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Acute PNP > Infectious Disease Part 3 > Flashcards

Infectious Disease Part 3 Flashcards

1
Q

Causes:
Sinusitis, mastoiditis, and otitis media, abscesses, emboli from congenital heart disease, AVM, pulmonary infection, skin infection, endocarditis, abdominal and pelvic infections

A

Brain abscess

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2
Q

Anaerobic cocci & gram-negative and gram-positive anaerobic bacilli

A

Common organisms for brain abscess

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3
Q

Staphylococcus aureus, Enterobacter, Streptococcus species

A

Anaerobic cocci & gram-negative and gram-positive anaerobic bacilli for brain abscess

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4
Q

In order of occurrence:
Headache-> mental status changes-> focal neurologic deficits-> fever-> seizures-> nausea and vomiting -> nuchal rigidity-> papilledema

A

Brain abscess

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5
Q

Facial weakness, headache, fever, vomiting, dysphagia, and hemiparesis

A

Brainstem lesion

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6
Q

Diagnostic evaluation for brain abscess

A

MRI/CT of the head
CBC with diff, blood culture, ESR, CRP, specific serology
Surgical aspiration or stereotactic CT for culture

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7
Q

Brain abscess treatment

A

Vancomycin, cefotaxime, metronidazole
Control of ICP
Surgical resection, aspiration, or drainage (esp if more than one area is involved)
Consult with neurosurgeon and ID specialists

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8
Q

Inflammation of membranes lining the brain and spinal cord

A

Meningitis

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9
Q

When is the peak incidence for meningitis?

A

3-12 months

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10
Q

When is the peak season for meningitis?

A

Late fall and early winter

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11
Q

Males > Females
Urban areas, crowded living conditions, poverty
Underlying chronic illness/immunosuppression, asplenia
Routes of CNS invasion
Congenital or acquired defects in skull or spinal cord

A

Risk factors for meningitis

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12
Q

Age-associated pathogens for meningitis

<1 mo

A

Group B streptococcus
E. coli
Listeria monocytogemes
Klebisella species

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13
Q

Age-associated pathogens for meningitis

1-2 mo

A 
Group B strep
E. coli
Strep. pneumoniae
H. infleunzae type B
N. meningitidis
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14
Q

Age-associated pathogens for meningitis

2 mo - 5 yr

A

Strep. pneumoniae
H. influenza type B
N. meningitidis

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15
Q

Age-associated pathogens for meningitis

5 yr and up

A

N. meningitis

Strep. pneumoniae

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16
Q

WBC in CSF will be _____ for bacterial meningitis

Increased or Decreased or Normal

A

Increased

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17
Q

Protein in CSF will be _____ for bacterial meningitis

Increased or Decreased or Normal

A

Increased

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18
Q

Glucose in CSF will be _____ for bacterial meningitis

Increased or Decreased or Normal

A

Decreased

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19
Q

Pressure in CSF will be _____ for bacterial meningitis

Increased or Decreased or Normal

A

Increased

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20
Q

Lactate in CSF will be _____ for bacterial meningitis

Increased or Decreased or Normal

A

Increased

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21
Q

Fever/chills, anorexia/poor feeding, myalgias/arthralgias, URI symptoms, tachycardia/hypotension, petechiae, purpura, erythematous macular rash

Severe throbbing headache, photophobia
Nuchal rigidity
Kernig sign
Brudzinski sign

A

Bacterial Meningitis

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22
Q

Passive extension of the knee in supine position causing back pain and resistance

A

Kernig sign

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23
Q

Passive flexion of the neck resulting in involuntary flexion of knees and hips

A

Brudzinski sign

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24
Q

When there is a traumatic/bloody spinal tap, how do you calculate the predicted WBC count?

A

CSF RBC x (serum WBC/serum RBC)

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25
Q

What is the safest interpretation of traumatic spinal tap for WBC?

A

Count the total number of WBCs and disregard RBC count

If there are more than normal WBC for age, then treat

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26
Q

If a child is too unstable for lumbar puncture, should antibiotics be on hold or started prior to obtaining LP cultures?

A

Start

DO NOT WAIT TO OBTAIN CULTURES PRIOR TO STARTING ANTIBIOTIC THERAPY IF CHILD IS UNSTABLE

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27
Q

Treatment for basilar skull fracture antimicrobials

A

Vancomycin + 3rd generation cephalosporin (cefdinir, cefixime, cefotaxime, ceftazidime)

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28
Q

Antimicrobials for recent neurosurgery or ventricular shunt infection

A

Vancomycin + Cefepime
Vancomycin + Ceftazidime
Vancomycin + Meropenem

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29
Q

What is the mortality rate for bacterial meningitis?

A

5-15%

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30
Q

Long-term neurodevelopmental sequelae of bacterial meningitis

A

Hearing loss, neurologic impairment, seizures, visual impairment, delay in language acquisition, chronic residual hydrocephalus

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31
Q

Most common cause of meningitis in children

A

Viral meningitis

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32
Q

When is the peak incidence of viral meningitis?

A

Late summer/early fall

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33
Q

Glucose in CSF will be _____ for viral meningitis

Increased, Decreased, Normal

A

Normal or Slightly Decreased

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34
Q

Protein in CSF will be _____ for viral meningitis

Increased, Decreased, or Normal

A

Slightly Increased

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35
Q

WBC in CSF will be _____ for viral meningitis

Increased, Decreased, or Normal

A

Mildly increased with neutrophil predominance (early) and lymphocyte (later)

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36
Q

What is the gold standard for HSV meningitis diagnosis?

A

CSF PCR for HSV

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37
Q 
Acute-onset fever/lethargy/irritability
Increased ICP, autoregulation
Anorexia/vomiting
Hyper/hyporeflexia
Bulging fontanel, increased ICP
Seizures
Skin rash (varicella, enteroviruses)
Diarrhea (enteroviruses)
URI (enteroviruses)
Not as "toxic" appearing
A

Viral Meningitis

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38
Q

Treatment for viral meningitis

A

Usually self-limiting and resolves in 7-10 days
Control of seizures
Specific antiviral therapy if HSV suspected

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39
Q

Ataxia, focal neurologic signs, acute encephalopathy

A

High suspicion for viral meningitis

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40
Q

If HSV meningitis is suspected, which medication should be promptly initiated?

A

Acyclovir IV

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41
Q

Inflammatory process of brain parenchyma which usually is caused by infectious process or hyperimmune reaction

A

Encephalitis

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42
Q

Can occur with bacterial meningitis with organisms, such as Borrelia burgdorferi, Bartonella, and Treponema pallidum

A

Encephalitis

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43
Q

Caused by cryptococcus and others; concern for immunocompromised children

A

Fungal encephalitis

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44
Q

Rabies virus, herpes simplex virus, and other etiologies can trigger this

A

Viral encephalitis

45
Q

Fever, altered consciousness, seizures, focal neurologic signs
Neonates/infants present with shock, lethargy, irritability, poor feeding, seizures, apnea

A

Encephalitis

46
Q

CSF is usually ___ and ____ for LP of encephalitis

A

Clear and colorless

47
Q

Opening pressures may be ____ or ______ for LP for encephalitis

A

Normal or elevated

48
Q

What is the typical mononuclear pleocytosis in LP for encephalitis?

A

> 5 WBC/uL

49
Q

Protein and Glucose are ____ in LP for encephalitis

Increased, Decreased, or Normal

A

Normal

50
Q

What is a normal protein in a normal CSF?

A

15-45 mg/dL CSF

51
Q

What is normal blood/RBC in normal CSF?

A

NONE

52
Q

What is normal glucose in a normal CSF?

A

50-75 mg/dl CSF

53
Q

What is normal WBC for neonates in normal CSF?

A

0-30 cells/uL

54
Q

What is normal WBC for 1-5-year-old in normal CSF?

A

0-20 cells/uL

55
Q

What is normal WBC in 6-18 year old in normal CSF?

A

0-10 cells/uL

56
Q

What is normal WBC in an adult in normal CSF?

A

0-5 cells/uL

57
Q

Temporary placement of a needle in the subarachnoid space of spinal column to obtain CSF

A

Lumbar Puncture

58
Q

What does cloudy CSF appearance indicate?

A

Increased WBC or protein

59
Q

What does red-tinged CSF appearance indicate?

A

Presence of blood

60
Q

What do neutrophils mean in CSF?

A

Bacterial meningitis/cerebral abscess

61
Q

What do mononuclear lymphocytes mean in CSF?

A

Viral meningitis/encepahlitis

62
Q

What causes protein to be present in CSF?

A

meningitis, encephalitis, and myelitis

63
Q

When does glucose decrease in CSF?

A

When bacteria, inflammatory, or tumor cells are present

64
Q

If CSF blood glucose level is less than 60% of blood glucose level, what does that indicate?

A

Neoplasm or meningitis

65
Q

What are contraindications for LP?

A

Increased ICP (herniation)
Patient receiving anticoagulation (epidural hematoma)
Patients with an infection near LP site

66
Q

Mild: Fever; headache; muscle aches; eye pain; itchy rash on neck, body, arms, or legs; lymphadenopathy, weakness, anorexia, nausea and vomiting

A

West Nile Virus

67
Q

Severe: High fever, body and muscle weakness; itchy rash on neck, body, arms, and legs; GI upset; CNS symptoms

A

West Nile Virus

68
Q

IgM antibody capture enzyme-linked immunosorbent assay (MAC_ELISA) of serum or CSF within 8 days of onset

A

West Nile Virus diagnosis

69
Q

West Nile Virus Prevention

A

Stay indoors during most active times (between dust and dawn)
Apply insect repellant
Remove standing water
Use screens on doors and windows
Report dead birds to local health department

70
Q

Borrelia bugdorferi spirochete organism causes what?

A

Lyme Disease

71
Q

Where is the prevalence highest for Lyme disease?

A

Northeast, mid-Atlantic, Wisconsin, Minnesota, Northern California

72
Q

ELISA from blood sample

IgG and IgM Western blot if symptoms > 30 days

A

Lyme disease

73
Q

What is treatment for uncomplicated lyme disease?

A

Doxycycline

74
Q

What is the treatment for complicated lyme disease?

A

IV ceftriaxone or penicillin

75
Q

Rickettsia rickettsii (obligate intracellular gram-negative) caused what?

A

Rocky Mountain Spotted Fever

76
Q

Where is the prevalence for rocky mountain spotted fever?

A

Everywhere but Maine/Vermont

77
Q

Fever, severe headache, myalgia, characteristic rash (starts on wrists, ankles, palms, and soles and then progresses to trunk), thrombocytopenia

A

rocky mountain spotted fever

78
Q

RMSF serologic assay

A

diagnosis of rocky mountain spotted fever

79
Q

Treatment for rocky mountain spotted fever

A

Doxycycline until afebrile for 72 hours

80
Q

Should treatment be delayed for serologic testing for rocky mountain spotted fever?

A

NO

81
Q

Where is dengue fever typically present?

A

Tropics and subtropics

Puerto Rico, Virgin Islands, and American Samoa

82
Q

Acute phase–nonspecific febrile phase, retro-orbital headache pain, myalgias, maculopapular rash

Critical phase–defervescence within 2 to 7 days after onset; some progress to severe case (vomiting, mucosal bleeding, leukopenia, thrombocytopenia, elevated hematocrit, difficulty breathing, shock, DIC, pleural effusion, and ascites)

A

Dengue Fever

83
Q

Leukopenia with thrombocytopenia and elevated hematocrit

A

Dengue Fever

84
Q

ELSIA for anti-dengue IgM and IgG antibodies

A

Dengue Fever

85
Q

What medications do patients with dengue fever avoid>

A

Aspiring and NSAIDs

86
Q

Where is typhoid most common?

A

Tropics, subcontinental India, Southeast Asia, and southern Africa

87
Q

How is typhoid fever acquired?

A

Ingestion

88
Q

Fever, headache, lethargy, malaise, abdominal pain with diarrhea or constipation, hepatosplenomegaly, stupor, rose spots (blanching erythematous macules), confusion, delirium, convulsion, obtundation

A

Typhoid Fever

89
Q

What is the most life-threatening complication of thyroid fever?

A

Intestinal perforation

90
Q

What is the best source for culture for typhoid?

A

Bone marrow

91
Q

Blood culture in large volumes (1-15 mL)

Normal-to-low WBC count, elevated LFTs

A

Typhoid

92
Q

Treatment for typhoid

A

Ceftriaxone or ciprofloxacin

Ampicillin

93
Q

How long can fevers persist with appropriate therapies with typhoid?

A

up to 7 days

94
Q

Vi capsular polysaccharide (Typhim Vi) vaccine can be given to what age groups? How soon should be given prior to exposure?

A

Older than 2 years

At least 2 weeks prior to possible exposure

95
Q

Ty21a (Vivotif) vaccine is what kind of vaccine?

A

Live-attenuated oral vaccine

96
Q

How old can you be to receive Ty21a?

A

Older than 6 years

97
Q

How many doses of ty21a?

A

4 doses; taken every other day

98
Q

Where is Japanese encephalitis present?

A

Eastern Asia, subcontinental India, and western Pacific

99
Q

Leading cause of vaccine-preventable encephalitis

A

Japanese encephalitis

100
Q

Vast majority are asymptomatic
Incubation period of 5-15 days

headache, vomiting, fever, altered mental status, weakness, parkinsonism, seizures progressing to paralysis

mild leukocytosis, mild anemia, hyponatremia

A

Japanese encephalitis

101
Q

Normal glucose, elevated protein, leukocytosis with lymphocyte predominance

A

CSF Japanese encephalitis

102
Q

Anti-JEV IgM antibodies

A

Japanese encephalitis

103
Q

Mosquito-transmitted Plasmodium parasitic infection

A

Malaria

104
Q

What are the high-risk travel places?

A

Sub-Saharan Africa, Vanuatu, Papua New Guinea, Solomon Islands, Indian subcontinent

105
Q

Paroxysmal fever, due to synchronicity of reproductive cycles, is characteristic sign

Chills, headache, malaise, cough
Anemia with thrombocytopenia
Proteinuria and hemoglobinuria in times of fever or presence of rapid hemolysis

A

Malaria

106
Q

Hypotension, renal dysfunction, metabolic acidosis, hypoglycemia

A

Severe Malaria

107
Q

Artesunate monotherapy or quinidine in combination with doxycycline, tetracycline, or clindamycin

A

Severe Malaria

108
Q

Chloroquine or hydroxychloroquine

A

Mild Malaria

109
Q

Avoid doxycycline and tetracycline in those ___ years of age

A

<8

Acute PNP (8 decks)

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