Infectious Disease Exam 2 Cards Flashcards
Herpes Virus
DNA virus
Eight types
Don’t survive long outside of the host
2 HSV viruses and their GENERAL locations
HSV-1 Oral
HSV-2 Genital
First you kiss, then you have sex
Presentation of Oral HSV and genital HSV
Vesicles and crusts around the mouth and nose, may also appear digitally
Genital HSV has a similar presentation but around the genitals
Herpes is ALWAYS painful!!
4 Associated symptoms with HSV 1 (besides the vescicles)
Burning skin, Pain with eating, swollen lymph nodes, low grade fever
6 associated symptoms of a genital infection with herpes
Skin pain, Dysuria, Cervicitis, Urinary retention, Swollen lymph nodes, Fever and aches
How often is herpes painful
ALWAYS
What happens after the initial herpes infection
It remains dormant in the basal ganglia and can flare up in response to stress
Progression of HSV keratoconjunctivitis
Starts with blepharitis and can lead to impaired visual acuity and blindness
Transmission of HSV keratoconjunctivitis
Direct inoculation or trigeminal nerve spread - take precautions if cysts are anywhere near the eyes!
4 diagnostic ways to identify HSV
Appearance
Cultures
PCR (used for HSV enchaphalitis)
Tzanck smear (also positive for Varicella)
Tzank smear
Looks for multinucleated giant cells as seen in HSV or Varicella
Diagnostic for HSV conjunctivitis
Appearance of dendritic lesions on fluorescein stain and slit lamp examination
Screening recommendation for HSV
Screening NOT recommended
Usual healing time for HSV - initial outbreak and recurrence
Initial 10-20 days
Recurrence 5-10 days
3 treatment options for HSV
Antivirals (oral or topical)
Anesthetics for symptom relief
Antibiotics for secondary bacterial infections
3 antivirals for treating HSV
Acyclovir - $4 at kroger and comes in more forms than just oral
Famciclovir
Valacyclovir
Drug for ophthalmic HSV
Trifluridine
PK of Valaciclovir and Famciclovir
Renal primarily, no CYP450 interaction
3 most common adverse reactions to herpes antivirals and pregnancy category
Pregnancy category B
GI symptoms, HA, Arthralgia
2 Drugs for CMV infections in immune compromised HIV patients
Ganciclovir and Valganciclovir
Drug used for Acyclovir resistant HSV
Foscarnet (can also be used in CMV in AIDS)
How soon should HSV treatment begin?
48-72 hours after onset
Recipe for Herpes magic mouthwash
1/3 Licocaine or Zilocaine
1/3 Maalox
1/3 Benadryl
2 3oz refills and may make the patient numb
Etiology and progression of Varicella virus
Initial infection results in chicken pox, later recurrence results in shingles
Shingles lesion presentation
Lesion on erythematous base - due drop on a rose petal
Pain precedes the rash
4 potential complications from Herpes Zoster
Post herpatic neuralgia
Secondary skin infections
Vision loss
Bell’s palsy
Treatments for:
Shingles
Herpes Zoster Opthalmicus
Post hepatic neuralgia
Shingles - Acyclovir, Valacyclovir, Famciclovir started within 72 hours
HZO - Admit for IV acyclovir, topical steroids
Post-Hepatic Neuralgia - Opioids, TCAs, Gabapentin for pain
Dosing and age recommendation for shingrix/RZV
Same vaccine
Offer to those of 50 years of age
2 vaccines 2-6 months apart
Etiology and transmission of Mononucleosis
Caused by Epstein-Barr Virus (Human herpesvirus 4)
Transmitted via saliva and blood products
5 signs of mononucleosis
Posterior Cervical Lymphadenopathy
Pharyngeal irritation
Splenomegaly
Palatal petechiae
Maculopapular rash
(Classic triad if Fever, Pharyngitis, and Lymphadenopathy)
What happens if you give a person with mono ampicillin?
Rash is seen in over 90% of patients
Serology, Blood Smear, CBC, and EBV antibody findings for Mono
Serology - Mono spot test showing heterophile agglutination
Blood smear - Atypical large lymphocytes
CBC - Leukopenia and Lymphocytosis
EBV antibodies - IgM for acute, IgG for non-acute
3 potential complications from mono
Splenomegaly/Rupture - avoid contact sports
Hepatitis - Watch for jaundice
CNS involvement - Infrequent
Drug interaction with Mono - What’s the drug, What’s the interaction
Rash with PCN
3 treatments for Epstein-Barr Virus
Fluids, Antipyretics, Antibiotics and Antivirals NOT indicated
Hospitalize if necessary
Prognosis for Mono
Fever/sore throat resolves in 10 days
LAN, splenomegaly resolves in 4 weeks
Fatigue can linger for months
3 transmission routes for CMV
Blood, body fluids, transplacentally
CMV inclusion disease in newborns 3 things
Hepatitis, retardation, hearing loss
3 symptoms of CMV active viral syndrome
Fever, Malaise, Neuralgia
Mono-like minus pharyngitis
Strains of HPV (4)
6 and 11 - genital warts (condyloma acuminatum)
16 and 18 - 18-70% of cervical cancers
HPV demographics and spread
Only spread via sexual contact
More common in women with a 3 week to 8 month incubation period
Asymptomatic people can still transmit the virus
HPV clinical presentation
Fleshy lesions with a pedunculated stem that can be in the genital, perianal or anal region may interfere with intercourse or defacation
4 ways to treat HPV warts
Chemical destruction with Podophylin/Podofilox or Imiquimod
Cryotherapy
Systemic Interferon
Laser of Excisive surgery
Aplication for cream for HPV lesions
Put around the base of the lesion
Do you need a biopsy to diagnose HPV warts?
NO
Prevention of HPV
Gardasil vaccine
HPV vaccine reccomendations
Males and Females 11-12, catch up recommended in females up to 26 and males up to 21
Antigenic drift
Slow gradual change
Antigenic shift
Sudden change
3 clinical presentation elements of Influenza
Sudden onset fever, chills, headache, myalgia and malasie
Non-productive cough, sore throat, nasal discharge
Unremarkable PE
4 complications in influenza
Secondary Bacterial infection
Rhabdomyolysis
Aseptic meningitis
Cardiac complications
SCAR
2 Diagnostic tests for Influenza
Rapid Diagnostic Test - More false negatives
Viral culture - conduct in all hospitalized patients
2 types of antivirals for influenza
Neuraminidase inhibitors
NMDA receptor agonists
3 neuriminidase inhibitors with routes for flu
Oseltamivir (Tamiflu) - PO
Zanamivir (Relenza) - Inhaled
Peramivir (Rapivab) - IV
2 NMDA receptor antagonists for influenza and what they cover
Amantadine
Rimantadine
ONLY for Influenza A!
Dosage for Oseltamivir (Tamiflu)
75 mg PO BID for 5 days
How soon do neuraminidase inhibitors need to be started for influenza
Within 48 hours of sx
What are anti-flu treatments intended to do for the patient?
Prevent their symptoms from getting worse
Adverse effects of neuraminidase inhibitors
Which one causes bronchospasms?
Which needs renal dosing?
Side effects may be worse than the flu - use judgement
N/V/D, HA - Are most common
Bronchospasms with Zanamivir
Renal dosing with Oseltamivir
Flu vaccination - when and who
In october for anyone 6 months or older
2 main types of flu vaccines
Inactivated shot
Live attenuated - IN
5 causative agents of viral pneumonia
Influenza
RSV
Parainfluenza
Adenovirus
Coronavirus
4 clinical presentation hallmarks of viral pneumonia
Fever, chills, myalgias
Nonproductive cough
May have rhonchi on PE
Non diagnostic CXR
“Lung gunk goes away when the patient coughs”
What does an adenovirus affect and what is one key sign of one
EVERY mucous membrane in your body
Look for STERILE pyuria
Rotavirus
Fecal oral non inflammatory gastroenteritis most often seen in children - now has a vaccine available
Norovirus
Gastroenteritis in older children and adults
4 vector viruses
Which one is a rhabdovirus
Arbovuruses
West Nile
La Crosse encephalitis
Zika
Rhabdovirus
Rabies
Spinal tap for viral meningitis should be _________________?
Clear
West nile vector
Mosquito
Clinical presentation of West Nile Virus
Often mild with aches, GI issues and a rash
Can have serious symptoms such as seizures, stiff neck, or paralysis - serious sx can linger for months
Diagnosis treatment and prevention for West Nile
Diagnose via lumbar puncture - only in SEVERE cases
Supportive treatment and mosquito control
LaCrosse Virus transmission
Mosquito
4 aspects of La Crosse clinical presentation
Can be asymptomatic
Febrile illness
Encephalitis
Most severe in patients under 16
Most common mosquito born virus in WV
La Crosse
General information about Rabies
From the bite of an infected mammal, sometimes a pet
Causes encaphalitis and leads to death if untreated
Initial rabies presentation
Flu like symptoms
When does acute neurologic disease set in with rabies
after 2-10 days
Delerium, abnormal behavior, hallucinations, insomnia
Post exposure prophylaxis for rabies
Wash wound immediately
Give doses of rabies vaccine on days 1,3,7,14 -double and add one…kinda
Target of most antifungals
Fungal cell membrane
Two types of Azoles and what they are used for
Triazoles - Systemic w/ fewer side effects, usually oral or IV
Flu and Itra are topical, Itra is not IV
Imidazoles - Usually topical because they have more side effects
MOA of Azoles
Inhibit synthesis of ergosterol
Fluconazole
Covers candida albicans and cryptococcus used for superficial and uncomplicated systemic infections
CSF penetration
FIVE Systemic Azoles from least to most effective
Fluconazole
Itraconazole
Voriconazole
(E)Posaconazole/Isavuconazole
Itraconazole
Drug of choice against Histoplasmosis, Sporotrichosis, and Blastomycosis
Variable bioavailability
Voriconazole
Drug for invasive aspergillosis
CSF penetration
Posaconazole and Isavuconazole
BIG GUNS
Invasive fungal infections in IC patients OR resistant infections
Posa=CSF
Isavu=No CSF
2 cheap, topical azoles
Clotrimazole and Miconazole
3 effective topical azoles
Econazole, Ketoconazole, Sulconazole
2 Daily topical Azoles
Econazole, Ketoconazole
Usual dosing for most Azoles
BID
MOA of polyenes
Bind to ergosterol in fungal cell membrane creating pores that cause cell leakage
Absorption and toxicity of Polyenes
Generally not absorbed well via the GI tract
Have major side effects - Nystatin is TOO TOXIC for systemic use
Amphotericin B
Polyene for severe disseminated mycotic infection
Given IV
Nephrotoxic, Causes hypokalemia, hypercholemic acidosis, hypotension
Nystatin
Topical and Oral Polyene - too toxic for systemic use
Non-invasive candidal infections
Can cause irritation and allergic reaction
3 echinocandins
caspofungin, anidulafungin, micafungin
MOA of echinocandins
Inhibit fungal cell wall synthesis
Route of echinocandins
Administered IV only
2 indications for echinocandins
Disseminated candidiasis
Aspergillosis infection in HIV
Drug interactions of echinocandins
Fewer than azoles
2 adverse effects of echinocandins
Insomnia and hepatotoxicity
Drug class of griseofulvin
Mitotic inhibitor
Route of Griseofulvin
Take orally with a fatty meal
Indication of Griseofulvin
Dermatophyte/Tinea infections of the skin and hair
4 Drug interactions for Griseofulvin
Alcohol, Warfarin, Barbiturates, Contraceptives
Griseofulvin and pregnancy
Contrindicated
3 serious side effects of griseofulvin and one lab that needs to be drawn
Hepatotoxicity, Teratogenicity, Neutropenia
Weekly CBCs needed during tx
Drug class of terbinafine
Allyamine
MOA of terbinafine
interfere with ergosterol synthesis
2 routes of terbinafine
Oral or topical but irritating to mucous membranes
2 Oral indications for terbinafine
onychomycosis, dermatophyte (tinea) infections of hair and skin
1 topical indication for terbinafine
Dermatophyte (tinea) infections of hair and skin
2 serious side effects of terbinafine
hepatotoxicity and neutropenia
Flucystosine MOA
Converted to 5FU Inhibits fungal RNA and protein synthesis
Route of flucytosine
Oral
2 indications for flucystosine
Combo drug with amphotericin B, severe cryptococcal or candidal infections in the immune compromised
Only when patients REALLY need it
3 adverse effects of flucystosine
Renal failure, Pancytopenia, Aplastic anemia
Class of Ibrexafungerp
Triterpenoid (new class)
Indication of ibrexafungerp
vulvovaginal candidiasis - one day tx
Inbrexafungerp and pregnancy
contraindicated
3 side effects of ibrexafungerp
Dysmenorrhea/Vaginal bleeding, Back pain, abdominal pain
3 alternative topicals indicated for tinea infections
Butenafine, Tolnaftate, Naftifine (Not OTC)
3 topical therapies for onychomycosis
Ciclopirox, Tavaborole, Efinaconazole
Presentation of Oral candadiasis
Edematous mucosa with white plaque that can be scraped off. Advance stages may result in altered taste and difficulty swallowing
3 ways to diagnose oral candidiasis
Clinical diagnosis, KOH prep, Culture
3 topical, 1 systemic, and 1 alternative therapy for oral candadiasis
Topical/swish and spit - Nystatin, Clotrimazole, Miconazole x 7-14 days
Systemic - Fluconazole x 7-14 days
Alternative - Gentian Violet x3 days
Treatment for Esophageal candidiasis
Fluconazole PO or IV
If resistant Itraconazole PO or Voriconazole
Presentation of Vulvovaginal Candidiasis
Itching, burning and pain around the genital area with a non-malodourous cottage cheese discharge
Candidal intertrigo
Candidiasis in skin folds
Presentation of candidal intertrigo
Well defined plaques with satelite papules and pustules
3 treatments for intertrigo
Talc, Nystatin (Topical), Fluconazole (systemic)
Tinea that isn’t really a tinea
Tinea versicolor
Tinea KOH prep finding
Segmented hypae
Candida KOH prep finding
Budding yeast and pseudohyphae
Clinical presentation of tinea capitis
Hairless patches on the scalp with black dots at the follicles, slowly enlarge over time
Diagnosis for most tineas
Usually a clinical diagnosis but can use KOH prep if ambiguous
Primary spread of tinea capitis
child to child spread
Spread of tinea corporis
Usually person to person, can also be spread from animals
Presentation of tinea corporis
Circular plaque that spreads outwards and develops central clearing with a scaly, red border
Tinea cruris
Tinea that develops in the genital region, a result of sweating or HIV
Clinical presentation of tinea cruris
Scaly erythematous rash confined to the groin region, may have central clearing
Clinical presentation of tinea pedis
Itching, burning or stinging with self-limiting exacerbations
Acutely presents with erythematous bullae
One factor that can lead to a false negative KOH prep for Tinea
Sample taken from macerated skin
Clinical presentation of tinea unguium
Thickened nail with yellow/brown discoloration that may separate from the nail bed
Difference between diagnoses of Tinea unguium and other tineas
A KOH prep or culture is recommended to rule out other nail infections
One antibiotic that is NOT effective for tinea/dermatophyte infections
Nystatin
Treatment for tinea capitis
Always systemic - use griseofulvin
Treatment for tinea corporis and cruris
Topical Azole or systemic griseofulvin
Treatment for tinea pedis
Topical azole or Systemic terbinafine
Treatment for tinea unguium
Topical efinaconazole
Systemic - terbinafine
Region in the US for Blastomycosis
East
Region of the US for Coccidioidmycosis
South West
Region of the US for Histoplasmosis
South East
Region of the US for cryptococcus
West Coast
2 Vectors for Histoplasmosis
Batman and Robin
1 characteristic presentation of histoplasmosis
Calcification, including Egg-Shell lymph nodes
Acute pulmonary histoplasmosis presentation
Mild flu like illness with fever cough and myalgias
Presentation of progressive disseminated histoplasmosis (5)
Seen in HIV
Fever, cough, dyspnea, prostration and septic like symptoms
Presentation of chronic pulmonary histoplasmosis
Usually in patients with chronic respiratory disease - leads to lung nodules
Complication of histoplasmosis
Granulomatous mediastinitis - fibrosis of the mediastinum leads to constriction of the esophagus
3 diagnostic studies for histoplasmosis
Labs, CUltures, Bronchoscopy with biopsy
3 Lab findings for Histoplasmosis
Anemia
Elevated LDH and Ferritin
Treatment for Mild/Moderate; Severe; and Granulomatous histoplasmosis
Mild/Moderate - Itraconazole
Severe - Amphoterricin B
Granulomatous - Itraconazole +/- Rituximab +/- Corticosteroids; surgical intervention sometimes needed
3 Presentations of primary coccidioidmycosis
Flu like symptoms (HA, myalgia)
Erythematous rash
Joint swelling
Presentation of disseminated coccidioidmycosis
Multiorgan involvement and worsened lung symptoms including lung abscesses; localized infiltrates also seen on CXR
Two lab results possible with coccidioidmycosis
Leukocytosis and Eosinophilia
Most reliable diagnostic method for coccidioidmycosis
Bronchoscopy with culture
Treatment for Mild/Moderate and Severe Coccidioidmycosis
Mild/Moderate - Fluconazole or Itraconazole
Severe - Amphotericin B
CD4 count for Coccidioidmycosis prophylaxis
Under 250
Most common clinical presentation for Blastomycosis
Flu-like symptoms, nodular wart-like lesions, May resolve or progress to pneumonia
Most common CXR finding for blastomycosis
Airspace consolidation or masses
Disseminated blastomycosis presentation
Skin lesions as well as bone and GU system issues
Treatment for Mild/Moderate and severe or CNS blastomycosis
Mild/Moderate - Itraconazole
Severe - Amphotericin B
Cryptococcus
Spread via pigeon dung, only significant in the immune compromised
Presentation of cryptococcus (3)
Pulmonary disease, Meningitis (HA, altered mental status) without meningeal signs, Nodular skin lesions
3 diagnostic tests for cryptococcus
Serum or CSF antigen, Bronchoscopy with culture, Other cultures
Treatment for cryptococcal pneumonia
Fluconazole for 6-12 months
Treatment for cryptococcal meningitis
Amphotericin B for 2 weeks followed by 8 weeks of fluconazole
Potential CSF shunt needed
Presentation of pneumocystis jirovecci
Sudden onset of fever, dyspnea, and non-productive cough
Culture for Pneumocystis
Cannot be cultured
First line treatment for pneumocystis jirovecci
TMP-SMZ (Bactrim)
Historical question to ask if you suspect a parasitic infection
Have you traveled in the last month or two?
Mild/Moderate presentation of amebic dyssenterry
Gradual onset of abdominal pain with bloating and diarrhea. Hematochezia may be present
NO fever
Presentation of severe amebic dyssentery
Fever with 10-20 watery/bloody stools per day
Complications of amebic dyssentery
Necrotizing colitis, Granulomatous lesions, Bowel ulcerations
Extraintestinal complication of amebiasis
Amebic liver abcess - causes pain and fatal if ruptured
2 tests for diagnosis of intestinal amebiasis
Stool antigen test and Stool PCR
2 tests for diagnosis of an amebic hepatic abcess
Serum for anti amebic antibodies and CT of liver
Treatment for amebiasis
Metronidazole for 10 days or tinidazole for 3 days followed by Paromomycin for 7 days
2 forms of Giardia
Trophozooites or Cysts
Clinical presentation of acute diarrheal syndrome from Giardia
Profuse watery diarrhea without fever or vomiting
Clinical presentation of chronic diarrhea from GIardia
Daily or cyclical greasy diarrhea without blood or fever. May go on for months
2 Diagnostic tests for giardia
Stool antigen and stool PCR
Giardia drugs for:
Adults
1-3 yrs
Under 12 months
Adults - Tinidazole
1-3 - Nitazoxanide
Under 12 months - Metronidazole
Key side effect of nitazoxamide
Bright yellow urine
Most common cause of cryptosporidium outbreaks
Swimming pools
Why does giardia cause greasy stools
It gets in the way and causes bad absorption
Boiling water and giardia
might not kill giardia spores
Form of cryptosporidium found in nature
Thick walled cysts - can survive for years
Presentation of cryptosporidias acute infection
Watery, non-bloody diarrhea with a low grade fever
Clinical presentation of cryptosporidias in the HIV patient
Foul smelling chronic diarrhea with pulmonary billiary tract problems
2 diagnostic tests for cryptosporidium
Stool antigen assay and stool PCR testing
Treatment for cryptosporidiosis
Acute form is self limiting - can use nitrozoxanide or paromomycin if needed
3 endemic areas for cyclosporiasis
Haiti, Nepal, Peru
Most common source of cyclosporiasis
Imported fresh produce
Clinical presentation of cyclosporiasis
Watery diarrhea and cramping with a potentially flu-like prodrome - relapses are possible
More severe and prolonged in immune compromised patients
Diagnostic of choice for cyclosporiasis
Stool microscopy O&P with acid fast stain
Treatment for cyclosporiasis
Bactrim - first line
Second line - Ciprofloxacin or Nitazoxamide
Transmission of trichomoniasis
Sexually transmitted - more common in women
Clinical presentation of trichomoniasis
Frothy yellow/green vaginal discharge, dyspareunia, strawberry cervix
3 diagnostic tests for trichamoniasis
MOTILE on wet prep microscopy
Rapid antigen testing
PCR
Treatment for trichamoniasis
Tinidazole or Secnidazole - treat ALL sexual partners
May also use metronidazole
Leading cause of foodborne illness deaths in the US
Toxoplasmosis
Clinical presentation of toxoplasmosis in the immune competent
GI to Lymphatics to Systemic
Mono-like symptoms with malaise and sore throat
Can also present with heaptitis
Clinical presentation of toxoplasmosis in the immune compromised
Encephalitis with necrotizing brain lesions, can resurface in AIDS patients
Presentation of congenital toxoplasmosis
Passed from infected mother to baby
Causes: Stillbirth, Seizures, Retardation, CNS or eye disease, Retinochoroiditis in teenagers
3 diagnostic tools for toxoplasmosis
Serum antibodies, Tissue biopsy, Body fluid PCR
Treatment of toxoplasmosis during pregnancy
Spiramycin
Toxoplasmosis treatment for immune compromised patients or for fetal infection
pyrimethamine (teratogen in early pregnancy) + sulfadiazine
Malaria vector
Anopheles mosquito
Typical incubation for malaria
9-14 days
When considering recent travel, when is risk of P. falciparum the greatest
2 months after exposure
Simplified malaria life cycle
Sporozoites infect liver cells (come from mosquito)
Merozoites infect red blood cells - these cause systemic symptoms
Clinical presentation of an acute malarial attack
High fever, chills, sweats
Dry cough
Myalgia
May have some anemia of jaundice
Start sporadic and become regular
Most severe form of malaria
Falciparum
5 clinical manifestations of severe malaria
Altered consciousness, Hemolysis, Secondary bacterial infection, Pulmonary edema, Hypotension
Gold standard diagnostic for malaria
Giemsa-stained blood smear
First line treatment for Falciparum/Resistant; Non-resistant; and Severe malaria
Non-resistant - Chloroquine
Resistant/Falciparum - Artemether-lumefantrine (Coartem)
Severe - Artesunate - only available from the CDC
Antifolate drug for malaria
Malarone - second line after arteminisin, can cause liver enzyme elevation
MOA of chloroquine
Collects in parasite food vacuole - Effective against Malaria that is in the RBC stage
Malaria drug used to eliminate liver cysts
Primaquine - can cause cardiac issues and is CI in pregnancy
Onset of Chloroquine derivatives
Fast - symptoms go away in 24-48 hours, parasites in 48-72
Side effect of chloroquine
Pruritis
Mefloquine
Used for prophylaxis of malaria - toxic when used for treatment. Avoid with seizure hx and psychiatric disorders
Quinine
5 Side effects
MOA not well understood, can cause nausea, blurred vision and tinnitus as well as hemolysis and cytopenia
Arteminisin derivatives
Fore resistant Malaria, encourage the formation of free radicals and have a short half life. Well tolerated but should be given in combo regimens
2 antimalarial prophylaxis drugs safe for pregnancy
Chloroquine and Mefloquine - these must be taken early before travel
3 antimalarial prophylaxis drugs NOT safe for pregnancy
Atovaquone-proguanil (Malarone), Doxycycline, and Primaquine - These must be taken daily for travel
Made mode of transmission for tape worms
Ingestion of undercooked meat
What happens when tapeworm eggs from himan feces are ingested?
Brain cysts
Habitat of tapeworms
Live in the intestines and can reach several feet in length
Common presentation of noninvasive Taeniasis (Tapewroms)
May have abdominal pain, with eosinophilia. Most commonly detected via proglottids in the stool
Common presentation of invasive tapeworm infection
Invades the brain causing altered cognition, seizures, and deficits
Treatment for intestinal tapeworm
Praziquantel 1 dose PO
Treatment for Neurocysticercosis (Brain Tapeworm)
Albendazole BUT killing cysts can cause inflammation
MOA of praziquantel
Paralyzes worms by causing calcium to enter cells which creates muscle spasms, causing them to detach from their host
Side effect of praziquantel
Secondary inflammation following parasite death
Transmission of hookworms
Transcutaneous (migrate to lungs) although some can be transmitted through contaminated food/water
Path of hookworms in the human body
Foot to Lungs to Mouth to Gut
Clinical presentation of hookworm infection
Serpigionous rash at site of entry
Fever, Wheezing, and Dry cough during pulmonary stage
Bloating, abdominal pain nausea and diarrhea
2 complications of hookworms
Can cause iron deficiency
Can cause cognitive delay in children
Diagnostic tool for hookworms
Stool microscopy for ova and parasite - Rapid PCR becoming increasingly available
Treatment for hookworms
Albendazole or Mebendazole usually 1 dose
Treat for anemia or low protein as needed
2 benzamidazoles
Albendazole
Mebendazole (Not common in the US)
MOA of albendazole
Inhibits helminth microtubule formation and glucose uptake
4 drug interactions of albendazole
Antimalarials, Grapefruit juice, cimetidine, anticonvulsants
Transmission of Pinworms
Fecal-Oral can be contracted from contact with a contaminated fomite - most common in children
Clinical presentation of enterobiasis (pinworms)
Perianal pruritis (often nocturnal), insomnia, and enuresis (bed wetting)
Diagnostic test for pinworms
“Scotch tape test” eggs are not typically found in the feces but on the perianal skin
Treatment for hookworms
Albendazole or Mebendazole - 1 dose PO and repeat in 2 weeks
Wash sheets and clothing and treat close contacts
Transmission of trichinosis
Ingestion of larvae from undercooked pork or other meat
Incubation of trichanosis
1-7 days
Clinical presentation of trichinosis
Abdominal pain to eosinophilia and periorbital edema, signs of muscle involvement in severe cases
3 diagnostic tests for trichinosis
Elevated serum muscle enzymes
ELISA assay 2+ weeks after infection
Muscle Biopsy
Treatment for trichanosis
No specific treatment for systemic stage - supportive care
Can us albendazole early on
Transmission of Roundworms (Ascariasis)
Fecal-Oral - ingestion of contaminated eggs or food
Incubation period for round worms
6-8 weeks
Clinical presentation of roundworms
Fever, eosnophilia, dry cough, chest pain, pancreatitis
2 ways to diagnose roundworms
Stool microscopy or emergence of adult worms
Treatment for Roundworms
Albendazole or Mebendazole 1 dose
4 viral childhood exanthems
Rubeola (1st) Rubella (3rd) Parvovirus(5th) and Roseola ((6th)
Cause and most common age for measles
Caused by the rubeola virus and mostly seen in children under 5
Transmission of measles
Airborne and highly contagious, communnicable for 4 days after rash appears
Initial Clinical presentation of measles
LG Fever, Dry cough, Little white “Koplicks” spots with blue centers on buccal mucosa
Later clinical presentation of measles
Blotchy red rash, starts at the hairline and descends receding in the same direction it appeared with a high fever
Treatment for measles (rubeola)
No established cure - supportive care but no aspirin in under 18
6 complications from measles
Otitis Media - MC
Bronchitis
Pneumonia
Pregnancy complications
Encephalitis
THrombocytopenia
Scheduling for the MMR vaccine
1st dose at 12-15 months 2nd dose at 4-6 years
Cause of mumps
The mumps virus
Transmission of mumps
Airborne, Saliva, and contaminated surfaces
Isolation for mumps patients
5 days after glands begin to swell
3 symptoms of mumps
Fever, Loss of appetite, Parotitis (Swollen salivary glands)
Treatment for mumps
Supportive care
4 complications of mumps
Orchitis, Encephalitis, Mastitis, Deafness
Rubella
German measles, 3 day measles, or 3rd diease
Transmission
Can be transmitted to children by pregnant women
Communicable period of rubella
10 days prior and 1-2 weeks after rash appearance
4 clinical presentations of rubella
Congestion and HA, Descending rash (as in measles), Symmetrical postauricular occipital tender lymphadenopathy, Arthralgia
3 complications of Rubella
Arthritis, Otitis Media, Encephalitis
Triad of congenital rubella syndrome
Microcephaly, Cataracts, Cardiac defects
Diagnosis and treatment for rubella
IgM antibody titer - isolation and supportive care
MMR vaccine and pregnancy
Cannot give while pregnant, women should make sure they are up to date on it before becoming pregnant
Erythema Infectiosum
5th disease or Parvovirus-19
Transmission, Incubationof Erythema infectiosum
1-2 week incubation
Transmitted via blood, respirattory secretion, springtime and pregnancy
When is erythema infectiosum infectious
BEFORE the rash appears
Clinical presentation of Erythema infectiosum
Usually in 5-7 year-olds
Slapped cheeks erythema
Later develop a lacy (reticular erythema on extremities - gets worse with stimuli, Polyarthropathy also possible
Diagnosis and treatment for erythema infectiosum
Usually a clinical diagnosis but can also blood test for antibodies
IV immune globulin for immune compromised, or supportive
Complications of erythema infectiosum
Can pass to infants - counsel patients about contacts who are pregnant
Can cause red cell aplasia
Roseola infantum
6th disease caused by HHV 6&7
Incubation and transmission of roseola infantum
5-15 day incubation
Airborne and most common in the spring or fall
Epidemiology of roseola infantum
Usually caught around 2-4 years of age
Clinical presentation of roseola
High fever for 3-5 days followed by a nonpruritic rosy pink macular rash
Diagnosis and treatment of roseola infantum
Diagnosis is usually clinical with supportive care
Rare complication of roseola
Febrile seizures
What is the aspect of fever that we are most concerned about?
The LENGTH rather than the HEIGHT
Why do febrile seizures occur
Because of how fast the fever comes on NOT because of the height of the fever
Incubation and transmission of varicella
Incubation 10-21 days
Very contagious and can be spread w/o skin to skin contact
When is varicella communicable
1-2 days before the rash appears until all blisters have scabbed over
4 stages of chickenpox
Macule, Papule, Vesicle, Crust
2 diagnostic tools for chickenpox
PCR swab of the lesion and IgM titers
Treatment for chickenpox
Trim nails, lotion and oatmeal baths
Can use 10x dose acyclovir or Ig therapy for those at high risk
If using acyclovir for varicella when must it be started
within 24 hours, treat for 5 days
Recommendations for Varicella vaccine
12-15 months, again at 4-6 years
Causitive agent of hand foot and mouth disease
Coxsackievirus
Incubation and transmission of hand foot and mouth
3-7 day incubation
Highly contagious, various secretions and spread most in summer and fall
Communication of HFMD
Most contagious in the first week but still contagious until all blisters have resolved
Clinical presentation of HFMD
Fever and malaise with a red non-pruritic rash -vesicles surrounded by a red halo on palms and soles
Painful red lesions on tongue, gums and hard palate
3 things that help us differentiate HFMD from other infections
Age, Pattern of signs and symptoms, Appearance of rash
Treatment for HFMD
Supportive, can use an oral rinse for discomfort
2 complications of HFMD
Dehydration and encephalitis
6 Category A bioterrorism agents
Anthrax, Botulism, Plague, Smallpox, Tularemia, Viral Hemorrhagic Fevers
Anthrax
Organism
Spread
Signs/Symptoms
Management
Past Use
Bacillus anthracis Gram + Rod
Used before in 2001
Bioterrorism use most likely respiratory
Treat with antitoxin, or clindamycin
PEP vaccine and fluoroquinolone
Botulism
C. bot toxin
Has been used at various times in the 1900s (Japanese cult)
A-G forms
Flacid paralysis
Antitoxin if caught early
Intubation and supportive care is caught late
Plague
Caused by yersinia pestis
Used as an aerosol potentially
Used by Japan in WWII
Bubonic (LAD) and Pneumonic
Use gentamycin, streptomycin, doxycycline, or chloramphenicol to treat
Smallpox
Eradicated in 1980 by WHO
Double stranded DNA virus
Scabbing maculopapular rash, with death usually from severe systemic illness
Strict isolation - antivirals not really studied
Tularemia
Extremely infectious - can be caught from a petri dish
Aerosol or drinking water weapon
Not spread person to person
Inflammation of the airways with conjunctivitis
Streptomycin or doxycycline recommended for treatment
Viral hemorrhagic fevers
Fever, myalgia, prostration, DIC
Direct contact required for spread
Single stranded RNA viruses
Temp voer 38.3 for under 3 weeks and bleeding internally from at least two sites
Universal Precautions
Established in 1980s - Treat all bodily fluids as if they are infected
Standard precautions
Added protection to UP, includes hand hygeine, PPE, and safe injection practices
Contact precautions
Gown and gloves required for patient contact or even upon entering the room
Droplet precautions
Surgical mask required within 3 feet of the patient
Airborne infective isolation
Negative pressure with a respirator
3 examples of airborne precaution pathogens
TB, Varicella, Measles
3 examples of droplet precaution pathogens
Mycoplasma, Influenza, Meningococcal meningitis
Active immunity
Induced by vaccines either derived from bacteria or their products
Passive immunity
Induced by administration of preformed antibodies
Inactivated vaccine
Contains dead parts and is safer but may require booster doses
Includes Flu and Polio
Live attenuated vaccine
Live but weakened virus
Provides the greatest benefit and typically does not cause the disease
Includes MMR
Subunit vaccine
Contain only antigens - hard to make
Include Hep B
Toxoid vaccines
Inactivate bacterial toxins
Include TDaP
Conjugate vaccine
Woeks against bacteria with a cell wall - synthetic product containing cell wall produces
Includes HIB type B and Pneumoccocal
3 contraindications to vaccines
Anaphylaxis, Pregnancy and Immunosuppression for LIVE vaccines
Take precaution with acutely ill patients
DTaP
Childhood Diptheria, Pertussis, Tetanus, Five part series given at 2,4,6,15 months and 4 years
Tdap
Diptheria Tetanus Pertussis vaccine booster at 11 or 12 and every 10 years thereafter
Td
No pertussis, just tetanus and diptheria - given for a dirty wound if its been over 5 years since last tetanus
2 contraindications of Tdap
Hx of encephalopathy with administration
Uncontrolled seizures
1 contraindication for MMR vaccine
Postpone a month if pt on steroids
Polio vaccine dosing schedule
2 months, 4 months, 6 months, 4 years
Dosing route and schedule for Hep A vaccine
Killed virus vaccine
Given IM
Given at 12 months and 2 years
Dosing route and schedule for Hep B vaccine
Subunit vaccine
IM
1 month, 2 months, 4 months, 6 months
Combined with other vaccines
1 contraindication to HEP B vaccine
Hypersensitivity to yeast
Rotavirus vaccine
Live attenuated
Give PO on a 2,4 or 2,4,6 schedule
CI for those with hx of intussusception
Flu vaccine type
Conjugate vaccine
Schedule for Flu vaccination
2,4,6 months and then every 12-15 months thereafter
Pneumococcal vaccine type
Conjugate vaccine
4 pneumococcal vaccines
PCV13 - Better for children
PCV23 - Better for adults
PCV15 - Combines 13 with some 23
PCV20 - Combines 13 with all of 23 and some extra
3 types of quadrivalent flu vaccine
Fluzone - Egg based and 6+ months
Flucelvax - Mammal cell based and 4+ years
Flublock - Recombinant and 18+
2 flu vaccines for 65+
Fluzone (5x standard dose) and FLUAD
Age recommendation for intranasal flu vaccine
2-49 - Not pregnant or immune suppressed
Flu vaccine number of doses
2 a season before 8
1 a season after 8
Varicella vaccine type
Live attenuated vaccine
Doseing route and schedule for varicella vaccine
12 month and 4 years
Given SQ
2 meninggococcal vaccines and when to give them
IM
ACYW - give at 11 and 16
B - 16 years with 6 month booster
Route and schedule for HPV vaccine
IM
Indicated 9-45 but not beneficial over 26
Only 2 doses before 15, one at 11 with a booster 6-12 months later
Yellow fever vaccine
17D - Live attenuated
Given IM to those 9months to 59 travelling to Africa or South America
2 types of typhoid vaccine
Oral, live attenuated and capsular polysaccharide
Dosing route and schedule for typhoid vaccine
Oral - 1 capsule PO every other day (4 pills)
Good to travel 1 week later given at 6+ and good for 5 years
IM - One dose and able to travel 2 weeks later
Boost every 2 years
Dosing for rabies immune globuline
Inject around the wound up to 7 days after vaccine
Rabies vaccine dosing schedule
Give on days 0,3,7,14 (and 28 for immune compromised)
Min age for botulinum antitoxin
For use in those under 12 months of age
RSV vaccine - who is it for?
Only for high risk because it is expensive - chronic lung disease and under 6 months at start of RSV season
When should antivenom be administered
ASAP - 4 hours after bite is best
3 dosing stages for antivenom administration
Initial - 4-6 vials in 1 hour
Subsequent - 4-6 more vials
Maintenance dose - 2 vials every 6 hours
Control is usually achieved during initial dose
Caution with administering antivenom
Test sensitivity via SQ injection first
Have epinephrine and antihistamine at bedside
Side effects of antivenoms
Allergic reaction, serum sickness
Main causitive agent of tuberculosis
Mycobacterium tuberculosis
4 factors that determine likelihood of TB transmission
Infectiousness of TB patient
ENvironment
Frequency and duration of exposure
Immune status of exposed individual
2 drugs that drug resistant TB is resistant to
Isoniazid and rifampin
Latent TB infection
Occurs when TB is in the body but the immune system has it under control
Where does a TB infection begin
In the alveoli
3 differences between latent and non-latent TB
LTB - Cannot spread to others, Has no symptoms, has a normal CXR
Percentage of people for whom LTBI will progress to TB
5% within the first 2 years 10% over a lifetime
2 conditions that are risk factors for developing full blown TB disease
DM and CKD
2 sites of extrapulmonary TB
Lymph nodes and brain
5 groups who are more likely to develop active TB once infected
HIV+, Gastric bypass surgery, Low body weight, smokers, children under 5
Strongest known risk factor for developing TB
HIV+ - TB is the leading cause of death for AIDS patients
TST
Tuberculin Skin Test
When should a TST be read
48-72 hours after administration
Groups for whom a 5mm induration or less is considered positive (5)
HIV+, Recent TB+ contacts, Suggestive X-ray findings, Organ transplant recipients, Immune compromised
4 groups for whom 10mm or less is a positive TB test
People from endemic areas, Drug abusers, Lab workers, People who live/work in high risk settings
Induration considered positive for everyone regardless of risk factors
People with no known risk of infection
3 things that can cause a false positive TST reading
Different mycobacterium, Administration of wrong antigen, BCG vaccination
4 factors that can cause a false negative TST
Anergy, Infection too recent, under 6 months, Recent live vaccine administrtion
How long between initial TB infection and Positive TST
2-8 weeks
5 components to incorporate when evaluating for TB
History, Physical, TST, CXR, Bacteriological evaluation
3 pulmonary symptoms of TB
Chest pain, Cough over 3 weeks, Hemoptysis
Confirmatory test for TB
CULTURE
Standard treatment for LTBI
9 months of isoniazid
LTBI treatment for patients with potentially resistant TB
4 month daily Rifampin
Strategy for managing close contacts of TB patients
Don’t treat prophylactically, test and then restest in 8-10 weeks
Drug regimen for LTBI for HIV+ patients
Isoniazid and rifapentine once a week for 12 weeks
Contacts of TB+ individuals that we want to treat even if the test is negative
HIV+ and under 5 years old
4 drug regimen for the initial treatment of TB
Isoniazid, Rifampin, Pyrazinamide, Ethambutol
TB drug that can cause peripheral neuropathy
Isoniazid
3 TB drugs that can cause liver damage
Isoniazid, Pyrazinamide, RIfampin
TB drug that causes eye damage
Ethambutol
TB drug causing orange urine
Rifampin
Three ways to determine whether a patient is responding to TB treatment
Evaluate TB symptoms
Conduct bacteriologic exam
Use chest X-ray
3 criteria for when TB is considered infectious
Recieved treatment for 2+ weeks
Symptoms have improved
3 consecutive negative sputum smears ((collect at 8-24 hour intervals with at least on early morning specimen)
Proper protection for TB
A fitted respirator in all TB rooms, rooms where cough inducing procedures are done, ambulances carrying infected patients, Homes of infected patients
