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Infectious dz Flashcards

1
Q

presents similar to TB – cough, chest pain, fever, weight loss, upper lobe infiltrates & cavities

A

Mycobacterium avium complex

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2
Q

Mycobacterium Avium Complex transmission

A

Transmission: present in soil & water (NOT person to person)

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3
Q

Sx of Mycobacterium Avium Complex

A

Symptoms seen in patient w/ underlying pulmonary disease (Bronchiectasis, COPD) &/ immunocompromised patients (HIV with CD4 count less than or equal to 50cells/uL)

Symptoms rarely occur in immunocompetent patients without underlying lung disease, inc. risk in bronchiectasis

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4
Q

Tx of Mycobacterium avium complex

A

MAC is treated with clarithromycin + ethambutol + Rifampin/Rifamycin/Rifabutin fort at least 12 months

Life threatening disease? Add a parenteral aminoglycoside to above regimen

Second line: Ethambutol + Rifamycin (or Rifabutin) + Aminoglycoside

Surgical excision of infected lymph nodes = curative in 90% of patients w/ lymphadenitis

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5
Q

Mycobacterium Marinum is found where

A

Atypical Mycobacterium – found in fresh & salt water ** MARINUM = AQUARIUM = WATER **

Transmission: Inoculation of a break in skin barrier (laceration, abrasion, etc.) with exposure to contaminated water

Occupational hazard of aquarium handlers, marine workers, fisherman & seafood handlers

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6
Q

Sx of mycobacterium marinum

A

Localized cutaneous disease: erythematous bluish papule or nodule at the site of trauma that can ulcerate (w/ history of exposure to non-chlorinated water 2-3w earlier)

Subsequent lesions may occur along the path of lymphatic drainage over a period of months

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7
Q

Chronic disease caused by Mycobacterium leprae & lepromatosis that primarily affects superficial tissues (especially skin & peripheral nerves)

Endemic in subtropical areas – requires long exposure (few months to 20-50 years incubation period)

A

Leprosy; Hansens dz

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8
Q

Sx of Leprosy

A

Lepromatous: nodular, plaque, or popular skin lesions (lepromas) with poorly defined borders • Hypopigmented lesions can be seen in cooler areas of the body – face (leonine), ears, wrists, elbows, knees & buttocks; loss of eyebrows & eyelashes ; Slowly evolving SYMMETRIC nerve involvement (sensation preserved), paresthesia in affected peripheral nerves

* MC seen in immunocompromised patients

Tuberculoid: limited disease – sharply demarcated hypopigmented macular lesions numb to the touch (loss of sensation) w/ sudden onset of ASYMMETRIC nerve involvement

MC in immunocompetent patients (immune system rxn in the nerves causes the loss of sensation) ; Mononeuritis multiplex: nerve damage – posterior tibial nerve, median & ulnar involvement (clawing), common peroneal nerve (foot drop), vibratory & proprioception preserved

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9
Q

Tx of leprosy

A

Lepromatous: Dapsone, Rifampin, Clofazimine x2-3 years

Tuberculoid: Dapsone + Rifampin 6-12 months → then Dapsone x2 years

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10
Q

Epstein Barr etiology/transmission

A

Epstein-Barr virus (part of Human herpesvirus family) infects B cells, incubation period 30-50 days

saliva (kissing disease), especially ages 15-25

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11
Q

Sx of Epstein Barr

A

Fever, lymphadenopathy (especially posterior cervical), can be generalized

Tonsillar pharyngitis – may be exudative; may have petechiae on the hard palate

Associated with headache, fatigue, malaise, splenomegaly (inc. risk of splenic rupture), hepatomegaly

Maculopapular rash seen in ~5%, especially if given Ampicillin

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12
Q

Dx of epstein barr

A

Heterophile antibody (Monospot) – test of choice (+ within 4 weeks) • Rapid Viral Capsid Antigen test, increased LFTs • Peripheral Smear: lymphocytosis >50% with >10% atypical lymphocytes

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13
Q

Tx of Mono

A

Mainstay of treatment: supportive – rest, analgesics, antipyretics – symptoms may last for months

Corticosteroids used ONLY if airway obstx d/t lymphadenopathy, hemolytic anemia, or severe thrombocytopenia – Strep & EBV can coexist

Avoid trauma & contact sports x3-4 weeks if splenomegaly is present to prevent splenic rupture

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14
Q

Why avoid contact sports if a pt has mono aka epstein barr

A

Avoid trauma & contact sports x3-4 weeks if splenomegaly is present to prevent splenic rupture

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15
Q

Infectious mono aka EBV is what herpes family?

A

EBV = 4

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16
Q

Roseolavirus is what herpes family

A

6 or 6th disease

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17
Q

Measles aka

A

RubeOLA or 1st disease

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18
Q

Transmission of Rubeola (measles)

A

Transmission: respiratory droplets, airborne, ~6-21 day incubation period • 3-phase progression: Prodrome → Enanthem → Exanthem

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19
Q

3 C’s of Measles

A

Prodrome: URI syx + malaise, anorexia, fever + 3 C’s!!:

Cough, coryza, conjunctivitis

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20
Q

Rash seen with Rubeola

A

Enanthem: Koplik spots: small 1-3mm pale white/blue papules w/ an erythematous base on buccal mucosa opposite the 2nd molars (pathognomonic)

Exanthem: Rash: morbilliform (maculopapular), brick-red rash beginning @ hairline spreading cephalocaudally & centrifugally that darkens & coalesces, blanches

Rash lasts 7 days w/ (+) lymphadenopathy & pharyngitis

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21
Q

Tx of measles

A

Mainstay: supportive – PO hydration, Tylenol or Ibuprofen, isolate x1w

Vitamin A: ↓ morbidity & mortality

Measles immunoglobulin: for high risk children

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22
Q

Transmission of mumps

A

Transmission: respiratory droplets, saliva, & household fomites ~12 day incubation period • Increased in spring & most infectious 48h prior to onset of parotitis & infectious for 9 days after onset

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23
Q

Sx of Mumps

A

Prodrome: low-grade fever, myalgia, malaise, HA, earache → parotitis (bilaterally usually)

PE: parotid swelling & tenderness, erythema & edema of Stensen’s duct

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24
Q

Complications of mumps

A

Epididymo-orchitis (unilateral) = MC complication, esp in postpubertal males – may occur 5-10d after parotitis onset

Neurologic: aseptic meningitis (MC), encephalitis, deafness

Oophoritis, arthritis, infertility

MCC of pancreatitis in children

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25
Tx of mumps
Supportive: antipyretics, analgesics, self-limited [syx last 7-10 days] Hospitalized: patient placed on droplet precautions & CDC recommends isolation for at least 5 days after syx onset
26
Rubella aka german measles sx
Prodrome: low grade fever, cough, anorexia, & posterior cervical/posterior auricular lymphadenopathy **Exanthem: Rash: pink/red nonconfluent maculopapular rash** that starts on face & spreads to trunk & extremities lasting 3 days [spreads more rapid than measles and much darker & confluent in measles] **Forchheimer spots: small red macules/petechiae on soft palate** Photosensitivity & joint pain
27
Dx of Rubella
Rubella-specific IgM antibody w/ enzyme immunoassay Rubella-virus specific IgM antibodies present – can be + up to one year after infection
28
Tx of Rubella
Supportive: Tylenol/Ibuprofen, oral hydration
29
Neonate born w/ hepatosplenomegaly, jaundice, continuous machinery-like murmur, cataracts, sensorineural hearing loss & thrombocytopenia [Blueberry muffin rash]
Congenital rubella syndrome
30
Erythema Infectiosum – Fifth Disease MC bug + transmission
**Parvovirus B-19**: infects & destroys reticulocytes, leading to a decrease or transient alt in erythropoiesis (can lead to aplastic crisis [Sickle cell patients @ highest risk, & G6PD patients]) MC in children \<10 y/o **Transmission: respiratory droplets, 4-14 day incubation period**
31
Sx of fifth dz
Nonspecific viral symptoms (coryza, malaise, fever) followed by erythematous malar rash w/ **“slapped-cheek”** appearance & circumoral pallor for 2-4 days ## Footnote **Malar rash is followed by a lacy, reticular maculopapular rash on the extremities (especially upper) that usually spares palms & soles, resolving in 2-3 weeks – pruritic**
32
Tx of fifth disease
Symptomatic Self-limited disease, use anti-inflammatories [Acetaminophen or NSAIDs] EXANTHEM: Hand-foot-and-mouth Di
33
Hand foot mouth etiology
**Coxsackievirus type A – this is an Enterovirus that is part of a Picornavirus family** Commonly in children under 5 & in Summer/early Fall Transmission: primarily fecal-oral & oral-oral, most contagious in 1st week
34
Sx of hand/foot/mouth
**stomatitis & a vesicular rash on hands and feet** Mild fever, URI symptoms [sore throat, malaise, irritability], & decreased appetite starting 3-5 days after exposure **Oral exanthem: erythematous macules that become painful oral vesicles surrounded by a thin halo of erythema that undergoes ulceration (esp on buccal mucosa & tongue) followed by exanthem** Exanthem: greyish-yellow vesicular, macular or maculopapular lesions on the distal extremities (often including palms & soles) – less commonly vesicles are seen on face & torso **\*\*Not painful or pruritic**
35
Sixth disease aka Roseola etiolgy
**Respiratory droplets with a 10-day incubation period;** 90% occur in children, \< 2 years of age
36
Sx of Roseola
**Fever prodrome: high fever 3-5 days (may exceed 104) & lymphadenopathy – child appears well & alert during febrile phase, the fever resolves abruptly before the onset of the classic rash\*** Rash: rose, pink, macular or maculopapular, blanchable rash beginning on the trunk & neck before spreading to the face; Macules 2-5mm & rash lasts hours up to 2 days ***_Only viral exanthem that starts on the trunk_***
37
Tx of Roseola
**Supportive – mainstay of treatment (self-limited) – rest, maintain fluid intake, antipyretics** Adequate handwashing important to prevent spread of infection
38
child appears well & alert during febrile phase, the fever resolves abruptly before the onset of the classic rash
Roseola aka sixth dz
39
Highly contagious infection secondary to \_\_\_\_\_\_\_\_\_\_, a gram-negative coccobacillus
**Bordetella Pertussis**
40
What age group is MC for bordatella pertussis
Rarely seen d/t widespread vaccination – **MC in children under 2 y/o**
41
3 phases of bordatella whooping cough
**Catarrhal Phase:** URI syx lasting 1-2 weeks – most contagious during this phase **Paroxysmal Phase:** severe paroxysmal coughing fits with inspiratory whooping sound after cough fits – may have post coughing emesis, lasts 2-4 weeks **Convalescent Phase:** resolution of the cough (cough may last for up to six weeks)
42
Inflammation of the bronchioles – the smallest air passages of the lungs which usually occurs in children under 2
Acute bronchiolitis
43
MCC of bronchiolitis
**Respiratory Syncytial Virus (RSV) = MCC**, Rhinovirus, Adenovirus, Influenza virus, parainfluenza virus, etc At risk: Infants 2 months to 2 years most commonly affected, exposure to cigarette smoke, lack of breastfeeding, prematurity, & crowded conditions
44
Tx of acute bronchiolitis
**Supportive measures mainstay of treatment** – humidified oxygen, IV fluids, nebulized saline, cool mist humidifier, antipyretics (Acetaminophen) Mechanical ventilation may be indicated if severe
45
Inflammation of the larynx & subglottic airway
Croup aka laryngotracheitis
46
MCC of croup
MCC = parainfluenza virus type I, RSV, Adenovirus, & Rhinovirus MC between 6 months-6 years; especially in fall & winter
47
Sx of Croup
**Upper airway involvement: harsh, “seal-like barking” cough** – hallmark of the disease in infants & young children, inspiratory stridor, hoarseness (especially in older children & adults), dyspnea, low-grade fever – symptoms often worse @ night URI symptoms (coryza) prior, during, or after acute presentation
48
Dx of Croup
Clinical diagnosis - once epiglottitis & foreign body aspiration are excluded Frontal cervical radiograph: **Steeple sign** (subglottic narrowing of the airway) – 50%, rarely done
49
Tx of Croup
Supportive (air humidifier), antipyretics Severe: **IV fluids and nebulized racemic epinephrine,** steroids
50
Autosomal recessive exocrinopathy → abnormal mucus production → obstruction of glands & ducts
Cystic fibrosis
51
Cystic fibrosis pathophys
Mutation in the cystic fibrosis transmembrane conductance receptor (CFTR) gene leads to abnormal chloride & water transport across exocrine glands throughout the body, leading to a thick, viscous secretion of the lungs, pancreas, sinuses, intestines, liver & genitourinary tract MC in Caucasians & Northern Europeans
52
Sx of cystic fibrosis
Infancy: **meconium ileus,** failure to thrive, diarrhea from malabsorption (may lead to rectal prolapse) Pulmonary: **CF is the MCC of Bronchiectasis in the US** GI: malabsorption (especially fat-soluble vitamins [A, D, E, K], steatorrhea, diarrhea, recurrent pancreatitis (may lead to pancreatic insufficiency), distal intestinal obstruction, biliary cirrhosis
53
Dx of cystic fibrosis
**Elevated sweat chloride:** test of choice (most accurate) – NaCl 60mmol/L or greater on 2 occasions after Pilocarpine administration (Pilocarpine is a cholinergic drug that induces sweating)
54
PFT on cystic fibrosis
Obstructive pattern, usually irreversible
55
CF tx
**Antibiotics are often needed – Macrolides; Cephalosporins (Cefuroxime, Cefixime), Augmentin, Fluoroquinolones &/ inhaled aminoglycosides** Airway clearance treatment: inhaled bronchodilators, decongestants, mucolytics, inhaled recombinant human deoxyribonuclease (breaks down large amounts of DNA in the respiratory mucous that clogs up the airways) Supportive: **pancreatic enzyme replacement**, supplementation of fat soluble vitamins, vaccinatinos – Pneumococcal, influenza • Lung & pancreatic transplant in selected cases
56
patient, young, growth retardation, long history of recurrent pneumonia/chroic diarrhea, foul smelling stools
Cystic fibrosis
57
Atelectasis & pulmonary perfusion without ventilation d/t insufficiency of surfactant production by an immature lung
Hyaline membrane dz = IRDS (neonatal/infant resp distress syndrome)
58
MC single cause of death in the first month of life
Hyaline membrane dz; Disease of preterm infants caused by a lack of pulmonary surfactant production
59
CXR findings of hyaline membrane disease
CXR: diffuse bilateral reticular atelectasis (causes ground-glass appearance) opacities + air bronchograms, poor lung expansion, domed diaphragms
60
Tx of hyaline membrane dz
**Exogenous surfactant via endotracheal tube to open the alveoli + mechanical ventilation (CPAP)** 2-3 day clinical course with or without treatment 90% survival rate w/ treatment & normal return of lung function within 1 month
61
udden onset of one time chills & rigors (violent shivering), fever, productive cough w/ blood-tinged (rusty) sputum – (common in patients with a splenectomy)
Strep pneumo pneumonia
62
**extremes of age (under 6, elderly),** immunocompromised (DM, HIV, chemotherapy), underlying pulmonary disease (asthma, COPD, bronchiectasis, CF), alcoholics ## Footnote **What type of pneumonia?**
H. Flu
63
superimposed infection after a viral infection – hospital-acquired pneumonia, seen with salmon colored sputum **What type of pneumonia?**
Staphylococcus Aureus
64
purple-colored (currant jelly) sputum **(chronic alcoholism, sick patients, patients with chronic illnesses (Diabetes)** What type of pneumonia?
Klebsiella
65
cavitary lesions are hallmark\* (nonspecific) or lobar consolidations **What type of pneumonia?**
Klebsiella
66
MCC of atypical walking pneumonia – outbreaks in late summer & early fall • Risk factors: young & healthy (school-age children, college students, military recruits) **What type of pneumonia?**
Mycoplasma pneumonia
67
CXR findings of mycoplasma pneumonia
atypical pattern – reticulonodular pattern most common, diffuse, patchy or interstitial infiltrates
68
Tx of mycoplasma pneumonia
Macrolides (Azithromycin) or Doxycycline Lacks a cell wall so naturally resistant to beta-lactams
69
outbreaks related to contaminated water sources (air conditions, portable water, vents), no person-person Risk factors: immunosuppressed, smokers, elderly, chronic lung disease **GI symptoms prominent – diarrhea (watery & non-bloody), N/V** What type of pneumonia is this?
Legionella
70
Tx of legionella pneumonia
Macrolides (Azithromycin) or respiratory Fluoroquinolones (Levofloxacin, Moxifloxacin, & Gemifloxacin)
71
CURB65 criteria
CURB65 (ADMIT IF AT LEAST 2) Confusion, Uremia (30+), RR 30+, BP low (under 90/60), age 65+
72
Congenital CMV sx
**Blueberry muffin rash** (thrombocytopenia, petechiae, purpura) Chorioretinitis **Periventricular calcifications** Sensorineural hearing loss Hepatosplenomegaly IUGR
73
Congenital CMV tx
IV ganciclovir or oral valganciclovir
74
Chlamydia Trachomatis sx
Purulent conjunctivitis Staccato cough (Machine gun like) Tachypnea Interstitial or patchy infiltrates
75
Tx of **_Newborn Chlamydia Pneumonia_**
Macrolide abx
76
MCC of neonatal sepsis (gram positive cocci)
***Streptococcus agalactiae*** (Group B Strep/GBS)

EOR- PEDS (9 decks)

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