
- SCOTCH TAPE TEST (early AM) - look for eggs w/ micro
-tx-
ALBENDAZOLE, Mebendazole; Pyrantel 2nd line
43
chagas disease (american trypanosomiasis)
- TRYPANOSOMA CRUZI, PROTOZOA; sx mc in children
- LEADING CAUSE CHF IN LATIN AMERICA
- vector: ASSASIN BUG (bites in evening)
-sx-
Acute: lasts 3wk - 3 mo - fever, lymphadenopathy, edema at bite, hepatosplenomegaly
-ROMANA'S SIGN: UNILAT PERIORBITAL SWELLING
-CHAGOMA: INFLAM NODULE @ BITE SITE
Latent: destruction of nerve cell ganglia causes CARDIOMYOPATHY, CHF, arrhythmias, GI abnormalities (MEGACOLON + MEGAESOPHAGUS)
- dx-
- Peripheral Smear or Culture
- Serology or Muscle BX in latent phase
- ECHO: CARDIOMEGALY W/ APICAL ATROPHY/ANEURYSM
- tx-
- BENZNIDAZOLE OR NIFURTIMOX 90-120 DAYS (FROM CDC)
44
african trypanosomiasis (african sleeping sickness)
- T. BRUCEI (PROTOZOA)
- vector: TSETSE FLY
2 Stages:
EARLY/HEMOLYMPHATIC STAGE:
-PAINLESS CHANCRE @ BITE SITE - 2-3 days after, inc in size and resolves 2-3 wks
-intermittent malaise, ha, joint pains, itching
-GENERAL OR REGIONAL LYMPHADENOPATHY
-WINTERBOTTOM SIGN - posterior-cervical lymphadenopathy
LATE/CNS STAGE:
-persistent headache, DAYTIME SLEEPINESS FOLLOWED BY NIGHTTIME INSOMNIA (tryptophol induces sleep), bx changes, wasting syndrome, seizures in kids
- dx-
- PERIPH SMEAR OR ASPIRATION OF NODE
- tx-
- ID CONSULT; PENTAMIDINE, SURAMIN
45
trichinosis (trichinellosis)
- TRICHENELLA SPIRALIS - parasitic round-worm infx
- transmission: RAW OR UNDERCOOKED MEAT, ESP PORK, WILD BOAR, BEAR
-larvae of cysts ingested --> to duodenum/jejunum and grow into adults, replicate --> adults excreted in stool and larva penetrate intestinal wall and INCAPSULATE IN STRIATED MUSCLE TISSUE
- sx-
- GASTRO PHASE: abd pain, N/D/V in WEEK 1
- MUSCLE PHASE: MYOSITIS, swelling, weak, high fever
- Eye: PALPEBRAL/CIRCUMORBITAL EDEMA +/-retinal hemorrhages, conjunctivitis
- Cardiac: myocarditis (eosinophilia)
- CNS: encephalitis or meningitis
- Pulm: pneumonia, dyspnea, dysphagia
-dx-
-EOSINOPHILIA HALLMARK, INC CREATININE KINASE,
INC LDH
-Muscle BX: larvae in striated muscle - definitive
- tx-
- Mild: most self-limited only sx treatment
- Severe: ALBENDAZOLE or mebendazole + CORTICO
46
ascariasis
- ASCARIS LUMBRICOIDES (GIANT ROUNDWORM)
- MC intestinal helminth worldwide
- transmitted by: contaminated soil
- sx-
- Small worm load: asymptomatic
- Larger worm load: vague abd sx
- High worm load: may migrate to pancreatic duct, bile duct, appendix, diverticula and cause sx
- dx-
- Stool O+P; Eosinophila
- egg in feces or large worm coughed, vomited, leave nose, anus or mouth
- tx-
- MEBENDAZOLE, ALBENDAZOLE
- PYRANTEL IF PREGNANT (AFTER 1ST TRI)
47
leishmaniasis
- protozoa Leishmania sp; Mediterranean, C+S Amer, Af, As
- SPREAD BY BITE OF FEMALE SANDFLY
- sx-
- CUTANEOUS: SMALL ERYTHEMATOUS PAPULES W/ ULCERATION OF DRY INDURATED PLAQUE W/ SATELLITE PUSTULES that develops at the bite site weeks-months
- NOT PAINFUL INITIALLY, REGIONAL LYMPHADENOPATHY
- MUCOCUTANEOUS: esp cartilaginous areas of nasal mucosa and mouth
- VISCERAL: fulminant dz if organism migrates to vital organs; HEPATOSPLENOMEGALY
- dx-
- CULTURE
- tx-
- ID CONSULT
48
ehrlichiosis
-gram neg intracellular bacteria that INFECTS AND DESTROYS WBC (2 types)
1. HUMAN GRANULOCYTIC ANAPLASMA
- TRANSMITTED BY IXODES TICK
2. HUMAN MONOCYTIC EHRLICHIOSIS
- TRANSMITTED BY LONE STAR TICK
- sx-
- usually 7-10 days after bite
- prodrome: rigors, malaise, nausea --> high fever, toxicity, myalgia, headache
- NO RASH, +/- SPLENOMEGALY (petechial rash reflects thrombocytopenia)
- dx-
- Periph Smear/BUFFY COAT: MORULAE IN WBC
- MULBERRY-SHAPED AGGREGATES IN CELLS
- inc LFTs, THROMBOCYTOPENIA, LEUKOPENIA
-tx-
DOXY 1ST LINE, Rifampin
49
mycobacterium avium complex (MAC)
- transmission: present in soil/water
- sx occur rarely in immunocompetent; HIV if CD4<50
- sx-
- PULMONARY INFX: in immunocompetent --> cough w/ sputum, fever, WL, BRONCHIECTAISIS
- DISSEMINATED (HIV): FUO, sweating, WL, fatigue, diarrhea, dyspnea, RUQ pain
- LYMPHADENITIS IN CHILDREN
- dx-
- ACID FAST BACILLUS STAIN/CULTURE
-tx-
CLARITHROMYCIN + ETHAMBUTOL @ least 12 mo
-HIV prophylaxis CD4<50 --> Clarithromycin, Azithromycin
50
mycobacterium marinum "fish tank granuloma"
-inoculation of SKIN ABRASION OR PUNCTURE IN PT W/ CONTACT OF AQUARIUM, SALTWATER, MARINE ANIMALS
- sx-
- LOCAL CUTANEOUS DZ: ERYTHEMATOUS BLUISH PAPULE OR NODULE AT SITE OF TRAUMA (hx of exposure 2-3 wks prior)
- SUBSEQUENT LESIONS ALONG PATH OF LYMPHATIC DRAINAGE
- dx-
- Culture
- tx-
- Tetracyclines, FQ, Macrolides, Sulfonamides; 4-6 wks
51
leprosy (hansen's disease)
- MYCOBACTERIUM LEPRAE (req long exposure - months to 20-50 years incubation period)
- PRIMARILY AFFECTS SUPERFICIAL TISSUES
-sx-
LEPROMATOUS: NODULAR, PLAQUE OR PAPULAR SKIN LESIONS, esp cooler areas of body
-loss of eyebrows and eyelashes
-SLOWLY EVOLVING SYMMETRIC NERVE INVOLVEMENT (SENSATION PRESERVED) PARASTHESIAS IN AFFECTED PERIPHERAL NERVES
TUBERCULOID: LIMITED DZ; HYPOPIGMENTED MACULAR LESIONS NUMB TO TOUCH (LOSS OF SENSATION)
-mc in immunocompetent patients
MONONEURITIS MULTIPLEX:
-nerve damage --> clawing (median + ulnar), foot drop (peroneal), vibratory and proprioception preserved
- dx-
- SKIN BX: acid fast bacillus smear performed on tissue
- tx-
- Lepromatous: DAPSONE, RIFAMPIN, CLOFAZIMINE 2-3Y
- Tuberculoid: DAPSONE + RIFAMPIN 6-12 MO, THEN DAPSONE X2 YRS
52
human herpesvirus family
```
HSV1 - oropharyngeal
HSV2 - genital
Varicella Zoster
EBV
CMV
Roseola
Pityriasis Rosea
Kaposi Sarcoma
```
53
HSV 1 + 2**
- sx-
- Prodromal 24h prior: BURNING, TINGLING, PARESTHESIAS --> PAINFUL, GROUPED VESICLES ON ERYTHEMATUS BASE
ORAL LESIONS:
- ACUTE HERPETIC GINGIVOSTOMATITIS: primary infx in children, sudden onset of fever, anorexia --> GINGIVITIS (gum swelling, friable/bleeding), vesicles in mouth, tongue, lips --> gray/yellow lestions (90% of US pop has HSV1)
- ACUTE HERPETIC PHARYNGOTONSILLITIS: primary infx adults; vesicles that rupture --> ulcerative lesions w/ gray exudates in posterior pharynx
- HERPES LABIALIS: 2ry INFX MOST OFTEN HSV-1 (cold sore, fever blister w/ stress/illness)
GENITAL LESIONS: most often HSV-2 (about 25% pop)
HERPES KERATITIS: usually unilateral, DENDRITIC ULCERS
BELLS PALSY: assoc w/ HSV-1
HSV ESOPHAGITIS: small, deep ulcers on EGD (usually immmunocompromised)
HERPETIC WHITLOW: HSV infx of nail or finger
ENCEPHALITIS: HSV MC CAUSE OF ENCEPHALITIS
- dx-
- PCR MOST SENSITIVE/SPECIFIC, clinical dz
- TZANCK SMEAR: multi-nucleated giant cells and intracunclear inculsion bodies
- tx-
- ACYCLOVIR (IV FOR ENCEPHALITIS), VALACYCLOVIR, Famciclovir
54
cytomegalovirus (HHV 5)
-present in most people (70%) - clinical dz in immunocomp
- sx-
- PRIMARY DZ: MOST ASYMPTOMATIC OR MONO-TYPE
- CONGENITAL: SENSORINEURAL HEARING LOSS + BLUEBERRY MUFFIN RASH (TTP), hepatosplenomegaly, mental & motor dysfunction (part of congenital ToRCH)
CMV REACTIVATION: seen w/ immunocompromised (HIV, steroid use, chemo, s/p transplant)
- RETINITIS: hemorrage w/ soft exudates (SCRAMBLED EGGS/KETCHUP APPEARANCE - PIZZA PIE) on fundo if CD4 <50
- ESOPHAGITIS: odynophagia, LARGE SUPERFICIAL ULCERS ON UPPER ENDOSCOPY
- dx-
- Serologies, PCR
- BX of tissue: OWL'S EYE APPEARANCE
- tx-
- GANCICLOVIR TX OF CHOICE
- alt: foscarnet, cidofovir, valacyclovir
55
varicella zoster (HHV-3)
- transmission: respiratory droplets, direct contact
- 10 to 20 day incubation period
-sx-
VARICELLA (CHICKEN POX): PRIMARY INFX
-fever, malaise, DEW DROPS ON ROSE PETAL IN DIFFERENT STAGES; begin face, trunk --> extremities
-complications: Bacterial MC, encephalitis, guillain barre
HERPES ZOSTER (SHINGLES): VZV REACTIVATION ALONG ONE DERMATOME (disseminated in HIV)
HERPES ZOSTER OPHTHALMICUS: involves 1st division of TRIGEMINAL NERVE (CN 5)
- HUTCHINSON'S SIGN: lesion on nose HERALDING OCULAR INVOLVEMENT
- DENDRITIC LESIONS seen on slit-lamp if keratoconjunctivitis is present
HERPES ZOSTER OTICUS (RAMSAY-HUNT SYNDROME):
-FACIAL NERVE CN 7 - otalgia, lesions on ear, auditory canal, TM, facial palsy, auditory sx
POST HERPATIC NEURALGIA: > 3mo, pain or dec sensation
- tx-
- Chicken Pox: Symptomatic
- Shingles: Acylovir, Valacyclovir, Famciclovir (w/in 72 hrs)
- HZO: PO antivirals
- Ramsay-Hunt Syndrome (Otic): Oral Acyclovir + Cortico
- PHN: Gabapentin or TCAs
56
epstein-barr virus (HHV-4)**
- transmission: saliva
- 80% of adults are seropositive
EBV infects B cells --> assoc w/ Hodgkin Lymphoma
-may cause Burkitt's lymphoma and may cause CNS lymphoma in pt w/ AIDS
- sx-
- FEVER, SORE THROAT (+/- EXUDATE), POSTERIOR CERVICAL LYMPHADENOPATHY, malaise, myalgias
- SPLENOMEGALY
- PETECHIAL RASH IN 5% - ESP IF GIVEN AMPICILLIN
- dx-
- HETEROPHILE (MONOSPOT) AB TEST (positive w/in 4 weeks)
- Periph Smear: >50% lymphocytes w/ >10% ATYPICAL LYMPHOCYTES, inc LFTs
- tx-
- SUPPORTIVE, sx may last months
- Cortico used only if airway obstx, hemolytic anemia, or servere thrombocytopenia
- AVOID TRAUMA/CONTACT SPORTS FOR 1 MO IF SPLENOMEGALY
57
rabies
- life-threatening, RHABDOVIRUS, infx of CNS
- transmission: INFECTED SALIVA BITES FROM ANIMALS (NOT RODENTS); incubation 3-7 weeks
- sx-
- Prodrome: pain, paresthesias, itching at initial site pathognomic --> CNS phase
- CNS phase: encephalitis, aerophobia (sensitive to air), HYDROPHOBIA (painful laryngospasm after drinking liquid), numbness, paralysis
- rabid rage, hypersalivation, thick sputum --> resp phase
-Resp phase: respiratory muscle paralysis --> death
- dx-
- NEGRI BODIES in brain of dead animals (observe 7-10d)
- tx-
- once sx occurs, pt rarely survive
- coma induction, Amantadine + Ribavirin
- Post-Exposure Prophylaxis for 1st Episode:
- HDCV (RABIES VAC) DAYS 0, 3, 7, 14 + RABIES IMMUNE GLOBULIN 1/2 WOUND, 1/2 IM (20U/KG) started w/in 6 days of the exposure
- subsequent exposure: vaccine on day 0 +3
- IF PERSON WAS ASLEEP IN ROOM WITH BAT, SHOULD GET PROPHYLAXIS EVEN IF NO VISIBLE BITE
58
smallpox (variola)
- Orthopox virus (category A bioterrorism agent) IP 7-14
- transmission: inhalation
- virus migrates + multiplies in lymph node, spleen, BM
- sx-
- FLU-LIKE PRODROME: quick onset of high fever + SEVERE HEAD/BACK PAIN, chills, rigors, coryza, pharyngitis --> SKIN ERUPTIONS (macules progress to papules and umbilicated pustules, crust over)
- PALMAR + PLANTAR LESIONS COMMON (unlike varicella)
- dx-
- LAB CONFIRM of tissues from lesions w/ e-micro
- tx-
- Supportive, abx if secondary infx
- isolate and vaccinate household/contacts w/in few days
- Eczema, dermatitis, burns are contraindications to vaccine
59
west nile fever
- FLAVIVIRUS - transmitted by infected mosquitos
- BIRDS ARE RESERVOIR
- sx-
- most asymptomatic, flu-like sx
- may devo roseola, maculopapular rash, stiff neck and mental status change
- tx-
- intense supportive management
60
severe acute respiratory syndrome (SARS)
-CORONAVIRUS - transmitted by resp droplets
- sx-
- NONSPP FLU-LIKE SX: fever, rigors, rhnochi, ha, malaise, pharyngitis --> cough, dyspnea, rales ATYPICAL PNEUMO
- elderly may present w/ malaise and delirium
- dx-
- RT-PCR for SARS-CoV in urine, stool, nasal secretions (STOOL IS BEST TO BE POSITIVE W/IN 14 DAYS)
- CT SCAN: ground glass opacities or focal consolidation
- tx-
- aggressive supportive care
61
hantavirus (hemorrhagic fever)
- RODENTS MAIN VECTOR (DEER MOUSE FECES OR RODENT URINE)
- MC IN SW UNITED STATES (affects young healthy adults, esp males)
- sx- 3 wk incubation
- Prodromal Febrile Phase: aerosolized virus enters lung causing fever, chills, SEVERE MYALGIAS ESP INVOLVING BACK + LEGS, n/v/d, ha, weakness
- Cardiopulmonary Phase: sudden resp distress + PULMONARY EDEMA (massive capillary leadage in pulm vascular bed) --> may lead to CARDIO COLLAPSE (shock + coagulopathy) + RENAL FAILURE
- lasts 2-7 days, in survivors, recovery is rapid
- tx-
- Supportive, ICU admission
62
dengue fever
-FLAVIVIRUS transmitted by AEDES MOSQUITO (tropics)
- sx-
- BIPHASIC FEVER PHASE: sudden onset of chills, INITIAL HIGH FEVER (3-7D) --> remission hours to 2 days --> SECOND FEVER PHASE (1-2 days), severe myalgias, "BREAK BONE" JOINT PAIN, HA
- BIPHASEIC RASH: erythematous skin mottling, FLUSHED SKIN --> defervescence w/ onset of MACULOPAPULAR RASH (spares palms/soles) --> PETECHIAE on extensors
- HEMORRHAGIC FEVER: bruising, GI bleeding, nosebleeds, pleural effusions, ascites, shock. Usually occurs in children, "TOURNIQUET TEST" --> PURPURA, HEPATITIS
- dx-
- leukopenia, elevated LFTs (hepatitis), IgM, IgG, ELISA
- tx-
- volume support, pressors, ACETAMINOPHEN (not nsaid to reduce bleeding)
63
creutzfeldt-jakob disease
-PRION-MEDIATED DEGENERATIVE BRAIN DZ --> RAPIDLY PROGRESSIVE DEMENTIA (FATAL W/IN 1 YR)
- prion is a misfolded protein that enters CNS cells inducing abn folding of normal proteins --> SPONGIOFORM CORTEX (HOLES IN TISSUES)
- idiopathic or transmitted from infected tissue (ex corneal transplant), contaminated beef w/ CNS tissue of infected animals (ex Mad Cow Dz)
- sx-
- RAPIDLY PROGRESSIVE DEMENTIA, gait abnormalities, myoclonus
64
hookworm
ANCYLOSTOMA DUODENALE or NECATOR AMERICANUS
- 25% of world is infected (occasional cases in US)
- skin exposure to larvae in soil contaminated by human feces --> larvae penetrate skin and migrate to pulm capillaries; also carried to mouth (mucociliary escalator) and swallowed --> enter small bowel and suck blood
- sx-
- Skin: pruritic, erythematous dermatitis at entry site
- Pulm: asyx, low fever, blood-tinged sputum, cough
- Intestinal: abd pain, ulcer-like sx, diarrhea, anorexia, anemia
- dx-
- Stool: eggs noted, positive guaiac, eosinophilia, hypochromic microcytic anemia
- tx-
- ALBENDAZOLE, Mebendazole, Pyrantel
- supportive: iron, vitamins, protein
65
HIV
- HIV: retrovirus (changes viral RNA to DNA via REVERSE TRANSCRIPTASE) HIV-1 MC
- transmission: SEX, IV DRUG USE, mother to child during birth or breastfeeding, receipt of blood products before 1985, mucosal contact w/ infected blood or needle stick
- sx-
- ACUTE SEROCONVERSION: FLU-LIKE ILLNESS - malaise, general rash, lymphadenopathy
- AIDS: DEFINED AS CD4 COUNT <200 -OR- DEVO OF AIDS-DEFINING ILLNESS
- recurrent severe opportunistic infx or malignancies
- HIV wasting syndrome (chronic diarrhea and weight loss)
- AIDS-assoc neurologic change (encephalopathy or dementia)
- dx-
1. AB TESTING:
- ELISA (SCREENING TEST) if reactive --> CONFIRM W/ WESTERN BLOT (usually becomes reactive w/in 3-6 mo)
- RAPID TESTING: blood or saliva
2. WESTERN BLOT: confirmatory test
3. HIV RNA VIRAL LOAD: can be positive in window period, also used to monitor infectivity + treatment effectiveness
66
HIV OPPORTUNISTIC INFX**
CD4 700-1,500 (1ST LN PROHYPLAXIS, 2ND LN)
-dz: Normal, Lymphadenopathy
CD4 >500
- dz: Tuberculosis (1st INH if latent; 2nd Rifampin)
- Kaposi Sarcoma, Thrush, Lymphoma, Zoster
CD4 <200
-dz: PNEUMOCYSTIS (PCP) (1st Bactrim; 2nd Dapsone)
CD4 <150
-Histoplasmosis - routine prophylaxis in select pt
(1st Itraconazole; 2nd AmphoB)
CD4 <100
-TOXOPLASMOSIS (1st Bactrim; 2nd Dapsone +)
-CRYPTOCOCCUS - routine prophylaxis in select pt
(1st Fluconazole; 2nd AmphoB)
CD4 <50
- MAC (1st Azithro or Clarithro; 2nd Rifabutin)
- CMV Retinitis (1st Valganciclovir; 2nd Ganciclovir + Fosc)
Others: Diarrhea (cryptosporidium, isospora, microspora), HPV
67
HIV - HAART Regimens for Tx of Naive Patients
```
1. NNRTI + 2 NRTIs
or
2. PI + 2NRTIs
or
3. INSTI + 2 NRTIs
```
```
NNRTI = non-nucleoside reverse transcriptase inhibitor
NRTI = nucleos(t)ide reverse transcriptase inhibitor
PI = protease inhibitor
INSTI = integrase strand transfer inhibitor
```
68
cholera tx*
CIPRO (gram neg vibrio)
| -macrolides, tetracyclines
69
chancroid*
- caused by HAEMOPHYLIS DUCREYI
| - tx AZITHRO
70
SIRS**
systemic inflammatory response syndrome --> 2+ sx:
- temp >100.4 or <96.8 (>38 or <36)
- HR >90
- RR >20 or PaCO2 <32
- WBC >12K or <4K or >10% bands
71
sepsis
SIRS + suspected infx/source
72
severe sepsis
sepsis + lactic acidosis (or SBP <90 or drop >40)
| -organ dysfx, hypoTN, hypoperfusion
73
septic shock
severe sepsis + hypoTN despite adequate fluid resuscitation
74
rheumatic fever
- hx GAS infx
- sx- fever, red lesions trunk + proximal limbs, small tender lumps on joints
- PE: JONES
- joints, oh no carditis, nodules, erythema marginatum, Sydenham chorea
tx-
-abx, NSAIDs
