Infectious Dz Flashcards
What is the most common fungal meningitis? Where is this organism found? How is it diagnosed?
Cryptococcosis
found in contaminatd soild with dried pigeon dung
Dx: CXR, CSF
Culture-Budding, encapsulated fungus
Indian ink stain with agglutination assay
Tx: Fluconazole for pulmonary infxn
Amphotericin B for severe infx x 2 weeks, followed by fluconazole
What is the gold standard for diagnosiing Histoplasmosis? where is it found? How do you treat it?
- Found in soil infested with bird droppings in ohio river valley
- Culture-gold standard–can take 6 weeks to grow
- urine antigen assay-confirms
Tx: Itraconazole
Amphotericin B-in severe dz
What is the gold standard for diagnosing Pneumocystis Jiroveci Pneumonia (PCP)? What is the tx?
Dx: Bronchoscopy
Tx: TMP/SMX (prophylaxis if CD4 <200)
Dapson if allergic to Sulfa
What causes “floppy baby syndrome”
Infant botulism: secondary to production of neurotoxin in GI tract after colonization of C. botulinum from soil or honey
What are the sxs of Botulism? tx?
- Cholinergic sxs: decreased salivation, ileus, and urinarty retention
- Ptosis, impaired EOM, diplopia and loss of accomodation, fixed dilated pupils
- Tx: Botulinum antitoxin
How do you treat Diphtheria?
Horse serum antitoxin
Laryngoscopy–remove membrane if airway obstruction
PCN or erythromycin
What causes Typhoid fever? what are the sxs?
- Salmonellosis
- “pea soup” diarrhea; malaise, HA, cough, sore throat
- 2nd week: pink papular rash primarily on trunk
- fever peaks on days 7-10
How do you dx typhoid fever? How do you tx?
- Blood culture! (stool culture not reliable!)
- Tx: Ceftriaxone and fluoroquinolones x 2 weeks
Which type of diarrhea can cause seizures? tx?
Shigella
tx: TMP/SMX
DTAP vs. Tdap vs. TIG
- DTAP (active immunization)-immunization given to kids <7 y/o
- Tdap–>11 y/o. given as a booster every 10 years
- TIG: Tetanus immune globulin 500 IM given with puncture wounds when tetanus status is unknown
What is the common atypical mycobacterial infection in AIDs patients? At what CD4 count is it found?
Mycobacterium avium complex (MAC)
CD4 <50
How do you treat atypical mycobacterial infection (such as MAC)?
Clarithromycin plus ethambutol
Tuberculosis: classic PE finding? Gold standard of diagnostics? What do you see on biopsy?
- PE: posttussive rales–classic PE finding
- Culture: gold standard; Acid fast stain-more rapid but not specific
- Bx: caseating granulomas–histological hallmark
TB skin test >/ = 5 mm
Positive if HIV +, Recent active TB contact, evidence of TB on CXR, immunosuppressed patients on steroids
TB skin test >/=10 mm
Positive if Recent immigrant from high TB area, Healthcare worker/Lab personell, DM, CRF, Children exposed to high risk adults
TB skin test >/= 15 mm
Everybody else
Treatment for Active TB
- First 2 months: RIPE=Rifampin, INH, Pyrazinamide, and Ethambutol
- After 2 months: discontinue Ethambutol and Pyrazinamide; Continue INH + Rifampin x 4 more months
- Total tx duration=6 months
Latent TB tx
INH x 9 months; Rifampin x 4 months
What are common SE of INH, Rifampin, and Ethambutol?
- INH=Hepatitis, peripheral neuropathy=give B6
- Rifampin=hepatitis, Flue syndrome, orange blody fluid
- Ethambutol=optic neuritis
How do you diagnose Malaria? How do you treat?
- Giemsa or Wright stain
- examined at 8 hour intervals for 3 days
- Tx: Chloroquine -DOC for tx and prophylaxis
- add doxycycline in severe illnesses
How do you dx pinworms? How do you treat?
- dx: tape over perianal skin
- Tx: Albendazole, Mebendazole, or pyrantal–then repeat 2-4 weeks later
- wash all linens, and treat all family members!
What is the most common space occupying lesion in HIV? where can one be exposed?
Toxoplasmosis
CAT LITTER! raw/undercooked meats
What are the sxs of toxoplasmosis? what do you see on CT/MRI? How do you treat?
- sxs: Cervical LAD, fever
- CNS abnormalities: UVeitis, pain, photophobia,
- Immunocompromised adult: Encephalitis (most common), Choriortinitis (ocular pain),
CT/MRI: multiple ring-enhancing lesions
Tx: Pyrimethamine with leucovorin (folinic acid)-to prevent bone marrow suppression
Add second drug–Sulfadiazine, Clindamycin
What are the stages of Lyme dz?
- Tick transmits Borrelia burgdorferi
- Stage I: Erythema Migrans-“bulls eye rash”
- resolves in 3-4 weeks without tx
- Flu-like illness
- 2nd stage (days to weeks): involves skin, CNS, musculoskeletal system
- Pericarditis, Bells’ palsy
- 3rd stage (months to years:
- Joint pain, synovitis, frank arthritis
- Subacute encephalopathy, axonal polyneuropathy
What is the DOC for Lyme dz? In children and pregnancy?
- DOC Doxycycline
- PG and kids: Amoxicillin
Rocky Mountain spotted fever: organism, clinical presentation, Tx (DOC and PG/Kids)?
- Rickettsia rickettsii
- 2-24 days after exposure: flue sxs
- Rash–Palms and soles–purpuric as it spread
- Flushed face
- Tx: Doxycycline; PG/kids: Chloamphenicol
Most common congenital infection?
Cytomegalovirus infection
How do you diagnose Cytomegalovirus infections? tx?
- Tissue biopsy: Intracytoplasmic inclusions (“Owl eyes”)
- Tx: Ganciclovir
Which childhood exanthem has a prodromal phase that includes Koplik spots, conjunctivitis, and cough? What happens on day 3 to 7 of this dz?
Measles (Rubeola)
On day 3, an erythematous maculopapular rash starts on the face and then spreads down to trunk/ext. But rash remains on face
What childhood exanthem involves a rash that starts on the face but then spreads to trunks and limbs (leaving the face)?
Rubella (German Measles)
What congenital syndrome is involved with Rubella?
Torch infection: Cataracts, PDA, microcephally, deafness, and “blueberry muffin” baby
What childhood exanthem involves a rash (starting days after fever) that starts on the trunk and then spreads to neck/extremities?
Roseola, AKA exanthem subitum
What is the complication of erythema infectiosum?
Aplastic crisis–Tx with immunoglobulin
Kawasaki’s Disease: symptoms/signs, Treatment, and complications
- A systemic vasculitis
- Common cause of acquired heart disease and arthritis
- sxs: Acute onset fiever, bilateral conjunctivitis, truncal polymorphous rash, oropharynx mucosal changes (dry fissured lips, strawberry tongue)
- Peripheral extremity changes: Edema, erythema, and desquamation
- Tx: IV immunoglobulin, ASA
- Complications: Coronary aneurysm, Coronory vasculitis
