INFECTIOUS DISEASES Flashcards
red eye with purulent discharge, tense edema of eyelids with marked chemosis; incubation period 2-5 days
Neisseria gonorrhoeae
Ceftriaxone 50 mg/kg/day for 1 dose
mild to severe swelling of eyelids with copious purulent discharge; incubation period 5-14 d
Chlamydia trachomatis
Systemic antibiotics; Gentamicin eye ointment
EYE INFECTIONS AND CAUSATIVE AGENTS
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most common cause of viral conjunctivitis pharyngoconjunctival fever (red eye, red throat, fever)
Adenovirus
Cestodes (flatworms) – all are treated with ______ EXCEPT Echinococcus granulosus (_______)
Praziquantel
Albendazole
All TREMATODES (flukes) are treated with
Praziquantel
DOC Ascaris, Ancylostoma, Necator, Capillaria
Albendazole
DOC Trichuris
Mebendazole
DOC Enterobius
Pyrantel pamoate
DOC Strongyloides
Ivermectin
DOC Wuchereria and Brugia
DEC
DOC Trichinella
Thiabendazole
Retinopathy w/ keratitis in a newborn or a young child; Mother has hx of drug abuse
Cytomegalovirus (CMV chorioretinitis)
Which drug will you give topically to eradicate the nasopharyngeal carriage of Staphylococcus aureus in an adolescent with recurrent carbunculosis?
Mupirocin
old name for staphylococcal scalded skin syndrome; exfoliatins A and B are distinct proteins that produce localized or generalized skin manifestations; produce skin separation by splitting the desmosome changing the IC matrix in the stratum granulosum
Ritter Disease
DOC for Staph SSS
Oxacillin or if MRSA is suspected, start Vancomycin
POST-EXPOSURE PROPHYLAXIS for Varicella in a younger child
live varicella vaccine itself can be given within 3-5 days of exposure to modify the course.
Passive immunization with Varicella Zoster IG (VZIG) is for
(1) immunocompromised,
(2) pregnant, and
(3) newborns whose mother had chickenpox 5 days before up to 2 days after delivery
* VZIG 125 U/10 kg IM (max. 625 units) to be given within 96 hours after exposure
MC causative agent of erysipelas / St. Anthony’s Fire
Streptococcus
Management for Sporotrichosis:
Itraconazole; Amphotericin B for the severely ill
Empiric treatment for LGV Chlamydia trachomatis (Lymphogranuloma venereum)
Doxycycline 100 mg orally 2x a day for 21 days
Drug of choice for Syphilis
single dose of benzathine Penicillin G 2.4 million units IM
Drug of choice for W. bancrofti:
single dose Diethylcarbamazine (contraindicated in patients coinfected with onchocerciasis) regardless whether symptoms or microfilaremia are present; with the addition of Doxycycline 200 mg/day for 4-6 weeks for its macrofilaricidal activity
- Jaw area swelling
- Sinus tract formation
- Yellow exudate
- Carious teeth
- Dental procedure
- Yellow granules in exudates
Actinomyces
Subcutaneous swelling of shoulder Sinus Tract formations Granules
Nocardia
- Target lesion
- Bull’s eye
- Fever,
- headache
- Rash border
- Bite site
Borrelia burgdorferi (Lyme disease)
Erythema migrans is seen in
Borrelia burgdorferi (Lyme Disease)
* lesion that appears at the site of tick bite 7-14 days after; occurs most often on the head, neck, arms, legs, back
Pharyngoconjuctival fever in children is most commonly caused by:
Adenovirus
TREATMENT OF DIPHTHERIA
• Aqueous Penicillin G IM or IV 100,000-150,000 U/kg/day every 6 hours for 14 days
• Erythromycin: eradicates nasopharyngeal carriage 40-50 mg/kg/day orally or IV every 6 hours for 14 days
White papules with red base on posterior palate & pharynx
Herpangina
Purulent tonsils
Fatigue
Lymphadenopathy
Infectious mononucleosis
- Low grade fever with gradual onset of membranous nasopharyngitis
- Bull neck from lymphadenopathy
Diphtheria
Finely popular, erythematous eruption producing a bright red discoloration of the skin, which blanches on pressure, more intense along the creases of the elbows, axillae, and groin. The skin has a goosepimple appearance & feels rough. After 4 days, the rash begins to fade & is followed by desquamation
Scarlet Fever
Reiter’s syndrome (reactive arthritis):
Can’t see (Conjunctivitis),
Can’t pee (Urethritis),
Can’t climb a tree (Arthritis)
PATIENTS PRESENTING WITH OSTEOMYELITIS
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PATIENTS PRESENTING WITH TOXIC LOOKING RASHES
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DOC for rickettsia
Doxycycline
TSST- toxic shock syndrome toxin
- Staph aureus, Strep pyogenes;
- major criteria: fever 38.8 or greater, hypotension. rash
An 8 year-old male presents to the clinic with a history of low-grade fever, headache, and cough and colds for the past 3 days. He then develops a reddish facial flushing which then spread into the trunk and the upper arms. On close examination, the rash is erythematous macular with central clearing and does not affect the palms and soles. What is the most likely diagnosis?
Erythema Infectiosum
A 1 year-old male came for consult for rashes. Four days prior, patient started having runny nose with clear nasal discharge with mild conjunctival redness. Three days ago, patient had a fever of 39C which resolved on the 3 rd day but a few hours after there was appearance of a rash starting on the trunk which eventually spread to the face and extremities. PE revealed small pinkish maculopapular lesions over the trunk, face and extremities, HR: 120, RR: 33, T37.2°C. What is the most likely diagnosis?
Roseola
causative agent for roseola
HHV-6
Cough, coryza and conjunctivitis, and fever
Measles or Rubeola
Posterior cervical, cervical or auricular nodes
German Measles or Rubella
Slapped cheek looking then spread to trunk with central clearing
Erythema infectiosum or 5 th disease
Abrupt onset of fever with URTI for 3-4 days, fever disappears & rashes appears on trunk and spread
Roseola or 6 th disease
Preceded by rapid onset of fever, myalgia, ocular pain, hypesthesia. Rashes blanch on pressure
Dengue Fever
- Cough, coryza and conjunctivitis fever
- fever disappears once rash has moved down to feet
Rubeola/MEASLES
postexposure prophylaxis of Measles
- Measles Ig for prevention & attenuation within 6 days of exposure (0.25 mL/kg max. of 15 mL IM)
- Measles active vaccine can be given for susceptible children > 1 yr old within 72 hours
- Infants <6 months old, pregnant & immunocompromised persons should receive Ig but not the active vaccine.
Warthin-Finkeldey cells
Measles
A 13 year-old female presents to the clinic due to generalized rash of 2 days duration. It initially started in the face and spread rapidly up to the legs within 1 day. There was accompanying fever of 38°C, (+) joint pains over the knees and ankles, persistence of symptoms prompted consult. PE revealed: slightly hyperemic conjunctivae and posterior pharynx, (+) generalized maculopapular rash over the whole body with some evidence of clearing in the face, (+) tender enlarged posterior auricular and cervical lymph nodes. What is the most likely diagnosis?
Rubella
Forchheimer spots
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Rubella / German Measles
Strawberry tongue may be seen in
Kawasaki disease or in scarlet fever.
Koplik Spot
- 2-3 days before rashes
- grains of salt on a wet background
- Clustered white lesions of buccal mucosa, adjacent 2 nd -3 lower molar
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Measles
Nagayama Spot
Roseola
* Reddish papules of soft palate
- Coryza, Cough, Conjunctivitis
- High grade fever.
- Rashes appear at peak of fever
- Photophobia
- Cephalo-caudal progression
- Desquamation when rash reaches sole
- Koplik Spot
Measles (Rubeola)
Measles (Rubeola) period of communicability
4 days before and 4 days after onset of rash
- Low grade fever.
- No photophobia
- Cephalo-caudal rash.
- POSTERIOR AURICULAR LN
• Forchheimer Spots
Rubella (German measles or 3 day measles)
- Togaviridae,
- RNA
Rubella (German measles or 3 day measles)
Period of communicability of Rubella (German measles or 3 day measles)
7 days before 7 days after rash
- Fever 3-5 days
- High grade fever
- Fussiness
- Seizures
• RASHES APPEAR WHEN FEVER ABATES
• Nagayama spots
Roseola (Exanthem Subitum, Sixth Disease)
- Fever, malaise 1-2 days before rash
- Maculopapular, vesicular, pustular lesions present simultaneously
- Appear first on the trunk (sim to roseola)
Varicella
Period of communicability of Varicella
1-2 days before rash, 7 days after rash and ALL LESIONS HAVE CRUSTED
- Ulcers in tongue, buccal mucosa
- Tender ulcers on hands and feet
Hand, foot and mouth disease
Etiology of Hand, foot and mouth disease
Coxsackie Virus A16
- Slapped cheek appearance
- Spread to trunk
- Spares palms and soles
- Complication: Aplastic Crisis
Erythema Infectiosum 5th disease
Etiology of Erythema Infectiosum 5th disease
Parvovirus B19
A 2 year-old male patient presents to the ER with fever 40°C and sore throat. Upon inspection, there are multiple vesicles and ulcers over the tonsillar pillars and posterior pharyngeal wall, no rashes on the body or extremities. What is the most likely diagnosis?
Herpangina
Causative agent for Herpangina
Coxsackie A Virus
Period of communicability of mumps
1-2 days before the onset of parotid swelling until 5 days after the onset of swelling
• Pain & swelling in one or both parotid glands (peaks in 1-3 days)
• Swollen glands push the ear lobe upward & outward & the angle of mandible is no longer visible
• Swelling subsides within 3-7 days
MUMPS
COMPLICATIONS OF MUMPS
- Meningoencephalitis
- Orchitis & epididymitis
- Oophoritis
- Pancreatitis
- Arthritis
o Severe form of leptospirosis affecting <10% of children
o Hemorrhage & cardiovascular collapse
o RUQ pain, hepatomegaly, increased liver enzymes, hyperbilirubinemia
o Azotemia to oliguria to anuria
Icteric (Weil syndrome)
most useful screening test for leptospirosis
Microscopic slide-agglutination test using killed Ags
Treatment for Leptospirosis
- Penicillin or Tetracycline
- Parenteral Penicillin G 6-8 M U/m2/day in 6 divided doses for 1 week
Dengue with warning signs:
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