Infectious Diseases Flashcards
Patients with measles are infectious within this period
3 days before up to 4-6 days after the onset of rash
measles virus is spead thru?
respiratory tract or conjunctivae following contact with large droplets or small-droplet aerosols in which the virus is suspended
Warthin-Finkeldey giant cells are pathognomonic of what diease?
Measles
measles virus come from what family and genus
Paramyxoviridae — Morbilivirus
represent the enanthem and the pathognomonic sign of measles
Koplik spots
— discrete red lesions with bluish white spots in the center on the inner aspects of the cheeks at the level of the premolar
of the major symptoms of measles, which among them lasts the longest?
cough
Measles is characterized by these symptoms, give 6
high fever
enanthem — koplik spots
cough
coryza
conjunctivitis
prominent exanthem — red maculopapular eruption which starts on the forehead downward
Serologic confirmation of measles
IgM antibody in serum
most common cause of death in measles
Pneumonia
most common complication of measles
Acute otitis media
this condition is a postinfectious, immunologically mediated process seen in Measles
Encephalitis
— occurs in 20% among patients with malignancy
chronic complication of measles with a delayed onset and an outcome that is nearly always fatal
Subacute sclerosing panencephalitis (SSPE)
Clinical manifestations of SSPE begin insidiously ___ yr after primary measles infection
7-13 years
this is given and indicated for all patients with measles
Vitamin A Therapy once daily x 2 days
200,000 IU - children >12 mos
100,000 IU - children 6-11 mos
50,000 IU - children <6 mos
if with s/sx of Vitamin A deficiency, 3rd dose of Vitamin A after 2-4 weeks from the 2nd dose
most effective and safe prevention strategy in measles
Vaccination
major clinical significance of Rubella especially when mother is inflicted
Congenital Rubella Syndrome
period of highest communicability in Rubella
5 days before to 6 days after the appearance of the rash
most important risk factor for severe congenital defects in pregnant mothers affected with Rubella
stage of gestation at the time of infection
— 90% before 11 wks
— 33% at 11-12 wks
— 24% at 15-16 wks
Defects occuring after 16 wks of gestation are uncommon
most distinctive feature of congenital rubella
chronicity
These are tiny rose colored lesions in the oropharynx or petechial hemorrhages on the soft palate during Rubella infection
Forchheimer spots
most serious complication of postnatal rubella
Encephalitis
single most common finding among infants with Congenital Rubella Syndrome
Nerve deafness
how many days is the isolation for postnatal rubella infection?
isolation for 7 days after the onset of rash
late onset manifestations of CRS
Progressing Rubella Panencephalitis
DM (20%)
Thyroid dysfunction (5%)
Glaucoma and visual abnormalities
period of maximum infectiousness in Mumps
1-2 days before to 5 days after onset of parotid swelling
Isolation period for mumps
5 days after onset of parotitis
most common complication of mumps
Meningitis with/without encephalitis
Gonadal (orchitis, oophoritis) involvement
Hand-foot-and-Mouth Disease is frequently caused by
Coxsackievirus A16
this is characterized by sudden onset of fever, sore throat, dysphagia and painful lesions in the posterior pharynx — anterior tonsillar pillars, soft palate, uvula, tonsils, posterior pharyngeal wall, posterior buccal surface
Herpangina
this is characterized by sudden onset of fever, sore throat, dysphagia and painful lesions in the posterior pharynx — anterior tonsillar pillars, soft palate, uvula, tonsils, posterior pharyngeal wall, posterior buccal surface
Herpangina
This is caused by coxsackie B viruses 3,5,1,2 and echoviruses 1,6 which is an epidemic or sporadic illness characterized by paroxysmal thoracic pain due to myositis involving chest and abdominal wall muscles and possibly pleural inflammation
Pleurodynia (Bornholm disease)
Most common cause of viral meningitis in mumps-immunized populations
Enteroviruses
etiologic agent in erythema infectiosum or fifth disease
Parvovirus B19 (B19V)
primary target of B19V infection
erythroid cell line
virus that can cause aplastic crisis
Parvovirus B19
this rash is well established in dermatologic literature as distinctly associated with B19V infection
— present as fever, pruritus, painful edema and erythema localized to the distal extremities in a distinct gloves-and-socks distribution, followed by acral petechiae and oral lesions
Papular-purpuric gloves-and-socks syndrome (PPGSS)
hallmarks of common HSV infections
skin vesicles
shallow ulcers
HSV infection of fingers or toes
Herpes whitlow
course of classic primary genital herpes from onset to complete healing
2-3 weeks
most common cause of recurrent aseptic meningitis (Mollaret meningitis)
HSV
reactivation of latent infection of Varicella causes this condition
Herpes zoster (shingles)
Varicella predisposes to these bacterial infections
Group A streptococcus and
Staphyloccocus aureus infections
Persons with varicella may be contagious up to when?
24-48 hr before the rash and until vesicles are crusted, usually 3-7 days after onset of rash
characteristic skin lesion of varicella
simultaneous presence of lesions in various stages of evolution (macules/papuples/vesicles)
etiology of varicelliform rash after VZV vaccination
rash within 1-2 weeks -> wild type VZV
rash after 14-42 days -> wild type or vaccine strains
disease that occurs in a person vaccinated more than 42 days before rash onset and is caused by wild-type VZV
Breakthrough varicella
Newborns who should be given with VZIG as soon as possible
newborns whose mothers develop varicella during the period of 5 days before to 2 days after delivery
Well-describe neurologic complications of varicella
Encephalitis
Acute cerebellar ataxia
only antiviral drug for treatment of varicella
Acyclovir
population who are at increased risk for moderate to severe varicella
- nonpregnant individuals older than 12 yo and individual older than 12 mo with chronic cutaneous or pulmonary disorder
- individuals receiving short-term, intermittent, or aerosolized corticosteroid therapy
- individuals receiving long-term salicylate therapy
- secondary cases among household contacts
what is TORCH?
Toxoplasmosis
Other infections: Syphilis, Varicella-Zoster Virus, Parvovirus, Human Immunodefiency Virus Infection
Rubella virus
Cytomegalovirus
Herpes simplex virus
most common long-term sequelae associated with congenital CMV infection
hearing loss
responsible for the majority of cases of roseola infantum/6th disease
Human herpesvirus 6B (HHV-6B)
95% of children being infected with HHV-6 occur at what age
2 years of age
self-limited disease of infancy and early childhood characterized by high fever then after 72 hours, appearance of faint pink or rose-colored nonpruritic 2-3 mm morbilliform rash on the trunk
Roseola infantum (6th disease/exanthem subitum)
ulcers at the uvulopalatoglossal junction reported in infants with roseola
Nagayama spots
gold standard method to document active viral replication in HHV-6 or HHV-7 infection
Viral culture
most common complication of roseola
Convulsions
primary human pathogens causing seasonal epidemics
Influenza A and B
when initiated early in the course of uncomplicated influenza illness, antiviral agents can ____
reduce the duration of symptoms and the likelihood of complication
clinical benefit is greatest when antiviral treatment is administered early, within ___ hr of influenza illness onset
48
recommended treatment course of uncomplicated influenza
oral oseltamivir x 1 dose or
inhaled zanamivir 2x a day for 5 days or
IV permivir or oral baloxavir x 1 dose
Who are the children and adolescents at risk for influenza complications for whom antiviral treatment is recommended?
- children younger than 2 yo
- persons with chronic pulmonary, cardiovascular, renal, hepatic, hematologic and metabolic disorders or neurologic and neurodevelopmental conditions
- persons with immunosuppression
- adolescents who are pregnant, or postpartum (within 2 wks after delivery)
- persons younger than 19 yO who are receiving long-term aspirin or salicylate-containing medications therapy
- persons who are extremely obese (BMI >40)
- Hospitalized patients at high risk for influenza complications
major cause of bronchiolitis and viral pneumonia in children younger than 1 yo and the most important respiratory tract pathogen of early childhood
Respiratory syncytial virus (RSV)
these symptoms are present in about 50-60% of children with rotavirus infection
fever, vomiting, frequent watery stools
Dengue IgM disappear after ___ weeks
6-12 weeks
Characteristic signs of increased vascular permeability in Dengue Fever
Thickening of the gallbladder and presence of perivesicular fluid
warning signs of dengue
- abdominal pain or tenderness
- persistent vomiting
- clinical fluid accumulation
- mucosal bleed
- lethargy, restlessness
- liver enlargement > 2 cm
- laboratory findings: increase in hematocrit concurrent with rapid decrease in platelet count
pathologic hallmark of rabies based on histology
Negri body
— clumped viral nucleocapsids that create cytoplasmic inclusions
cardinal signs of rabies
Hydrophobia and aerophobia
components of rabies PEP
1st component - cleanse the wound thoroughly
2nd component - passive immunization with RIG
3rd component - immunization with inactivated vaccine
Rabies post exposure prophylaxis with inactivated vaccine schedule
day 0, 3, 7 and 14, 1 mL given via IM in the deltoid or anterolateral thigh
primary route of HIV infection in the pediatric population (<15 yr) is thru ____
vertical transmission
HIV infected infants have detectable HIV-1 in peripheral blood by what age
4 months
this value in HIV infected children younger than 1 yr of age is indicative of severe CD4 depletion and is comparable to <200 CD4 cells/uL in adults
750 CD4 cells/uL
most common serious infections in HIV-infected children
Bacteremia
Sepsis
Bacterial Pneumonia
most common opportunistic infection in the pediatric population with HIV infection
Pneumocystis jiroveci pneumonia
first line therapy for Pneumocystic pneumonia
TMP-SMX (15-20 mkday) q6 IV x 21 days
most common fungal infection seen in HIV-infected children
Oral candidiasis
most common chronic lower respiratory tract abnormality for HIV infected children
Lymphocytic interstitial pneumonia
most common manifestation of pediatric renal disease in HIV patients
nephrotic syndrome
most commonly reported neoplasms among HIV-infected children
Non-Hodgkin lymphoma
Primary CNS lymphoma
Leiomyosarcoma
Most uninfected infants without ongoing exposure lose maternal HIV antibody between what age and they are known as seroverters
6 and 18 months of age
preferred test to diagnose HIV-1 subtype B infection in infants and children younger than 24 months of age
HIV DNA PCR
preferred test to identify non-B subtype HIV-1 infections
HIV RNA PCR
Definitive exclusion of HIV infection in nonbreastfed infants
2 or more negative virologic tests, one obtained at age >1 mo and one at age >4 mo or 2 negative HIV antibody test from separate specimens obtained at age >6 months
What is virologic failure in HIV treatment
repeated plasma viral load >200 copies/mL after 6 months of therapy
what vaccines are contraindicated in HIV+ children
Live oral polio vaccine
BCG vaccine
these medications facilitate Candida colonization and overgrowth among neonates and infants
Histamine-2 blockers
Corticosteroids
Broad-spectrum antibiotics
mainstay of therapy for systemic candidiasis in neonates and infants
Amphotericin B deoxycholate
most commonly isolated species in oral thrush seen in neonates
Candida albicans
most commonly prescribed antifungal agent for oral thrush when indicated/warranted
Topical nystatin
most common cause of invasive candidiasis among immunocompromised pediatric patients and is associated with higher rates of mortality and end-organ involvement
Candida albicans
primary immunodeficiencies associated with an increased risk of invasive Candida infections
Severe congenital neutropenia
CARD 9 deficiency
Chronic granulomatous disease (CGD)
Leukocyte adhesion deficiency type 1 (LAD-1)
Entamoeba infection is usually acquired through ???
ingestion of parasite cysts
this is a significant parasitic pathogen in children with malnutrition and immunodeficiencies such as IgA deficiency, common variable deficiency and X-linked hypogammaglobulineamia
Giardia duodenalis
first line treatment of trichomoniasis
metronidazole or tinidazole
most common nonviral sexually transmitted infection globally
trichomoniasis
presence of vaginal trichomoniasis in a younger child should raise this possibility
child abuse
Fever pattern for P. vivax and P. ovale, P. malariae
every 48 hours for P. vivax and ovale
every 72 hours for P. malariae
this is congruent with the rupture of schizonts
most severe form of malaria is caused by this species
P. falciparum
type of erythrocytes infected by the plasmodium species
falciparum - both immature and mature erythrocytes
ovale and vivax - immature erythrocytes
malariae - mature erythrocytes
mildest and most chronic of all malaria infections
P. malariae
this rare complication of P. malariae infection is not observed with any other human malaria species
Nephrotic syndrome
treatment for p. falciparum
Quinidine gluconate or Quinine sulfate + Doxycycline/Clindamycin/Tetracycline
this medication warrants for checking of G6PD deficiency before prescribing this medication in malaria treatment
Primaquine
toxoplasmosis is acquired thru?
orally by eating undercooked or raw meat that contains cysts or food or other material contaminated with oocysts from acutely infected cats
most prevalent human helminthiasis in the world
Ascariasis
treatment of gastrointestinal ascariasis
Albendazole 400 mg x 1 dose
Mebendazole 500 mg x 1 dose or 100 mg 2x/day x 3 days
Ivermectin (150-200 ug/kg) PO x 1 dose
treatment of intestinal or biliary obstruction caused by Ascaris lumbricoides
Piperazine citrate (75 mkday) x 2 days
cause of pinworm infection
enterobius vermicularis
prevalence of pinworm infection is highest in this age group
5-14 yr old
most common complaints in enterobiasis
itching and restless sleep secondary to nocturnal perianal or perineal pruritus
treatment of choice for enterobiasis
Albendazole 400 mg x 1 dose, repeat after 2 weeks
or
Mebendazole 100 mg x 1 dose, repeat after 2 weeks
or
Pyrantel pamoate (11 mkdose) 3x a day, repeat after 2 weeks
Examples of endogenous pyrogens
IL-1, IL-6, TNF-alpha, IFN-Beta, IFN-Gamma, PGE2
drugs known to cause fever
Vancomycin
Amphotericin B
Allopurinol
definition of FUO
temp of 38 C documented by a healthcare provider and for which the cause could not be identified after at least 8 days of evaluation
staphylococci species which is coagulase positive
Staphylococcus aureus
most common cause of pyogenic infection of the skin and soft tissues
Staphylococcus aureus
these conditions increase the risk for staphylococcal infections
Congenital defects in chemotaxis — Job, Chediak-Higashi, Wiskott-Aldrich Syndromes
and
Defective phagocytosis and killing
— Neutropenia, Chronic Granulomatous disease
this medication is for initial treatment for penicillin-allergic individuals and those with suspected serious infections caused by MRSA
Vancomycin
Major criteria of Staphylococcal Toxic Shock Syndrome
Acute fever; temperature >38.8C
Hypotension
Rash (erythroderma with convalescent desquamation)
most common nosocomial bacteremia usually in association with central vascular catheters
S. epidermidis
initial drug of choice in coagulase negative staphylococci
Vancomycin
GAS cause these 2 potentially serious nonsuppurative complications
Rheumatic Fever
Acute glomerulonephritis
drug of choice for pharyngeal infections as well as for suppurative complications caused by GAS
Penicillin or Amoxicilllin
age of greatest risk for GAS pharyngitis
5-15 yr old
Jones Criteria for ARF
fulfills 2 major or 1 major and 2 minor + evidence of preceding GAS infection
MAJOR:
- Carditis
- Polyarthritis (monoarthritis or polyarthralgia in moderate/high risk)
- Erythema marginatum
- Subcutaneous nodules
- Chorea
MINOR
Clinical: Arthralgia, Fever (>38 for moderate/high risk, 38.5 for low risk)
Laboratory: Elevated ESR (>30 mm/hr for moderate/high risk >60 mm/hr for low risk), CRP, or prolonged PR interval
Supporting evidence of recent GAS infecion:
- (+) throat culture or rapid strep antigen test
- elevated or increasing Strep antibody titer
most serious manifestations of acute RF
carditis and resultant chronic RHD
universal finding in rheumatic carditis
Endocarditis
characterisitic rash of Rheumatic fever
Erythema marginatum
— erythematous, serpiginous, macular lesions with pale centers, non-pruritic, seen on the trunk and extremities
absolute requirement for the diagnosis of acute RF
evidence of recent GAS infection
antibiotic therapy for acute RF
10 days of oral penicillin or amoxicillin or single IM of benzathine penicillin
if penicillin allergic: 10 days of erythromycin/clarithromycin or 5 days fo Azithromycin
regimen of choice for secondary prevention of RF
Single IM of benzathine pen G every3- 4 weeks or Penicillin V (250 mg 2x/day) or Sulfadiazine/Sulfisoxazole (500 mg or 1000 mg OD)
treatment of choice of confirmed GBS infection
Penicillin G
empiral therapy of neonatal sepsis
Ampicillin + aminoglycoside
mainstay of therapy of Diphtheria
Diphtheria Antitoxin, single dose of 20,000-100,000 units +
Erythromycin or aqueous crystalline pen G or procaine penicillin
antimicrobial prophylaxis for contacts and people who have had intimate respiratory or habitual physical contact with diphtheria infected patient
benzathine Pen G or Erythromycin
highest rate of meningococcal disease occurs in this age group
infants <1 yr old
— due to immunologic inexperience, immaturity of alternative and lectin complement and poor response to bacterial polysaccharides
empiric antibiotic therapy for meningococcemia
3rd generation cephalosporin
most effective agents for prophylaxis in meningococcemia for close contacts of patients
Ceftriaxone and ciprofloxacin
initial antibiotic therapy of invasive infections caused by H. influenza
extended-spectrum cephalosporin such as Ceftriaxone
prophylaxis for members of household or close-contact group of patient with Hib infection
Rifampin 10 mkdose for 0-1 mo
20 mkdose for >1 mo
OD for 4 days
Etiologic agent of Chancroid
Haemophilus ducreyi
current treatment recommendation for chancroid
Azithromycin 1 g PO x 1 dose or
Ceftriaxone 250 mg IM x 1 dose or
Erythromycin 500 mg 3x a day PO x 7 days
most common clinical presentation of salmonellosis
acute enteritis
most common mode of transmission of Salmonella typhi
ingestion of contaminated food or water from human feces
typical manifestation of typhoid fever
high grade fever — 95%
mainstay of diagnosis of typhoid fever
positive blood culture or positive culture from another anatomic site
Treatment of choice for uncomplicated typhoid fever which is fully sensitive
Chloramphenicol
Treament of choice for severe typhoid fever which is fully sensitive
Fluoroquinolone
most important major risk factor for outbreak of typhoid fever
Contamination of water supplies with sewage
post infectious manifestations of shigellosis
HUS
Reactive arthritis
IBS
Malnutrition
first line oral therapy for SHigellosis
Ciprofloxacin 15 mkday 2x a day x 3 days or
Cetriaxone x 3 days IV/IM for severe illness
most common cause of traveler’s diarrhea
ETEC or enterotoxigenic E. coli
this type of diarrheagenic e. coli resembles bacillary dysentery
EIEC or Enteroinvasive e. coli
this diarrheagenic e coli causes acute, prolonged, and persistent diarrhea primarily in children <2 yo in developing countries
Enteropathogenic e. coli or EPEC
characteristic presentation of HUS (hemolytic-uremic syndrome)
Acute kidney failure
Thrombocytopenia
Microangiopathic hemolytic anemia
most virulent serotype of E. coli most frequently associated with HUS
E. coli O157:H7
main modes of transmission of cholera
consumption of contaminated water and ingestion of undercooked shellfish
most severe form of cholera
cholera gravis
antibiotics effective against cholera
doxycycline
ciprofloxacin
azithromycin
drug of choice for campylobacter infection
Azithromycin
fatigability with repetitive muscle activity is the clinical hallmark of this infection/disease
Botulism
classic triad of botulism
acute onset of a symmetric flaccid descending paralysis with clear sensorium + no fever + no paresthesias
this medication should be avoided in patients with UNCOMPLICATED infant/foodborne botulism since it can potentiate the action of botulinum toxin at the neuromuscular junction
Aminoglycosides
half of the cases in generalized tetanus will present this symptom
trismus/masseter muscle spasm
simple diagnostic bedside test in tetanus
spatula test
— touching the oropharynyx with a spatula or tongue blade
» elicit gag reflex
negative: expels the spatula
positive: bites the spatula
antibiotic of choice for tetanus infection
Metronidazole (30 mkday) q6 or Parenteral Pen G
for 7-10 days
lesions prominent in primary and secondary syphilis
primary: chancre — painless papule
secondary: condylomata lata — gray-white to erythematous wart-like plaques in moist areas around the anus, scrotum, or vagina
pseudoparalysis of parrot is seen in what condition
Syphilis
— painful osteochondritis which results in irritability and refusal to move the involved extremity
Treatment drug of choice for congenital syphilis
Aqueous crystalline Penicillin G for 10-14 days
most prevalent sexually transmitted disease, causing urethritis in men, cervicitis and salpingitis in women and conjunctivitis and pneumonia in infants in developed countries
Chlamydia trachomatis
criteria for the diagnosis of trachoma
lymphoid follicles on the upper tarsal conjunctivae
typical conjunctival scarring
vascular pannus
limbal follicles
— must meet at least 2
first line treatment regimens for uncomplicated c. trachomatis infection in men and nonpregnant women
azithromycin 1 g PO x 1dose and
doxycycline 100 mg PO 2x a day x 7 days
recommended treatment regimens for c. trachomatis conjunctivitis or pneumonia in infants
erythromycin (50 mkday) q6 x 14 days and azithromycin (20 mkday) OD x 3 days
gold standard for the diagnosis of TB
demonstration of the organism by culture
in TB, this is a state where individual is clinically asymptomatic
latent TB infection
how many inhaled bacilli are necesary for a successful TB infection
5 to 200 inhaled bacilli
classic lesion in the lung of primary tuberculosis
Ghon focus
— caseous granuloma
a condition in which a child is in close contact with contagious adult or adolescent TB cases, but without any signs and symptoms of TB, with negative TST reaction, and no radiologic and laboratory findings suggestive of TB
TB exposure
most common form of extrapulmonary TB and probably the most common cause of chronic lymphadenitis in children
Scrofula
most severe form of extrapulmonary TB with substantial morbidity and mortality in children and adults
Tuberculous meningitis (TBM)
CT scan findings most common in TB meningitis
Hydrocephalus (80%) — communicating
Basal meningeal enhancement (75%)
Hypodensities due to cerebral infarcts, cerebral edema and nodular enhancing lesions
most common skeletal site affected by TB
Spine (vertebrae)
most common form of childhood cutaneous TB
Scrofuloderma
true or false: a child below 5 years of age, asymptomatic, but exposed to a documented case of PTB should be started on preventive chemotherapy?
True
conditions which an induration of 5 mm or more is already considered positive in Mantoux test or TST
- Severely malnourished
- those who are immunocompromised (HIV-AIDS, with congenital immune deficiencies, history of prolonged intake of immunosuppressants)
- close contact with an infectious TB source
- persons with chest radiographs consistent with prior untreated TB
- organ transplant recipients
only finding that may be highly suggestive of TB in infants and children
uniform stippling of both lungs (found in miliary TB)
most common chest radiograph findings in childhood TB
lymphadenopathy and parenchymal abnormalities
most often affected lymph nodes in the lungs seen in childhood TB
right upper paratracheal area
triad of TB arthritis/phemister triad
juxtaarticular osteoporosis
peripherally located osseous erosions
gradual narrowing of the interosseous space
preferred method of investigation for CNS TB
MRI with gadolinium contrast
most common complication of TB meningitis
Communicating hydrocephalus
most common clinical manifestation of abdominal TB
Peritonitis
situations where false positive Mantoux test can happen
-infection with nontuberculous mycobacteria
-previous BCG vaccination
-incorrect method of TST administration
-incorrect measurement and interpretation of reaction
-incorrect strength of antigen used
this anti TB drug serves to prevent emergence of resistant bacilli
Ethambutol
both a bactericidal and most potent sterilizing anti TB drug
Rifampicin
enumerate the first line anti TB drugs
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
adverse reaction of this anti TB drug include peripheral neuropathy and retrobulbar optic neuritis
Ethambutol
this anti TB drug has the best bactericidal activity against rapidily multiplying MTB and less effective in slowly or intermittently multiplying organisms
Isoniazid
treatment regimen for newly diagnosed extrapulmonary TB of the CNS/Bones/Joints
2 HRZE, 10 HR
treatment regimen for pulmonary or extrapulmonary previously treated drug-susceptible TB (Category II)
2 HRZES/ 1 HRZE / 5 HRE
treatment regimen for Category IIa
2 HRZES/ 1 HRZE / 9 HRE
Isoniazid prophylaxis is indicated among these population
- all HIV positive individuals
- children less than 5 yo who are household contacts of a bacteriologically confirmed TB case, regardless of TST results
- children less than 5 yo who are household contacts of a clinically diagnosed TB case, if the TST is positive
5 types of tb diseases which corticosteroids should be given
TB meningitis
TB pericarditis
TB pleural effusion
Endobronchial TB
Miliary TB
dosage of prednisone as adjunctive therapy for TB
2 mg/kg for 4-6 weeks
how long do you give corticosteroids in TB pericarditis
11 weeks
most hepatotoxic among anti TB medications
Pyrazinamide
definition of DILI during TB treament
ALT 3x UNL + symptoms (nausea, vomiting, abdominal pain) or
ALT 5x UNL
Among anti TB drugs, which is 80% cleared by the kidney?
Ethambutol
which among the anti TB medications cause peripheral neuropathy?
Isoniazid
Distinct syndrome caused by Adenovirus which presents as high temperature, pharyngitis, nonpurulent conjunctivitis and preauricular and cervical lymphadenopathy
Pharyngoconjunctival fever
Administration of Palivizumab prophylaxis may be considered among these population
- infants born before 29 weeks in the 1st yr of life
- infants born before 32 weeks who have chronic lung disease of prematurity in the 1st yr of life
- infants younger than 1 yr of age with hemodynamically significant CHD ff cardiac transplantation (<2 yo)
- children 24 mo or younger with profound immunocompromising conditions during RSV season
- infants in the 1st yr of life who have either congenital abnormalities of the airway or neuromuscular disease
- children 24 mo who have ongoing treatment for chronic pulmonary disease (oxygen, steroids, diuretics)
most common cause of gastroenteritis outbreaks in older children and adults
Caliciviruses
schedule of preexposure prophylaxis of rabies vaccine
day 0, 7, 21 or 28
This syndrome is characterized by an increased inflammatory response from the recovered immune system to subclinical opportunistic infections caused by appropriate therapy with antiretroviral agents in HIV infection
Immune reconstitution inflammatory syndrome (IRIS)
In exposed children with negative virologic testing (for HIV) at 1-2 days of life, additional testing should be done at what age?
2-3 weeks of age, 4-8 weeks of age and 4-6 months of age
confirmed diagnosis of HIV infection can be made with one positive virologic test result, true or false?
false
— it should be made with 2 positive virologic test results
Initial virologic response in HIV treatment should be achieved within how many weeks of initiating ARV
4-8 weeks
definition of virologic response in HIV treatment
5 fold reduction in viral load
how often do you monitor for viral load once an optimal response has occured in HIV treatment?
every 3-6 months
in general, these are the best prognostic indicators in HIV infeciton
sustained suppression of the plasma viral load
restoration of normal CD4+ lymphocyte count
all AIDS defining conditions have the worst prognosis with 75% of them dying before the age of?
3 years
All infants born to HIV-infected mothers should receive what prophylaxis and how long?
Zidovudine prophylaxis for 6 weeks
most common finding in amebic liver disease
single abscess in the right hepatic lobe
most sensitive and preferred method for diagnosing E. histolytica and can distinguish it from other species
Conventional and real time multiplex PCR on stool
this organism causes frothy discharge with vaginal erythema and cervical hemorrhages (strawberry cervix)
Trichomonas vaginalis
erythrocytes lacking Duffy blood group antigen are relatively resistance to what plasmodium species
P. vivax
erythrocytes containing hemoglobin F (fetal hemoglobin) and ovalocytes are resistant to what plasmodium species?
Plasmodium falciparum
most common serious complication seen in Malaria
severe anemia
diagnosis of malaria is established by ____
thru Giemsa stained smears of peripheral blood or by rapid immunochromatographic assay (rapid diagnostic test)
triad of congenital toxoplasmosis
Chorioretinitis
Hydrocephalus
Cerebral calcifications
Autoinoculation can occur in individuals who habitually put their fingers in their mouth is observed in what parasitic infection
Entorobiasis caused by Enterobius vermicularis
Classic presentation of Visceral Larva Migrans caused by toxocariasis
Eosinophilia
Fever
Hepatomegaly
characteristic histopathologic lesion seen in Toxocariasis
Granulomas containing eosinophils, multinucleated giant cells (histiocytes) and collagen
Minor criteria in diagnosing Staphylococcal Toxic Shock Syndrome
should satisfy at least 3 or more:
- mucous membrane inflammation (vaginal, oropharyngeal or conjunctival hyperemia, strawberry tongue)
- Vomiting, diarrhea
- Liver abnormalities (Bilirubin or Transaminase >2x UL)
- Renal abnormalities (BUN/Crea >2x UL or >5 WBC/HPF)
- Muscle abnormalities
- CNS abnormalities
- Thrombocytopenia (<100,000/mm3)
duration of prophylaxis for people who have had acute rheumatic fever without carditis
5 years or until 21 years of age, whichever is longer
duration of prophylaxis for people who have had acute rheumatic fever with carditis but without residual heart disease
10 years or until 21 years of age, whichever is longer
duration of prophylaxis for people who have had acute rheumatic fever with carditis and residual heart disease
10 years or until 40 years of age, whichever is longer; sometimes lifelong prophylaxis
All patients who are presumed or proven to have gonorrhea should be evaluated for what diseases?
Syphilis
HIV
C. trachomatis infection
Treatment regimen for adolescents and children with gonococcal infection particularly in the pharyngeal, anorectal and urogenital
Ceftriaxone 250 mg IM + Azithromycin 1 g PO for 1 dose
treatment for mild-moderate PID
Single dose of Ceftriaxone (250 mg IM) + Doxycycline (100 mg PO BID) +/- Metronidazole (500 mg PO BID) x 14 days
Subtype of E. coli associated with HUS
STEC (Shiga-Toxin E. coli)
gram negative bacteria with incubation period of 12 hours causing dysentery
Shigella
this gram negative bacteria causes painless purging of profuse rice-water stools with a fishy smell
Vibrio cholerae
what medication to be avoided in the treatment of botulinum since it can potentiate the action of botulinum toxin at the NMJ
Aminoglycocides
Recommended initial diagnostic test in suspected cases of MDR-TB or HIV-associated TB
Xpert MTB/RIF Assay
Important clinical findings in First stage of Anicteric leptospirosis
Myalgia
Headache
Abdominal pain
Vomiting
Conjunctival suffusion
Fever
Important clinical findings in the second stage of anicteric leptospirosis
Meningitis
Uveitis
Rash
Fever
Which organs are leptospires present
Blood
CSF
Urine
(BCU - Busy you?)
4 subtypes of FUO
Classic FUO: >38 C, >3 weeks, >2 visits or 1 week in hospital
Healthcare-associated FUO: >38 C, >1 week, not present or incubating on admission
Immune-deficient FUO: >38 C, >1 week, negative cultures after 48 hour
HIV-related FUO: >38 C, >3 week for outpatients, >1 week for inpatients, HIV confirmed
management of SSPE
Primarily supportive
Isoprinosine with/without Interferon suggest significant benefit (30-34% remission rate)
