Infectious diseases Flashcards
Describe the approach to a patient with fever of unknown origin.
- Careful history: travel, animal/insect exposure, immunosuppression, drugs/toxins, localizing s/s, occupation/hobbies, age, geography, season, incubation time
- Physical exam: complete exam, with focus on:
- mucous membranes/conjunctiva
- cardiac murmurs
- organomegaly
- skin
- genitals
- lymph nodes
- joints
- complete neuro exam & meningeal signs
- Suggested labs: ESR, CRP, LDH, TB, HIV, blood cultures, rheumatoid factor, creatine phosphokinase, ANA, serum electrophoresis; biopsy of clinically suggested sites
- Suggested studies: CT chest, CT abdomen
* purple book 6-22, UpToDate*
What are the most common locations for hospital-acquired infections?
- Catheter-associated UTIs
- Surgical site infections
- Pneumonia
- GI, usually C. difficile
* Medscape, Cochrane*
What are the most common pathogens in hospital-acquired infections?
- STAPH AUREUS
- Pseudomonas aeruginosa
- E. coli
CDC
Discuss precautions that should be implemented to protect patients from nosocomial infections.
- Hand hygiene
- Externally-conducted inspections of compliance
- Interventions to improve professional adherence to guidelines
- Improve antibiotic prescribing practices
What lab tests are used to diagnose and monitor HIV?
Screening: ELISA
Confirmatory: Western blot, nucleic acid assays
When to initiate HIV treatment: CD4 T-cell count
Marker of disease progression, recommended once/year: HIV viral load
Rapid Review Pathology, Goljan
What are the most common opportunistic infections in HIV and their treatments?
Pneumocystis jiroveci pneumonia (TMP-SMX or clindamycin-primaquine)
Esophageal candidiasis (fluconazole PO)
Kaposi sarcoma [HHV-8] (anti-retrovirals, systemic chemotherapy)
~~~
Also: toxoplasmosis, Mycobacterium avium complex, histoplasmosis, cryptococcus, coccidioides, CMV, cryptosporidium
UpToDate
What are some of the noninfectious problems seen in HIV?
- Increased risk of CAD - major cause of death in AIDS pts
- AIDS dementia
- Hairy leukoplakia
- Progressive multifocal leukoencephalopathy (PML)
* Rapid Review Pathology, Goljan*
What is the natural history of AIDS (i.e. no treatment/before HAART)?
- Viral transmission
- Acute infection (lasts weeks)
- Seroconversion - antibodies detectable
- Asymptomatic carrier - clinically latent (can last several years)
- Symptomatic - lymphadenopathy, fever, weight loss (lasts a few years)
- AIDS - CD4 < 200 or AIDS-defining condition (months)
- Advanced HIV infection - CD4 < 50
What are the indications for starting antiretroviral therapy in patients with HIV?
In 2012, the HIV treatment guidelines from the United States Department of Health and Human Services (DHHS) and the 2012 International Antiviral Society-USA Panel were revised to recommend that antiretroviral therapy (ART) be offered to all HIV-infected patients, including asymptomatic patients, regardless of immune status.
UpToDate
What are some of the common side effects associated with antiretroviral medications?
