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Clinical Medicine I > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
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 pop.

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2
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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3
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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4
Q

What is an endemic?

A

The amount of a particular disease usually present in a community

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5
Q

What is a pandemic?

A

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

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6
Q

What are the requirements for an infectious disease case to be considered suspected?

A

Epidemiological exposure + 2 or more symptoms

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7
Q

What are the requirements for an infectious disease case to be considered Probable?

A

Relevant epidemiological exposure + no disease symptoms + positive IgM

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8
Q

What are the requirements for an infectious disease case to be considered confirmed?

A

Lab confirmation by viral RNA or antigen, IgM antibody and PRNT (plaque reduction neutralization test)

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9
Q

What are the direct laboratory methods for diagnosing an infectious disease?

A

Virus Isolation

Genome detection

Antigen detection

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10
Q

What are the indirect methods used to diagnose an infectious disease?

A

Serology IgM

Serology IgG

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11
Q

What agent causes Zika?

A

Flavivirus = a single stranded RNA virus

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12
Q

What carries the Zika Virus?

A

Aedes aegypti

Aedes albopictus

Both are types of mosquitos that live in tropical climates and are daytime and twilight feeders; they breed in standing water

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13
Q

How is Zika virus transmitted?

A

Patient it bit by an infected mosquito = primary

Maternal-fetal

Sex

Blood transfusions

Organ transplants

Lab exposure

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14
Q

In what bodily fluids has Zika virus been found?

A

Blood

Semen

Saliva

Female genitalia tract secretions

CSF

Amniotic fluid

Breast milk

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15
Q

What are the clinical manifestations of Zika?

A

Acute onset of low grade fever

Priorities rash

Arthralgia

Conjunctivitis

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16
Q

When will patients start to see symptoms of Zika?

A

2-14 days after being bit

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17
Q

How long does it take for symptoms of Zika to resolve?

A

2-7 days

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18
Q

What requirements are given in order to clinically diagnose a patient with Zika?

A

If they have 2 or more of the following symptoms:
Maculopapular pruritic rash
Arthralgia in small joints of hand and feet
Non-purulent conjunctivitis
Acute onset of low-grade fever

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19
Q

What is the complication/concern to patients with Zika?

A

In women who are pregnant, Zika causes the following symptoms to the unborn fetus:

Fetal loss
Microencephaly 
Gillian-Barre Syndrome
Brain Ischemia
Myelitis 
Meningoencephalitis
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20
Q

If the patient is presenting to you < 14 days after onset of symptoms, what diagnostic test should you order for Zika?

A

Serum or urine sample to test for Zika Virus RNA = rRT-PCR

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21
Q

If the patient is presenting to you > 14 days after onset of symptoms of Zika, what diagnostic testing should you order?

A

Serum sample to test for Zika virus IgM and PRNT (antibodies and title)

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22
Q

How do you treat Zika?

A

Supportive care:

Rest
Hydrate
Acetaminophen

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23
Q

What should you avoid prescribing to patients with Zika?

A

NSAIDS until Dengue is ruled out completely

Aspirin in children due to Reyes Syndrome

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24
Q

How do you prevent Zika?

A

Limit travel to certain areas

Remove standing water

Mosquito repellant

Long sleeves and pants should be worn

Environmental control

Protected intercourse

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25
Q

What is the recommendation for women who are planning to get pregnant but have been diagnosed with Zika?

A

They should wait 3-6 months before trying to conceive

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26
Q

What is the Zika virus considered?

A

A Nationally notifiable disease

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27
Q

What is the causative agent of Chikungunya?

A

Alphavirus = single stranded RNA virus

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28
Q

What is Chikungunya carried by?

A

Aedes aegypti

Aedes albopictus

Day feeder mosquitos

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29
Q

How is Chikungunya transmitted?

A

Through infected mosquito bites

A patient can be infected with the virus and then travel to another part of the world; however, unless there are the specific mosquitos present in that new area that can carry the disease, there is no way for it to be spread

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30
Q

Where is Chikungunya endemic to?

A

West Africa

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31
Q

When do outbreaks of Chikungunya usually occur?

A

During the rainy season

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32
Q

What are the clinical manifestations of Chikungunya?

A

Abrupt, high grade fever ( 104 F)

Polyarthralgia of multiple joints (hands, wrists, ankles); bilateral and symmetrical

Intense and disabling pain

Macular or maculopapular rash

Pruritis

Non specific lab findings:
Lymphopenia
Thrombocytopenia

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33
Q

What is the incubation period for Chikungunya?

A

3-7 days

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34
Q

When is the acute phase of Chikungunya usually seen?

A

7-10 days after exposure

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35
Q

How long does the high grade fever seen with Chikungunya usually last?

A

3-5 days

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36
Q

When does the Polyarthralgia seen in Chikungunya usually occur?

A

2-5 days after onset of fever

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37
Q

What are the complications typically seen with patients who have Chikungunya?

A

Death in patients over 65 and with comorbidities

Persistent debilitating and immobilizing arthritis

Respiratory, renal, and cardiovascular failure

Some patients have persistent or relapsing disease for up to 3 years after infection

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38
Q

How do we diagnose Chikungunya?

A

Blood sample:

Virus RNA present 1-7 days after infection = use RT-PCR

IgM antibodies present > 8 days after infection = ELISA

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39
Q

When will IgM antibodies for Chikungunya be seen?

A

5 days after onset of symptoms and up to 3 months after

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40
Q

When will IgG antibodies for Chikungunya been seen?

A

2 weeks after onset of symptoms and persist for years

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41
Q

What is the treatment for Chikungunya?

A

Supportive care

NSAIDS

Steroids

Methotrexate

Immune modulating agents

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42
Q

How do we prevent Chikungunya?

A

Minimize mosquito exposure

Mosquito repellents

Bed nets

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43
Q

What is the causative agent of Dengue?

A

Single stranded RNA virus in the Genus Flavivirus

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44
Q

How many types of Dengue are there?

A

Four:

DENV 1-4

All types cause full disease

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45
Q

How many strains of Dengue are there?

A

47

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46
Q

What is Dengue carried by?

A

Aedes Aegypti

Aedes albopictus

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47
Q

How is Dengue transmitted?

A

Bite from infected mosquito

There is evidence of maternal-fetal transmission

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48
Q

What is the leading cause of death in the tropics and subtropics?

A

Dengue

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49
Q

When does Dengue usually transmit?

A

Late summer and early fall

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50
Q

What is the death to case ratio for Dengue?

A

Low = those that get this disease usually make a full recovery

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51
Q

What are the three classifications of Dengue?

A

Dengue without warning signs

Dengue with warning signs

Severe Dengue

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52
Q

What are the requirements in order for a patient to be diagnosed with Dengue without warning signs?

A

Fever + two of the following:

N/V
Rash
Aches
Pains
Leukopenia
Positive tourniquet sign
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53
Q

What are the clinical manifestations associated with Dengue without warning signs?

A

N/V

Rash

Headache

Eye pain

Muscle ache

Joint pain

Leukopenia

Positive tourniquet sign

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54
Q

What are the clinical manifestations associated with Dengue with warning signs?

A

Abdominal pain and tenderness

Persistent vomiting

Clinical fluid accumulation

Mucosal bleeding

Lethargy or restlessness

Hepatosplenomegaly > 2cm

Increase in hematocrit with decrease in platelets

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55
Q

What are the clinical manifestations associated with Severe Dengue?

A

Severe plasma leakage leading to shock and fluid accumulation with respiratory distress

Severe bleeding

Severe organ failure —> AST or ALT > 100

Impaired consciousness

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56
Q

What are the three phases of Dengue infection?

A

Febrile
Critical
Convalescent

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57
Q

When can you see the febrile phase of Dengue infection?

A

IN dengue with or without warning signs

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58
Q

What is the febrile phase of Dengue characterized by?

A

Sudden onset of high grade fever = > 101.3 F or 38.5 C

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59
Q

How long does the febrile phase of Dengue infection last?

A

3-7 days

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60
Q

What will you see upon physical exam of a patient in the febrile phase of Dengue infection?

A

Conjunctival injection

Pharyngeal erythema

Lymphadenopathy

Hepatomegaly

Facial puffiness

Petechiae

Leukopenia

Thrombocytopenia

Elevated liver enzymes

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61
Q

What are the outcomes for a patient in the febrile phase of Dengue infection?

A

Recovery/Convalescent phase

Critical phase

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62
Q

What is the critical phase of Dengue infection characterized by?

A 
Systemic vascular leak Syndrome:
Plasma leak
Bleeding
Shock
Organ failure

Moderate to severe thrombocytopenia

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63
Q

When will the critical phase of Dengue infection occur?

A

3-7 days after infection

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64
Q

How long does the critical phase of Dengue infection last?

A

24-48 hours

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65
Q

What is the outcome of a patient in the critical phase of Dengue infection?

A

These patients typically will not recover

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66
Q

What is the Convalescent phase of Dengue infection?

A

Recovery phase

Plasma leakage and hemorrhage resolve

Vital signs stabilize

Profound fatigue

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67
Q

How long does the convalescent phase of Dengue infection last?

A

Usually 2-4 days but can take weeks to months

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68
Q

How do we diagnose a patient with Dengue infection?

A

If its the first week of illness:
RT-PCR and viral antigen nonstructured protein test

ELISA test about 4 days after illness for IgM

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69
Q

How do we treat Dengue?

A

Supportive care

Fever management:
Acetaminophen
NO NSAIDS!!!

Bleeding management:
Blood replacement

Plasma leakage:
Volume replacement —> IV fluids

Shock treatment

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70
Q

How do we prevent Dengue?

A

Mosquito control

Vaccination outside of the US and is only given to those that test positive for Dengue antibodies or hav e a history of Dengue

Limit travel

Improve community participation

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71
Q

Out of the three mosquito/arthropod borne illnesses, which one will manifest conjunctivitis?

A

Zika

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72
Q

Out of the three mosquito/arthropod borne illnesses, which one will manifest Hemorrhage and Shock?

A

Dengue

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73
Q

Out of the three mosquito/arthropod borne illnesses, which one will manifest arthralgia?

A

Chikungunya

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74
Q

What is the causative agent for Ebola?

A

Filoviridae family = non-segmented, single stranded RNA virus

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75
Q

What are the 5 species of Ebola?

A 
Zaire
Sudan
Tai Forest
Bundibugyo
Reston
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76
Q

Which species of Ebola CANNOT infect humans?

A

Reston

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77
Q

What other disease does Ebola resemble?

A

Rabies
Measles
Mumps

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78
Q

How is Ebola transmitted?

A

Direct contact with infected body fluid of infected animal or human

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79
Q

How long can the virus live on surfaces for?

A

Hours to days

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80
Q

What are the clinical manifestations of Ebola?

A

Fever

Chills

Malaise

Diffuse Maculopapular rash

GI:
Watery diarrhea
Nausea
VOmiting
Abdominal pain

Blood in stool
Petechiae
Mucosal bleeding

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81
Q

What symptoms cause severe cases of Ebola?

A

VOmiting and Diarrhea which cause severe volume loss

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82
Q

How long is the incubation period for Ebola?

A

6-12 days post exposure

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83
Q

What are the phases associated with Ebola?

A

Early phase

GI phase

Shock phase

Recovery phase

Convalescence phase

84
Q

What are the defining characteristics of the early phase of Ebola?

A

Occurs within 1-3 days

Fever

Malaise

Symptoms are vague

85
Q

What are the characteristics of the GI phase of Ebola?

A

Occurs 3-10 days

Nausea

Vomiting

Diarrhea

86
Q

What are the characteristics of the Shock phase of Ebola?

A

Occurs 7-12 days

With or without major hemorrhage

87
Q

What are the characteristics of the recovery phase of Ebola?

A

Occurs within 7-12 days

Resolution of symptoms

88
Q

What are the characteristics associated with the Convalescent phase of Ebola?

A

Up to 2 years after infection

Prolonged symptoms of arthralgia, weakness, fatigue, and insomnia

89
Q

When do symptoms of Ebola usually start to resolve?

A

Within 2 weeks of illness

90
Q

What diagnostic test is used for Ebola?

A

ReEbov:

Rapid immunoassay test that gives results within 15 minutes

91
Q

What are some non specific lab studies that can be done that diagnose Ebola?

A

Leukopenia
Thrombocytopenia
Hematocrit increase or decrease
Transaminase elevations
Coagulation abnormalities
Renal abnormalities —> proteinuria or renal insufficiency
Electrolyte abnormalities —> Hyponatremia or Hypokalemia

92
Q

What is the treatment for Ebola?

A

Supportive Care to prevent volume depletion

Aggressive fluid and electrolyte resuscitation —> be careful not to do too much

Anti-emetics

Antipyretic

Blood products —> FFP, PRBC, platelets

TPN = total parenteral nutrition

Antiviral

Compassionate use medications

93
Q

What are some of the Compassionate Use medications given to patients with Ebola?

A

Favipiravir

Artesunate-amodiaquine = antimalarial

Zmapp

G-S-5734

TKM-Ebola

BCX4430

94
Q

What are the factors that determine prognosis for a patient with Ebola?

A

Age —> young survive

Gender —> higher fatality in males

GI disease —> Higher rate of mortality with diarrhea

Viral load —> HIgher virus load in the blood increases the likelihood of death

95
Q

How do we prevent Ebola?

A

Strict infection control

Proper use of PPE

Effective communication between the government and healthcare workers

No vaccination yet

96
Q

What is Ebola considered but the CDC?

A

A Category A bioterror agent

97
Q

What is bacteremia?

A

A bacterial pathogen enters the blood stream

98
Q

What bacteria is the most common cause of COMMUNITY and HOSPITAL acquired bacteremia?

A

Staph aureus

99
Q

What bacteria is most common in the setting of skin and soft tissue infection?

A

Group A Strep

100
Q

What other bacteria are associated with Bacteremia?

A

E. Coli

Klebsiella

Enterobacter

Pseudomonas

101
Q

How does bacteremia get transmitted?

A

Seeding of the blood from different sources

102
Q

What are the clinical manifestations of Bacteremia?

A

Fever

Chills

Malaise

SIRS = Systemic Inflammatory Response Syndrome

Hypotension

Tachycardia

103
Q

How do we diagnose Bacteremia?

A

Diagnostic Evaluation:
ID consult if necessary
TEE echo imaging

Lab values:
Leukocytosis with left shift (increased neutrophils)

Positive blood cultures will determine the type of bacteria

104
Q

What organisms found in a blood culture mean that the blood culture is contaminated?

A

Coagulase Negative Staph

Corynebacterium

Viridans

105
Q

What is the treatment for Bacteremia?

A

Empiric IV with use of:

Vanco

Daptomycin

Cefazolin (MSSA)

Pen G

106
Q

What is Sepsis?

A

Life threatening organ dysfunction by dysregulated host response to an infection

107
Q

What is the Continuum of Severity of Sepsis?

A

Infection —> Bacteremia —> Sepsis —> Septic shock —> MODS —> death

108
Q

When is sepsis more common?

A

Winter

109
Q

What commonly causes sepsis?

A

Gram + bacteria

110
Q

What are the clinical manifestations of Sepsis?

A

Hypotension with SBP < 90

Tachycardia

Tachypnea > 22

Fever > 100.9

111
Q

What lab values correlate with Sepsis?

A

Leukocytosis > 12
Leukopenia < 4

Hyperglycemia > 140

Elevated C-reactive proteins

Elevated Cr

Coag abnormalities

Thrombocytopenia < 100

Elevated Serum lactate

112
Q

What are the clinical requirements for a patient to be diagnosed with SIRS (Systemic Inflammatory Response Syndrome)?

A

Presence of two or more of the following:

Temp > 38C or < 36 C

Heart rate > 90 bpm

RR > 20 breaths/min

PaCO2 < 32 mm Hg

WBC > 12000 cell/mm3 or > 10% immature (band) forms

113
Q

What are the risk factors for Sepsis?

A

ICU admission

Bacteremia

Advanced age

Immunosuppression

Diabetes and cancer

Community acquired pneumonia

Previous hospitalization

114
Q

What is septic shock?

A

Sepsis with circulatory, cellular, and metabolic abnormalities

115
Q

What are the clinical manifestations of septic shock?

A

Cool skin

Cyanosis

Oliguria

Altered Mentation

Elevated lactate

116
Q

What is Vasodilator or distributary shock?

A

Circulatory, cellular, and metabolic abnormalities with greater risk for mortality than just sepsis

117
Q

What is MODS (Multi-organ Dysfunction Syndrome)?

A

Progressive organ dysfunction

Severe end of severe illness

Can be primary or secondary

No universally accepted criteria

118
Q

If a patient with HIV has blood cultures that do not detect the virus, what are their chances of spreading HIV?

A

0%

119
Q

What are the CDC Defined Stages of HIV infection?

A

Early Infection
Clinical Latency
AIDS

120
Q

What are the characteristics of an early infection of HIV?

A

Virus is present in large numbers

Patient is highly contagious

121
Q

What is characteristics about the clinical latency period of HIV?

A

No or subtle symptoms in patient

122
Q

What are the two criteria for a patient to be diagnosed with AIDS?

A

CD4 count must be below 200, regardless of symptoms

Patient develops an AIDS defining condition regardless of CD4 count

123
Q

What are the lab tests that we can take on a patient to diagnose HIV?

A 
Viral Load
CD4 count
HIV genotype
TB test
Hep B or C test
Other STDs
124
Q

If an HIV patient has a PPD test for TB, what is considered a postive result for this patient?

A

A bump greater than 5mm

125
Q

What is the 90/90/90 COntinuum of Care Goal?

A

90% of people with HIV have been tested

90% of those patients who have been tested are steadily on treatment

90% of those patients steadily on treatment have viral loads less than 200 copies/mL

126
Q

What are the top two routes of transmission for HIV?

A

MSM –> Men

Heterosexual contact –> Women

127
Q

What age range has the highest rates of HIV diagnosis?

A

24-34 years

128
Q

What races are most commonly infected with HIV?

A

Minorities esepically African american men and women

129
Q

How can HIV be transmitted?

A

Sex
Blood
Birth

130
Q

What are the risk factors for HIV?

A 
Viral Load > 200
Lack of Circumcision
Greater number of sexual partners
More likely to get HIV if receiving anal sex
Increased risk with active STDs
Genetics
131
Q

What are the clinical manifestations of Acute HIV infection?

A 
Fevere
Lymphadenopathy
Pharyngitis
Rash
Myalgia/arthralgia
Headache
Oral or Genital ulcers
N/V
Diarrhea

Patient will feel like they have a virus

132
Q

What is the screening test for HIV?

A

4th Generation Antibody/Antigen test

133
Q

If patients screening test comes back positive for HIV, what is the next course of action?

A

Order a viral load test to see where in the course of their HIV infection they are

134
Q

If a patient comes into your office and appears to have mono, what should you do?

A

Do a viral load test for HIV

135
Q

When would a viral load for HIV become detectable?

A

5-20 days after infection

136
Q

What are the differential diagnoses for HIV?

A 
EBV (mono)
CMV
Toxoplasmosis
Rubella
Syphillis
Hepatitis
Disseminated GC
Any viral infection
137
Q

What are the B conditions that may occur in early syptomatic HIV infection?

A

Thrush

Vaginal candidiasis that is persistent, frequent, or difficult to manage

Oral hairy leukopenia

Herpes Zoster involving two episodes or more than one dermatome

Peripheral Neuropathy

Bacillary Dysplasia

Cervical dysplasia

Cervical carcinoma in situ

Constitutional symptoms such as fever or diarrhea for more than one month

Idiopathic Thrombocytopenic purpura

Pelvic inflammatory disease, espeically if complicated by a tuboovarian abscess

Listeriosis

138
Q

What disease does the CDC consider AIDS-defining conditions?

A

Bacterial infections that are multiple or recurrent

Candidiasis of bronchi, trachea, lungs, or esophagus

INvasive Cervical Cancer

Disseminated or extrapulmonary Coccidioidomycosis

Extrapulmonary Cryptococcosis

Chronic intestinal (> 1 month) Cryptosporidiosis

CMV and CMV retinitis

Encephalopathy

Herpes simplex that has chronic ulcers or bronchitis, pneumonitis, or esophagitis

Disseminated or extrapulmonary Histoplasmosis

Chronic intestinal Isopsoriasis

Kaposi Sarcoma that occurs sporadically

Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex

Burkitt, immunoblastic, or Primary brain lymphoma

Mycobacterium avium complex or disseminated or extrapulmonary Mycobacterium kansasii

Mycobacterium tuberculosis of any site that is pulmonary, disseminated, or extrapulmonary

General Mycobacterium species infection

Pneumocystitis jirovecii pneumonia

Recurrent Pneumonia

Progressive multifocal leukoencephalopathy

Recurrent Salmonella septicemia

Toxoplasmosis of the brain

Wasting syndrome

TB of any site + HIV positive

139
Q

What is the primary prophylaxis if a patient has a CD4 count less than 200 or 14%?

A

Bactrim or alternative for Pneumonitis jirovecii

140
Q

What is the primary prophylaxis if a patient has a CD4 count less than 100 and Toxoplasmosis IgG serology is positive?

A

Bactrim

141
Q

What is the primary prophylaxis if a patient has a CD4 count less than 50?

A

Azithromycin or other for MAC

142
Q

What immunizations should an HIV positive patient have?

A

Flu vaccine yearly but not the live strain

Strep pneumo

Hep B if not immune

Hep A if in risk group

Routine Td

143
Q

How many new diagnoses of HIV occur yearly in the US?

A

44000

144
Q

How many deaths due to HIV are there per year in the US?

A

10000

145
Q

Who do you treat for HIV?

A

EVERYONE that has HIV

Exception is for practical and psychosocial reasons

146
Q

Why do we treat everyone who has HIV?

A

It helps the individual and helps to prevent transmission to others

147
Q

What must you do before prescribing treatment for HIV?

A

Obtain a genotype study

148
Q

What drug class is the backbone of HIV treatment?

A

nRTIs

149
Q

What side effect can all nRTIs have?

A

Metabolic acidosis early in use

The patient will feel really sick

150
Q

What are the 4 nRTIs commonly used to treat HIV?

A

Tenofovir (TDF or TALA)
Lamivudine (3TC) or Emtricitabine (FTC)
Abacavir
Zidovudine (AZT)

151
Q

What is special about the drug Abacavir?

A

You must check the patient to make sure they are NOT HLA B*5701 positive before using

152
Q

What are the nnRTIs that are commonly used to treat HIV?

A

Efavirenz (Sustiva)
Etravirine
Rilpivirine
Doravarine

153
Q

What are the side effects of Efavirenz?

A

Transient Rash
Vivid dreams
CNS effects

154
Q

When should you not prescribe Rilpivirine?

A

If the patients viral load is >100,000 or CD <200

155
Q

What medications should you use with Protease Inhibitors in order to metabolically boost them?

A

low-dose Ritonavir or Cobicistat

156
Q

What are the protease Inhibitors?

A

Atazanavir

Darunavir

157
Q

What is the side effect of Atazanavir?

A

Increase in unconjugated bilirubin causing patient to become jaundice

158
Q

When are protease inhibitors typically used?

A

In alternative regimens

159
Q

What are the Integrase Inhibitor drugs?

A

Raltegravir
Elvitegravir
Dolutegravir
Bictegravir

160
Q

Which integrase inhibitor can you not use in pregnancy due to risk of neural tube defects?

A

Dolutegravir

161
Q

Which integrase inhibitor needs Cobicistat for a metabolic boost?

A

Elvitegravir

162
Q

What are the two Entry inhibitors?

A

Maraviroc

Monoclonal anti-CD4 injection

163
Q

What is the recommended starting regimen for HIV treatment?

A

INSTI (integrase inhibitors) + 2 Nukes

164
Q

If a patient is considered to pre-exposed to HIV, what can they take for prophylaxis?

A

Truvade (TNF) + Emtricitabine

PrEP

165
Q

Who are at risk of getting opportunistic infections?

A

Patients on chemotherapy, chronic steroid use (> 21 days), and the elderly

166
Q

What are opportunistic infections associated with?

A

T cell immunosuppression

167
Q

What are the fungal opportunistic infections?

A

Cryptococcus
Histoplasma
Candida
Pneumocystis

168
Q

What is the viral opportunistic infection?

A

Cytomegalovirus (CMV)

169
Q

What is the parasite opportunistic infection?

A

Toxoplasma

170
Q

What factors increase the risk of getting fungal infections?

A

Severity of impairment of cell-mediated immunity

Recent or current use of antifungal medication

Risk of exposure such as where the patient work and use of steroids

Neutropenia

171
Q

What is Criptococcus caused by?

A

C. neoformans

C. gotii

172
Q

How is Criptococcus transmitted?

A

Air droplets
Bird droppings

Spores are inhaled, become lodged into the lung alveoli, then disseminate hematogenously and cause infection

173
Q

What are the clinical manifestations of Criptococcus?

A 
Meningitis
Meningoencephalitis
Malaise
Fever above 38.4C
Papilledema
Meningeal Signs
Headache
N/V
Cough/SOB
Altered Mental Status
174
Q

How do we diagnose Criptococcus?

A

Cryptococcal antigen in CSF

175
Q

What is the treatment for Criptococcus?

A

Amphotericin B

Fluconazole

Drainage of CSF if opening pressure during LP is >20; this will relieve symptoms but not get rid of the fungus

176
Q

How is Histoplasmosis transmitted?

A

Inhalation

177
Q

When do symptoms of Histoplasmosis start to appear?

A

1-3 months after exposure

178
Q

What are the clinical Manifestations of Histoplasmosis?

A

Weight loss

Hepatosplenomegaly

Fever

Skin Ulcers

Lymphadenopathy

Dyspnea on exertion

179
Q

What tests do we use to diagnose Histoplasmosis?

A

Urine sample –> H. capsulatim antigen

CBC –> Pancytopenia and LFT abnormalities seen

Chest xray –> Bilateral diffuse reticulonodular infiltrates

Lymph node biopsy –> Budding yeasts

180
Q

How do we treat Histoplasmosis?

A

Amphotericin B
Itraconazole

12 weeks

181
Q

When is oropharyngeal candidiasis most common?

A

when the patients’ CD4 count is below 200

182
Q

When is esophagitis most common?

A

When the patients’ CD4 count is below 100

183
Q

What are the four types of Candidiasis?

A

Erythematous

Hyperplastic

Angular Cheilitis

Pseudomembranous

184
Q

What are the clinical manifestations of Candidiasis?

A

Mild burning sensation in mouth

Pt. will describe that it feels like there is food stuck in their esophagus but there isn’t

Erythema must occur around the spots

185
Q

What is the treatment for Candidiasis?

A

Itraconazole 200mg/day for 14 days

Fluconazole 100mg/day for 14 daysDOC

If patient cannot swallow, use IV meds

AVOID topical treamtents like swish and spit

186
Q

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

A

Esophageal candidiasis

187
Q

What test do we use to see if a patient has Candidiasis?

A

Endoscopy

188
Q

How long does it take for the patient to feel better once starting treatment?

A

2 days

189
Q

What is Pneumocystisi caused by?

A

Environmental exposure to the fungus

190
Q

What damage does Pneumocystis jirovecii do to the lung?

A

Inflammation
Interstitial Edema
Diffuse Alveolar damage

191
Q

What are the clinical manifestations of Pneumocystis jirovecii?

A

Gradual onset and progression of fever

Dry Cough

Dyspnea/SOB gradually gets worse

Symptoms occur about 1 month after exposure

192
Q

What imaging test should we order for a patient we suspect has Pneumocystis jirovecii?

A

HRCT chest

193
Q

What lab test should we order for a patient we suspect has Pneumocystis jirovecii?

A

BAL+ immunofluorescence

194
Q

What is the treatment for Pneumocystis jirovecii?

A

Bactrim (TMT-SMX)

IV 15-20 mg/kg/day for 21 days
PO 2 DS tablets every 8 hours for 21 days

195
Q

What is a differential diagnosis of Pneumocystis jirovecii?

A

TB

196
Q

If a patient comes in with a CD4 count <50 and presents with an eye problem, what must we automatically consider them to have until proven otherwise?

A

Cytomegalovirus

197
Q

Where does CMV usually effect?

A

Retina

CNS

GI tract

198
Q

What are the clinical menifestations of CMV?

A

CMV Retinitis:

No pain but floaters, blurry vision, decreased peripheral vision

LIght flashes or sudden vision loss

Starts in one eye but can become both

If left untreated, patient will become blind due to retinal detachment 2-6 months after infection

199
Q

How do we diagnose CMV?

A

Perivascular, fluffy, yellow-white retinal infiltrates +/- hemorrhage

200
Q

What is the treatment for CMV?

A

IV Ganciclovir, lifelong

201
Q

What is Toxoplasmosis caused by?

A

T. gondii

202
Q

What are the clinical manifestations of Toxoplasmosis?

A

Seizures

Headache

Confusion

Fevere

Lethargy

Focal sign

Altered Mental Status

Psychomotor retardation

Meningissmus

No increased CSF pressure

Aggressive

Patient can have strokes

203
Q

What imaging test should we order if we suspect Toxoplasmosis?

A

Brain MRI –> will show more than 1 lesion present

204
Q

What is the differential diagnosis for Toxoplasmosis?

A

CNS lymphoma

205
Q

How do we treat Toxoplasmosis?

A

Pyrimethamine + Sulfadiazine + Leucovorin

Brain biopsy

Clinical Medicine I (15 decks)

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