INFECTIOUS DISEASES Flashcards by Sharmaine Lozano

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

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mild to severe swelling of eyelids with copious purulent discharge; incubation period 5-14 d

Chlamydia trachomatis

Systemic antibiotics; Gentamicin eye ointment

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EYE INFECTIONS AND CAUSATIVE AGENTS

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most common cause of viral conjunctivitis pharyngoconjunctival fever (red eye, red throat, fever)

Adenovirus

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Cestodes (flatworms) – all are treated with ______ EXCEPT Echinococcus granulosus (_______)

Praziquantel

Albendazole

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All TREMATODES (flukes) are treated with

Praziquantel

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DOC Ascaris, Ancylostoma, Necator, Capillaria

Albendazole

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DOC Trichuris

Mebendazole

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DOC Enterobius

Pyrantel pamoate

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DOC Strongyloides

Ivermectin

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DOC Wuchereria and Brugia

DEC

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DOC Trichinella

Thiabendazole

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Retinopathy w/ keratitis in a newborn or a young child; Mother has hx of drug abuse

Cytomegalovirus (CMV chorioretinitis)

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Which drug will you give topically to eradicate the nasopharyngeal carriage of Staphylococcus aureus in an adolescent with recurrent carbunculosis?

Mupirocin

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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

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DOC for Staph SSS

Oxacillin or if MRSA is suspected, start Vancomycin

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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.

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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

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MC causative agent of erysipelas / St. Anthony’s Fire

Streptococcus

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Management for Sporotrichosis:

Itraconazole; Amphotericin B for the severely ill

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Empiric treatment for LGV Chlamydia trachomatis (Lymphogranuloma venereum)

Doxycycline 100 mg orally 2x a day for 21 days

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Drug of choice for Syphilis

single dose of benzathine Penicillin G 2.4 million units IM

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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

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Jaw area swelling
Sinus tract formation
Yellow exudate
Carious teeth
Dental procedure
Yellow granules in exudates

Actinomyces

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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

PATIENTS PRESENTING WITH TOXIC LOOKING RASHES

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

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

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

1. Meningoencephalitis 2. Orchitis & epididymitis 3. Oophoritis 4. Pancreatitis 5. 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: