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Clinical Medicine II > Infectious Disease: Bacterial Infections II > Flashcards

Infectious Disease: Bacterial Infections II Flashcards

1
Q

Most common STI in the US ?

A

Chlamydia Trachomatis

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2
Q

How does Chlamydia pneumoniae spread?

A

Respiratory Tract

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3
Q

How does Chlamydia Psittaci spread?

A

Bird transmission

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4
Q

What are the two transmissions routes of Chlamydia Trachomatis

A

1) Sexual contact

2) During birth

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5
Q

Chlamydia Trachomatis is
highly transmissible?

T of F

A

True

  • Incubation period
    7–21 days
  • Significant asymptomatic reservoir
  • Reinfection is common
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6
Q

Common S&S for women with Chlamydia Trachomatis?

A
  • Urethritis
  • Asymptomatic
  • Dysuria, frequency
  • “sterile” pyuria
  • Cervicitis
  • Mucopurulent endocervical discharge
  • Edematous cervix with erythema and friability
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7
Q

Common S&S for Men with Chlamydia Trachomatis?

A
  • Urethritis
  • Asymptomatic (>50%)
  • Mucopurulent or clear discharge
  • Dysuria
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8
Q

Complications for women with Chlamydia Trachomatis?

A
  • Pelvic Inflammatory Disease (PID)
  • Perihepatitis (Fitz-Hugh-Curtis Syndrome)
  • Reactive arthritis
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9
Q

Complications for Men with Chlamydia Trachomatis?

A
  • Epididymitis

- Reactive arthritis

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10
Q

How do you Dx Chlamydia Trachomatis?

A

1) Clinical Dx

2) Nucleic acid amplification tests (NAATs)

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11
Q

T or F

Cultures are the gold standard for Chlamydia Trachomatis Dx?

A

False

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12
Q

What are the treatment medications for Chlamydia Trachomatis?

A

1) Azithromycin

2) Doxycyline

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13
Q

What is the treatment medication for Chlamydia Trachomatis in a pregnant woman?

A

Erythromycin

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14
Q

What is Inclusion Conjunctivitis and how is it caused?

A

Direct contact with the epithelial cells of the conjunctiva (Eye) with infected Chlamydia Trachomatis genital secretions

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15
Q

Inclusion Conjunctivitis pt’s present with what S&S?

A
  • Non purulent Unilateral conjunctivitis
  • Eye Lids sticking together
  • Cobblestoning
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16
Q

Inclusion Conjunctivitis pt’s are treated with ?

A

Azithromycin 1 gram Po

Treat partners too

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17
Q

Chlamydia pneumoniae occurs mostly in what age group?

A

Children

Asymptomatic or only mild symptoms

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18
Q

Can Adults and Elderly get Chlamydia pneumoniae?

A

Yes

Slow development over weeks

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19
Q

What are some S&S of Chlamydia pneumoniae in adults and elderly?

A
  • Nonproductive cough
  • Nasal congestion
  • Sore throat
  • Hoarseness
  • HA
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20
Q

What are PE findings of Chlamydia pneumoniae in adults and elderly?

A
  • Localized pulmonary crackles or rhonchi
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21
Q

Can Pt’s with Chlamydia pneumoniae be co infected with other pathogens?

A

Yes

1) S. pneumoniae
2) M. pneumoniae

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22
Q

Pharyngitis caused by Chlamydia (STI) is tested using ?

A

Nucleic Acid Amplified Testing (NAAT)

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23
Q

What is the #1 and #2 most common STI in the US?

A

1 Chlamydia

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24
Q

T of F Gonorrhea is gram negative?

A

True

Gram Negative Diplococci

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25
Q

Ages of M/W of high prevalence of Gonorrhea

A

15 - 29

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26
Q

T of F Women are usually asymptomatic with Gonorrhea?

A

True

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27
Q

True of False, Men are usually asymptomatic with gonorrhea

A

False

  • Urethritis
  • Purulent discharge with dysuria
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28
Q

What are some complications of Gonorrhea in women?

A
  • Bartholin gland infection
  • Pelvic inflammatory disease
  • Disseminated gonococcal infection
  • Conjunctivitis
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29
Q

Complications of Gonorrhea in men?

A
  • Epididymitis: Infrequent but most common local complication
  • Disseminated gonococcal infection
  • Conjunctivitis
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30
Q

Dx of Gonorrhea includes?

A
  • Gram stain of urethral discharge may show gram-negative intracellular diplococci
  • Culture
  • Nucleic acid amplification testing
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31
Q

Tx of Gonorrhea?

A
  • IM Ceftriaxone or oral Cefixine

PLUS

  • Doxycycline or Azithromycin

All partners should be treated

Reportable infection in most states

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32
Q

What are Disseminated Gonococcal Infections DGI?

A

Bacteremic spread of N. gonorrhea

M > W

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33
Q

What sex is more at risk of Gonorrhea?

A

Women

Usually no symptoms of genital gonorrhea

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34
Q

T of F there is a prodomal period with Gonorrhea?

A
  • False
  • No prodromal period
  • Feel well up to the time symptoms start
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35
Q

What are the two separate groups of clinical manifestations with Gonorrhea?

A

1) Arthritis Dermatitis Syndrome
(Tenosynovitis, Dermatitis, and Polyarthralgias)

70% of Pt’s Spontaneously resolve or evolves into overt septic arthritis

2) Purulent arthritis
(< 50% of pt’s present with actual arthritis

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36
Q

PE findings associated with Gonorrhea and Arthritis Dermatitis Syndrome?

A
  • Tenosynovitis (Multiple joints, Wrist, Fingers, Ankles, Toes)
  • Dermatitis 75% of Pt’s (Painless, Pustular or Vesiculopustular)
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37
Q

PE findings associated with Gonorrhea and Purulent Arthritis?

A
  • Abrupt onset of mono-or oligarthritis
  • Pain and swelling in one or more joints
  • Gonococcal arthritis (Distal joints
    Knees, Wrist, and Ankles)
  • afebrile
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38
Q

What are some lab test done to help Dx DGI?

A
  • Blood Cultures (2 Sets)
  • Swabs (Urogenital, Rectal, Pharyngeal)
  • Synovial fluid
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39
Q

Initial treatment of DGI?

A
  • Ceftriaxone 1gm IM or IV every 24 hours

IV for those who have septic arthritis

  • Azithromycin 1gm in a single dose
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40
Q

What organism causes Syphilis?

A

Treponema pallidum (Spirochete)

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41
Q

Who is at higher risk of Syphillis?

A
  • Gay Men

- 90% of cases of primary and secondary case occur in men

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42
Q

Primary Syphilis S&S?

A
  • Painless chancre or ulcer (site of inoculation)
  • Most commonly the Genitals and Anus
  • Associated with regional lymphadenopathy
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43
Q

Secondary Syphilis S&S?

A
  • Constitutional symptoms
  • Generalized lymphadenopathy
  • Rash
  • Alopecia
  • Renal issues
  • GI Hepatitis
  • Muscular
  • Neurological (HA, Meningitis)
44
Q

What disease is called the great pretender?

A

Syphilis

45
Q

Secondary Syphilis classic sign?

A
  • Rash
  • Vesicular lesion is most common
  • Diffuse symmetric maculopapular
  • Trunk and Extremities
  • MC Palms & Soles
  • Mouth / Mucous membranes
46
Q

S&S of tertiary (Late) Syphilis?

A
  • Gumma (granuloma) body trying to fight infection
  • Cardiac (Dilated thoracic aorta)
  • CNS (Tabes Dorsalis)
  • Argyll Robertson Pupil
  • Broad Based Ataxia
47
Q

T of F Syphilis can be cultured in a lab?

A

False

Organism can not be cultured

48
Q

Most common Dx test for Syphilis?

A

FTA-ABS: Fluorescent treponemal antibody absorption test

49
Q

Problem with using VDRL and RPR test for Syphilis?

A
  • Only accurate after 4 - 6 weeks after infection
  • Will only catch Primary and Secondary syphilis
  • Negative in Tertiary Syphilis
50
Q

Treatment of Primary Syphilis?

A
  • Benzathine Penicillin G

- Single dose

51
Q

Treatment of Secondary and Tertiary Syphilis?

A
  • Benzathine Penicillin G

- 3 weekly injections

52
Q

True of False Syphilis should be followed up with HIV testing?

A
  • True

- Must be reported to local health Dept.

53
Q

What is a classic finding on XRay for a pt with a Mycobacterial disease?

A
  • Cavitary infiltrate of the upper lobe
54
Q

What are the two forms of Mycobacterium?

A
  • Tuberculous

- Nontuberculous

55
Q

How is tuberculosis spread?

A
  • Inhalation of organisms contained within the aerosolized droplets from an infected individual
56
Q

Most pt’s will be able to clear Tuberculosis

True of False?

A
  • True
  • 90% will clear disease
  • 10% will develop TB Pneumonia (TB seeds in lung hilum)
57
Q

What population is at higher risk of TB?

A
  • Pt’s on immunosuppressants
  • HIV
  • Chronic kidney disease
  • DM
  • Infants & Elderly
58
Q

What are the phases of TB?

A
  • Primary
  • Latent
  • Reactivated
59
Q

S&S of primary TB in a pt?

A
  • Asymptomatic
  • Local bacterial replication
  • Host able to fight off infection
  • Progressive TB in small percent of patients within 2 years
  • In immunocompetent becomes “latent”
60
Q

S&S of latent TB?

A
  • Pt is noncontagious
  • Asymptomatic
  • Persistent state of immune response to M. tuberculosis
61
Q

S&S of Reactivated TB?

A
  • After latent phase
    5-10%
  • Typically pulmonary manifestations
  • > 2 years after primary infection
62
Q

Primary TB clinical symptoms?

A
  • Cough most common
  • Dry then Wet
  • Hemoptysis (bloody cough)
  • Pleuritic chest pain
  • 2 to 3 weeks
  • Fever/Chills
  • Night sweats
  • Anorexia
  • Weight loss
63
Q

Most common finding TB Xray findings?

A
  • Hilar Adenopathy
  • Pulmonary cavitation upper lobe
  • Infiltrates (Right side)
    Perihilar
64
Q

Treatment of TB?

A
  • Multi drug Tx (Gold Standard)
  • 10 drugs (FDA Approved)
  • HUGE ISSUE Drug resistance
  • Seek expert advice when treating TB
65
Q

TB can develop into Pneumonia and then spread where?

A
  • Cervical lymphadenopathy
  • Meningitis
  • Pericarditis
  • Millary dissemination
66
Q

Non-tuberculosis clinical manifestations?

A
  • Disseminated disease
  • Pulmonary disease
  • Cervical lymph nodes
  • Skin and soft tissue
67
Q

Best way to Dx Non-Tuberculosis?

A
  • PPD (Fast and Easy) gold standard
  • Interferon assays
  • CXR may be normal
68
Q

Prevention of Non-Tuberculosis is pt’s with HIV?

A

Prophylaxis

HIV and CD4 count
< 50K

  • Azithromycin
  • Clarithromycin
  • Rifabutin
69
Q

Treatment of Non-Tuberculosis ?

A
  • Multidrug therapy

1st line: Macrolide (clarithromycin or azithromycin), ethambutol, rifampin or rifabutin

  • 18 months of therapy (must continue 12 months after culture conversion)
  • May need to refer to Infectious Disease specialist
70
Q

Two types of Tick Borne illnesses?

A
  • Lyme disease (spirochete)

- Rockey Mountain Spotted Fever

71
Q

Lyme Disease is caused by ?

A
  • Spirochete Borreila burgdorferi

- Wooded areas up north

72
Q

Vector for Lyme disease in the US?

A
  • Spread from the bite of the Ixodes tick
  • Ixodes Scapularis
  • Lxodes Pacificus
73
Q

What are some reservoirs for lyme disease?

A
  • Black Legged Tick
  • Rodents or the White foot mouse
  • Ticks feed on the rodents
  • Ingest the spirochete
  • Tick feeds on deer (obtain a blood meal) fall off
  • Deer are important for survival but not a reservoir for the spirochete
74
Q

Primary reservoir for B burgdorferi (Cause of lyme Disease)

A

Rodents, White foot mouse

75
Q

Primary vector for lyme disease?

A

Black legged tick

  • Ixodes Scapularis
  • Lxodes Pacificus
76
Q

How long must the tick be attached to a human for transmission?

A

24 to 36 hours

77
Q

Lyme disease three stages?

A
  • Early localized
  • Early disseminated
  • Late disease
78
Q

Hallmark sign of the Tick bite?

A
  • 75% Erythema Migrans
    Bulls Eye Rash
  • 25% do not exhibit a rash or recall having a rash
79
Q

When does the bull eye rash usually develop?

A
  • 7 to 14 days after bite

- Range 3 to 30 days

80
Q

Erythema migrans rash most common locations?

A
  • Axilla, groin, popliteal fossa, or belt line
81
Q

T of F Erythema migrans is painful and hurts?

A

False

Painless, may burn or itch

82
Q

Early localized lyme disease S&S?

A
  • Fatigue
  • Anorexia
  • Headache
  • Neck stiffness
  • Myalgias
  • Arthralgias
  • Regional lymphadenopathy
  • Fever
83
Q

What lab will be elevated in a pt with early localized lyme disease?

A

ESR levels elevated

84
Q

Early disseminated lyme disease S&S?

A
  • Acute Neurological or Cardiac involvement
  • Ocular manifestations
  • Weeks to months after bite
85
Q

Most common neurological Early disseminated lyme disease S&S?

A
  • Unilateral or bilateral cranial nerve palsies (facial nerve most common)
  • Bells palsy
86
Q

Early disseminated lyme disease cardiac S&S?

A
  • Carditis

- Av Blocks

87
Q

Early disseminated lyme disease ocular manifestations S&S?

A
  • Conjunctivitis
  • Keratitis
  • Optic neuritis
  • Uveitis
88
Q

Late disseminated lyme disease S&S?

A
  • Months to years after exposure
  • Arthritis
  • Large joints (knees)
  • Joint swelling and Pain
89
Q

Gold Standard to confirm Dx of Lyme Disease?

A
  • Western blot is the confirmatory test
90
Q

Can an Immunofluorescent Assay or ELISA technique test be used to test for antibodies in lyme disease?

A

Yes, but Antibodies can wax and wane in the first several months

91
Q

What is the prophylaxis TX of lyme disease?

A
  • Tick attached for > 36hrs
  • Began within 72 hours of removing the engorged tick
  • Doxycycline not contraindicated
92
Q

How is Rocky Mountain Spotted Fever transmitted?

A
  • Wood ticks
  • American dog tick
  • Brown dog tick
93
Q

Classic S&S of Rocky mountain spotted fever?

A
  • Abrupt onset
  • Fever
  • Headache
  • Myalgias
  • Red macular rash Starts on wrists
    and ankles
  • Rash spreads centrally, Petechiae develops
94
Q

How do you Dx rocky mountain spotted fever?

A
  • PCR of the skin Bx

- Serology antibodies confirms

95
Q

T of F All pt’s remember the tick bite in rocky mountain spotted fever?

A
  • False

- 40% do not remember

96
Q

Treatment of Rocky mountain spotted fever?

A
  • Doxycycline

- Risk factors for Elderly and Comorbidities

97
Q

What causes Tetanus?

A

Caused by contamination of wounds from the bacteriaClostridium tetani

or

The spores they produce that live in the soil, and animal feces, - ubiquitous

98
Q

True of False

Tetanus can be transmitted from person to person ?

A

False

99
Q

How does Tetanus enter the body?

A
  • Puncture wounds
  • Burns / wounds
  • IV drug access
100
Q

Characteristics of Clostridium Tetani?

A
  • Anaerobic

- Gram positive Rod

101
Q

What is the incubation period of Tetanus?

A

5 days to 15 weeks

102
Q

S&S of Tetanus?

A
  • Pain & tingling at site of inoculation
  • Dysphagia
  • Drooling
  • Excess sweating
  • Uncontrolled urination and defecation
  • Fever
  • Risus sardonicus (raised eyebrows, grin)
  • Muscle spasms
103
Q

How is Tetanus Dx?

A

Clinically

  • Cultures and Serology have low Sen and Spe
104
Q

Treatment of Tetanus?

A
  • Protect the Airway
  • Benzo’s
  • Human Tetanus Immunoglobulin (Flown in from CDC)
  • Wound debridement
  • Metronidazole or Penicillin
105
Q

Vaccinations for Tetanus are 100% effective

True of False

A

True

  • 100% effective
  • Booster every 10 years

Clinical Medicine II (9 decks)

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