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PANCE > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Botulism

Bacterial Diseases

A

Clostridium botulinum, Gram+ anaerobic bacilus,

canned food products

Sxs

  • muscle weakness, difficulty swallowing
  • respiratory paralysis “floppy babies”
  • diplopia, eyelid drooping,

Dx

  • Toxin assays or electromyography
  • Foodborne botulism - C. botulinum toxin in stool or serum
  • Would botulism - serum toxin or anaerobic wound

Tx

  • Equine heptavalent antitoxin
  • Wait until baby is 12 mos old before givine honey
  • Heat 120 degrees for 30 mins
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2
Q

Campylobacter jejuni

Bacterial Disease

A

MCC acute bacterial diarrhea

contaminated poultry

Sxs

  • fever, watery-bloody diarrhea, abd pain
    • post campylobactr Guillain-Barre syndrome & reactive arthritis possible

Dx

  • Skirow agar culture at 42 degrees (CAMPing in the heat)
  • Comma or S shaped w/ polar flagella a

Tx

  • azithromycin or FQ
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3
Q

Candidiasis

Fungal Disease

A

Common in opportunistic infx, C albicans

Dx - KOH smear

Esophageal candidiasis

  • linear erosions on endoscopy, tx with flucanozole

Vaginal Candidiasis

  • vulva itching, erythema, white curdy dc
  • tx w/ miconazole cream x7d or fluconazole (diflucan) 150mg PO x1

Oral thrush

  • friable white plaques that bleed if scraped
  • tx w/ nystatin

Intertrigo

  • moist macerated areas, pruritis rash - Beefy red erythema w/ distinct scalloped borders and satellite lesion
  • Tx w/ clotrimazole, ketoconazole, miconazole
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4
Q

Cholera

Bacterial Disease

A

Undercooked shellfish or contaminated water

Vibrio colerae, G-, oxidase positive, comma shaped bacteria

Sxs

  • rice water diarrhea

Dx

  • Stool culture
  • electrolytes, BUN, and Cr measured

Tx

  • _Fluid replacement ***_
  • Doxy, azithromycin, furazolidone, Bactrim, ciprofloxacin
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5
Q

Congenital Varicella Zoster

Prenatal transmission Disorders

A

If infx in first 28 wks => congenital varicella syndrome + risk of developing herpes zoster in first 4 years of life.

Dx - PCR of fetal blood or amniotic fluid for VZV DNA + US

Tx - VariZIG immune globulin for non-immune preg for exposure to VZV w/in 10d

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6
Q

Cryptococcosis

Fungal Disease

A

Cryptococcus neoformans, common in AIDs and IMC

From pigeon/bird droppings transmitted through inhalation

Sxs:

  • Meningoencephalitis - MCC fungal menigitis
    • AMS, HA, meningismus
  • Pna - cough w/ little sputum + pleuritic chest pain

Dx

  • CSF (incr protein, decr glucose) and serum
  • indian ink stain** showing cysts
  • CT ror MRI if + cryptococcoma

Tx

  • Amp B + Flucytosine for 2 wks then Fluconazole x 10 wks
  • prophy CD4 < 100 with Fluconazole
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7
Q

Cytomegalovirus

Viral Diseases

A

DS linear DNA in herpes family HHV5

  • Similar to infectious mononucleosis but no pharyngitis
  • pneumona and inflammation of retina in IMC and transplant pts CD4 <50
  • one of the ToRCH

Dx

  • Tissue biopsy with owl’s eyes inclusion

Tx

  • Ganciclovir, valganciclovir, foscarnet, cidofovir
  • Initial IV then maintenance
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8
Q

Diphtheria

Bacterial Diseases

A

URI w/ thick gray pseudomembrane in the throat that bleeds if scrapped

unvaccinated (2,4,6, and 15-18 mos; booster at 4-6 yo)

Sxs

  • neck swelling = enlarged cervical lympadenopathy (bull neck)
  • pharyngitis
  • low grade fever
  • systemic toxicity + hoarseness, palatal paralysis, stridor

Dx

  • PCR - rapid detection
  • Culture

Tx

  • Diphtheria antitoxin
  • Erythromycin or Penicillin x 2 wks
  • Post exposure Abx - contact monitor for 7d, nasopharyngeal and throat culture
  • Asymptomatic = tx w/ macrolide abx (erythromycine 500 mg PO q6h x 7 or Pencilling G benzathine x1)
  • Vaccine
  • Myocarditis common complication
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9
Q

EBV

Viral Diseases

A

Epstein barr mononucleosis, incubates 30-50d, transmission via oropharyngeal secretions and saliva

Sxs

  • fever + cervical posterior chain lymphadenopathy + pharyngitis
  • maculopapular rash develops in 80% of pts when tx with amox
  • RUQ pain 2/2 splenomegaly for splenic rupture

Dx

  • Monospot or heterophile antibodies test - EB IgM
  • Atypical lymphocytes

Tx

  • Supportive tx, abx not helpful
  • Splenic rupture
  • recover in 1-4 wks
  • Rash after given amoxicillin
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10
Q

Erythema Infectiosum

Viral Diseases

A

Parvovirus B-19

Sxs

  • Slapped cheek rash on face,
  • circumoral pallor 2-4d lacy reticular rash on extremities
  • no prodromal

Dx

  • Clinic - enlarged nuclei
  • Parvo B19 IgM ab and PCR

Tx

  • symptomatic
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11
Q

Genital Herpes Simplex Virus Infection

Congenital Disorders

A

HSV is ToRCH => neonatal herpes

Sxs

  • multiple vesciular lesion on skin, involvement of internal organs or CNS

Tx - antiviral drugs or C section

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12
Q

Hand Foot Mouth Disease

Viral Exanthems

A

Coxsackie type A virus

Children < 10 yo; very contagious in 1st week - spread via direct contact w/ saliva and mucus

Herpangina Is blister located to just the mouth

Sxs:

  • Small, tender, erythematous papules or vesicles on pharynx, mouth, hands, feet
  • Punched out, cratered
  • Irritability
  • Loss of appetite
  • General irritability
  • Feeling unwell

Dx - clinical

Tx

  • clears up in 10 days
  • pain meds for sxs relieve
  • Good hand hygiene
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13
Q

Helminth

Parasitic Infections

A

intestinal infections - worm like parasites

Nematode - GI symptoms and cough

  • pinworm - anal pruritus morning, scotch tape test
  • Ascaris lumbricoide - roundworm - vague abd symp
  • tx w/ mebendazole

Cestodes - tapeworm - cause GI symp and wt loss

  • tx w/ praziquantel

Trematodes - flukes - Schistoma - swimmers itch

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14
Q

Herpes Zoster

A

Varicella (chickenpox) - reactivation causing maculopapular rash along one dermatome

Dx - Tzanck Smear - multinucleated giant cells

Zoster Opthalmicus

  • shingles w/ CN V - dendritic lesions on slit lamp

Zoster Oticus (Ramsay-Hunt Syndrome)

  • facial n CN 7, otalgia
  • lesion on ears, auditory canal and TM
  • facial palsy auditory symptoms
  • ddx Bell’s palsy

Tx:

  • Acyclovir, valacyclovir, famciclovir - given w/in 72 hrs to prevent post-herpetic neuralgia
    • Disseminated IV acyclovir
  • Post herpetic Neuralgia pain > 3 mos- parethesias or decreased sensation
  • Vaccine - Shingrex (not live) > 50yo, 2x shot
  • Zostavax - live attenuated virual vaccine
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15
Q

Histoplasmosis

Fungal Disease

A

Histoplasma capsulatum;

  • HIV pts low grade fevers = CD4 < 150
  • _bat droppings, bat caves, Mississippi and Ohio River valley_s; inhalation of fungal spores

Sxs

  • low grade fevers
  • cough
  • hepatosplenomegaly
  • tongue ulceration

Dx

  • Fungal staining
  • ele Alkaline phosphatase and LDH

Tx

  • Ampho B
  • Itraconazole PO - mild to mod dz
  • no need for prophy
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16
Q

HIV

A

AIDS = CD4 < 200 ;suspectible to many opportunistic infx

Sxs

  • Acute HIV syndrome: mononucleosis like illness - rash and mucocutaneous ulceration**

Dx

  • EIA = 4th gen antigen/antibody combo HIV 1/2 immunoassy - measure HIV antibodies and antigen
  • confirmatory HIV Viral Load
    • detect ​sooner exposure
  • ELISA and confirmed by Western blot

Tx

  • HAART if CD4 <350 or viral load PCR RNA > 55,0000
  • 2NRTIs + NNRTI or PI
    • NRTI - Emtricitabine, and Tenofovir
    • NNRTI - Efavirenz - can cause CNS disengagement*
    • PI - Darunavir
  • NRTIs + INSTI
    • INSTI - Raltegravir, Dolutegravir
      • can cause lipodystrophy + metabolic SEs (lactic acidosis and N/V/D)
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17
Q

HPV

Viral Diseases

A

DS DNA,

Cervical intraepithelial neoplasia - 16, 18, 21, 33 are cancerous

Condyloma acuminatum - genital warts, 6 & 11 w/ kiocytes

Condyloma lata - 2/2 syphillis

Cutaneous warts - 1, 2, 4

Dx

  • Shave or punch biopsy
  • Koilocytic squamous epithelia cells in clumps
  • HPV DNA on cervical swabs

Tx

  • Skin warts - self limited or podofilox or cryotherapy
  • Gardasil quadrivalent vaccine against 6, 11, 16, 18
    • M and F 11 to 12 and approved through 9 to 26
18
Q

Influenza

A

Viral respiratory infx by orthomyxovirus (three strains A, B, C)

sxs

  • fever, coryza, cough, headache, malaise

Dx

  • rapid antigen test in clinic
  • rapid serology more accurate
  • CXR - bilateral diffuse infiltrates

Tx

  • symptomatic for most
  • antivirals w/in < 48-72 hrs
    • Tamiflu/Oseltamivir or Zanamivir/Relenza for influ A & B
    • hospitalized pts
    • outpt with severe progressive illness
    • high complications risk
      • IMC
      • chronic med conditions
      • >65yo
      • pregnant or 2 wks pp
19
Q

Lyme Disease

A

Borrelia burgdorferi from Ixodes/deer tick

Sxs

  • Early localized - 7 to 10d after bite, erythema migrans rash “bullseye”
  • Early Disseminated - 1-12 wks after bite
    • flu-like syndrome (malaise, fatigue, chills, fever, HA, stiff neck, myalgias, arthralgias)
  • Late Disease - persistent synovitis and arthritis, AV block

Dx - ELISA + by 3rd week

Tx - Doxycycline 200 mg x 1d w/in 72 hrs

20
Q

Malaria

Parasitic Infections

A

Plasmodium vivax, p. malaria, p. ovale, p. falciparum (most virulent), knowlesi (new)

transmitted by anopheles mosquito

Sxs

  • Periodic chills, fever, and sweats (fever every 3 days)
  • Splenomegaly > 4d of sxs
  • travel hx

Dx

  • Giemsa stain peripheral smear
  • thick/thin blood microscopy

Tx

  • Chloroquine,
    • chloroquine resistance - atovaquone-proguanil> mefloquine (night terrors, nightmares)
  • Primaquine - P. Vivax but G6PD
21
Q

MRSA

Bacterial Diseases

A

Common in diabetics, hospitals, prisons, IVDU, nursing homes = people with open wounds, invasive devices (catheters) and weakened immune systems

Sxs:

  • Boil or pimple type lesion = spider type lesion
  • “pustule on erythematous base”
  • transmission via direct contact

Dx - culture

Tx

  • Irrigation and debridement
  • Mupirocin 2% = small lesions
  • PO Abx for bigger lesion = Bactrim, Doxy, clinda
  • IV Abx for severe = Vanco, linezolid,
22
Q

Mumps

Viral Diseases

A

Paramyxovirus family; transmitted w/ respiratory droplets

incubats 12-14 d;

Sxs

  • parotitis
  • orchitis
  • aseptic meningitis
  • MCC of pancreatitis in children

Dx:

  • Clinical, PCR if needed
  • amylase ele if +inflammation of salivary gland

Tx:

  • supportive; lasts 7-10 days
  • Contagious up to 9d after onset
  • isolate pt 5 days
  • MMR vaccine 12 -15 mos, then 4-6yo
23
Q

Mycobacterial

Fungal Disease

A

Mycobacterium avium complex (MAC) - CD4 <50

  • fever, diarrhea, wt loss, anemia
  • present in soil and water
  • dx w/ AFB and culture
  • Tx w/ clarithromycin + ethambutol for at least 12 mos
  • Prophy w/ azithro or clarithro if CD4<50

Tuberculosis - Mycobacterium tuberculosis

  • cough, nt swts, wt loss, IMC
  • XRay cavitary lesion, infiltrates ghon complexes
  • Acid fast bacilli, caseating granulomas
  • Mantoux Skin test - check TB slide in pulm
  • tx
24
Q

Pinworms

Parasitic Infections

A

Enterobiasis vermicularis

Sxs

  • perianal itching at night
  • eggs transmitted via food or surfaces

Dx

  • scotch tape test - eggs under microscopy

Tx

  • Mebendazole or albendazole
25
Q

Pneumocystis

Fungal Disease

A

P. jiroveci - transmitted by aerosol route, no disease in IMC pts

CD4< 200

Sxs

  • Subactue fever, SOB, non productive cough - exam often not consistent w/ degree of hypoxia

Dx

  • CXR - diffuse, bilateral perihilar infiltrates
  • gold std - silver stain vs PCR
  • ele LDH

Tx

  • Bactrim
    • if allergic tx with pentamidine
    • add prednisone if PaO2 < 72mmHg
  • proph bactrim CD4<200
26
Q

Rabies

Viral Diseases

A

CNS infection with RNA Rhabdovirus

transmission via dogs, raccoons, skunks, bats, fox, coyote

Incubate 1-3 mos

Sxs

  • Hydrophobia**
  • pharyngeal spasms, aerophobia (fear of drafts of fresh air)
  • Hyperactivity

Dx

  • Negri bodies - eosinophilic inclusion bodies, found in brain of dead bodies
  • animals observed for 7-10d

Tx

  • Once sxs occur, patients rarely survive
  • Post exposure prophy
    • HDCV (Rabies vaccine) given day 0, 3, 7, 14 PLUS
    • rabies Immune globulin 1/2 injected into wound, 1/2 IM
  • If previous exposure or vaccine - rabies vaccine day 0 and 3 w/o immune globulins
27
Q

Rheumatic Fever

Bacterial Diseases

A

Inflammatory reaction to GABHS pharyngitis w/ formation of antistreptolysin antibodies (ASO) => reacts with synovium, myocardium, and heart valves

Sxs

  • initial sxs 2-4 wks after strep infection

Dx

  • GAS culture or ASO, ESR, CRP
  • EKG
  • Jones Criteria (2 major criteria, 1 major + 2 minor)
    • Major
      • J - joint involvementpolyarthritis
      • O - myOcarditis
      • N - subcut nodules
      • Erythema marginatum
      • Sydenham Chorea - rapid involuntary movement on face, hands and feet
    • Minor
      • CRP incr
      • Arthralgia
      • Fever
      • ESR incr
      • Prolonged PR invtl on EKG

Tx

  • pen G benzathine 1.2mil units IM q 3-4 wks
    • if < 27kg, 600k unites IM q 3-4wks
28
Q

Rocky Mountain Spotted Fever

Bacterial Diseases

A

Rickettsia rickettsii, spread by American dog tick

Sxs

  • 2-14 days after tick bite => develop flu like symptoms
    • fever, chills, myalgias, headache
    • red maculopapular rash on starts wrists and ankles (palms and soles) spread centrally over 2-3 days. face is spared

Dx - Indirect fluorescent antibody (IFA)

Tx -

  1. doxycycline or
  2. chloramphenicol 2nd line for preg
29
Q

Roseola (6th Disease)

Viral Diseases

A

Caused by HHV 6 and 7; Between 6mos-2yo

Sxs:

  • Sudden high fever (102-104)
  • Red rash appears as fever subsides
  • blanching maculopapular rash - neck/trunk => face => extremities
  • rash lasts for 1-2 days

Dx - clinical

Tx - bed rest, fluids, antipyretics

30
Q

Rubella (German’s Measles)

A

Rubella virus - spreads through sneezing/coughing

Contagious 1-2 wks before sxs

Teratogenic in 1st Trimester

Sxs:

  • Erythematous, discrete maculopapular exanthem
  • First on face, spreads to trunk and extremities; generalized w/in 24 hrs
  • lasts for 3 days
  • Fever
  • Lymphadenopathy

Dx -

  • EIA
  • Serological assays
  • Rubella specific IgM abs remain + for > 1 year.
  • MMR vaccine - 12-15mos, then 4-6yo
31
Q

Measles (Rubeola)

Viral Diseases

A

Paramyxovirus via respiratory droplets

Sxs:

  • 10-12 days incubation
  • Prodrome
    • 1-3 d; 3 C’s
      • Cough, Coryza, Conjunctivitis
  • Enanthem
    • 48 hrs before Exanthem
    • Koplik’s spots - red/white/blue spots In mouth
  • Exanthem
    • 4 days after fever onset
    • Morbilliform - maculopapular, blanching rash
    • Cephalocaudal - head to extremities spread

Dx: Clinical, Measles IgM abs

Tx:

  • supportive, anti-inflammatories, isolate 1 wk after rash onset
  • MMR vaccine - 12-15mos, then 4-6yo
32
Q

Salmonellosis

Bacterial Disease

A

Typhoid & Enteric fever vs Gastroenteritis; transmitted via fecally contaminated food

Sxs

Enteric/ Typhoid fever - salmonella typhi = flu like bacterial infection

  • Constitution sxs, HA, rose spots on abd, constipation or diarrhea, returning traveler
  • Tx FQ or ceftriaxone 1g IM or IV q 12h for 14 d

Gastroenteritis

  • egg yolk or improperly handled food
  • GI symptoms “pea soup diarrhea”, HA
  • tx w/ FQ

Dx

  • Leukocytosis, low plts
  • Stool culture
33
Q

Sepsis

A

Systemic Inflammatory Response Syndrome (SIRS) in repsonse to toxins

RF - increased aged, immunosuppressed, prolonged hospitalization

Sxs

  • fever, hypotension, incr WBC, change in LOC, Tachycard/pnea

Severe Sepsis

  • poor organ function or insufficient blood flow, evident with low blood pressure, high blood lactate, or low UO

Septic Shock

  • low BP d/t sepsis that does not improve with IV fluids

Quick SOFA - predict mortality

  • new or worsened mentation
  • RR >/=22
  • Systolic BP = 100 mmHg

Tx

  • IV fluids/pressors
  • empiric abx, send blood cultures
  • remove all existing lines
34
Q

Shigellosis

Bacterial Disease

A

Gram neg bacteria; crowded conditions - daycare, transmission via direct person-person or contaminated foods and water

Sxs

  • Diarrhea, lower abd cramps, tenesmus
  • fever, chills, anorexia, headache, malaise
  • Stools loose and mixed with blood, mucus
  • Dehydration common

Dx

  • HLA-B27

Tx

  • Fluid resus
  • Abx - Bactrim > Cipro > FQ
    Loperamide, or diphenoxylate
35
Q

Syphilis

A

Treponema pallidum - 3 phases, 3 weeks incubation

Primary syphilis

  • painless chancre in genital or groin region = 3-6 weeks

Secondary syphilis

  • erythematous rash on palms and soles
  • condyloma lata

Tertiary syphilis (latent)

  • major vessel change (aorta), neurosyphilis or gummas

Neurosyphilis - years later

  • Tabes dorsalis - slow degen of nerve fibers
    • small nonreactive pupils, sensory ataxia, lancinating pain

Dx - RPR/VDRL confirmed with treponemal antibody-absorption test (FTA-ABS)

Tx

  • IM Penicillin G
36
Q

Tetanus

Bacterial Disease

A

Clostridium tetani - anaerobic toxin; neurotoxin that interferes with neurotransmission; uncontrolled spasms and exaggerated relfexes; usu from puncture wounds; incubation - 5d to 15 wks

Sxs

  • pain and tingling at inoculation site - spasticity of muscles nearby
  • Jaw and neck stiffness, dysphagia, irritability
  • Hyperreflexia & muscle spasms (trimus) develop
  • Painful tonic convulsions, glottis spasms, respiratory muslces, asphyxia

Dx

  • Culture but can have false negative

Tx

  • post exposure prophy - Vaccination Td, Tdap
  • Hyperimmune human globulin (TIG) neutralizes toxin
  • Metronidazole or penicillin = high mortality
  • spasmolytic drug - diazepam
37
Q

Toxoplasmosis

A

Toxoplasma gondii - parasitic protozoan

pregnant female exposure to cat feces

Sxs:

  • encephalitis + chorioretinitis + intracranial calc in AIDS pts CD4 <100

Dx

  • ring enhancing lesion
  • toxo IgG and IgM
  • part of ToRCH syndrome

Tx

  • Prophy CD4 < 100 with bactrim
38
Q

Trichomoniasis

Parasitic Infections

A

Sexually active women

foul smelling, greenish dc

Vaginal pH > 4.5

strawberry cervix

motile flagellated protozoa

Tx metronidazole 2g PO x 1

39
Q

Zika Virus

Congenital Disorders

A

SS RNA transmitted through Aedes mosquito; screen pregnant women 1st and 2nd trimester

Sxs

  • Macular pruritic rash
  • arthralgia, conjunctivitis, low grade fever, and miscarriage
  • Fetus w/ microcephaly, Intracranial calcifications, cerebral malformation

Dx

  • Serum or urine Zika virus IgM w/ real time PCR for confirmatory

Tx

  • self limited, conservative and supportive care
  • avoid aspirin and NSAID
40
Q

Coccidioides

Fungal

A

Western US

Non-remitting cough, not responding to usu treatment

Dx - EIA for IgM and IgG

Tx - fluconazole and itraconazole

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