INFECTIOUS DISEASES Flashcards
the most frequent complication of amebic liver abscess
Pleuropulmonary involvement
What is the most common type of infection related to the pathogen Entamoeba histolytica?
Asymptomatic cyst passage
benign quartan malaria
P. malariae
Chancre (single, painless, papule / ulcers). Stage of syphilis?
Primary
Treatment for Uncomplicated falciparum malaria
Artemisinin-based combination (ACT) for 3 days
o Artemeter + lumefantrine
o Artesunate + amodiaquine
o Artesunate + mefloquine
o Dihydroartemisinin + piperaquine
o Artesunate + sulfadoxine/pyrimethamine (SP)
What is the best predictor of long-term clinical outcome in HIV infection?
plasma viral load
Plasma viral load measurement are a critical element in assessing the effectiveness of antiretroviral therapy.
What is the most common infection site of tetanus in adults?
Superficial abrasion to the limbs
What will you ALWAYS rule out if you are entertaining PID?
Pregnancy. So always do a pregnancy test
Early physical findings of Enteric (Typhoid) fever:
o faint, salmon-colored, blanching, maculopapular rash “rose spots” on trunk and chest
o Bradycardia, hepatosplenomegaly
treatment for malaria in Pregnancy (1 st trimester)
- Uncomplicated falciparum: Quinine + Clindamycin (7 days)
- Non-falciparum: Quinine
The hallmark of HIV is profound immunodeficiency from progressive deficiency of _________
helper T-cells
The most accurate test for syphilis is _____
darkfield microscopy
Treatment for PID
Single dose Ceftriaxone plus 14 days of Doxycycline and Metronidazole.
Define Fever of Unknown Origin
o Fever >38.3°C (101°F) on at least two occasions
o Illness duration of ≥3 weeks
o No known immunocompromised state
o Diagnosis that remains uncertain after thorough history and PE, and the obligatory investigations
What is the most common manifestation of salmonella infection?
Enterocolitis
• Occurs after 3-6 weeks of primary infection
• Fever, skin rash, pharyngitis, myalgia
- Most patients spontaneously recover
- Many have mildly depressed CD4 count that remains stable
acute hiv syndrome
- Vulvar itching/irritation
- White clumped discharge
Diagnosis? Treatment?
Vulvovaginal Candidiasis (C. albicans)
Fluconazole 150mg PO single dose
Definitive diagnosis of PCP can be established by use of _______
Giemsa or silver stain to visualize the organism
What is the preferred treatment of tetanus?
Metronidazole
the patient is normothermic but manipulates the thermometer
fraudulent fever
Mean survival time from onset of severe dementia is usually ______
less than 6 months.
What is the most common opportunistic infection affecting AIDS patients?
Pneumocystis pneumonia
- Dark field microscopy or immunofluorescence or LM with staining
- Only important in 1st 7-10 days of illness during leptospiremia
Microscopic demonstration (Direct detection)
If the patient is allergic to penicillin, what is the DOC for neurosyphilis and pregnant women.
desensitization to penicillin
Bacterial disease caused by an enterotoxin elaborated outside the host, such as that due to ____ or ____ has the shortest incubation period (1–6 h) and generally lasts <12 h.
Staphylococcus aureus or B. cereus
Without ventilatory support, what is the most common cause of death in tetanus?
respiratory failure
Therapy should include single-dose regimen effective for gonorrhea plus treatment for chlamydial infection in cervicitis. What is the treatment regimen?
o Ceftriaxone 250mg IM single dose or Cefixime 400mg PO single dose
o Azithromycin 1g PO single dose or Doxycycline 100mg PO twice a day for 7 days
treatment for acute colitis and amebic liver abscess.
Metronidazole or Tinidazole + Luminal agent (iodoquinol/paromomycin)
A 20-year-old woman presents to the emergency room with lower abdominal pain and tenderness, fever, leukocytosis, and cervical motion tenderness. Diagnosis?
PID
What muscles are affected first in tetanus?
Muscles of the face and jaw
What is the toxin responsible for tetanus?
Tetanospasmin
- 4-fold rise in titers is confirmatory for leptospirosis
- In endemic areas like the Philippines, single titer 1:1600 in symptomatic patient is diagnostic
Microagglutination test or MAT (Indirect Detection)
- Vulvar itching
- Profuse white/yellow homogenous discharge
Diagnosis? Treatment?
Trichomonal Vaginitis (T. vaginalis)
- Metronidazole 2g PO single dose
- Metronidazole 500mg BID PO x 7 days
- Median time: 10 years (if not treated)
- Ongoing and progressive HIV disease with active virus replication
- Rate of progression is directly correlated to HIV RNA levels
ASYMPTOMATIC STAGE (HIV)
First line NNRTI for AIDS
Nevirapine (NVP)
Neurosyphilis (tabes dorsalis), gummas, Argyll Robertson pupil
What is the most common diagnosis of FUO among the neoplasms?
Malignant lymphoma
benign tertian malaria
P. vivax, ovale
single best test for both gonorrhea and chlamydia.
Nucleic acid amplification tests (NAATs)
When do you start treatment in HIV?
o AIDS defining illness / symptomatic regardless of CD4
o CD4 <350
o All HIV-infected pregnant women
o Specific HIV related conditions
- HIV-associated nephropathy
- Co-infection w/ HBV infection when HBV treatment is indicated
A 40-year-old man complains of fever and right-sided abdominal pain. Diagnostic workup shows liver abscess. Needle aspiration shows characteristic “anchovy paste” material.
Amebic liver abscess
Alternative drug for syphilis if allergic to penicillin
Doxycyclin
“multiple vesicular lesions on an erythematous base”
HSV
As children born with HIV infection are living to adolescence and adulthood due to antiretroviral therapy, many appear to be at high risk for psychiatric disorders. The most common problems are _____
anxiety disorders
What is the infective stage during asexual cycle of malaria?
Sporozoites
What is the treatment of choice for schistosomiasis?
Ppraziquantel
Give examples of Non- inflammatory, inflammatory and penetrating causes of diarrhea.
Febrile phase of dengue (Day 2-7)
o Non-specific signs and symptoms
o Tourniquet test is (+)
o Mucosal bleed and GI bleeding may occur
o decreased WBC count
drug of choice for treatment of all stages of syphilis
Single dose of IM Penicillin G
High yield during leptospiremic phase before appearance of antibodies; Limited use due to cost
High yield during leptospiremic phase before appearance of antibodies; Limited use due to cost
What is the best initial test for cervicitis?
Swab for gram stain
• Gold standard in diagnosis
• Time consuming, requires 6-8 weeks for results
Culture and isolation (Direct detection)
What is the first line of antibiotic for mild cases of leptospirosis?
Doxycycline 100mg BID PO
What is the earliest CBC abnormality in Dengue?
Decrease in Total WBC count
most prominent serotype of Enterohemorrhagic E. coli
O157:H7
Bloody stools without fecal leukocytes should alert to the possibility of infection with ______
Shiga toxin–producing enterohemorrhagic Escherichia coli
Submucosal extension of ulcerations under viable appearing surface mucosa causes the classic “flask-shaped” ulcer containing trophozoites at the margins of dead and viable tissues.
INTESTINAL AMEBIASIS
treatment for Nonfalciparum malaria
- ACT or chloroquine
- Give primaquine for 14 days for eradication of hypnozoites to prevent relapse.
Critical phase of dengue (Day 3-7)
o Defervescence around this time
o Progressive leukopenia, rapid decrease in platelet count, increase hematocrit.
o Fluid accumulation (effusion, ascites)
o Shock, organ impairment, DIC, hemorrhage
What are the are hallmark features of Enteric (Typhoid) fever?
Prolonged fever and abdominal pain
PROPHYLAXIS REGIMEN for leptospirosis (started within 24-72 hrs of exposure)
- Low risk (- wound): Doxycycline 100mg 2 caps single dose
- Moderate risk (+ wound): Doxycycline 100mg 2 caps OD x 3-5 days
- High risk (continuous exposure, +/wound): Doxycycline 100mg 2 caps once weekly until end of exposure
In some infected individuals of schistosoma, egg-induced granulomatous responses lead to severe periportal fibrosis known as ______
Symmers clay pipestem fibrosis
What is the most likely etiology of Mucopurulent Cervicitis?
Neisseria gonorrhea or Chlamydia trachomatis
(fever artificially induced by the patient—for example, by IV injection of contaminated water) should be considered in all patients but is more common among young women in health care professions.
Factitious fever
______ is the sudden onset of mononucleosis-like illness with fever, headache, pharyngitis, lymphadenopathy, skin rash occurring 3-6 weeks of primary infection.
Acute HIV syndrome
- HIV + CD4 < 200/uL OR
- HIV + HIV associated diseases indicative of a severe defect in cell-mediated immunity
AIDS
- Fishy order with 10% KOH
- Slightly increased discharge
- Clue cells: vaginal epithelial cells with coccobacillary organisms giving a granular appearance
Diagnosis? Treatment?
Bacterial Vaginosis (Gardnerella vaginalis)
Metronidazole 500mg BID PO x 7 days
Specimen for typhoid that is positive in 1st to 2nd weeks
Blood
What is the toxin responsible in Escherichia coli 0157:H7?
Shiga-toxin
What is the most infectious stage of syphilis?
Secondary syphilis
What is the most accurate test to identify salpingitis?
Laparoscopy
What is the best predictor of short-term risk of developing an opportunistic infection?
CD4 lymphocyte count
What is the first line of antibiotic for severe cases of leptospirosis?
Penicillin G 1.5M units q-68 IV for 7 days
Marker for fecal leukocytes
Fecal lactoferrin
A 20-year-old man complains of non-painful rash on his penis. On examination, there is a non-tender ulcerated nodule with indurated border.
Primary syphilis
Which plasmodium species is responsible for dormant forms of parasite that can reactivate and cause relapses months to years later?
P. vivax or ovale
What is the infective stage of schistosoma?
Cercaria
- Quick detection of Leptospira genus specific IgM antibodies
- Better sensitivity if taken >7 days of illness, highly specific
Specific IgM Rapid (Indirect Detection)
Widely distributed macular rash (also on palms and soles); Condyloma lata (wart like)
Secondary Syphilis
gold standard for diagnosis of malaria
Thick and thin smear
This is seen in what stage of Syphilis?
Tertiary Syphilis
Hemolytic uremic syndrome is characterized by ____
§ Acute renal failure
§ Microangiopathic hemolytic anemia
§ Thrombocytopenia
What are the dormant forms of malaria responsible for relapse?
Hypnozoites
What is the most common neurologic syndrome of AIDS (25-65%)?
AIDS dementia complex
o Poor memory
o Inability to concentrate
o Apathy
o Psychomotor retardation
o Behavioral changes
malignant tertian malaria
P. falciparum
A 30-year-old male presents with 5 days fever and abdominal pain. He recently travelled in an area that has poor sanitation and lack of clean drinking water. On examination, there’s a faint salmon-colored, maculopapular rash on the trunk.
Typhoid fever
Chancroid = painful ulcer is caused by what organism?
Haemophilus ducreyi
What are the warning signs of dengue?
Treatment for asymptomatic carriage of amebiasis.
Luminal agent: Iodoquinol or paromomycin
What is most severe complication of hepatosplenic schistosomiasis?
death may result from massive loss of blood
Hematemesis
The definitive diagnosis of amebic colitis is made by the demonstration of_______
hematophagous TROPHOZOITES (not cyst) of E. histolytica.
First line NRTI for AIDS
Zidovudine (AZT) + Lamivudine (3TC)
What is the antibiotic choice for drug-susceptible infection to Salmonella typhi or paratyphi?
Ciprofloxacin
Recovery phase of dengue
Rashes described as “isles of white in the sea of red” is a sign of recovery. (Herman’s rash)
Signs of plasma leakage in dengue
o Rising hematocrit
o Effusion or ascites
o Shock (decreased pulse pressure)
Treatment for Severe falciparum malaria
- Artesunate IV/IM (1st 24 hours), then oral ACT for 3 days
- primaquine (areas of low transmission)
