Infectious Diseases Flashcards
What are the different infectious diseases?
- acute bronchitis
- influenza
- community acquired pneumonia
- hospital acquired pneumonia
- pnuemoncystis jiroveci
- mycobaterium TB
What is acute bronchitis?
- inflammation of the medium bronchi
- HYPERACTIVE AIRWAY W/MUCUS
What cx acute bronchitis?
- INFLUENZA A&B (supportive)
- parainfluenza
- cornoavirus (types1-3)
- rhinovirus
- RSV (respiratory snyactal virus)
- human metapneeumovirus
PE of acute bronchitis?
-NO FEVER
-viral URi
-mucus
-cough for more than 5 days
+/- wheezing, clearing rhonchi, chest wall tenderness (d/t coughing)
Labs for acute bronchitis?
CBC to check if there is a significant WBC increase/left shift b/c that means it is bacterial pneumonia!
How to tx acute bronchitis?
supportive for 2-3 wks and in the mean time you can give them:
- NSAID/aceteminophen
- bronchodilator
- cough suppressant
- Mucinolytic to break down the mucus
What is influenza?
- spreads 4-6hrs
- sx shows in 24 hrs
- viral shedding stops in 2-5 days
- NECROSIS OF THE EPITHELIAL TISSUE
- the systemic sx goes down as respiratory sx goes up
Who are at higher risk for influenza?
- chronic dz
- facilities that have close proximities with other patients/sick people
- older or younger people
PE of influenza?
ABRUPT SYSTEMIC onset:
- fever
- headache
- chills
- myalgia
- malaise
- cough
- sore throat
- ocular pain/burning/photophobia
- cervical lymphadenopathy
Elderly PE of influenza?
MOTTLE
Labs for influenza?
- Rapid flu test
- Rapid strep to RULE OUT
- throat swabs
Tx influenza?
- resolves in 2-5 days
- immunocompromised, age, cormordities:
- -ZanamIVIR (NOT for asthma)
- -OsteltamIVIR
- -peramIVIR
- ONLY W/IN 48 hrs
Prognosis for influenza?
- good but may have persistent cough
- may have postinfluenza asthenia (weakness)
Complications for influenza?
- primary viral pneumonia
- -not that often but SEVERE
- secondary bacterial pneumonia
- -fever goes away but comes back
- d/t S. pneumonia, H. influenza
- muscle inflammation can cx:
- -rhabdo
- -myositis
- -myoglobinuria
- Reye’s syndrome (if child is given aspirin)
What is NOT a normal sign of influenza?
- not getting better after 5 days
- DIFFUSE RALES, INTERSTITIAL INFILTRATE
What is community acquired pneumonia?
-OUT of the hospital for 48 hrs
How does CAP spread?
air droplets
What bugs for 0-1 mo?
CAP
- E coli
- S. agalactae
What bugs for 2-5 mo?
CAP
- chlamydia trachomatis
- RSV
What bugs for 5mo-5 yrs?
CAP
- RSV
- parainfluenza
What bugs for 5-15yo?
CAP
- influenza A
- mycoplasma
What bugs for 15-30yo?
CAP
-mycoplasma
What bugs for older adults?
- s. pneumonia
- h. influenza
RF for CAP?
- elderly
- smoking
- drinking
- comorbitities
PE for CAP?
- ill appearing: fever, coughing, dyspenea, tachypnea, tachycardia, O2 down
- lungs: inspiratory crackles(rales), dullness
Labs for CAP?
- DIAGNOSTIC: CXR
- -pulmonary opacity
- sputum culture –> to find out what the bugs are
- HIV testing –> POSITIVE: P. jirovecci
Tx for CAP?
General
- might not respond to abx if had previous abx (must get from hx
- if pt has pleural effusion labs should come back as transudate
- empiric tx for 5 days or until afebrile for 48-72 hrs
Tx for CAP?
Healthy
- macrolide
- doxycycline
Tx for CAP?
Abx resistant
- fluorquinolone
- macroline AND Beta lactam
Tx for CAP?
Hospitalization
- fluorquinolone
- macroline AND Beta lactam
Tx for CAP?
ICU
- azithromycin
- fluorquinolone
- macroline AND Beta lactam
Prevent CAP?
-polyvalent pneumococcal vaccine: for those who are 65 yo older asplenic nephritic syndrome immunocompromised cancer HIV transplant sickle cell
What is hospital acquired pneumonia?
pneumonia after 48 hrs of being admitted to the hospital but MUST BE NOT SICK upon admission
Pathophysio of HAP?
pneumonia gets in via nasal or gastric b/c of nasogatric tube, dirty hands of care providers
Labs for HAP?
sepsis panal - procalcitonin (untxd pneumonia can lead to sepsis b/c of the mucus that is leaking into the capillaries)
Tx for HAP?
broad spectrum (more than 1 is used)
What is pneumocystis jiroveci?
HIV/AIDs
What is the PE of pneumocystis jiroveci?
- fever
- cough w/ white sputum
- RETROSTERNAL chest pain
- unexplained weight loss
- wks of fatigue
Labs for pneumocystis jiroveci?
- if CXR is early: normal +/- interstitial infiltrates
- if CXR w/aids: DENSE PERIHILAR INFILTRATES
- CT: ground glass appearance
Tx for pneumocystis jirovci?
TMP-SMX for 14-21 days
What is mycobacterium tuberculosis?
infxn of the lungs of m. tuberculosis
What are RF of TB?
- HIV
- corticosteroid use
- immunosuppresive therapy
- silicosis
- diabets
- gastrectomy
What are HIGH RF of TB?
- living in close contacts
- children
- foreign born
- unhygenic
What is primary TB?
when you are first infected with TB and the macrophages in the lungs are at war with the TB virus
What is latent TB?
the war is over in the lungs but the virus didn’t die and is DORMANT and triggers (stress or reinfxn) can cx the dormant virus to come back to life
What is Progressive Secondary TB?
the dormant virus is reinfxnd OR triggered that cx virus to wake up
What is Progressive Primary TB?
the first infxn and the macrophages were not able to overcome them so they multiplied
PE for TB?
- chronic cough +/- blood
- slow progressive maliase
- anorexia
- weight loss
- POST-TUSSIVE APICAL RALES
Labs for TB?
- 3 sputums cultures
- CXR: primary: unilateral infiltrates; secondary: cavitations
Mantouc TST?
-injection under the skin for 48-72 hrs
5mm: HIV positive, close contacts (jail)
10mm: health care workers, foreign born, children, IV drug users
15mm; low incidence of exposure, low risk of active TB
Mantouc TST FALSE positive?
- BCG vaccination
- NONTB mycobateria related:
- MAC
- -may be in elders +/-underlying lung dz
- -+/-cystic fibrosis
Negative w/ overcrowded areas?
TB
repeat again on other arm
Negative w/ occupation risk?
TB
- baseline is needed
- Boosted phenomenon (and those who have been affected once): the first TB test will be negative but they need to get another to confirm that they are negative b/c if they have another TB testing comes around they will awaken the TB virus and will test as POSITIVE when they’re not really waking up the TB virus (can be interpreted as a NEW infxn when it’s not)
- must wait 8 wks or else you will get skin conversion which may also give out a false positive
Tx for TB?
- isoniazid
- rifampin
- pyarzinamide (DO NOT IN PREGGOS)
- ehtambutol
