Infectious Diseases Flashcards
1
Q
IgM specific antibodies
A
Recent infections
2
Q
IgG specific antibodies
A
2-4 months after; past infection
3
Q
Spider bites: brown recluse spider (5)
A
- Local reaction with mild itching or stinging at the time of bite
- Bite is painless
- Pain starts 2-8 hours later with redness around the puncture and a central pustule or blister
- Swelling, itching, tenderness, red vesicle 12-24h later
- Black star shaped bite with central necrosis and edema
4
Q
Spider bites: black widow (5)
A
- No local symptoms
- Severe muscle cramping started from 10 minutes to one hour post bite. Cramping is in the abdomen, flank, thighs, and chest
- Sweating, irritability, N/V in children
- CNS with headache, anxiety, salivation, lacrimation, sweating and HTN
- Mortality in young children is 50%
5
Q
Spider bites: Scorpion (3)
A
- Severe local and painful burning sensation with redness discoloration and edema with necrosis
- SYSTEMIC reaction, restlessness, hyperactivity, abnormal eye movements, facial twitching, hypersalivation, diaphoresis, respiratory paralysis
- Death from pulmonary edema, shock or respiratory failure
6
Q
What are the basics of the coxsackie viruses? (5)
A
- Enterovirus family, Types A and B
- Fecal-oral contamination
- Common between 1 and 4 years old
- Prevalent in the summer months (May-Oct)
- Incubation is 3-6 days, shed for several weeks
7
Q
Describe the clinical course of herpangina (7)
A
- Herpangina = coxsackie A
S/S:
- Sudden onset with high fever
- Anorexia
- Sore throat/dysphagia
- N/V
- Minute vesicles and ulcers on the tonsils, uvula, pharynx and soft palate (back of mouth)
- Will resolve spontaneously in 3-6 days
8
Q
Describe the clinical course of hand, foot, and mouth disease (7)
A
- Coxsackie A
S/S:
- Fever
- Vesicles on buccal mucosa
- maculopapular rash on hands/feet
- Anorexia
- Vomiting
- Spontaneous resolution in 1-2 weeks
9
Q
What are some coxsackie A illnesses? (5)
A
- Acute respiratory illness: sore throat, N/V/D, coryza, pneumonia
- Nonspecific febrile illness: fever, mylagia, malaise
- Acute lymph node enlargement with pharyngitis: acute, sore throat x 1 week
- Aseptic meningitis: fever, stiff neck, HA, altered senses, seizures
- Paralytic disease: guilliain-barre like, ascending paralysis
10
Q
Coxsackie B Neonatal Infection (8)
A
- Vomiting
- Fits
- Cyanosis
- Pallor
- Tachycardia
- Serious disseminated disease
- Can be fatal
- Transplacental infection with symptoms starting within 2 weeks after birth
11
Q
Coxsackie B Pleurodynia (8)
A
- Severe sudden chest pain with waves of spasms
- Increased pain with cough
- Deep breathing
- Before pain –> headache
- Malaise
- Anorexia
- Fever
- Lasts 1-10 days
12
Q
Coxsackie B Myocarditis/pericarditis (2)
A
- Mild to severe acute heart disease
2. Symptoms 2 weeks after exposure
13
Q
Describe the clinical course of Hepatitis A (7)
A
- Picornavirus, RNA, primary liver infection, contagious, fecal-oral transmission
- Contagious 2 weeks before to 1 week after symptoms
- Preicteric: fever, malaise, N/C, anorexia, RUQ pain, dig comp
- Jaundice: dark urine/stool, sickness increases
- Dx: IgG, IgM, will spontaneously resolve
- Children often asymptomatic, adults are symptomatic
- HAV is now routine (…..I’m assuming HAV means Hepatitis A vaccine)
14
Q
Describe the clinical course of measles (4)
A
- Incubation is 8-12 days before rash
- Contagious 3-5 days before rash to 4 days after rash appears
- Prodromal (4-5 days): URI symptoms, fever, cough, coryza, conjunctivitis, Koplik spots (blue, white granules in the mouth)
- Rash (day 3-4): increased temp, starts on ears/forehad, rash = erythematous maculopapular
15
Q
Describe the clinical course of rubella (8)
A
- Incubation: 14-23 days
- Infection: 3 days before and 5-7 days after rash
- Generalized erythematous mac/pap rash
- Post-occipital lymphadenopathy
- Fever and malaise
- Joint pain
- Can be asymptomatic
- Purpura is rare
16
Q
Describe the clinical course of Erythema Infectiosum/5th Disease (6)
A
- Parvovirus B19
- Seen in 2-15 year olds
- Incubation: 4-20 days
- Rash appears 2-3 weeks after exposure and person is infectious until rash resolves
- Prodrome: fever, HA, myalgia (may be no prodrome)
- Rash: 7-10 days after prodrome; truncal lacy rash that spreads outward, “slapped cheeks,” can have periodic reocurrences and lasts up to a month
17
Q
What is roseola or exanthem subitum/6th disease (6)
A
- Herpes virus 6,7
- Common in 6-18 month olds, rare in children >3
- Incubation: 9-10 days
- Sudden onset of high fever for 3-6 days, URI symptoms, LAD, lethargy, GI symptoms as fever decreases
- Diffuse rose colored rash appears and lasts for 1-3 days
- Rare complication: febrile seizure
18
Q
Describe infectious mononucleosis (7)
A
- EBV, can be CMV in younger children
- Transmitted by pharyngeal secretions
- 2-6 week incubation period
- Increased size of lymphoid tissue (nodes, tonsils, spleen, liver)
- Atypical lymphocytes in blood
- Fever for 2-3 days, sore throat, gray tonsillar exudate, skin rash
- Dx: EBV serology, CMV serology if EBV(-)
19
Q
What is the clinical course mumps? (6)
A
- Paramyxovirus, carried in saliva
- Incubation: 14-24 days
- Infectious 1 day before swelling and 3 days after swelling resolves
- Prodromal: rare, fever, HA, anorexia, neck pain, malaise
- Swelling: 24 hours after prodrome, parotid swelling, discrete pink rash, salivary glands all over swelling, “pink sign,” sour foods cause pain
- Complications: meningoencephalitis, orchitis, epididymitis
20
Q
What is the clinical course of varicella? (6)
A
- Herpes virus, direct contact/droplet/airborne
- Incubation: 10-21 days
- Contagious: 1-2 days before rash and until all lesions have crusted over
- Prodrome: asymptomatic, fever, lethargy, back/abd pain, URI symptoms
- Rash: highly pruritic lesions that progress to teardrop vesicles and scab over, can have increased fever during this time, headache, and malaise
- Tx: antihistamines, acetaminophen, antibiotics for secondary infections
21
Q
What is the clinical course of cat scratch disease? (6)
A
- Bartonella henselae, gram(-) Bacillus
- Usually occurs after cutaneous exposure to a cat, time between injury and lesion is 7-12 days, 5-50 for LAD
- Lesions are nonpruritic papules then LAD close to scratch site
- Can have fever, malaise, anorexia, fatigue, HA
- Usually resolves in 2-4 weeks
- Antipyretics, mosit wraps, azithromycin, clarithromycin, Bactrim, rifampin, Cipro can be used if needed
22
Q
Describe the clinical course of meningococcal disease (9)
A
- N. meningitides: gram(-)
- Spread through respiratory secretions
- Incubation: 1-10 days
- Contagious until on treatment for 24h
- Bacteremia: fever, URI, GI symptoms, rash
- Meningococcemia: fever, chills, pharyngitis, conjunctivitis, myalgia, stiff neck, seizures, prostration, N/V, petechial rash leads to purpura and septic shock
- Complications: meningitis, pericarditis, myocarditis, pneumonia, arthritis
- Dx: culture +
- Tx: PCN G, Cefotxamine, Chlor (if PCN allergic), rifampin or Cipro for ppx
23
Q
What are the basics of Lyme disease? (3)
A
- Borrelia burgdorferi, spirochete, western deer tick is the carrier
- Risk is increased 36-48 hours after nymphal bite, 48-72 hours after adult bite
- Incubation from bite to rash: 1-55 days, late manifestations can occur up to one year
24
Q
Stage 1 Lyme Disease (7)
A
Localized disease
- Erythema migrans: bullseye rash, clear center
- Fever
- Malaise
- HA
- Arthralgias
- Stiff neck
- Rash remains for a few weeks then fades, symptoms can be intermittent
25
Stage 2 Lyme Disease (2)
Early disseminated disease
1. Multiple skin lesions, smaller than 1st lesion, develop days-weeks after primary lesion
2. Blood/lymph spread leads to disease in multiple organ systems (including 7 nerve palsy), can last for years without tx
26
Stage 3 Lyme Disease (3)
Late disease
1. Arthritis of the knees
2. Can have late CNS sequelae
3. Arthritis usually resolves but can become recurrent and chronic
27
Lyme Disease Dx and Tx
Dx: culture from edge of rash, 2 step testing (EIA, Western Blot), if EIA is (-) then no furtehr testing is required
Tx:
<8 y/o- Amox 50mg/kg/day PO in 3 doses for 14-21 days
>8 y/o- Doxycycline 100mg PO BID for 14-21 days
*Erythromycin can be used as an alternative for Cefuroxime
28
Describe the clinical course of malaria (4)
1. 4 plasmodium species, transmitted by female mosquito endemic in tropical areas
2. S/S: high fever, chills, rigor, sweats, HA, fever is cyclical, can have N/V/D, cough, arthralgia, back/abd pain, hemolytic anemia, thrombocytopenia
3. Dx: blood smear
4. Tx: based on species/severity; Mefloquine once/week as chemoprophylaxis
29
Common organisms causing neonatal sepsis (3)
Newborn period: 3 days-3 months; transplacental during birth
1. GBS
2. Ecoli
3. Listeria
30
S/S Neonatal Sepsis (9)
1. Poor feeding
2. Temp instability
3. Cyanosis
4. Apnea
5. Resp distress
6. Seizures
7. Lethargy
8. Rapid onset with quick deterioration
9. Listeria: white pharynx/cute granulomas, erythematous papules
31
Tx for Neonatal sepsis (2)
1. GBS: IV PCN G (must be identified as having GBS)
| 2. Listeria: Amp + Gent IV
32
Clinical Course of Congenital Syphilis (3)
1. Treponema pallidum: transplacental infection
2. Most have no s/s, but develop s/s in 2nd week of life
3. S/S: early ~LBW, rhinitis, jaundice, FTT, LAD, pseudoparalysis of parrot, osteochondritis, rash like 2nd syphilis, CNS abnormalities, late ~bony changes, dental changes (peg shaped teeth)
33
Dx and Tx of Congenital Syphilis
Dx: nontreponemal (VDRL, RPR); trepomenal (FTA ABS/TP-PA)
Tx: 10 das of Pen G 100,000-150,000 units/kg/day q12, procaine Pen G single daily dose for 10 days
34
Syphilis as STI (5)
1. Treponema pallidum
2. Primary: chancre (painless papule with serous discharge)
3. Secondary: copper penny rash on hands/feet with LAD and mucocutaneous lesions
4. Dx: nontreponema (RDR, VPRL)
5. Tx: Benzathine PCN 2.4 million UIM or Doxy/Tetra if PCN allergic
35
Gonorrhea as STI (4)
1. N gonorrhea gram(-), sex transmission, often asymptomatic
2. S/S: dysuria, discharge (thick, green, purulent), bleeding, dyspareunia, urethritis, cervicitis, gland abcess, exudative pharyngitis
3. Dx: + culture
4. Tx: ceftriaxone 125mg IM x 1 dose; Cefixime/Cipro/Levo; use azithromycin/doxy if chlamydia is also suspected
36
Botulism Poisoning in Infants (4)
1. Clostridium botulism spores release toxins in the GI tract, seen in infants <6 months old, associated with honey intake
2. S/S: constipation, poor feeding, weakness, loss of head control, floppiness, decreased deep tendon reflexes, decreased cranial nerve responses, decreased tone
3. Tx: hospitalize, stool softener
4. NEVER GIVE HONEY UNDER 12 MONTHS OLD!
37
Rocky Mountain Spotted Fever (4)
1. Caused by Rickettsia, transmitted via tick
2. Incubation: 1-14 days
3. S/S: fever, myalgia, N/V --> erythromycin macular petechial rash, starts on wrists and ankles then spreads, can cause multiorgan system disease (neuro deficits, murmur, crackles, decreased urine, jaundice)
4. Tx: doxy/tetra
38
General Info on Pertussis (5)
1. Bordetella pertussis, spread by droplet
2. Incubation: 6-21 days
3. Contagious: during catarrhal stage
4. Adults often transmit to infants
5. Leukocytosis can be seen
39
Pertussis Stages w/ S/S (3)
1. Catarrhal (1-2 weeks): cough, coryza, sneezing, fever
2. Paroxysmal (2-4 weeks): staccato, paroxysmal cough with whoop, vomiting, cyanosis, exhaustion. In infants <6 m/o: apnea, pneumonia, pulmonary HTN, no whoop
3. Convalescent (2-3 weeks): cough resolves
40
Pertussis Dx and Tx
Dx: + culture
Tx: hospitalize infants, Erythromycin (alternative: azithromycin)
41
Rabies treatment (4)
1. Any exposure to a bat —> rabies vaccine and RIG
2. Any unprovoked bite —> rabies vaccine and RIG
3. Rabies vaccine is given on days 0,3,7, and 14 of exposure
4. RIG: 20 IU/kg IM into area of bite
