Infectious Diseases Part 3 Flashcards
What is Malaria?
Mosquito borne red blood cell disease caused by Plasmodium spp
What is the most dangerous type of Malaria?
Falciparum
What are two protective traits against Malaria?
Sickle cell trait
Thalassemia Trait
Transmission of Malaria
-Protozoa that are transmitted via female Anopheles mosquito (at dusk and dawn)
Symptoms of Malaria
- Cyclical Fever, irregular, every 48 hours-ish
- Cerebral Malaria (AMS, seizures, coma)
- Blackwater Fever (renal failure + dark urine + hemolysis)
Diagnostics for Malaria
- Giemsa-stained blood smear: thick and thin
- Leukopenia, Hemolytic anemia, thrombocytopenia
Treatment for Malaria
-Chloroquine or Hydroxychloroquine
Leishmaniasis is transmitted via
female Sand fly (in Mediterranean, Central and South America, Africa, and Asia
Prophylaxis for Toxoplasmosis
Bactrim when CD4 < 100
Toxoplasmosis is MC CNS infection in patients with AIDS who…
are not receiving appropriate prophylaxis or not on HAART
How else is Toxoplasmosis transmitted?
Soil or cat litter contaminated with feline feces or undercooked meat from infected animal
Symptoms of Toxoplasmosis
- Encephalitis: headache, neuro symptoms, fever, AMS
- Chorioretinitis: posterior uveitis, eye pain, decreased visual acuity
Serologies for Toxoplasmosis show
Anti-toxoplasma IgG antibodies
On neuroimaging (MRI) for Toxoplasmosis, what is seen?
Multiple ring-enhancing lesions
Treatment for Toxoplasmosis
- Sulfadiazine + Pyrimethamine
- Spiramycin if pregnant
Trichomonas Vaginalis is what type of bacteria?
Flagellated protozoan that is transmitted sexually
Symptoms of Trichomoniasis
- Copious frothy yellow-green vaginal discharge
- Cervical petechiae (strawberry cervix)
Treatment for Trichomoniasis
-Metronidazole 2g oral dose x 1 days
Partners must be treated too!
What is seen on a saline wet mount for trichomoniasis?
Mobile protozoan trophozoites
Congenital Varicella syndrome develops if a mother develops Varicella (Chickenpox) between ____ and ____ weeks gestation
8 and 20
What reduces the severity of infection after exposure to Varicella virus in patients with high risk if pregnant?
Varicella immune globulin VZIG
What groups are at high risk and get the VZIG?
- Newborns of mothers with Varicella 5 days before to 2 days after delivery
- Premature infants at or greater than 28 weeks who are exposed
- Pregnant women who lack immunity to VZV
Management for Perinatally-acquired infection of Herpes Simplex Virus
IV Acyclovir x 14 days then oral Acyclovir for 6 months
Zika Virus is transmitted from the Aedes mosquito. What are other transmission routes?
- Infected mosquito
- Sex
- Maternal-fetal
- Organ transplantation
Although most people with Zika Virus are asymptomatic, what are some symptoms they can have?
-Congenital Zika Syndrome: microcephaly, intracranial cerebral malformation, ocular lesions, hypertonia
What is the initial test of choice for Zika Virus?
-Serum or urine Zika virus IgM
For prevention of Zika Virus, what are the recommendations for Men Vs Women?
Men: wait at least 3 months before having unprotected sex
Women: wait at least 8 weeks before having unprotected sex
Pregnant women should avoid travel to areas below 6,500 feet where transmission is ongoing.
Lyme Disease is spread through Borrelia Burgdorferi, which is a
gram-negative spirochete spread by the Deer Tick
Clinical Manifestations of Lyme Disease (3 stages)
- Early: Erythema Migrans: expanding, warm, annular, erythematous rash that may develop central clearing (Bullseye rash)
- Disseminated: neurologic, CNVII facial nerve palsy, AV block, headache, weakness
- Late disease: intermittent or persistent arthritis of the knee
Serologic testing for Lyme Disease
-ELISA followed by Western Blot if ELISA is positive or equivocal
What condition can cause a false positive for Lyme?
Syphilis
Prophylaxis for Lyme
-Doxycycline x 1 dose given within 72 hours of tick removal if tick was present for at least 36 hours
Treatment for Lyme Disease
- Doxycycline first line (Amoxicillin or Cefuroxime)
- Amoxicillin is first line in pregnancy (Azithromycin or Erythromycin)
If the Lyme disease is late or severe, what is the treatment? For example, if the patient has a 2nd/3rd heart block, syncope, dyspnea, chest pain, CNVII palsy
IV Ceftriaxone
Transmission of Syphilis
Direct contact of mucocutaneous lesion (sexual activity) or to the fetus via the placenta
Symptoms of Syphilis
- Primary: Chancre (painless ulcer near or at inoculation site) with raised edges. Nontender LAD near site that lasts 3-4 weeks
- Secondary: Maculopapular rash, involvement of palsy and soles. Condyloma Lata (wart like moist lesions evolving mucus membranes). Fever, LAD, headache, meningitis, alopecia
- Tertiary: Gumma (noncancerous lesions on skin and body), Neurosyphilis (headache, Tabes dorsalis of posterior columns leading to ataxia, weakness), Argyll-Robertson Pupil: small irregular pupil that constricts with light accommodation but not reactive light. Aortitis, AR, aortic aneurysm
Diagnostics for Syphilis
- Nontreponemal Tests (nonspecific): RPR and VDRL
- Treponemal Test (confirmatory): FTA-ABS
- Darkfield Microscopy: direct visualization
Treatment for Syphilis
-Penicilin G Benzathine
What if the patient is allergic to PCN and needs treatment for Syphilis?
Doxycycline is first line
What is a Jarisch-Herxheimer Reaction?
Acute, self-limited febrile reaction that occurs within first 24 hours after receiving therapy for a spirochetal infection. Fever, chills, headache, myalgias, hypotension, and worsening of rash
-Self limited and give NSAIDs or antipyretics
Cytomegalovirus occurs primarly in patients that are immunocompromised. Symptoms are like Mononucleosis, but are…
- Without sore throat or LAD
- Fever, cough, myalgia, arthralgias
With reactivation of CMV, what are the symptoms?
- Colitis: MC (bloody stools, fever, abdominal pain)
- Retinitis: hemorrhage with yellow-white soft exudates when CD4 < 50
- Esophagitis: large superficial ulcers on upper endoscopy
On biopsy of tissues with CMV, what is seen?
Owl’s Eye appearance (epithelial cells with enlarged nuclei surrounded by clear zone and cytoplasmic inclusions)
Treatment for reactivation CMV
-Gangiclovir first line
Congenital CMV can lead to stillbirth, prematurity, and hydrops fetalis. True or False, it is the MC congenital viral infection?
True
Treatment for congenital CMV
Ganciclovir
What is the MC sequelae of congenital CMV?
Sensorineural hearing loss
Also have vision impairment, seizures
EBV (HHV-4) is an infection due to Epstein-Barr Virus that is characterized by what things?
Fever, posterior cervical LAD, and tonsillar pharyngitis
- Splenomegaly, fatigue
- Rash if given Ampicillin
Diagnostics for EBV Mono
- Heterophile Antibody (Monospot) test of choice
- Peripheral smear: atypical lymphocytes
Treatment for EBV Mono
- Supportive is mainstay
- Avoid trauma and contacts sports for at least 3-4 weeks to prevent splenic rupture
Erythema Infectiosum also known as _______, is most common in children aged < 10 years old.
Fifth Disease
Erythema Infectiosum is caused by
Parovirus B19 (respiratory droplets)
Symptoms of Erythema Infectiosum
- Erythematous malar rash with a slapped cheek appearance
- Circumoral pallor for 2-4 days
- Lacy, reticular maculopapular rash on extremities
- Arthropathy or arthralgia
- Increased fetal loss during pregnancy
- Aplastic Crisis in sickle cell patients
What are the only two vaccines you should get when pregnant?
Inactivated flu
Tdap
