infectious disease - pseudomonas/viral Flashcards
Pseudomonas aeruginosa
- A major opportunistic pathogen and one of the most common hospital and nursing home-acquired pathogens
- Children also at risk
- Spread by contact
Pseudomonas aeruginosa: clinical manifestations
- Acute inflammatory response
- Vascular thrombosis and hemorrhagic necrosis in lungs and skin
- Causes infections of the respiratory tract (pneumonia), - CNS< skin, and other parts of the body
Pseudomonas aeruginosa: diagnosis, treatment and complications
- Diagnosis: isolation of blood or sputum culture
- Treatment: antibiotic resistance (sometimes multiple meds)
- Complications: Often causes respiratory failure after mucus plugging
Bacteremia:
- infection where 90% of cases in patients with underlying conditions (comorbidities - cancer, diabetes, renal failure, congestive heart failure, immune system deficiencies or posttransplant)
- Cause of serious, life-threatening bloodstream infections in clients with neutropenia
Bacteremia: Clinical manifestations
- Fever,
- tachypnea/tachycardia
- Hypotension
- Delirium
- Can lead to renal failure, acute respiratory distress syndrome and death
Meningitis: definition
infection of the CNS
Are like the other forms of bacterial meningitis and brain abscess
Meningitis: clinical manifestations
- Fever headache
- Stiff neck
- Nausea- Usually comes on within 24-48 hours of symptoms
- Confusion
Meningitis Diagnosis and treatment
- Diagnosis: blood, CSF/spinal tap, labs
- Treatment: antibiotics, respiratory assistance as needed
Pseudomonas Disease
- disease of the skin and mucous membrane
- Often occurs after surgery, burns, trauma, and pressure ulcers
Pseudomonas Disease Clinical Manifestations
- Characteristic fruity odor (sweet, grape like odor)
- Blue green exudate that forms a crust on wounds
- Fever
- Disorientation
- Hypotension
- Oliguria (low urine output)
- Ileus
- Leukopenia
Pseudomonas disease Diagnosis and treatment
- Diagnosis: culture of skin biopsy
- Treatment: surgical debridement, antibiotics
P. aeruginosa Bone and joint
- Infections of bones and joints from hematogenous spread
- Most common cause of osteochondritis of the foot following a puncture wound
P. aeruginosa Bone and joint: clinical manifestations
- Erthema (redness) surrounding the surgical site,
- joint pain
- Fever
- Edema
- Drainage
- Necrosis at surgical site
- Tenderness to deep palpation (Is the pain just the incision or is it deep?)
- Cellulitis
P. aeruginosa: diagnosis and treatment
- Diagnosis: may take weeks no fever or other systemic signs (blood , CFS, urine, exudates or tissue lab tests)
- Treatment: antibiotics, surgery debridement
*if bandage is getting soaked/discolored = possible sign
Otitis/corneal infections:
- Swimmer ear-otitis: benign or malignant (Dizzy, change in hearing, titinous, change in pitch)
- Corneal infections: keratitis or corneal ulcers (Thickening or cornea)
Otitis/corneal infections: Diagnosis and treatment
- Diagnosis: Requires isolation of pseudomonas organism in blood, spinal fluid, urine, exudate or sputum culture
- Treatment: antibiotics, Surgical, pulmonary therapy, respiratory assistance, Preventive cleaning an proper hygiene
Viral blood borne pathogens
Blood borne viral pathogens:
- Hepatitis B - HBV: Direct or indirect
- Hepatitis C - HCV: Needle stick
- Human immunodeficiency virus HIV: Sexual transmission, needle sticks
Herpes Virus
- The term herpes is derived from the Greek word
-Herpein which means to creep - The known Human herpesviruses are divided by genomic and biologic behavior into eight types
- All have similar morphological characteristics
- All remain in body through life of host
- Severe or fatal illness may occur in infants and immunocompromised
Herpes type 1 and type 2
- HSV-1: usually responsible for cold sores
- HSV-2 most commonly STD in the world - genital herpes
Simplex herpes type 1 and type 2 clinical manifestations
- Mouth, oral cavity, throat moist ulcers = HSV-1
- Genital herpes or ulcers HSV-2
Herpes type 1 & 2 diagnosis and treatment
- Diagnosis: culture, appearance
- Treatment: acyclovir, famcoclovir, valcyclovir - HSV-2, Topical ointments, Counseling, Protection
Type 3 herpes
- chicken pox or shingles
- Transmitted by airborne droplets or contact with lesions
Herpes type 3 clinical manifestations
- Dew drop on a rose petal
- Macules→ papules → vesicles → crusting
- Unilateral pattern in adults that follows nerve dermatome pattern
Herpes type 3: diagnosis and treatment
- Diagnosis: Pattern, Lab test
- Treatment: oral antihistamines, topical lotions (calamine), antiviral for high risk (valacyclovir, famciclovir, or acyclovir) , Vaccine
Herpes type 4:
- Infectious mononucleosis
- Primarily affect young adults and children
- Transmission contact with oral secretions, blood, or transplanted organs infected with the virus
- Incubation is 4-6 weeks
Herpes type 4: clinical manifestations
- Fever, sore throat, and tender cervical lymphadenopathy
- Headache, malaise and abdominal pain (from splenic enlargement or hepatitis)
Herpes type 4: diagnosis and treatment
- Diagnosis: Physical exam, labs, monospot blood test
- Treatment: rest, supportive care, restrict athletic participation due to liver and spleen involvement
Herpes type 5:
- 1% born with it
- ⅔ over 35 acquire it and are symptomatic
- Transmitted by human contact with infected secretions
- Acquires- transplanted organs or transfusion
- CMV disease (infected with symptoms)
- CMV infection (lab test +)
Herpes Type 5: clinical manifestations
Presents as an infectious mononucleosis like illness
herpes type 5 complications, diagnosis and treatment
- Complications: diffuse interstitial pneumonitis, GI ulcerations and bleeding, vision loss, transplant failure
- Diagnosis: Culture (blood sputum, urine) Real time PCR
- Treatment: antivirals: ganciclovir and valganciclovir
Herpes type 6:
- A B-cell lymphotropic virus that is the principle cause of exanthema subitum (roseola infantum or 6th disease)
- Common in children with 90% infected by age 2
Herpes type 6, 7, 8: clinical manifestations
- 3-5 days of high fever followed by macular rash on the neck and trunk
- Children more commonly develop a fever, runny, nose, and fussiness
- Adults associated with HIV, transplant rejection, lymphoma
- Exacerbations in MS( also type)
Type 7 Herpes
T-cell lymphotropic virus similar to type 6, associated with recurrence of roseola
*same clinical manifestations as
herpes type 8
Associated with Kaposi sarcoma in AIDS and other immune-related disease
Influenza
- influenza virus A or B
- Transmission by inhalation of aerosolized virus or direct contact
- 50% mortality
Influenza clinical manifestations
- High fever, chills, malaise, muscular aching, headache
- Sore throat, congestion and nonproductive cough
- Fever lasts about 1-7 day but usually only 3-5 days
Influenza diagnosis, complications, and treatment
- Complications: bacterial pneumonia 5-10 days after onset
- Diagnosis: culture
- Treatment: antivirals for high risk, analgesics, cough medications (don’t want to suppress the cough)
- Vaccinations
- Droplet precautions
RSV
- Most common lower respiratory tract infections in children
- Causes annual outbreak or pneumonia, bronchiolitis and tracheobronchitis in infants and very young children
- The main cause of hospitalization for respiratory illness in young children
- Usually shed the virus for 3-8 days but young infants may shed the virus for as long as 3-4 weeks
- Spread through large droplet or direct contact with fluids
RSV diagnosis and treatment
- Diagnosis: Viral antigen identification of nasal washing using ELISA or immunofluorescent assay
- Treatment: Hydration, humidification of inspired air and ventilatory support as needed antivirals: ribavirin
COVID-19
- Contagious
- Transmission: airborne, droplets, saliva, stays on surfaces
- Incubation period is 7-14 days
- Susceptible populations = everyone but people with comorbidities may get more severe cases
COVID-19 clinical manifestations
- Some may be asymptomatic
- Lost of smell and taste
- Fever
- Muscle aches
- Fatigue
- SOB
- Dry cough
- Sore throat
- Nausea, vomiting, and/or diarrhea
COVID-19: Diagnosis, treatment
Diagnosis: PCR tests, antigen tests, antibody tests
Treatment:
- OTC: acetaminophen, ibuprofen
- Antivirals:
- Nirmatrelvir with ritonavir 12+ within 5 days of symptoms
- Remdesivir (IV) Adults and children within 7 days of symptoms
- Molnupiravir - oral Adults within 5 days of symptoms
- Convalescent plasma for immunocompromised that may not be able to tolerate the vaccine
- Physical therapy for reconditioning
Lymes disease
- An infectious multisystemic disorder caused by the tick-borne spirochete Borrelia burgdorferi (bacteria)
- Unusual type of arthritis and bull’s-eye rash
- Most prevalent vector borne infection in the USA
Lymes disease: clinical manifestations stage 1
- The early, localized stage, usually occurs within days following a tick bite resolves within an average of 4 weeks
- Flu Like symptoms are suggestive of early dissemination
Lymes disease: clinical manifestations stage 2
- Disseminated infection
- Occurs within days to weeks after the spirochete spreads particularly to the nervous system heart and joints
- Neurological symptoms in 15% of all cases
- Most commonly manifested as aseptic meningitis with mild headache, stiff neck and difficulty with mentation
- Cranial Neuropathies, particularly bell palsy, and radiculopathies
- 50% develop lyme arthritis in large joint
Lymes disease: clinical manifestation stage 3
- Late persistent infection, may become apparent weeks to months after initial infection
- Intermittent arthritis associated with marked pain and swelling especially in large joints (moves from joint to joint)
- 5% of untreated individuals, chronic neurological symptoms
Lymes disease diagnosis
- Test the blood for antibodies to the spirochete
- This is done with a sensitive enzyme immunoassay or IFA
- If this test is positive or equivocal, a western immunoblot should be performed to confirm the diagnosis
- Lyme arthritis does not affect the joint bilaterally
Monkey pox- clinical manifestations
- fever,
- an extensive characteristic rash and usually swollen lymph nodes.
Monkey pox - incubation period
- The incubation period of monkeypox can range from 5 to 21 days. The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and an intense asthenia (lack of energy). The febrile stage is followed by the skin eruption stage, lasting for 2 to 4 weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts.
- The proportion of patients who die has varied between 0 and 11% in documented cases and has been higher among young children.
Meningitis clinical manifestations and treatment
- Increase intracranial pressure headache
- Brain edema
- Altered mental status
- Fever,
- nausea/vomiting
- Stiff neck
- treatment: antibiotics IV
