Infectious Disease (Alice) (12%) Flashcards
firm inflamed swelling in the right submandibular area unresponsive to IV abx
atypical myobacterial dz
FNA findings of myobacterial dz
acid-fast bacilli on ziehl-neelsen staining
atypical myobacterial infections in children are most frequently located where
superior anterior cervical or submandibular nodes
95% of myobacterial infxns in kids present with
unilateral, subacute, painless, firm, progressive LAD
mc do NOT involve constitutional sx
mc age for pediatric myobacterium infxns
1-5 yo
3 pediatric myobacterial infxns to know
MAC
kanasaii
marinum
sx of MAC (4)
fever
diarrhea
wt loss
anemia
mode of transmission for MAC
soil
water
not person to person
MAC is mc symptomatic in what pt pop
HIV w. CD4 < 50
dx for MAC
AFB
culture
tx for MAC
clarithromycin
PLUS
ethambutol
x at least 12 mos
+/- rifampin
prophylactic tx for MAC for HIV pt
azithromycin OR clindamycin if CD4 < 50
which myobacterium infxn presents w. TB like sx
kanasii
tx for myobacterium kanasasii
rifampin
PLUS
ethambutol
where is myobacterium marinum found
fresh and saltwater
think aquarium/marine animals
tx for myobacterium marinum (4)
tetracyclines
fluoroquinolones
macrolides
sulfonamides
x 4-6 weeks
sore throat
fever
malaise
diffuse tonsillar exudate
EBV
splenomegaly
painful LAD
hepatomegaly
EBV
classic EBV triad
fever
LAD
pharyngitis
what lab trend does EBV make you think of
lymphocytic leukocytosis
what is this showing
atypical lymphotyctes w. enlarged nuclei and prominent nucleoli -> EBV
what is this rash associated w.
maculopapular rash w. ampicillin -> EBV
HSV viruses and associated symptoms/conditions
HSV1: oral lesions
HSV2: genital lesions
HHV3: varicella zoster - chicken pox/shingles
HHV4: EBV
HHV5: CMV
HHV6: roseolovirus (6th disease)
HHV7: similar to HHV6 - not classified
HHV8: rhadinovirus - kaposi’s sarcoma (KSHV)
what is this showing
HHV 3 - varicella zoster
what is this showing
HHV 3 - chickenpox
what is this showing
HHV4 - EBV
what is this showing
HHV5 - CMV
what is this showing
HHV 6/7 - roseola (6th dz)
what is this showing
HHV8 - kaposi sarcoma
what virus causes the influenza
orthomyxovirus
4 contraindications to influenza vaccine
- < 6 mo old
- severe egg allergy
- previous rxn
- guillain barre w.in 6 weeks of previous vaccination OR w.in past 6 weeks
contraindication for flumist flu vaccine
asthma
gs dx for influenza (2)
RT-PCR
OR
viral culture
CXR findings in primary influenza
bilateral diffuse infiltrates
are false positives or false negatives more common w. rapid influenza diagnostic tests (RIDT)
false negatives
which antivirals treat influenza A and B
oseltamivir
zanamivir
best w.in 48 hr of sx onset
5 indications for antiviral tx w. influenza
hospitalized
outpt w. severe/progressive sx
> 65 yo
pregnant/2 weeks postpartum
lots of comorbidities
what virus causes measles
paramyxovirus
3 phases of measles
prodrome: 3 c’s
enathem: koplik spots
exanthem: morbilliform, maculopapular, blanching rash
what are the 3 c’s of measles
cough
coryza
conjunctivitis
PLUS
fever
what is this showing
irregularly-shaped bright red spots in the mouth w. bluish white central dot -> koplik spots
how does the measles rash spread
cephalocaudally
clinical dx of measles requires (2)
fever x >/= 3 days
PLUS
at least one of the 3 c’s
or
koplik spots
gs dx for measles
IgM abs
viral PCR
management of measles (2)
isolation x 1 week after rash onset
symptomatic
4 complications of measles
otitis media
PNA
diarrhea
encephalitis
5 yo w. acute onset of painful swollen parotid glands - temp 100.8
mumps
what does this make you think
mumps
what virus causes mumps
paramyxovirus
how is mumps transmitted
respiratory droplets
3 different presentations of mumps
parotitis
orchitis
aseptic meningitis
incubation period of mumps
12-14 days
hallmark symptom of mumps
bilateral parotitis
mcc of pancreatitis in children
mumps
dx of mumps is usually made by
hx of exposure
PLUS
parotitis
2 diagnostic tests for mumps
saliva/blood test
real-time nested PCR
lab finding suggestive of mumps
elevated amylase (from parotitis)
2 CSF findings of mumps
lymphocytosis
decreased glucose
18 mo old w. increasing intermittent cough x 3 weeks that lasts 10 min at a time and causes gasping inhalations
whooping cough (pertussis)
what bacteria causes pertussis
bordetella pertussis
think pertussis if you see (2)
cough > 2 weeks
< 2 yo
3 stages of pertussis
catarrhal: cold-like
paroxysmal: inspiratory whooping cough
convalescent: residual cough
the convalescent stage of pertussis can last up to
100 days
dx for pertussis
nasopharyngeal swab culture
tx for pertussis
macrolide
supportive
SABAs/LABAs
enterobiasis vermicularis is aka
pinworm (variation of roundworm)
mc symptom of pinworm
perianal itching esp at night (when eggs are laid)
gross. stop it.
transmission of pinworm (3)
direct contact
food
surfaces
t/f: pinworm eggs can live for 2-3 weeks on an inanimate object
t!
dx for pinworm
scotch tape test -> eggs under microscopy
tx for pinworm
albendazole
mebendazole
teardrop vesicles on an erythematous base/dewdrops on a rose petal
varicella - chickenpox
what is this showing
dewdrops on a rose petal -> chicken pox
what is this showing
dewdrops on a rose petal -> chicken pox
describe the spread of chicken pox
cephalocaudal
acute chickenpox becomes dormant in the
dorsal root ganglion
what is this showing
maculopapular rash along one dermatome -> shingles
dx for shingles
tzanck smear -> multinucleated giant cells
what is this showing
multinucleated giant cells -> zoster
dendritic lesions on slit lamp
zoster ophthalmicus -> CN V shingles
ramsay hunt syndrome is aka _
and involves CN _
zoster oticus
CN VII
3 sx of ramsay hunt syndrome
otalgia
lesions on ear/auditory canal/TM
facial palsy
management of shingles
acyclovir
PLUS
valacyclovir
PLUS
famciclovir
w.in 72 hr to prevent post perpetic neuralgia
definition of postherpetic neuralgia
pain > 3 mo
paresthesias
decreased sensation
tx for postherpetic neuralgia (4)
gabapentin
TCA
topical lido
capsaicin
zoster vaccine is recommended for
adults > 60 yo