Infectious Diseases - Turnham Zoom Flashcards
1
Q
Scarlet Fever
Appearance
A
- Enlarged tonsils
- Sandpaper-like Papules
- Circumoral Pallor (white around mouth)
- Blanching (Pastia lines - skin fold lines don’t blanch)
- Increase density of rash on neck, axilla, groin
2
Q
Scarlet Fever
Dx Feature
A
- Petechiae on soft palate
- STRAWBERRY TONGUE
- Strep test
- Group A beta hemolytic strep is cause
3
Q
Scarlet Fever
Treatment
A
- PCN 10-14 days
- If PCN allergy, use Erythromycin or Clindamycin
- Should improve w/in 48 hours
- Goals: prevent acute rheumatic fever, decrease spread of disease, prevent glomerulonephritis
4
Q
Streptococcal Perianal Cellulitis
Characteristics
A
- Perianal erythema, tenderness
- Afebrile; otherwise well
- Heavy growth of group A strep (GAS) on culture
- Scant rectal bleeding with defecation possibly
5
Q
Enteroviruses
A
- Any RNA virus that occurs in GI tract, but can spread to other areas (including Hep A and Polio)
- Commonly spread through respiratory secretions
- More than 90% of these viruses are non-distinctive
6
Q
Enterovirus Examples
A
- Herpangia
- Acute lyphonodular pharyngitis
- Hand-Foot-Mouth Disease
7
Q
Hand-Foot-Mouth Disease
(Coxsackievirus Type A 5, 10, 16)
Rash Types
A
- Rash
- Macular (lesions flat and level with surrounding skin)
- Maculopapular (lesions flat and raised)
- Urticarial (raised, itchy skin, aka hives)
- Scarlatinaform (diffuse redness with small papules)
- Petechia (pinpoint round spots)
- Vesicular (happens near vesicles)
8
Q
Hand-Foot-Mouth Disease
(Coxsackievirus Type A 5, 10, 16)
Characteristics
A
- Lesions found on tongue, oral mucosa, hands, and feet
- Associated with fever, sore throat, malaise
9
Q
Mononucleosis
Transmission
A
- Exposure to EBV
- Transmitted through intimate contact - direct salivary transfer (kissing disease)
- After exposure, EBV remains in host for life
- Incubation is 1-2 months after exposure
10
Q
Mononucleosis
Characteristics
A
- Prolonged fever
- Exudative pharyngitis
- Generalized adenopathy
- Hepatosplenomegaly
- Atypical lyphocytes
11
Q
Mononucleosis
Presentation
A
- Incubation period 1-2 months
- 2-3 days prodrome of malaise leading to febrile illness
- Major complaint is pharyngitis
- Splenomegaly present 50-75% of the time
- Hepatomegaly present 30% of the time (LFTs elevated)
12
Q
Mononucleosis
Diagnosis
A
- Heterophile Antibodies
- More sensitive in pt over 5 yo
- May not be detectable until 2nd week of illness
- Monospot positive if titer is significant but this is NOT TOTALLY DIAGNOSTIC
13
Q
Mononucleosis
Treatment
A
- Avoid contact sports for 6-8 weeks
- Analgesics/Antipyretics if needed
- Drink plenty of fluids
- Bed rest
- F/U labs and US IF:
- Splenomegaly
- Elevated LFTs
- Abnormal CBC (lymphocytosis)
14
Q
Mononucleosis
Immunity
VCA IgG
VCA IgM
EBNA IgG
A
- No previous exposure = all 3 -
- Recent Infection = both VCA +
- Previous Infection = both IgG +
- Exposure in past = VCA IgG +
- Post Infection = + for all
15
Q
Erythema Infectiosum (Fifth Disease) Characteristics
A
- Caused by a parvovirus (B19)
- Spread by respiratory secretions
- Late Winter-Early Spring
- Starts with fever
- Rash on the face “slapped cheek”
- Symmetrical, full body reticulated (lacy) rash
- Patches usually have circumscribed macular borders that are non-tender (how to differentiate from cellulitis)
16
Q
Erythema Infectiosum (Fifth Disease)
A
- Rash appears 4-14 days post exposure
- Infectious prior to rash appearing
- Rash will fade in several days to weeks, but may reappear with local inflammation, heat, sunlight, stress
- Pregnant women may develop fetal infection (hydrops fetalis - accumulation of fluid in 2 or more fetal compartments)
- Increased risk for fetal demise
17
Q
Roseola
Characteristics
A
- Infants 6-36 months
- Late fall-Early spring
- Human herpes virus 6 or 7
- Transmitted through respiratory secretions
- Incubation period about 9 days
18
Q
Roseola
Presentation
A
- Abrupt onset of fever (102-105 for 3-8 days)
- Fever abruptly subsides, then faint pink spots that blanch appear on neck, upper arms, and trunk (sometimes face/legs)
- Benign illness (self-limiting)
19
Q
Rubeola (Measles)
Characteristics
A
- Incubation 9-14 days
- Fever, cough, conjunctivitis, and coryza (inflammation of nasal mucosa)
- KOPLIK SPOTS (red/white patches in oral mucosa): 1-2 days prior to and after onset of rash
- Maculopapular rash spreads down face to trunk over 3 days, then merges
- Leukopenia
20
Q
Rubella
“3 Day” German Measles
Characteristics
A
- No hx of rubella vaccine
- Incubation 14-21 days (most infectious 1-5 days after rash appears)
- Respiratory symptoms
- Low-grade fever
- Conjunctivitis
- Adenopathy behind ears and sub-occipital
- Rash starts on face @ hairline, then trunk/extremities as it fades from face
- Gone by 4th day
21
Q
Congential Rubella Syndrome
A
- Woman who gets rubella early in pregnancy has a 90% chance of giving birth to deformed baby
- Most are deaf or blind
- Many are mentally retarded
- May have damaged heart or unusually small brain
- Miscarriages also common
22
Q
Mumps
Characteristics
A
- Acute and self-limiting
- Swelling of one or more salivary glands
- Parotid gland enlargement typical
- Rubulavirus can be found in urine, respiratory secretions, CSF
- May be inactivated by heat, chemical agents (chloroform, formalin), or UV light
23
Q
Mumps
Exposure to Symptoms
A
- Transmitted through respiratory droplets
- Incubation 16-18 days, however some may develop in 12-25 days post exposure
- Prodromal complaints (last 3-5 days)
- Low-grade fever (< 101)
- HA
- Malaise/myalgias
- Loss of appetite
24
Q
Mumps
Symptoms
A
- Majority of pts have parotitis (parotid gland)
- One or both sides may be affected
- May have associated (same side) earache
- Parotid enlargement typically starts on one side then becomes bilateral
- Up to 80% of cases have bilateral enlargement
25
Mumps
| Other areas that may be affected
- CNS
- Most common location after parotid gland
- True aseptic meningitis
- GI
- Acute pancreatitis
- GU
- Unilateral orchitis (inflammation of testicle)
- Approx 10% of males
- High fever, severe testicular pain, erythema of scrotum
- Sterility is rare with orchitis
26
Mumps
| Treatment
- Educate pt/fam to isolate for 5 days after dx to lessen risk of transmission
- Warm/cold packs to affected areas
- NSAIDs/Tylenol
- Rest/Fluids
27
Varicella Virus
| Characteristics
- Incubation 10-21 days
- Contagious from 1-2 days before rash appears until lesions crust over (usually 5-6 days after onset)
- Spread by droplet precautions and direct contact with lesions
28
Varicella Virus
| Symptoms
- Variable fever
- Non-specific symptoms including malaise/fatigue, HA
- Rash begins on the head/face then mostly on face/trunk
- Widely scattered red macules and papules followed rapidly by vesicles, pustules, then crusting over 5-6 days
- New crops stop after 5-7 days
- Pruritis usually intense
- No longer contagious when crusting begins
29
Varicella Virus
| Treatment
- Varicella Vaccine (Varivax)
- Ages 12 months and booster @ 5 yo.
- Slight chance of outbreak in people who have been vaccinated
- May receive vaccine w/in 72 hours of exposure to prevent/diminish severity of illness
- Antiviral drugs
- Acyclovir, age 12 +
- Given in pts with COPD, on LT salicylate therapy, or on Corticosteroids (suppressed immunity)
- Must be started w/in 24 hours of onset of rash
30
```
Herpes Zoster (Shingles)
Info
```
- 1 in 5 Americans
- Associated with normal aging, certain meds, cancers, or infections
- Involves single dermatome (truncal or cranial)
- May have prodrome of neuropathic pain or itching in same area
31
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Herpes Zoster (Shingles)
Characteristics
```
- Vesicles often coalesce (come together to form one mass)
- Crusting occurs in 7-10 days
- Common in HIV infected/Immunocompromised pts
- Complications include bacterial infection, CN paralysis, Meningitis, Encephalitis, and Keratitis
32
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Herpes Zoster (Shingles)
Treatment
```
- Acyclovir = Preferred
- But...you know Dr. Turnham says that compliance is often better with fewer pills to swallow
- Ensure pt can pay for pills, or it won't matter
33
```
Herpes Zoster (Shingles)
Cranial
```
- REFER TO OPTHAMOLOGY IF THERE IS A LESION ANYWHERE ON HEAD
34
Salmonella Gastroenteritis
| Info
- Infects domestic and wild animals
- Fowls and reptiles have higher carriage rate
- Contaminated foods; fecal/oral route
- Highest attack rates in children < 6 yo with a peak 6 mos-2 yo
- Stools are watery, may have mucus, sometimes blood (suggests shigellosis)
35
Salmonella Gastroenteritis
| Symptoms
- N/V
- HA
- Fever
- Abd pain
- Diarrhea = frequently associated with bacteremia especially in newborn/infants
36
Salmonella Gastroenteritis
| Dx
- Stool culture for C&S
- May culture blood, urine, CSF, or pus from a lesion in acutely ill pt
- Reportable to health dept
37
Salmonella
| Differentials
- Staphylococcal Food Poisoning
- Shorter incubation (2-4 hrs), vomiting main symptom, no fever
- Shigellosis
- Bloody diarrhea, high fever, pus/blood in stool microscopically
- Incubation 2-4 days
- Campylobacter
- Resembles salmonella, but culture of stool differentiates the two
38
Salmonella
| Treatment
- Abx in infants < 3 mos, SSD, Immunosuppressed, severely ill children
- 3rd gen Cephalosporin recommended
- Fluoroquinolones for adults
- Abx does not shorten course of illness, may prolong convalescent carriage of organism
- Dr. Turnham's soapbox:
- Use Probiotics with abx to reduce C-diff
- PLEASE
39
Salmonella
| Follow-up
- 50% of pts have + stool culture after 4 wks
- Infants tend to remain carriers for up to 1 yr
- Food handlers and child care workers should have 3 negative cultures before resuming work
- Asymptomatic children do not need exclusion
- Infants, pts > 65yo, sepsis, and any pt requiring hospitalization should be considered for abx
40
Traveler's Diarrhea
- Benign, self-limiting
- Prophylaxis - only if comorbid disease (Inflammatory Bowel, HIV, etc.)
- Single-dose Fluoroquinolone is usually effective
- Test for Ova/Parasite in stool and do C&S to differentiate with parasitic infection
41
Traveler's Diarrhea
| Symptoms
- Fever (rare)
- > 10 watery stools/day
- Occasional vomiting
- Abd cramping that accompanies loose stool
42
Fever of Unknown Origin
(FUO)
Information
- Min. 3 week duration
- Fever > 38.3 C (100.9 F)on several occasions
- Dx has not been made after 3 outpatient visits or 3 days of hospitalization
43
Fever of Unknown Origin
(FUO)
Causes
- Adults: infections 25-40%, Cancer 25-40%
- Children: infections 30-50%, Cancer 5-10%
- Latent TB infection
- Opportunistic infection in immunocompromised pt
- Potential drug toxicity/drug interactions
44
Fever of Unknown Origin
(FUO)
Treatment
- Refer to Infectious disease specialist will interpret/coordinate specialized testing with CDC
45
Animal and Human Bites
- Most fatalities are d/t dog bites (mauling)
- Human and cat bites are majority of infected bite wounds
- Hand bites have higher risk of closed-space infection
- Abx prophylaxis - non-infected bites of hand
- Hospitalization required for infected hand bite
- Infected wound needs culture to direct therapy
46
Dog Bites
- Treat like any other wound: irrigate with NS, debridement of devitalized tissue, remove any foreign matter
- Td or TdaP
- Rabies vaccine?
- Suture with CAUTION
- Prophylactic abx???
- If bite involves joint, periosteum - prompt referral to ortho for sx consult
- Tx: Broad spectrum coverage with Augmentin or Cephalexin
47
Human Bite
- Treat prophylactically with abx
| - Only suture severe lacerations to face
48
Cat Bites
- Increased risk of infection
- Prophylactic PCN + Cephalexin OR Augmentin
- May result in cat scratch disease:
- Papule or pustule at site
- Fatigue
- Fever
- HA
- Adenopathy near site
- May have splenomegaly
- Consider admission and IV abx for infection
49
All Bites
| Tx
- Augmentin is tx of choice
50
Lyme Disease
| Info
- Caused by Borrelia Burgdorferi, a spirochete that is gram negative
- Tick usually active for 36-48 hours for transmission of Lyme Disease
- Black legged tick or deer tick
- NE
- Mid-Atlantic
- North Central
- Upper MW
- Western Black legged tick
- Pacific Coast
51
Lyme Disease
| Stage 1
- Early Localized infection
- Erythema migrans (bulls eye) - flat or slightly raised with central clearing
- Incubation 3-30 days, but usually 7-10 days
- Lesion expands over several days, concomitant viral-like illness w/myalgia, arthralgia, HA, and fatigue; may or may not have fever
- Resolves in 3-4 weeks even w/o tx
52
Lyme Disease
Stage 1
Differentials
- Chemical reactions
- Tick/Spider bites
- Drug Eruptions
- Urticaria
- Staph and Strep Cellulitis
- Tinea Corporis
53
Erythema Migrans
- Bulls-Eye: Flat or slightly raised lesion with central clearing
- Ex: Ringworm
- Common Sites:
- Thigh
- Groin
- Armpits
- Trunk
54
Lyme Disease
| Stage 2
- Early disseminated infection
- 50-60% of pts w/erythema migrans are bacteremic; secondary skin lesions develop in 50% of pts
- Malaise, fatigue, fever, HA, neck pain, generalized achiness are common
- Fatigue may last months
- Organism may sequester in certain areas and produce focal symptoms such as cardiac/neuro manifestations
55
Lyme Disease
| Stage 3
- Late persistent infection
- Months to years after initial infection and manifests as musculoskeletal, neurologic, and skin disease(s)
- Monoarticular (one joint) or Oligoarticular (few joints) arthritis
- Mostly in knees or other large weight bearing joints
56
Lyme Disease
| Testing/Diagnosis
- Serologic testing based on a 2-test approach:
- First test: Enzyme Immunoassay (EIA) OR Immunofluorescence Assay (IFA)
- If neg, consider alternative dx
- If + and s/s < 30 days -> check IgM, IgG/Western Blot
- If + and s/s > 30 days -> IgG/Western Blot only
57
Lyme Disease
| Treatment
- Prophylactic: Doxycycline 200mg x 1 dose
- Tx is 14-21 days in early stages of disease with:
- Doxycycline > 8 yo or Amox for all ages or pregnancy
- Cefuroxime axetil - costly - IM/IV doseage
- Erythromycin - less effective, not 1st line
- Most pts respond with prompt resolution of s/s w/in 4 weeks
- Referral to infectious disease specialist recommended for atypical/prolonged cases
58
Zika Virus Infection
| Info
- Spread mostly by bite of infected Aedes species mosquito
- Can be passed from pregnant woman to fetus. Infection during pregnancy can cause birth defects
- No vaccine or medicine to treat Zika
- Zika transmission has been reported in the U.S.
59
5 things to know about Zika
1 - Spreads through infected mosquitos, can also get through sex
2 - Best prevention of Zika is to prevent mosquito bites
3 - Zika is linked to birth defects
4 - Pregnant women should not travel to areas with Zika
5 - Travelers infected with Zika returning home can spread virus through mosquito bites
60
Coronavirus
COVID-19
Info
- Large family of viruses commonly exchanged between humans and animals
- Spread through respiratory droplets, may linger in air and on surfaces for up to...? (2020 info, no longer accurate)
61
Coronavirus
COVID-19
Diagnosis
- Test anyone with:
- Fever
- Dry cough
- Known exposure + s/s
- Over 65 yo
- Healthcare workers
- Immunocompromised or has comorbidities
- Hospitalized with resp s/s
62
Coronavirus
COVID-19
Treatment
- WHO currently endorsing systemic steroids in critically ill/severe cases of COVID-19
- Remdesevir is only CDC approved tx for COVID
- Blood thinner post-COVID for risk of clots
- CDC no longer recommends Azithromycin + Hydroxychloroquinne
63
COVID-19 Treatment
FOR TEST PURPOSES
Non-Hospitalized Pt
- Insufficient data to recommend for/against antiviral or antibody therapy
64
COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized, but no supplemental O2 needed
- Dexamethasone or other corticosteroids
| - Insufficient data to recommend for/against Remdesivir.
65
COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed (but not through high-flow device/Noninvasive ventilation)
- Remdesivir (e.g. for pts who require minimal supplemental O2)
- Dexamethasone + Remdesivir (for pts requiring increasing amounts of supp O2)
- Dexamethasone (when combo therapy with Remdesivir cannot be used/not available)
66
COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed (+ high-flow device/Noninvasive ventilation)
- Dexamethasone OR Dexamethasone + Remdesivir
67
COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed using INVASIVE MECHANICAL VENTILATION
- Dexamethasone
68
COVID-19 Treatment
| Antibody and Plasma Tx
- Monoclonal antibodies
- HIV, RSV, Influenza, MERS, Ebola, Zika, and COVID all have monoclonal antibodies
- Convalescent plasma
- Cytokine storm syndrome: hyper response of the body's immune system. In COVID it is more of an inflammatory response and not enough anti-inflammatory cytokines.
69
COVID-19 Treatment
| Monoclonal Antibody Guidelines
- Must meet at least 1 of the following:
- BMI > or = 35
- CKD
- DM
- Immunosuppressive disease
- Currently receiving immunosuppressive tx
- > or = 65yo
> or = 55yo AND have CV disease, HTN, OR COPD/respiratory disease
- Age 12-17 AND have BMI . or = 85th% for their age
- OR have sickle cell disease
- OR congenital heart disease
- OR neurodevelopmental disorders (cerebral palsy)
- OR medical-related technological dependence (trach, gastrostomy, + pressure ventilation)
- OR asthma, reactive airway, or other respiratory condition that requires daily medication for control
