Infectious Disease Flashcards
1
Q
Who does mycobacterium avium complex occur in?
A
HIV patients with CD4 <50
2
Q
What are the signs and symptoms of mycobacterium avium complex?
A
fever, diarrhea, weight loss, anemia
-symptoms rarely occur in immunocompetent patients (increased in bronchiectasis) HIV patients when CD4<50
3
Q
Where is mycobacterium avium complex present?
A
soil and water
4
Q
How do you diagnose mycobacterium avium complex?
A
AFB and culture
5
Q
What is the treatment of mycobacteria avium complex?
A
clarithromycin + ethambutol at least 12 months (+/- rifampin)
6
Q
What is the prophylaxis for HIV patients if CD4 <50?
A
azithromycin or clarithromycin
7
Q
What is mycobacterium kansasii?
A
causes tuberculosis-like disease
8
Q
What is the treatment of mycobacterium kansasii
A
rifampin + ethambutol
9
Q
What is mycobacterium marinum?
A
REMEMBER MARINUM = AQUARIUM
- atypical mycobacterium found in fresh and saltwater - infection occurs after inoculation of the skin via abrasion or puncture in a patient with contact of an aquarium, saltwater, or marine animals
- occupation hazard of aquarium handlers, marine workers, fisherman, and seafood handlers
10
Q
How is mycobacterium marinum dx?
A
culture
11
Q
How do you treat mycobacterium marinum?
A
tetracyclines, fluoroquinolone, macrolides, sulfonamides for 4-6 weeks
12
Q
What is Epstein-Barr disease?
A
a viral illness
13
Q
What is the classic triad of Epstein-Barr disease?
A
fever, lymphadenopathy, pharyngitis
14
Q
How id Epstien-Barr disease diagnosed?
A
positive heterophile antibody screen (mono spot) - may not appear early in the illness (positive within 4 weeks)
15
Q
What are the other signs and symptoms of Epstein-Barr disease?
A
- atypical lymphocytes with enlarge nuclei and prominent nucleoli
- a maculopapular rash develops in 80% of patients treated with ampicillin
- left upper quadrant pain secondary to splenomegaly and are at risk for splenic rupture - athletes should avoid vigorous sports for at least the first three to four weeks of the illness
16
Q
What is the treatment of Epstein-Barr disease?
A
supportive
17
Q
What is erythema infectiosum(fifth disease) caused by?
A
Parvovirus B19
18
Q
What are the characteristics of erythema infectuisum (fifth disease)?
A
“slapped cheek” rash on face - lacy reticular rash on extremities, spares palms and soles
19
Q
How long does it take for erythema infectiosum (fifth disease) to resolve?
A
2-3 weeks
20
Q
What is the treatment of erythema infectiosum (fifth disease)?
A
supportive, anti-inflammatories
21
Q
What is Hand-foot-and-mouth disease caused by?
A
coxsackievirus type A virus
22
Q
What are the characteristics of hand-foot-and-mouth disease?
A
produces sores in mouth and a rash on the hands, feet, mouth, and buttocks
23
Q
How long does it take hand-foot-and-mouth disease to clear up?
A
usually clears up on its own within 10 days
24
Q
What is the treatment for hand-foot-and mouth disease?
A
supportive, anti-inflammatories
25
Where does HSV 1 effect?
oral lesions (tongue, lips, etc.)
26
Where does HSV 2 effect?
genital lestions (vulva, vagins, cervix, glans, prepuce, and penile shaft)
27
What is Herpes Human Viruses (HHV) 3?
VZV (varicella zoster virus commonly known as chickenpox or shingles)
28
What is HHV 4?
EBV (Epstein Barr Virus is commonly known as infectious mononucleosis [mono or glandular fever])
29
What is HHV 5?
CMV (cytomegalovirus is most common virus transmitted to a pregnant woman's unborn child)
30
What is HHV 6?
Roseolovirus is more commonly known as the 6th disease or Roseola infant
31
What is HHV 7?
similar to HHV6 (not yet classified)
32
What is HHV 8?
a type of rhadinovirus known as the Kaposi's sarcoma-associated herpesvirus (KSHV)
33
What diseases are caused by HSV 1?
```
ginviostomatitis
keratoconjunctivitis
cutaneous herpes
genital herpes
encephalitis
herpes labialsis
esophagitis
pneumonia
hepatitis
```
34
What diseases are caused by HSV 2?
```
genital herpes
cutaneous herpes
Gingivostomatitis
neonatal herpes
aseptic meningitis
disseminated infection
hepatitis
```
35
What diseases are caused by HHV 3?
Varicella-zoster virus
| -chickenpox, herpes zoster, disseminated herpes zoster
36
What diseases are caused by HHV 4?
Epstein-Barr virus
-infectious mononucleosis, hepatitis, encephalitis, nasopharyngeal carcinoma, Hodgkin lymphoma, Burkitt lymphoma, lymphoprliferative syndromes, oral hairy leukoplakia
37
What diseases are caused by HHV 5?
```
infectious mononucleosis
hepatitis
congenital cytomegalic inclusion disease
hepatitis
retinitis
pneumonia
colitis
```
38
What diseases are caused by HHV 6?
roseola infrantum
otitis media with fever
encephalitis
39
What diseases are caused y HHV 7?
roseola infrantum
40
What disease is caused by HHV 8?
Kaposi sarcoma-associated herpesvirus
- non a known caused of acute illness but has a causative role in Kaposi sarcoma and AIDS-related non-Hodgkin lymphomas that grow primarily in the pleural, pericardial, or abdominal cavities as lymphomatous effusions
- also linked with multi centric Castleman disease
41
What is influenza?
a viral respiratory infection caused by orthomyxovirus resulting in fever, coryza, cough, headache, and malaise
42
What are the three strains of the flu?
A, B, and C
43
What should receive an influenza vaccine?
everyone >6 months
44
Who should the influenza vaccine be avoided in?
severe egg allergy, previous reaction, Guillain-Barre syndrome within 6 weeks of previous vaccination, GBS in the past 6 weeks, <6 month old
-avoid flutist in pt with asthma
45
What is the dx of influenza?
based primarily on patient history
- a rapid antigen test can be performed in the clinic - the virus can be isolated from the throat or nasal mucosa
- rapid serology test are often available and are most accurate during the first few days of the illness
- gold standard = RT-PCR or viral culture take 3-7 days to return
- CXR in primary influenza pneumonia will show bilateral diffuse infiltrates
46
What is the treatment for influenza?
symptomatic (for most) or with antivirals - ideally <48 hours - tamiflu (oseltamivir), inhaled Relenza (Zanamivir), IV Rapivab (peramivir), and oral baloxavir (xofluza)
-zanamivir and oseltamivirs both treat influenza A and B - (think Dr. "oz" treats the flu)
47
What are the indications for antiviral treatment with patients with influenza?
hospitalized, outpatient with severe/progressive illness, an outpatient at high risk for complications (immunocomporimsed, pt with chronic medical conditions, >65 years, pregnant women/2 weeks postpartum)
48
What is measles caused by?
paramyxovirus
49
How is measles transmitted?
respiratory droplets
| 10-12 day incubation period
50
What are the three phases of measles?
prodrome
enanthem
exanthema
51
What is the prodrome phase of measles?
1-3 days of a "the three C's" cough, coryza, conjunctivitis as well as fever
52
What is the enanthem phase of measles?
48 hours prior to exanthema - Koplik spots - irregularly- shaped, bright red spots often with a bluish-white central dot in the mouth
53
What is the exanthema phase of measles?
2-4 days after onset of fever: consists of a morbillifrom brick red erythematous, maculopapular, blanching rash, which classically begins on the face and spreads cephalocaudally and centrifugally to inolve the neck, upper trunk, lower trunk, and extremities
54
What is the dx of measles?
clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis)
- observation of Koplik's sports is also diagnostic of measles
- laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens
55
What is the tx of measles?
supportive with anti-inflammatories
| -patients must be isolated for 1 week after onset of rash
56
What are the known complications of rubeola?
otitis media, pneumonia, diarrhea, and encephalitis
57
When is the measles vaccination given?
administer a 2-dose series of MMR vaccine at ages 12-15 months and 4-6 years
- second dose may be administered before age 4f
- provided at least 4 weeks have elapsed since the first dose
58
What is mumps?
a viral disease that is part of the paramyxovirus family
59
How does mumps present?
parotitis (painful parotid gland swelling), orchitis, or aseptic meningitis
60
How is mumps transmitted?
respiratory droplets and has an incubation period of 12-14 days
61
What are the symptoms of mumps?
- prodrome of fever, malaise, and anorexia
- parotid enlargement (usually bilateral but not always synchronous) 24 hour later
- swelling of submaxillary and submandibular glands
- orchitis (usually unilateral) with testicular enlargement two to three times normal size
62
What is the most common cause of pancreatitis in children?
mumps
63
What is the dx of mumps?
- during an outbreak, a diagnosis can be made by determining recent exposure and parotitis
- usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed
- if there is uncertainty about the diagnosis, a test of saliva or blood may be carried out; a newer diagnostic confirmation, using real-time nests (PCR) technology, has also been developed
- as with any inflammation of the salivary glands, the serum level of enzyme amylase is often elevated
- CSF demonstrates increased lymphocytes and decreased glucose
64
What is the tx of mumps?
- there is no available cure for mumps and treatment is supportive
- symptoms usually last for 7-10 days and patients are contagious for up to 9 days after onset
- may need to provide scrotal support if painful or swollen testicle
65
When is the MMR vaccine given?
12-15 months then again at 4-6 years of age
66
What is pertussis?
whooping cough is a highly contagious respiratory tract infection
67
What are the signs and symptoms of pertussis?
severe hacking cough followed by a high-pitched intake of breath that sounds like a whoop
68
What causes pertussis?
gram-negative bacteria Bordetella pertussis
69
How do you consider pertussis in?
consider in adults with cough > 2 weeks, patients <2 years old
70
What are the stages of pertussis?
catarrhal, paroxysmal, convalescent
71
What is the catarrhal stage?
cold-like symptoms, poor feeding, and sleeping
72
What is the paroxysmal stage?
high-pitched "inspiratory whoop"
73
What is the convalescent stage?
residual cough (100 days)
74
How is pertussis diagnosed?
a nasopharyngeal swab of nasopharyngeal secretions -culture
75
What is the treatment of pertussis?
macrolide (clarithromycin/azithromycin), supportive care with steroids/beta2 agonists
- vaccination: 5 doses - 2,4,5,15-18 month, 4-6 yrs (DTap)
- 11-18 years = 1 Tdap
- expectant mothers should get Tdap during each pregnancy, usually at 27-36 weeks
76
What is pinworm infection?
also known as enterobiasis vermicularis
| -a human parasitic disease caused by the pinworm (a type of roundworm)
77
What is the most common symptom of pinworm?
itching in the anal area
| -can make sleeping difficult
78
What are the other signs and symptoms of pinworm?
- perianal itching especially at night (eggs are laid at night)
- eggs cling to the fingers while itching and are transmitted to other people either directly or through food or surfaces
- eggs can thrive for 2-3 weeks on inanimate object
79
What is the diagnosis of pinworms?
"scotch tape test" done in the early morning
| -can see the eggs under microscopy
80
What is the treatment of pinworms?
albendazole or mebendazole
81
What is roseola also known as?
```
exanthema subitum
roseola infantum
rose rash of infants
sixth disease
baby measles
```
82
What is roseola caused by?
HHV 6 and 7
83
Who does roseola usually affect?
child between six months and two years of age
84
How does roseola usually begin?
sudden high fever (102-104)
-can cause, in rare cases, febrile convulsions due to sudden rise in body temperatures, but in many cases the child appears normal
85
What happens after a few days with roseola?
- the fever subsides and just as the child appears to be recovering, a red rash appears
- a blanching macular or maculopapular rash starting on the neck and trunk and spreading to the face and extremities
- occasionally the rash is vesicular, generally non-rustic
- rash typically persists for one to two days
- only childhood viral exanthema that starts on the trunk - spreading to the legs and neck
86
What is the dx of roseola?
clinical
87
What is the tx of roseola?
supportive
| -bed rest, fluids, and medications to reduce fever
88
What are the characteristics of rubella?
- "3-day rash" pink light-red spotted maculopapular rash first appears on face, spreads caudally to the trunk and extremities and becomes generalized within 24 hours (lasts 3 days)
- cephalocaudal spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular
- although the distribution of the rubella rash is similar to that of rubeola, the spread is much more rapid, and the rash doe snot darken or coalesce
- teratogenic in 1'st trimester - congenital syndrome - deafness, cataracts, TTP, mental retardation
89
What is the dx of rubella?
laboratory diagnosis of rubella is warranted when congenital rubella syndrome is suspected or when the diagnosis is sough for a condition compatible with known complications of postnatal rubella, such as arthritis
- serologic assays, primarily enzyme immunoassays (EIA)< are used more frequently
- rubella virus - specific IgM antibodies are present in people recently infected with rubella virus but these antibodies can persist for over a year and a positive test result needs to be interpreted with caution
- the presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis
90
What is the tx of rubella?
consists of supportive care
- no specific therapy for rubella infection is available
- MMR vaccine (12-15 months, 4-6 year)
91
What is varicella?
chickenpox
- primary infections - clusters of vesicles on an erythematous base
- dewdrops on rose petal in different stages
- it starts on the face and spreads down
- acutely causes chickenpox - becomes latent in the dorsal root ganglion
- symptomatic treatment may use acyclovir in special populations
92
What is Herpes Zoster?
shingles
| -varicella reactivation of multinucleate giant cells
93
What is Zoster Ophthalmicus?
shingles involving CCN V, dendritic lesions on slit lamp exam if keratoconjunctivitis is present
94
What is Zoster Oticus (Ramsay-Hunt Syndrome)?
facial nerve (CN VII) otalgia, lesions on the ear, auditory canal and TM, facial palsy auditory symptoms
95
What is the treatment for shingles?
acyclovir, valacyclovir, and famciclovir - given within 72 hours to prevent post-herpetic neuralgia
96
What is postherpetic neuralgia?
pain > 3 months, paresthesias or decreased sensation
97
What is the treatment for postherpetic neuralgia?
gabapentin or TCA, topical lidocaine gel, and capsaicin
98
What are the characteristics and who should the herpes zoster vaccine be given to?
a live, attenuated virus vaccine - vaccination is recommend for immunocompetent adults >60 years of age
