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Infectious Disease Flashcards

1
Q

ABECB

A

acute bacterial exacerbations of chronic bronchitis

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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
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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
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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
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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

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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
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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

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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
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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)
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10
Q

FUNGAL INFX

A 
CANDIDIASIS
CRYPTOCOCCOSIS
HISTOPLASMOSIS
PNEUMOCYSTIS
ASPERGILLOSIS
MUCORMYCOSIS
BLASTOMYCOSIS
COCCIDIOIDOMYCOSIS
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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)
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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)
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13
Q

SPIROCHETAL DZ

A

SYPHILIS (TREPONEMA PALLIDUM)
LYMES (BORRELIA BURGDORFERI)
ROCKY MT SPOTTED FEVER (RICKETTSIA RICKETSII)

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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
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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

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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)

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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
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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
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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

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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

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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
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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)
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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
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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
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25
Q

plague

A
  • 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

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26
Q

necrotizing fasciitis

A
  • 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)

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27
Q

diphtheria

A
  • 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

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28
Q

ersipeloid

A
  • 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

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29
Q

tetanus

A
  • 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)

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30
Q

gas gangrene (myonecrosis)

A
  • 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
Q

botulism

A
  • 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
Q

listeriosis

A
  • 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
Q

anthrax

A
  • 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
Q

syphilis**

A
  • 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
Q

lyme disease**

A
  • 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
Q

rocky mountain spotted fever**

A
  • 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
Q

amebiasis

A

-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
Q

acanthamoeba keratitis

A

-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
Q

malaria

A
  • 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
Q

babesiosis

A
  • 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
Q

toxoplasmosis

A
  • 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
Q

enterobiasis (pinworm)

A
  • 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
Q

chagas disease (american trypanosomiasis)

A
  • 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
Q

african trypanosomiasis (african sleeping sickness)

A
  • 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
Q

trichinosis (trichinellosis)

A
  • 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
Q

ascariasis

A
  • 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
Q

leishmaniasis

A
  • 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
Q

ehrlichiosis

A

-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
Q

mycobacterium avium complex (MAC)

A
  • 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
Q

mycobacterium marinum “fish tank granuloma”

A

-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
Q

leprosy (hansen’s disease)

A
  • 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
Q

human herpesvirus family

A 
HSV1 - oropharyngeal
HSV2 - genital
Varicella Zoster
EBV
CMV
Roseola
Pityriasis Rosea
Kaposi Sarcoma
53
Q

HSV 1 + 2**

A
  • 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
Q

cytomegalovirus (HHV 5)

A

-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
Q

varicella zoster (HHV-3)

A
  • 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
Q

epstein-barr virus (HHV-4)**

A
  • 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
Q

rabies

A
  • 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
Q

smallpox (variola)

A
  • 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
Q

west nile fever

A
  • 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
Q

severe acute respiratory syndrome (SARS)

A

-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
Q

hantavirus (hemorrhagic fever)

A
  • 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
Q

dengue fever

A

-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
Q

creutzfeldt-jakob disease

A

-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
Q

hookworm

A

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
Q

HIV

A
  • 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
Q

HIV OPPORTUNISTIC INFX**

A

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
Q

HIV - HAART Regimens for Tx of Naive Patients

A 
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
Q

cholera tx*

A

CIPRO (gram neg vibrio)

-macrolides, tetracyclines

69
Q

chancroid*

A
  • caused by HAEMOPHYLIS DUCREYI

- tx AZITHRO

70
Q

SIRS**

A

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
Q

sepsis

A

SIRS + suspected infx/source

72
Q

severe sepsis

A

sepsis + lactic acidosis (or SBP <90 or drop >40)

-organ dysfx, hypoTN, hypoperfusion

73
Q

septic shock

A

severe sepsis + hypoTN despite adequate fluid resuscitation

74
Q

rheumatic fever

A
  • 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

Concepts / Lists (16 decks)

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