Infectious Disease-Notes Flashcards
What are some clinical features of irritable bowel syndrome?
pain relieved by BM
onset of pain related to change in frequency of stool and/or character of stool
noticeable abdominal bloating
sensation of incomplete evacuation or diarrhea with mucus in it.
What is a workup for suspected infectious diarrhea, bloody diarrhea?
ELISA tests for Rotavirus, C diff, Salmonella
Look for ova/parasites in the stool. helpful for giardia, entamoeba histolytica, ancylostoma duodenale. must do 3 samples.
sometimes…a colonoscopy. Ex: Cdiff would show pseudomembranous colitis.
What is the usual treatment for infectious diarrhea?
regular diet
oral rehydration
Infant pt is febrile. You find that stool is positive for salmonella. Do you do LP, blood cultures?
Yes.
What are some causes of infectious diarrhea to look out for in HIV patients?
cryptosporidium parvum
CMV
MAC
What are some important features of cryptosporidium parvum diarrhea in HIV patients?
protozoa
chronic watery diarrhea
acid fast cysts
happens when CD4
What are some important features of CMV colitis in HIV patients?
chronic bloody diarrhea
giant cells with owl’s eye inclusion bodies
What are some important features of MAC colitis in HIV patients?
chronic watery diarrhea
CD4
Which antibiotics do you use to treat the following: C diff salmonella EPEC Entamoeba histolytica
C diff: metro/vanco
salmonella: cipro
EPEC: cipro
entamoeba histolytica: metro
Which antibiotics do you use to treat the following: shigella EIEC Vibrio Cholera Giardiasis Cryptosporidium
shigella: cipro EIEC: cipro cholera: tetracycline, azithromycin giardiasis: metro cryptosporidium: nitazoxanide
Fever and bloody diarrhea could be caused by what?
shigella Salmonella campylobacter EHEC E. histolytica
What are some important features of fever & bloody diarrhea caused by E. histolytica?
can mimic IBD, but will worsen with steroids
can cause a liver abscess
peripheral eosinophilia
charcot-leyden crystals in stool (from eosinophils)
treat with metronidazole
What are some causes of diarrhea that consist of no fever, no blood?
norovirus rotavirus ETEC (will ONLY see diarrhea as a symptom) EPEC (in infants) Cholera vibrio parahemolyticus (oysters) giardia cryptosporidium parvum clostridium perfringens bacillus cereus
What are some important things to know about giardia diarrhea?
fatty, smelly diarrhea
onset is 1-2 weeks later
use proper sewage
treat with metronidazole
If you have diarrhea + N/V…what do you have?
viral gastroenteritis
What’s the deal with tropic sprue?
chronic fatty diarrhea
blunting of villi with infiltration of lymphocytes, plasma cells, eosinophils
malabsorption, VB12/folate deficiency
can present years after a person was in the tropics
What’s the deal with trichinella?
present in undercooked pork
get watery diarrhea
treat with albendazole
Ascaris lumbricoides can present how? What is the treatment?
post-prandial abdominal pain or vomiting
can even cause pancreatic duct or bile duct obstruction if there is a heavy enough burden
tx: albendazole, pyrantel pamoate
Ancylostoma Duodenale?
cough, anemia, malabsorption, weight loss, eosinophilia
tx: mebendazole, pyrantel pamoate
Treatment for enterobius vermicularis?
mebendazole or pyrantel pamoate
What are some non-inflammatory food poisonings?
S. aureus (intense vomiting 24 hours)
B. cereus (vomiting and diarrhea), from bad rice
C. perfringens, profuse diarrhea, rewarmed meat.
Inflammatory food poisoning?
C. jejuni. undercooked chicken. superficial ulcers in colon
EHEC: undercooked hamburgers. look at mackonkey agar. worry about HUS.
Y. enterocolitica. RLQ pain, mimics appendicitis
What causes ascending paralysis? Descending paralysis?
Ascending paralysis: Guillan Barre
Descending paralysis: Botulism
Features of HUS?
diarrhea illness GI bleeding purpura and HTN microangiopathic hemolytic anemia schistocytes
What are some important things to know about salmonella typhi?
gallbladder is the reservoir, can cause necrotizing cholecystitis
red spots on belly
high fevers.
treat with cipro, ceftriaxone
What are some things to know about shigella dysenteriae?
severe bloody diarrhea, seen in children in developing countries
What’s the deal with necrotizing enterocolitis?
premature infants w/ reduced intestinal perfusion translocation of bacteria and gas into the bowel wall feeding intolerance (bilious emesis) abdominal distention decreased BS sepsis (low platelet count) hematochezia metabolic acidosis
w/u:
serial abdominal radiographs. see pneumatosis intestinalis
NG tube to suction
What is the treatment for necrotizing enterocolitis? Possible complications?
Tx: bowel rest
vanco, gent, metro
IVF
NG tube suction
surgery if: abdominal wall erythmea, air in portal vein, intestinal pneumatosis, pneumoperitoneum
complications: septic shock, strictures, short bowel syndrome, death
What is pneumatosis coli?
NEC isolated to the colon
can happen after midgut volvulus, or malrotation
possible intestinal perforation
What is the organism seen in cat bites? treatment?
pasteurella multiocida
amoxicillin-clavulonate X5d (also covers anaerobes)
Causes sepsis in preterm infants?
enterococcus
Sepsis in infants under 2 mo?
Group B strep
E Coli
Listeria
tx: amp and gent
OR amp and cefotaxime
amp needed for listeria
Sepsis in infants over 2 mo?
strep pneumo
N. meningitidis
ceftriaxone and vancomycin
CSF findings?
Tuberculosis meningitis
Viral meningitis
Guillain Barre
Tuberculosis: glucose 250
Viral: High WBCs,
What is brudzinski and kernig?
brudzinski: flex the neck–>flex the legs
kernig: flex the thigh–>can’t extend the leg
Organisms that cause bacterial meningitis in these age groups? Neonates Infants Adults Elderly?
Neonates: GEL
Infants and adults: S. pneumo, neisseria meningitidis, h. influenza
elderly: s. pneumo, n. meningitidis, listeria
When do you need a CT in a bacterial meningitis workup in kiddos?
usu don’t need b/c open anterior fontanel can accomodate increased ICP
unstable neuro signs antibiotics, CT, LP
focal neuro: CT
stable neuro: LP then antibiotics
Once you have diagnosed meningococcemia…what do you treat it with?
Penicillin G
How do you treat N. meningitis?
ceftriaxone or rifampin
close contact: ceftriaxone, cipro, rifampin
Aseptic meningitis?
enteroviruses: coxsackie, echo
HSV-1
mumps
What is the presentation of encephalitis?
AMS seizures paralysis HA photophobia nuchal rigidity increased ICP
HSV–focal neuro deficits, odd behavior (hypersexuality, hypomania, amnesia)
abnormal EEG
What are the causes for encephalitis?
HSV2 (neonates)
HSV1 (children)
arboviruses St. louis, eastern equine, western equine, west nile
enteroviruses (coxsackie, echo)
toxoplasmosis and a bunch of other things.
What is the workup and treatment for encephalitis?
CSF, PCR HSV, CMV, EBV, VZV
EEG
tx: acyclovir for encephalitis
anticonvulsants if seizures are present
What are the important features of gonococcal conjunctivitis?
occurs at 3-5 days of life
bilateral purulent conjunctivitis
can cause corneal ulceration
Tx: topic erythromycin
What are the important features of chlamydia conjunctivitis?
1-2 weeks of life
red conjunctiva, mucoid discharge, lid swelling
tx: oral erythromycin
can get chlamydial pneumonia from this.
What is important to know about otitis media?
S. pneumo H. influenza M. Catarrhalis other: s. pyogenes, p. aeruginosa, mycobacterium treat with amoxicillin
Chronic suppurative otitis media?
S. aureus, pseudomonas, E coli
What is keratinized squamous epithelium on the TM from chronic middle ear disease?
choleastoma
otitis externa?
pseudomonas
E. Coli
S. aureus
Tx: Burrow’s solution, 2% Acetic Acid, cipro ear drops
Mastoiditis?
s. pneumo or HIB
post auricular pain and AOM
pinna pushed lateral and down
Sinusitis?
most common: ethmoid sinus
>18 mo: could be maxillary
>6yo: could be frontal or sphenoidal
see 10-14d nasal discharge
S. pneumo, non-typeable HI, moraxella.
CT, transillumination
high dose amoxicillin
What is a juvenile angiofibroma?
nasal obstruction (1 side of nose always congested)
epistaxis
erosion thru the septum
Tx: surgery
What’s the deal with herpangina?
fever, sore throat, pain with swallowing, fever, HA
1-2mm vesicles and ulcers with red ring in back pharynx, gray lesions
caused by coxsackievirus, echovirus.
seasonal presentation.
If pt is resistant to nystatin mouthwash for candida…what is a good alternative?
clomitrazole
Cervical adenitis?
causes: viral URI, bilateral enlarged nodes
bacterial: unilateral, staph & strep, bartonella (with maculopapular rash), atypical myco
tx: bartonella, cat scratch, use TMP-SMX clindamycin periodontal dx: amoxicillin excision/biopsy for w/u if >3cm fluctuant node.
Reye syndrome?
ASA in kiddos with influenza or varicella infections
microvesicular fatty infiltration & hepatic mitochondrial dysfunction
acute liver failure, encephalopathy
high Transaminases, PR, INR, PTT, Ammonia
Common cold v. flu?
Common cold: itchy, watery eyes, productive cough, gradual onset of symptoms.
Flu: dry cough, fever, fatigue, HA, myalgias, sudden onset
Fancy name for measles?
Rubella affects what?
measles=rubeola
rubella targets retroauricular, posterior cervical and occipital lymph nodes
Roseola?
Fever first, then rash
like Rose is super optimistic, when God takes away a fever, he gives you a rash.
Fifth disease?
parvovirus B19, creates erythema infectiosum
slapped cheek
What type of vaccine protects you from mumps? Possible complications?
parotitis is seen
LAV protects you.
can get meningitis within 10 days of onset
can get orchitis in rare cases with males.
Rocky mountain spotted fever?
maculopapular rash that begins in the flexor surfaces, usu involves the palms and soles
hyponatremia and thrombocytopenia may be seen
give doxycycline
ITP?
thrombocytopenia, triggered by virus, otherwise healthy
T/F Cryptosporidium is only seen in HIV + patients? Treatment?
False. oddly enough also seen in daycare centers.
Give nitazoxanide
What are some clues that you have a viral cause of pharyngitis? Bacterial?
Viral: hoarseness, abdominal pain, diarrhea
bacterial: localized, high grade fever
What are some bacterial causes of pharyngitis?
- strep pyogenes
- C. diphtheria
- candida, mycoplasma, n. gonorrhea
Presentation of strep throat?
pharyngeal erythema, swelling, tonsillar exudates, edematous uvula, palatine petechiae, anterior cervical LAD, strawberry tongue
Complications of strep throat?
- Acute Rheumatic Fever:
after strep pharyngitis
Jones criteria + ASO
need penicillin for at least 5 years after that. - Post-strep glomerulonephritis:
Type 3 hypersensitivity, immune complex deposition
decreased C3/C4
hypercellular glomeruli, granular deposits, humps
Corynebacterium diphtheriae pharyngitis?
gram positive, club shaped
grey film (made by ADP-ribosylation of mucosal cells), bleeding if you try to pull it off
bull neck: massive LAD
Treatment: Antiserum to toxin, vaccine, erythromycin, clindamycin
Bordatella Pertussis?
macrolides to pt and family.
respiratory isolation within the first 5 days.
Retropharyngeal abscess?
muffled voice, stridor, refusing to turn head to one side
I&D, ceftriaxone, ampicillin.
Peritonsilar abscess?
post strep, uvula deviation
I&D, ampicillin
