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Clin med 1 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is the most important factor that increases the risk for fungal infection?

A

The use of steroids, especially in high doses or intranasal with Diabetic pts

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2
Q

How do fungal infections present?

A

In a progressive manner, very slowly.

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3
Q

What are the top 3 things to know in order to diagnose a pt with Criptococcus?

A
  1. Number of white cells found in lumbar puncture
  2. High opening pressure form puncture
  3. Increased protein levels found in the CSF
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4
Q

What is the hallmark of Criptococcus?

A

High opening pressure (anything higher than 180)

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5
Q

What two species can cause Criptococcus?

A

C. Neoformans and C. Gatti

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6
Q

How is Criptococcus infected?

A

Via air droplets and bird droppings

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7
Q

What is the most common manifestation of cryptococcal infection?

A

Meningitis

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8
Q

What are the main characteristics of a cryptococcal infection?

A

Malaise, fever (above 38.4), N/V, Cough/SOB, Altered mental status

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9
Q

What else can be seen with Criptococcus?

A

Papilledema, meningeal signs, cryptococcal antigen present in CSF

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10
Q

The treatment for Criptococcus is?

A

Amphotericin B and Fluconazole

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11
Q

Which infectious disease involves exposure to chicken coops?

A

Histoplasmosis

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12
Q

What are the main characteristics of Histoplasmosis?

A

Fever, weight loss, skin ulcers, Hepatosplenomegaly, lymphadenopathy

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13
Q

Which tests are utilized to detect Histoplasmosis?

A

Urine: H. Capsulatum antigen sensitivty

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14
Q

What is the treatment for Histoplasmosis?

A

Amphotericin B and or Itraconazole total 12 weeks (any -azole will work)

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15
Q

Pt has bilateral diffuse reticulonodular infiltrates in the lungs, and budding yeast forms from lymph node biopsy

A

Histoplasmosis

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16
Q

What are the four types of OPC Candidiasis?

A
  1. Erythematous
  2. Hyperplastic
  3. Angular Cheilitis
  4. Pseudomembranous
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17
Q

Oropharyngeal candidiasis is more common if the CD4 cell count is below what?

A

300

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18
Q

Esophagitis (candidiasis) is more common if the CD4 cell count in below what?

A

100

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19
Q

In most candidiasis cases, the strain causing the disease comes from where?

A

Patients own GI flora

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20
Q

What is the treatment for OPC?

A

Fluconazole 100mg/d x 14d or

Itraconaozle 200mg/d x 14d

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21
Q

Why should you avoid topical treatments for OPC?

A

Lower cure rates, higher relapse rates

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22
Q

What is the most common cause of dysphagia and odynophagis in AIDS?

A

Esophageal candidiasis

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23
Q

Fluconazole is the DOC for what?

A

Esophageal Candidiasis

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24
Q

What is the dosing for Fluconazole for esophageal candidiasis?

A

200 mg/d first day
100 mg/day other 13 days
Can use IV if pt cannot swallow

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25
Q

Which fungus has a unique tropism for the lung and rarely invades the host?

A

Pneumocystis Jirovecii

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26
Q

This fungus attaches to the alveolar epithelium causing inflammation, interstitial edema and diffuse alveolar damage

A

Pneumocystis Jirovecii

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27
Q

What is the clinical presentation of pneumocystis jirovecii?

A

Gradual onset & progression of fever, dry cough and dyspnea. Av 1 mo before medical consult

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28
Q

What is the best imaging test for pneumocystis jirovecii?

A

HRCT chest (high resolution CT)

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29
Q

What is the best lab test for pneumocystis jirovecii?

A

BAL+immunofluorescence

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30
Q

What is the preferred tx for pneuymocystis jirovecii?

A

TMT-SMX IV for 21 days or oral for 21 days

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31
Q

Which virus targets the retina?

A

Cytomegalovirus. Also affects the CNS and GI

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32
Q

What are the si/sx of CMV retinitis?

A

No pain but floaters, blurry vision, decr peripheral vision, light flashes or sudden vision loss, blindness

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33
Q

What are some complications of CMV retinitis?

A

Blindness, retina detachment 2-6 if untreated, often involves both eyes

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34
Q

How can you diagnose CMV retinitis?

A

Perivascular fluffy yellow-white retinal infiltrate +/- hemorrhage

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35
Q

What is the tx for CMV retinitis?

A

IV Ganciclovir, lifelong

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36
Q

What is the best diagnostic tool for Toxoplasmosis?

A

MRI of the brain

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37
Q

What will the scans look similar to with Toxoplasmosis?

A

Look very similar to a scan of lymphoma

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38
Q

How else can you diagnose Toxoplasmosis?

A

IgG serology for T. gondii, look for MORE THAN ONE lesion in the MRI, order PCR for T. gondii

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39
Q

What is the treatment for toxoplasmosis?

A

Pyrimethamine+Sulfadiazine+Leucovorin

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40
Q

What is an epidemic?

A

An increase, often sudden, in the number of cases of a disease above what is normally expected in a population in a certain area

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41
Q

what is an outbreak?

A

Carries the same definition as epidemic, but is often used for a more limited geographic area

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42
Q

What is a cluster?

A

Aggregation of cases grouped in place and time that are greater than the number expected

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43
Q

What is an endemic?

A

Amount of a particular disease usually present (expected) in a community

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44
Q

An epidemic that has spread over several countries or continents, affecting a large number of people

A

Pandemic

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45
Q

A case with an epidemiological exposure and 2 or more symptoms is what?

A

Suspected case

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46
Q

A case with relevant epidemiological exposure, no disease symptoms and positive Zika IgM is what?

A

Probable case

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47
Q

A case with laboratory confirmation by viral RNA or antigen, Zika IgM antibody and positive PRNT is what?

A

Confirmed case

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48
Q

The Flavivirus causes what?

A

Zika Virus

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49
Q

How is Zika transmitted?

A

Mosquitos

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50
Q

Zika virus is carried by which mosquito?

A

Aedes aegypti, lives in tropical locations and Aedes albopictus, lives in temperate climates

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51
Q

Where do the mosquitos breed?

A

Standing water

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52
Q

Where was Zika virus first isolated?

A

Ugandan forest in 1947

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53
Q

What were some of the zika outbreaks?

A

2007 in Micronesia with 5,000 infections, 2014 French Polynesia with 32,000 infections, 2014 Chile

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54
Q

Have there been Zika cases in the US?

A

Yes, Florida and Texas. Some travel-reported cases in NY and sexually transmitted in Texas 2016

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55
Q

Transmission of Zika

A

Bite from mosquito, maternal-fetal, sex, blood transfusions, organ transplants, lab exposure

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56
Q

What are the si/sx of Zika?

A

Acute onset low-grade fever, pruritic rash, arthralgia and conjunctivitis

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57
Q

How long does is take for Zika symptoms to resolve?

A

2-7 days

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58
Q

Can you get immunity from Zika?

A

Yes, follows primary infection

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59
Q

Physical exam findings of Zika

A

Low grade fever, maculopapular pruritic rash, small joints of hands and feet (arthralgia), non-purulent conjunctivitis. Diagnose if 2 or more present!!!

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60
Q

What are complications from Zika?

A

Fetal loss, microcephaly, Guillian-Barre syndrome, brain ischemia, myelitis, meningoencephalitis

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61
Q

How can you diagnose Zika?

A

rRT-PCR (+real time reverse transcription-polymerase chain reaction) confirms it
Can also do an ELISA (can cross-react with other flaviviruses)

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62
Q

What is MAC-ELISA?

A

Developed by CDC for Zika, Zika IgM Antibody Capture ELISA test

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63
Q

How long are you serum positive with Zika?

A

3-7 days

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64
Q

How long are you urine positive with Zika?

A

Up to 14 days

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65
Q

Which lab test should you use for a pt presenting <7days Zika?

A

rRT-PCR urine or serum for IgM and PRNT

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66
Q

Which lab test should you use for a pt presenting 15 days to 12 weeks?

A

Serum for IgM and PRNT

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67
Q

How can you treat Zika?

A

Supportive, NSAIDs avoid until Dengue ruled out

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68
Q

Which disease involves the Alphavirus?

A

Chikungunya

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69
Q

How is Chikungunya transmitted?

A

Mosquitos, vertical, blood donation and organ transplant, nosocomial transmission

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70
Q

Who can carry Chikungunya?

A

Aedes aegypti and aedes albopictus

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71
Q

Epidemiology of Chikungunya

A

Outbreak in Tanzania in early 1950s, first case documented outside African was Thailand 1958

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72
Q

Where was the first US case reported of Chikungunya?

A

Florida July 2014

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73
Q

Clinical manifestations of Chikungunya

A

Fever and malaise, incubation period of 3-4 days

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74
Q

What will physical exam of Chikungunya show?

A

High grade fever 2-5 days long, polyarthralgia begins after fever onset, symmetrically involves joints, pain is usually intense and disabling. Maculopapular rash starting on limbs and trunk

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75
Q

What are the most common lab findings for Chikungunya?

A

Lymphocytopenia and thrombocytopenia

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76
Q

Complications of Chikungunya?

A

Rarely neurologic, death in pts older than 65, persistent debilitating and immobilizing arthritis, respiratory renal and CV failure

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77
Q

Diagnosis of Chikungunya?

A

1-7 days use RT-PCR, >8 days use ELISA IgM

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78
Q

How long will the IgM antibodies be present for Chikungunya?

A

5 days after onset of symptoms and up to 3 months

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79
Q

How to manage Chikungunya

A

Supportive, NSAIDs, steroids, methotrexate, immunomodulating agents, no vaccine!

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80
Q

What does Genus flavivirus cause?

A

Dengue virus. Mosquito born as well

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81
Q

How many different strains are there of Dengue?

A

47

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82
Q

What are the different classifications of Dengue?

A

Dengue Fever, Dengue hemorrhagic fever, Dengue shock syndrome

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83
Q

What is another way to classify Dengue?

A

Dengue without warning signs, Dengue with warning signs, severe Dengue

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84
Q

Leading cause of illness and death in the tropics and subtropics

A

Dengue

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85
Q

Epidemiology of Dengue

A

Originated in monkeys and independently jumped to humans in Africa or Southeast Asia

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86
Q

Transmission of Dengue

A

Bite from mosquito, rare in organ donation or blood transfusion, maternal-fetal transmission possible

87
Q

Physical exam findings of Dengue w/out warning signs

A

N/V, rash, headache, eye pain, muscle and joint aches, leukopenia, positive tourniquet test

88
Q

Physical exam findings of Dengue with warning signs

A

Abdominal pain and tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy or restlesness, hepatosplenomegaly, increase in HCT w/decrease in platelets

89
Q

Physical exam findings of severe Dengue

A

Severe plasma leakage leading to shock and fluid accumulation with respiratory distress, severe bleeding, severe organ failure, impaired consciousness

90
Q

What is the febrile phase of infection for Dengue?

A

Sudden onset high fever, HA, rash, vomiting, myalgia, arthralgia. Lasts 3-7 days. Also conjunctival injection, pharyngeal erythema, LAD, hepatomegaly, facial puffiness, petichiae

91
Q

Can patients recover from febrile phase of Dengue?

A

Yes, without complications

92
Q

Critical phase of infection for Dengue

A

Systemic vascular leak syndrome-plasma leak, bleeding, shock, organ failure. Days 3-7 and lasts 24-48 hours

93
Q

Convalescent phase of infection of Dengue

A

Plasma leakage and hemorrhage resolve, vital signs stabilize, typically lasts 2-4 days, profound fatigue that may take days-weeks to recover

94
Q

How can you diagnose Dengue?

A

1st week- Rt-PCR and viral antigen nonstructured protein

95
Q

When can you do an ELISA for Dengue?

A

IgM as early as 4 days after onset of illness

96
Q

Management of Dengue?

A

Supportive, fever management, acetaminophen no NSAIDs, blood replacement, volume replacement, shock treatment

97
Q

Prevention of Dengue

A

Vaccination (outside of US only), mosquito control, limit travel

98
Q

Filoviridae family causes what?

A

Ebola Virus

99
Q

What does Ebola resemble?

A

Rabies and Measles/Mumps

100
Q

How id Ebola spread?

A

Direct contact with infected body fluids

101
Q

What are the 5 species of Ebola?

A
  1. Zaire
  2. Sudan
  3. Ivory Coast
  4. Bundibugyo
  5. Reston
102
Q

Zaire Ebola

A

Recognized in 1976, responsible for 2014-15 outbreak in west africa

103
Q

Sudan Ebola

A

50% case fatality in 4 epidemics

104
Q

Ivory Coast Ebola

A

Only identified in 1 case. Exposure occurred in an ethologist who performed a necropsy on a chimp found dead

105
Q

Bundibugyo Ebola

A

Uganda 2007 outbreak. Case fatality of 30%

106
Q

Reston Ebola

A

Different as it has maintained an animal reservoir only.

107
Q

Which outbreak was the largest of all previous combined for Ebola?

A

2014-16 in West Africa

108
Q

Epidemiology of Ebola

A

881 infected healthcare workers-60% died. September 2014 first case in US

109
Q

Transmission of Ebola

A

Through contact w.meat or body fluids of infected animal or human. Ritual washing of Ebola victims at funerals, Vomit feces and blood most infectious.

110
Q

How long can the Ebola virus live?

A

On surfaces for hours to days, no known airborne or mosquito infections

111
Q

Clinical manifestations of Ebola

A

Major hemorrhage is less common, volume loss form V/D, symptoms occur suddenly, incubation is 6-12 days. Produces a systemic inflammatory response

112
Q

What will you find on a physical exam of Ebola

A

Fever, chills, malaise, rash maculopapular, watery N/V/D and abdominal pain, blood in stool, petechiae, mucosal bleeding

113
Q

What can be seen in the early phase of Ebola?

A

1-3 days, fever, malaise

114
Q

What can be seen in shock from Ebola?

A

With or without major hemorrhage, 7-12 days in

115
Q

Convalescence of Ebola

A

Up to 2 years, prolonged sx of arthralgia, weakness, fatigue, insomnia

116
Q

Lab studies useful for Ebola

A

Leukopenia, thrombocytopenia, hematocrit may be high or low, ALT and AST increase, PT and PTT abnormalities (severe cases), proteinuria and renal insuff, hyponatremia, hypokalemia

117
Q

Diagnosis of Ebola

A

RT-PCR for specific RNA sequences, negative RT-PCR collected >72 hrs after symptoms onset rules OUT Ebola

118
Q

Management of Ebola

A

Supportive care, aggressive fluid and electrolyte resuscitation, antiemetics, antipyretics, blood products, TPN, antivirals

119
Q

Management of Ebola (under investigation)

A

Favipiravir-2 trials, Artesunate-amodiaquine antimalarial, Zmapp- promising results

120
Q

Prognostic factors of Ebola

A

Younger age-lower mortality, higher fatality in men, higher rate of fatality with diarrhea

121
Q

Most common cause of community-acquired bacteremia?

A

Staph aureus

122
Q

What is the most common tick borne illness in the US and europe?

A

Lyme Disease

123
Q

Transmission of lyme dx occurs how?

A

Bite of infected Ixodes ricinus complex ticks. Transmitted by tick int he nymph stage of life

124
Q

What are some risk factors for lyme dx?

A

Outdoor occupational workers, recreational activities in wooded areas

125
Q

What are the 3 tick species that bite humans?

A
  1. Blacklegged tick (I. scapularis)
  2. Lone star tick (Amblyomma americanum)
  3. American dog tick (Dermacentor variabilis)
126
Q

What types of Qs can you ask pts with lyme dx?

A

Was the tick attached? How long was it attached for?

127
Q

SPirochetes are rarely transmitted within the first __ hours of tick attachment

128
Q

If the tick is attached for how long there is a high risk of transmission?

A

> 72 hours

129
Q

What are the 3 phases of lyme disease?

A
  1. Early localized disease
  2. Early disseminated disease
  3. Late disease
130
Q

Which phase of lym dx involves the rash erythema migrans with viral symptoms?

A

Early localized disease

131
Q

When does the rash occur for lyme dx?

A

At the site of tick bite, usually appears within 7-14 days after bite but can take anywhere from 3-30 days

132
Q

Erythema migrans occurs in what percentage of pts with lyme disease?

133
Q

Qualities of Erythema migrans

A

Painless, mild burning or pruritis, erythematous with a range form light pink to well defined, circular in appearance, often large in diameter, central clearing with a “bulls-eye or target lesion”

134
Q

What are some associated viral symptoms with early localized lyme?

A

Fatigue, anorexia, HA, neck stiffness, myalgia/arthralgia, lymphadenopathy, fever

135
Q

If your pt has upper repiratory symptoms or GI symptoms in the absense of erythema migrans…

A

Diagnosis is unlikely Lyme

136
Q

Early disseminated Disease (Lyme)

A

Neurologic or cardiac involvement, occurs weeks to several mos after the tick bite

137
Q

What is multiple EM lesions suggestive of?

A

Disseminated disease, not multiple bites

138
Q

What are some neurologic manifestations with lyme?

A

Unilateral or bilateral cranial nerve palsy, facial nerve commonly. Radiculopathy, peripheral neuropathy, lymphocytic meningitis, encephalopathic features

139
Q

What is the triad of neurologic abnormalities found in lyme disease?

A
  1. Meningitis
  2. Cranial neuropathy
  3. Sensory or motor radiculoneuropathy (irritation of nerve)
140
Q

Cardiac involvement (Lyme)

A

Can cause carditis that may manifest as heart block or myopericarditis

141
Q

What are some si/sx of late disease (Lyme)

A

Occurs mos to yrs after initial infection, arthritis in one or more joints, cognitive disturbances can also occur

142
Q

Lyme Arthritis

A

Intermittent or persistent arthritis in a few large joints, especially the knee

143
Q

Is serologic testing necessary for early disease (lyme)

A

No, if presence of EM and/or viral symptoms with a history of exposure to endemic area, no lab indication

144
Q

Is serologic testing necessary for early disseminated or late disease (Lyme)?

A

Usually positive at this point, the diagnosis is based on clinical syndrome with positive serologic tests

145
Q

What are the indications for serologic testing?

A

Reent exposure to area endemic for Lyme, risk factor for exposure to ticks, AND symptoms consistent with early disseminated or late disease

146
Q

When is serology not indicated?

A

In pts with EM rash, screening of pts in endemic areas, pts with non-specific symptoms only

147
Q

Need a two tier approach for lyme, what are they?

A

ELISA followed by Western blot

148
Q

ELISA

A

Most common initial serologic test for diagnosis

149
Q

Western Blot

A

Allows for detection of antibodies to individual components of organism, determines which specific antigens of B. burgdorferi are reacting w/serum antibodies

150
Q

Testing algorithm

A

-ELISA: no further test
+ELISA: Western Blot next
-Western Blot: No further test
+Wester Blot: evidence of encounter with B. burgdorferi

151
Q

IgM antibodies to B.burgdorfer typically appear how many weeks post op?

152
Q

IgG antibodies to B.burgdorfer typically appear how many weeks post op?

153
Q

Is routine follow-up serologic testing recommended for lyme?

154
Q

Treatment for lyme disease?

A

Doxycyline 100mg orally twice daily for 21 days. CANNOT BE GIVEN TO CHILDREN OR PREGNANT PTS

155
Q

Other treatment options for lyme disease

A

Amoxicillin 500mg orally 3x a day 21 days (best for children, pregnancy)
Cefuroxime 500mg twice a day 21 days

156
Q

What is the treamtne for early disseminated lyme disease?

A

Ceftriazone IV 2g once daily, Cefotaxime IV 2g every 8 hrs, Penicillin G 18-24 mill units IV 6 daily doses (ALL IV MEDS)

157
Q

How can you treat the facial palsy of lyme disease?

A

Oral doxycyline 100mg twice daily

158
Q

How can you treat late lyme disease?

A

Doxycyline or amoxicillin for 1 month

159
Q

What is the prophylactic antibiotic for lyme disease?

A

Doxycycline 200mg, single dose

160
Q

What is a lethal but curable tick borne disease?

A

Rock Mountain Spotted Fever (R. rickettsi)

161
Q

What does R. rickettsi lead to?

A

Gram - bacteria, leads to direct vascular injury

162
Q

What are some host responses to R. rickettsi?

A

Pneumonitis, myocarditis, encephalitis

163
Q

How is RMSF transmitted?

A

By tick bite, transmits the infection during feeding

164
Q

What are some clinical manifestations of RMSF?

A

Fever, HA, rahs in a person with history of tick bite. Malaise, N/V, myalgias and arthralgias

165
Q

Hallmark rash or RMSF is

A

Blanching erythematous rash with macules that become petechial over time

166
Q

Empiric therapy for RMSF should be initiated when?

A

Within 5 days of symptom onset

167
Q

When should a skin biopsy be performed for RMSF?

A

Before or within 12 hours of administering antibiotics. Should NOT withhold treatment in attempt to get skin biopsy within time frame

168
Q

The diagnosis of RMSF can be confirmed by what?

A

IFA: indirect fluorescent antibody

169
Q

What is the treament for RMSF?

A

Doxycyline, avoid in children and pregnancy

170
Q

Babesiosis is what?

A

Infection caused by protozoa of genus Babesia. Causes lysis of RBCs

171
Q

What are the clinical manifestations of babesiosis?

A

Can be fatal, sx usually develop within 1-6 weeks after tick bite. Splenomegaly and hepatomegaly, neck stiffness, sore throat, dry cough, SOB, V/D

172
Q

How can you diagnose Babesiosis?

A

Blood smear performed by pathologist

173
Q

What are the most common ways of getting HIV?

A

Anal sex, sharing needles, snorting cocaine and sharing

174
Q

When was the earliest case of HIV recorded?

A

1959 in a human, Kinshasa congo

175
Q

How does HIV replicate?

A

Reverse transcriptase that is continuous viral replication

176
Q

After 3 days, where does HIV travel to in body?

A

Lymph nodes, that is when CONTINUOUS REPLICATION OCCURS

177
Q

Can you be cured from HIV?

A

If treated within first 3 days before travels to lymph nodes

178
Q

How long does post exposure prophylaxis treatment last for?

A

4 weeks/1 month

179
Q

How long does pre-exposure prophylaxis treatment last for?

A

7 days, however this is a more controversial option, bad for society can cause resistance

180
Q

Is HIV 1 oncogenic?

A

No, but it decreases immunity which makes you more susceptible to cancer

181
Q

Is there a vaccine for HIV?

A

No, due to the variability of the virus envelope

182
Q

Is there a population that is more resistant to HIV?

A

Yes, people with the delta 32 gene will remain asymptomatic longer, HIV will have more difficult time invading the CD4 cells

183
Q

Delta 32 gene

A

Pts with this do not need tx right away, but need to monitor CD4 count, HIV will eventually find a way to get into CD4 cells

184
Q

What are the 3 mechanisms of HIV?

A
  1. Immunodeficiency
  2. Autoimmunity
  3. Hypersensitivity reactions
185
Q

Immunodeficiency in HIV

A

Causes chronic inflammation

186
Q

Autoimmunity in HIV

A

As a result of disordered cellular fxn or B cell dysfxn. Causes lymphocytic interstitial pneumonia and ITT

187
Q

Hypersensitivity reactions in HIV

A

High rates of allergic reactions, eosinophilic pustular folliculitis, medications reactions (Bactrim)

188
Q

What are the clinical findings if CD4 count is from 300-400

A

Bacterial infections: TB, Herpes simplex, Herpes Zoster, Vaginal candidiasis, hairy leukoplakia, Kaposi sarcoma

189
Q

What are the clinical findings is CD4 count is 100-200?

A

Pneumocystosis, Toxoplasmosis, Cryptococcosis, Coccidioidomycosis, Cryptosporidiosis

190
Q

What are the clinical findings if CD4 count is below 50?

A

Disseminated MAC infection, Histoplasmosis, CMV retinitis, CNS lymphoma

191
Q

What are some lab findings useful for CD4?

A

ELIZA and Western blot

192
Q

What are the si/sx of HIV?

A

Fever, lymphadenopathy, pharyngitis, skin rash, myalgia, arthralgia

193
Q

A physical exam suggestive of HIV

A

Hair leukoplakia tongue, Kaposi, cutaneous bacillary angiomatosis, generalized lymphadenopathy

194
Q

What to do if HIV pt has fever?

A

CXR, bacterial blood cultures, serum cryptococcal antigen, mycobacterial blood cultures, sinus CT

195
Q

What to do if HIV pt has weight loss/waste syndrome?

A

ART, high calorie drinks, megestrol, medical cannabis, growth hormone and anabolic steroids

196
Q

What to do if HIV pt has nausea?

A

Look for candida, can use medical cannabis

197
Q

What to do if HIV pt has PNS complications?

A

Do NOT use opioids, can use gabapentin, Capsaicin, acupuncture

198
Q

What is caused by neurotropic viruses in the Rhabdoviridae family?

199
Q

How does rabies affect the body?

A

Disseminates via peripheral nerves to the central nervous system

200
Q

What are the clinical manifestations of rabies?

A

Nonspecific viral type symptoms, can be either encephalitic or paralytic rabies

201
Q

Encephalitic rabies

A

More common type, causes death resulting from respiratory and vascular collapse

202
Q

Classic symptoms of encephalitic rabies

A

Hydrophobia, aerophobia, hyperactivity of facial, back and neck muscles, autonomic instability, agitation and combativeness

203
Q

Paralytic rabies

A

Has ascending paralysis, little CNS involvement until later in course, paraplegia occurs leading to failure of respiratory muscles and death

204
Q

How can you diagnose rabies?

A

Staining of skin biopsy, isolation of virus from saliva and anti-rabies antibodies from serum or CSF. Mostly diagnosed postmortem

205
Q

What is the treatment for rabies?

A

Most efforts should be on prevention, no known treatment for it

206
Q

Palliative approach for rabies

A

Treating disease to comfort, sedatives, analgesics, etc.

207
Q

Aggressive approach for rabies

A

Critical care unit with ID specialists, immunotherapy, antiviral therapy and neuroprotective therapies

208
Q

Rabies prophylaxis

A

Want to give post-exposure prophylaxis (PEP)

209
Q

Prophylaxis should definitely be considered in bites from what animal?

210
Q

PEP Rabies

A

Should begin ASAP, rabies immunoglobulin is “passive immunization” and vaccine is “active”

211
Q

Who is the rabies VACCINE given to?

A

Pre-exposure prophylaxis

212
Q

What is given to post-exposure rabies pts?

A

Both passive and active immunization

213
Q

Post-exposure prophylaxis

A

For previously vaccinated person, pt should receive two intramuscular doses of vaccine

214
Q

Malarial parasites

A

Plasmodium falciparum results in severe illness. Symptoms are anemia related

Clin med 1 (9 decks)

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