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PANRE > Infectious Dz-Panre > Flashcards

Infectious Dz-Panre Flashcards

1
Q

What is Botulism

A

Produces a toxin that inhibits release of acetylcholine at the neuromuscular junction
● Botulism is a Paralytic Disease (mortality from respiratory paralysis)-

Associated with home-canned food products and honey in infants (pediatricians recommend waiting until your baby is at least 12 months before introducing honey)

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2
Q

Botulism s/s? Pearls?

A

Symptoms: “D’s”: double vision (diplopia), dysarthria, droopy eyes (ptosis), dilated
pupils, dry mouth, dysphonia
● No mental status changes or sensory symptoms; muscle weakness leading to respiratory paralysis; symmetric descending weakness and flaccid paralysis without sensory deficits.

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3
Q

Botulism DX? Types?

A

Toxin assays

Sometimes electromyography; Food, Wound

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4
Q

Food Botulism?

A

,Canned foods; the pattern of neuromuscular disturbances and ingestion of a likely food source are important diagnostic clues. The simultaneous presentation of at least 2 patients who ate the same food simplifies diagnosis, which is confirmed by demonstrating C. botulinum toxin in serum or stool or by isolating the organism from the stool. Finding C. botulinum toxin in suspect food identifies the source.

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5
Q

Wound Botulism?

A

, finding toxin in serum or isolating C. botulinum organisms on the anaerobic culture of the wound confirms the diagnosis.; Contamination of wound
■ Seen in skin poppers who use black-tar heroin
© Hippo Education, LLC All Rights Reserved
Infectious Diseases
4
■ Pearl: may look like heroin overdose (droopy head, fatigued), but no mental
status changes

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6
Q

Botulism Tx?

A

Supportive care, administration of activated charcoal may be helpful for food botulism.; atients should be hospitalized and closely monitored with serial measurements of vital capacity. Progressive paralysis prevents patients from showing signs of respiratory distress as their vital capacity decreases. Equine heptavalent antitoxin may be given; Antitoxin is less likely to be of benefit if given > 72 h after symptom onset

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7
Q

What is greatest threat to life that results from botulism?

A

respiratory impairment

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8
Q

C. botulinum spores are resistant to heat but at temperature they are not?

A

However, exposure to moist heat at 120° C for 30 min kills the spores. Toxins, on the other hand, are readily destroyed by heat and cooking food at 80° C for 30 min safeguards against botulism.

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9
Q

What type of organism is Botulism?

A

Botulism is an anaerobic gram-positive rod

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10
Q

Infant Wound: Botulism

A

Honey
■ Colonizes intestines
■ Poor feeding, weak cry, poor head control, loss of facial expression (bulbar
palsies)

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11
Q

Botox botulism:

A

Medical uses: sweating, strabismus, cervical dystonia, spasms, twitching eyelids(botox is used to paralysis muscle)

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12
Q

What is Tetanus ? *

A

Clostridium tetani (ubiquitous in soil); Puncture wounds are most susceptible
● A spore-forming gram- positive anaerobic organism
● Spores germinate in wounds and bacteria produce a neurotoxin
● Tetanospasmin (neurotoxin) blocks release of GABA/glycine (inhibitory transmitters)
resulting in unopposed excitatory discharge (causing severe muscle spasms)
○ Affects sympathetic and parasympathetic neurons

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13
Q

Tetanus Presentation? *

A

Classic presentations: Risus sardonicus (spasm of the facial muscles causing a “joker
smile”) and opisthotonus (spasm causing body to go into extreme hyperextension); muscle spams, truisms, lockjaw, drooling, increase DTR, autonomic dysfunction
Painful tonic convulsions, but no mental status changes

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14
Q

Tetanus Dx? *

A

Clinical

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15
Q

Tetanus TX? *

A

Prevention via immunizations starting in childhood
○ booster every 5-10yrs
○ Tetanus Immunoglobin (given IM)
● Supportive Care: Benzodiazepines for muscle spasms, intubation; Metronidazole or Penicillin G, in addition to Tetanus immune globulin IM
● Prophylaxis with any laceration/skin break
○ Vaccinated: Tdap or Td vaccine q10 years or if major cut with booster >5yr
old
○ Never vaccinated: Tetanus immune globulin and tetanus toxoid vaccine

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16
Q

Cholera

A

Vibrio cholerae
● Produces a toxin that activates adenyl cyclase in intestinal epithelial cells of small
intestine → hypersecretion of water & chloride → massive diarrhea → hypovolemia
and metabolic abnormalities
● Common during epidemics, war-time, overcrowding, famine, poor sanitation

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17
Q

Cholera Presentation? *

A

Rice water diarrhea (severe, frequent, watery diarrhea)

○ Dehydration causes death

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18
Q

Cholera Treatment? *

A

Prevention via clean water and food supply
● Replace fluids and electrolytes
● Oral rehydration for mild to moderate disease
○ 1 cup water, 1 tsp salt, 4 tsp sugar
● Severe presentations require IVF
● Antibiotics will shorten duration and reduce severity:
○ Tetracycline, ampicillin, TMP/SMX, quinolones
● Vaccine available but need booster every 6 months
○ Good for health care professionals, Peace Corp volunteers

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19
Q

Cholera Key points?

A

Rice water diarrhea, severe dehydration, oral rehydration for mild to moderate
cases, antibiotics to shorten duration

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20
Q

Diphtheria?

A 
Corynebacterium diptheriae
● Affects mucous membranes in respiratory tract
● Transmitted by respiratory secretions
● Exotoxin causes myocarditis/neuropathy
● Deadly for infants
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21
Q

Diphtheria Presentation?

A

Pharyngeal infections (most common form)
● Pseudomembrane
○ visible, adherent gray membrane that covers tonsils and pharynx (corn flake
membrane)

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22
Q

Diphtheria Dx?

A

Clinical, culture

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23
Q

Diphtheria tx:

A

Horse serum antitoxin from CDC
● Airway protection
● Antibiotics: Penicillin or Erythromycin/Azithromycin
● Vaccination = key to prevention (“D” in Tdap vaccine)

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24
Q

Diphtheria Key points

A

pseudomembrane or corn flake membrane, pharyngitis, exotoxin, key to
prevention is vaccination with Tdap, horse serum antitoxin from CDC

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25
Q

Salmonella*

A

Salmonella species

● All types transmitted by food/water; 3 types Gastroenteritis, enteric fever and bacteremia

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26
Q

Salmonella Gastroenteritis? *Hours of incubation?

A

Most common form of Salmonella, esults from improperly handled food that has been contaminated by animal or human fecal material. It can also be acquired via the fecal-oral route, either from other humans or farm or pet animal
● 8-48 hrs incubation

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27
Q

Salmonella Gastroenteritis s/s? *

A

fever, nausea/vomiting, crampy abdominal pain, bloody diarrhea for 3-5 days

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28
Q

Salmonella Gastroenteritis Dx?

A

clinical, stool culture

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29
Q

Salmonella Gastroenteritis Tx?

A

Self-limited with normal immune systems
○ Symptomatic care
○ Severe cases require antibiotics: TMP/SMX, ampicillin or ciprofloxacin

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30
Q

Salmonella Enteric fever (typhoid fever)?

A

Organisms enter intestinal epithelium: 5-14 day incubation period
● Children may have abrupt onset
● 15% relapse
● Disease course
○ Gradual onset of ‘viral syndrome-like’ symptoms with abdominal distension/pain,
constipation and/or pea soup diarrhea
○ Fever peaks days 7-10 (at this time patients appear most toxic)
○ Symptoms improve over next 7-10 days

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31
Q

Salmonella Enteric fever *(typhoid fever) Pe /TX?

A

Exam
○ Splenomegaly, abdominal distension/tenderness, paradoxical bradycardia (low HR
even with fever), rash in week 2 (faint pink papular rash on trunk that fades with
pressure)
● Treatment
○ Ceftriaxone or quinolones for 2 wks

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32
Q

Salmonella Bacteremia*

A

Causes prolonged/recurrent fevers and infection in joints, bones, pleura, pericardium,
lungs
● Associated with osteomyelitis
○ typically seen in immunocompromised patients (like Sickle Cell Disease)
● Treatment
○ same as typhoid feve

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33
Q

Bacillary Dysentery*

A

Shigella dysenteriae; ram-negative bacteria shigella

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34
Q

Bacillary Dysentery; Shigella *s/s

A

Sudden onset diarrhea, abdominal cramps, tenesmus (feeling as if you constantly need
to evacuate bowels), fever, malaise, headache, loose stools with blood and mucous
● Dehydration is common

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35
Q

Bacillary Dysentery; Shigella dx?

A

Stool positive for fecal leukocytes and RBC

● Stool culture

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36
Q

Bacillary Dysentery; Shigella *TX?

A

TMP/SMX (Bactrim) is 1st choice (Note: many references also state ciprofloxacin is 1st choice)
○ Quinolone if allergic
● Replace fluid loses

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37
Q

How is Shigella transmitted? *

A

ransmission is via direct person-to-person contact and contaminated foods and water.

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38
Q

Diphtheria

A

is an acute pharyngeal or cutaneous infection caused mainly by toxigenic strains of gram (+) bacilli Corynebacterium diphtheriae
Corynebacterium diptheriae
● Affects mucous membranes in respiratory tract
● Transmitted by respiratory secretions
● Exotoxin causes myocarditis/neuropathy
● Deadly for infants

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39
Q

Diphtheria presentation?

A

Pharyngeal infections (most common form)
● Pseudomembrane
○ visible, adherent gray membrane that covers tonsils and pharynx (corn flake
membrane)
Pseudomembranes: Friable gray/white membrane on pharynx that bleeds if scraped + Bull neck: Neck swelling due to enlarged cervical lymphadenopathy.

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40
Q

Diphtheria Dx?

A

Clinical, culture confirms dx, pcr used for rapid detection of the toxigenic strain.

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41
Q

Diphtheria TX?

A

Horse serum antitoxin from CDC
● Airway protection
● Antibiotics: Penicillin or Erythromycin/Azithromycin
● Vaccination = key to prevention (“D” in Tdap vaccine); Diphtheria antitoxin + erythromycin or penicillin x 2 weeks

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42
Q

Diphtheria transmission?

A

Transmission is through inhalation of respiratory excretions

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43
Q

Pertussis

A

Bordetella pertussis (bacteria)Whooping cough; Infection in premature infants and those with chronic disease = most severe
presentation (especially kids with cystic fibrosis); Consider in adults with cough greater than 2 weeks who have no evidence of other
disease

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44
Q

Pertussis Presentation ? Phases?

A

3 phases of disease
○ Catarrhal: gradual onset of common cold-type symptoms and hacking cough
(mostly at night); most infectious stage
○ Paroxysmal: coughing spasms followed by high-pitched inspirations (whoops,
gasping for air); Infants at risk for apnea
○ Convalescent: happens about 4 wks after the onset of cough; paroxysms
improves; lasts another 2-3 wks

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45
Q

Pertussis DX

A

Clinical, PCR

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46
Q

Pertussis TX

A

Erythromycin to decrease transmission
● Vaccination of children
● Tdap vaccine needed in adulthood as immunity is not lifelong

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47
Q

Acute Rheumatic Fever (ARF*

A

Group A Streptococcus (S. pyogenes)
● A complication of group A ß-hemolytic strep infection
○ seen 2-3wks post infection (an acute autoimmune multi-system post strep)
● Peak age 5-15 yrs
● Common cause of valvular abnormalities in adulthood (think ARF w/ adult from
another country with valvular abnormality

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48
Q

Acute Rheumatic Fever (ARF) *Dx

A

JONES CRITERIA: Evidence of recent strep infection (ASO Titer) PLUS 2 major criteria
OR 1 major + 2 minor criteria

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49
Q

Acute Rheumatic Fever (ARF) TX

A

Complications: Rheumatic valvular disease
○ Mitral > Aortic > Tricuspid and Pulmonic.
Prevention is key: treat strep throat early with PCN, cephalosporin, macrolides; Aspirin + steroids
○ Penicillin G or erythromycin if penicillin-allergic
● Prevention is key; treat all GABHS with antibiotics

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50
Q

Acute Rheumatic Fever (ARF Complications?

A

Rheumatic heart disease (carditis) has poor prognosis:
○ 30% die within 2 yrs; ⅔ get valvular disease
○ 10% permanent serious heart disease or cardiomyopathy
● Acute glomerulonephritis is another complication of group A ß-hemolytic strep
infection

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51
Q

Major Criteria for Jones of Rheumatic Fever?

A

Major criteria: polyarthritis, carditis, nodules, chorea, (JONES-JOINT, OH MY HEART, N-NODULES E-ERYTHEMA MARGINATUM, SYNDENHAM’S CHOREA”-SAINT VITUS DANCE) erythema marginatum; J oint - Migratory polyarthritis (75% of cases)
● 2+ joints or migratory, med/large joints- knees, hips, wrists,
elbows
● Heat, redness, swelling, tenderness
● Lasts 3-4 wks
■ O h my heart - Active carditis (40-60% of cases)
● Valvular, myocarditis or pericarditis
■ N odules (subcutaneous)
● Rare, seen over extensor surfaces, scalp
■ E rythema marginatum
● Macular, red, non-pruritic annular rash with sharply
demarcated rounded borders
● Seen on trunk and extremities, not face
■ S ydenham’s chorea (<10% of cases)
● Classically called “Saint Vitus Dance”
● Develops weeks to months after initial infection
● Sudden involuntary jerky non rhythmic purposeful
movements

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52
Q

Minor criteria for Rhuematic Fever

A

arthralgias, fever, leukocytosis, elevated CRP/ESR, prolonged PR; Minor Criteria: CAFE PAL
C - C reactive protein, A - arthralgia, F - fever, E - ESR elevated, P - Prolonged PR, A - anamnesis of rheumatism, L - leukocytosis

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53
Q

Chlamydial infections?*

A

Chlamydia trachomatis, presents as urethritis, cervicitis/PID and LGV (lymphogranuloma venereum)

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54
Q

Chlamydial infections in male?

A

Urethritis: penile discharge (usually watery vs. purulent)

■ less painful than gonococcus

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55
Q

Chlamydial infections in *females?

A

Cervicitis/PID
■ usually asymptomatic
■ PID is a leading cause of infertility-Pelvic Inflammatory Disease (PID): Cervical motion tenderness, fever,
abdominal pain

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56
Q

Chlamydial infections can cause what type of ulcers? -

A

LGV (lymphogranuloma venereum); Vesicular lesions or ulcers spreading to lymph nodes (inguinal buboes)
○ Anorectal involvement possible

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57
Q

Most common STI in US?

A

Chlamydia trachomatis

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58
Q

Chlamydial infections Dx ?

A

High clinical suspicion warrants treatment

● ELISA/DNA test to confirm (cervical or urethral swab, or urine (nucleic acid amplification) sample)

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59
Q

Chlamydial infections TX?

A

Azithromycin (1gram PO x 1) or Doxycycline course
○ Azithromycin (single dose, better tolerated) or Erythromycin in pregnancy
● Treat all partners
● Treat concomitantly for Gonococcus as diseases are clinically identical

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60
Q

Chlamydial infections results in what type of arthritis?

A

Reactive arthritis: Autoimmune reaction to bacteria, +HLA-B27
■ Uveitis, urethritis, arthritis → “can’t see, can’t pee, can’t climb a tree”

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61
Q

Gonorrhea*

A

Neisseria gonorrhoeae-gram-negative intracellular
diplococci)
● Incubation is 2-8 days after exposure

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62
Q

Gonorrhea in Men

A

more painful than Chlamydia
○ milky discharge and dysuria initially, then days later have worsening symptoms
with profuse, yellow discharge

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63
Q

Gonorrhea in Women

A

asymptomatic or with dysuria

○ can cause PID, infertility

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64
Q

Gonorrhea can cause what eye condition?

A

If you touch your gonorrhea in GE and touch your eye -Conjunctivitis via direct inoculation-copious purulent discharge (pus pouring out of eye)

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65
Q

Gonorrhea bacteremia consists of?

A

Bacteremia
○ skin lesions (small pustules, gun metal gray, hemorrhagic component) seen on
hands and extremities, septic arthritis, tenosynovitis
○ more common in women since mostly asymptomatic

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66
Q

Infant conjunctivitis must think?

A

occurs at birth if mom infected with gonorrhea

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67
Q

Gonorrhea dx?

A

Culture from infected area
● Infant gonococcus: gram stain of discharge (will see gram-negative intracellular
diplococci)

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68
Q

Gonorrhea tx?

A

IM Ceftriaxone (250mg IM x 1)x 1 PLUS doxycycline 100 mg PO bid x 10 day or
azithromycin 1g PO x 1
● Treat all partners
● Treat concomitantly for Chlamydia as diseases are clinically identical

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69
Q

What is the mc cause of septic arthritis in young adults?

A

Gonorrhea

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70
Q

Urethritis & Cervicitis, PID, Epididymitis , Prostatitis ?

A

Gonorrhea CM

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71
Q

Herpes Family

A 
HHV 1 &amp; 2 → Herpes simplex 1 &amp; 2
HHV 3 → Varicella zoster (chicken pox and shingles)
● HHV 4 → Epstein-Barr virus
● HHV 5 → CMV
● HHV 6 &amp; 7 → Roseola
● HHV 8 → Kaposi sarcoma
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72
Q

Varicella zoster is also known as (hint what type of family)

A

HHV 3

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73
Q

Epstein-Barr virus-is also known as?

A

HHV 4

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74
Q

CMVis also known as?

A

HHV 5

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75
Q

Roseola is also known as?

A

HHV 6 & 7

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76
Q

Kaposi sarcoma is also known as?

A

HHV 8

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77
Q

Herpes Simplex: HHV 1 & 2

A

Only in humans – transmission by direct inoculation
● Latent in Dorsal Root Ganglia
● Reactivation with stress, immunocompromised state, trauma
Can result in Herpes encephalitis ;
Treatment: Acyclovir

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78
Q

HHV 2

A

Genital herpes, 25% of US population. Painful lesions, with
burning/stinging/malaise before full outbreak. Females have more severe disease –
can involve the cervix.
● Genital herpes at time of labor → Dangerous for mother and baby → higher
dissemination rate. C-section is recommended in the setting of active outbreak.
● People with severe or frequent outbreaks can get suppressive therapy

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79
Q

HHV 1 →

A

Oral, cold sores, 85% of the US population

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80
Q

HHV 3

A

Varicella Zoster Virus (shingles); Chicken Pox

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81
Q

Chicken Pox?

A

Transmission: Respiratory droplets, direct contact
● Incubation period: 10-20 days
● 1º infection: Varicella aka Chicken Pox
○ Fever, malaise
○ Rash characteristics: Vesicles on erythematous base “dew drops on a rose
petal”
■ Rash seen in different stages (macules, vesicles, crusted lesions)
○ Usually beginning on face and truck and moves to extremities
○ Pruritic;
Mucous membranes involved

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82
Q

Chicken pox Tx?

A

Symptomatic. Try to prevent super infection. If pt immunocompromised, Rx acyclovir
● Prevention: Vaccination

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83
Q

Chicken pox complications? Prevention

A

Bacterial infection, pneumonia, encephalitis, Guillain Barre

○ 1º infection: More serious and worse in adults; Chicken Pox vaccine for children

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84
Q

Shingles/Herpes Zoster

A

Culprit: Varicella Zoster Virus
● Transmission: Respiratory droplets, direct contact. VZV reactivation along one dermatome
Zoster is reactivation of dormant varicella zoster virus (VZV) – remains dormant in
nerves

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85
Q

Shingles/Herpes Zoster TX?

A

Shingles: Acyclovir, Valacyclovir

■ Given within 72 hours helps to prevent incidence of PHN

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86
Q

Herpes Zoster Ophthalmicus (op THAL mi cus)

A

CN V (trigeminal nerve) 1st division
■ Hutchinson’s sign: Lesion on nose strongly suggestive of ocular
involvement
■ Dendritic lesions seen on slit lamp exam with keratoconjunctivitis

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87
Q

Herpes Zoster Oticus aka Ramsey-Hunt Syndrome

A

CN VII (facial nerve)
■ Otalgia, lesions on ear, auditory canal and tympanic membrane, facial
palsy, tinnitus, vertigo, deafness, ataxia

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88
Q

Postherpetic neuralgia (PHN)

A

○ Pain > 3 mo, hyperesthesias or decreased sensation; may be prevented with steroids (poor
evidence) can treat neuralgia as chronic pain with TCA’s, capsaicin, gabapentin

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89
Q

Ramsey-Hunt Syndrome tx?

A

Ramsay-Hunt: PO antivirals + steroids

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90
Q

Postherpetic neuralgia (PHN) Tx?

A

Gabapentin, tricyclic antidepressant, topical lidocaine gel

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91
Q

Herpes Zoster Ophthalmicus TX?

A

PO antivirals, may need ophthalmic antiviral

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92
Q

Shingles/Herpes Zoster incubates?

A

10-20 days; Highly contagious starting the day before the rash

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93
Q

How does chicken pox differed from small pox?

A

Differentiated from small pox because small pox lesions are all in the same stage

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94
Q

MC areas that shingles present?

A

Thoracic or lumbar area most common

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95
Q

Epstein-Barr Virus

A

HHV 4:Infectious mononucleosis or “kissing disease”

● Transmitted via saliva

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96
Q

Epstein-Barr Virus triad?

A

Pharyngitis, POSTERIOR lymphadenopathy, fever

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97
Q

Epstein-Barr Virus is associated with 2 other dz?

A

Burkitt lymphoma and nasopharyngeal carcinoma

98
Q

Epstein-Barr Virus PE?

A

Fever, exudative pharyngitis, posterior cervical lymphadenopathy, malaise, myalgias,
splenomegaly
○ Petechial rash especially if given ampicillin

99
Q

Epstein-Barr Virus dx?

A

Heterophile antibody/monospot → positive within 4 weeks

○ Peripheral smear will show >50% lymphocytes with > 10% of those atypical

100
Q

Epstein-Barr Virus complications ?

A

secondary bacterial pharyngitis, splenic rupture, pericarditis,
encephalitis, chronic fatigue syndrome

101
Q

Epstein-Barr Virus tx?

A

Supportive, steroids if only airway obstruction due to lymphadenopathy
● Avoid contact sports at least 1 mo if splenomegaly present; supportive (do not give ASA b/c of concern for Reyes syndrome), No contact sports!

102
Q

How is Epstein Barr diff from strep in PE findings?

A

Epstein Barr has POSTERIOR lymphadenopathy vs strep has ANTERIOR

103
Q

CMV – Cytomegalovirus

A

HHV 5:
Most infections are asymptomatic
● 2 scenarios with serious complications
○ 1. Congenital CMV
■ Primary CMV in pregnancy: 10% of babies will have low birth wt, microcephaly,
seizures, rash, hepatosplenomegaly, jaundice, pneumonia, retinal damage
○ 2. AIDS or post-transplant pt’s
■ Retinitis in AIDS pt’s with CD4 < 50, “pizza pie” lesions on retinal exam
■ GI: esophagitis
■ Lung: 15% of bone marrow transplant pt’s, this is often fatal
■ Neuro: radiculopathy, transverse myelitis, encephalitis
● Tx: Ganciclovir, Foscarnet
● Prevention: limit blood transfusions, if necessary use leukocyte depleted PRBC’s

104
Q

Roseola/“Sixth disease” “Exanthem subitum”

A

HHV 6 & 7
Culprit: Human Herpes virus strain 6 or 7
● Aka “6th disease”
● Incubation period: Approximately 10 days
● Transmission: Respiratory droplets
● Demographic: Common in kids < 5y-6 months to 2 years old

105
Q

Roseola/“Sixth disease” “Exanthem subitum” S/S?

A

Prodrome: High fever x 3-5 days, resolves before onset of rash
○ Pink maculopapular blanchable rash starts on trunk/back proceeds to face
○ ONLY childhood viral exanthem to start on trunk and spread to face
○ Child appears well and alert during febrile phase

106
Q

Roseola/“Sixth disease” “Exanthem subitum” tx?

A

Tx: No ASA, treat with Tylenol

107
Q

Rubella (Level 2)

A

Culprit: Togavirus family
● Aka “German measles”
● Incubation period: 2-3 weeks
● Transmission: Respiratory droplets

108
Q

Rubella (Level 2) s/s

A

Low grade fever, cough, lymphadenopathy
○ Pink/light-red spotted maculopapular rash starts on face then moves out to
extremities
■ “3 day rash”
■ Spreads faster than rubeola and does not darken
○ Forchheimer spots: Small red macules/petechiae on soft palate (seen also
with scarlet fever)
○ May have transient photosensitivity and joint pain

109
Q

Rubella (Level 2) (dx )

A

Clinical rubella specific IgM antibody

110
Q

Rubella (Level 2) (Tx )

A

Supportive, generally no complications in kids

111
Q

Rubella (Level 2) (complications)?

A

Teratogenic esp in 1st trimester
○ Congenital syndrome: Deafness, cataracts, blueberry muffin rash, mental
retardation, heart defects; BAD in Pregnancy! – Congenital Rubella syndrome
○ Microcephaly
○ PDA (patent ductus arteriosus)
○ Cataracts

112
Q

Rubeola: Measles what is the culprit?

A

Paramyxovirus

113
Q

Rubeola: Measles s/s

A 
Fever, cough, coryza, conjunctivitis
● Koplik spots (not always seen)
● Rash starts on head and spreads
● Rash “stains” (turns brown)
● Diarrhea/pneumonia/ encephalitis/corneal complications
114
Q

Erythema Infectiosum: “Fifth Disease” PE?

A

Slapped cheek” syndrome
● Most infectious before rash starts
● Can also occur in adults; may cause arthralgias

115
Q

Rubella is not common in what age group?

A

Uncommon in infants or people > 40 yrs old

116
Q

influenza?

A

Orthomyxovirus
● 3 strains: A, B & C – typed based upon surface antigens (hemagglutinin and
neuraminidase)
● Type A: most common and more pathogenic

117
Q

How is influenza transmitted?

A

Airbone respiratory secretions

118
Q

Influenza s/s?

A

Sudden onset fever, sore throat, headache, myalgias, nonproductive cough

119
Q

Influenza TX?

A

No more amantadine/rimantadine because of resistance! Neuraminidase inhibitors (zanamivir or oseltamivir-s/e N/V ) only recommended if given within 48 hours of Sx onset. Also,
give to patients being hospitalized

120
Q

Influenza complications?

A

1º viral pneumonia, 2º bacterial pneumonia, COPD or asthma

exacerbation; Reye’s syndrome in kids with aspirin use

121
Q

Influenza MC cause of death?

A

secondary pneumonia (often staph

122
Q

Influenza prevention?

A

Influenza vaccine
■ Contraindication (CI): Egg, gelatin, thimerosal allergy
○ Intranasal live attenuated
■ CI: > 50y, pregnant, DM, chronic lung dz, h/o Guillain-Barre

123
Q

Rabies (Level 1)

A

Culprit: Rhabdovirus family
● Life threatening CNS infection
● Incubation period: 3-7 weeks

124
Q

Rabies (Level 1) transmission?

A

Transmission: infected saliva from bites of rapid animals
○ Bats, raccoons, skunks, foxes
○ Dogs cause > 90% in developing countries
○ Very unlikely with rodents and rabbits
NOT RODENTS OR LAGOMORPHS
(rabbits)

125
Q

Rabies (Level 1) s/s

A

Prodrome: Pain, paresthesias, itching at bite site
○ CNS phase: Hydrophobia (painful laryngospasm after drinking liquids),
encephalitis, numbness, paralysis, rage, hypersalivation (foaming at the
mouth)
○ Respiratory phase: Respiratory muscle paralysis → death

126
Q

Rabies (Level 1) s/s

A

Prodrome: Pain, paresthesias, itching at bite site
○ CNS phase: Hydrophobia (painful laryngospasm after drinking liquids),
encephalitis, numbness, paralysis, rage, hypersalivation (foaming at the
mouth)
○ Respiratory phase: Respiratory muscle paralysis → death

127
Q

Rabies (Level 1) Dx

A

Dx: Negri bodies in the brain of the dead animal or animal observation 7-10 days

128
Q

Rabies (Level 1) TX?

A

No tx or cure !! Once symptoms start, survival is unlikely

○ Coma induction, amantadine and ribavirin

129
Q

RAbies Post exposure prophylaxis for 1st exposure

A

If person asleep in room where a bat is found/seen, they need prophylaxis
even without visible bite**
○ HDCV (Rabies vaccine) on days 0, 3, 7, 14 PLUS rabies immunoglobulin (½
dose in the wound and ½ dose IM)
Exception is in immunosuppressed patients who should get a 5th shot on day 28
■ Ideally within 6 days of exposure
○ Subsequent exposures: Vaccine on day 0 and 3 only, no immunoglobulin
Pre-exposure vaccination of high-risk individuals (vets, animal handlers

130
Q

Human papillomavirus (HPV) infections (Level 2)? Types?

A

Clinical manifestation: Infects keratinized skin causing excess proliferation which
leads to papules
● Types:
○ Cutaneous HPV: Warts (verruca)
■ Common, plantar and flat
○ Mucosal HPV: Genital warts (condyloma acuminata), cervical
dysplasia/cancer and anogenital cancer

131
Q

Human papillomavirus (HPV) infections (Level 2)? Types?

A

Clinical manifestation: Infects keratinized skin causing excess proliferation which
leads to papules
● Types:
○ Cutaneous HPV: Warts (verruca)
■ Common, plantar and flat
○ Mucosal HPV: Genital warts (condyloma acuminata), cervical
dysplasia/cancer and anogenital cancer

132
Q

Human papillomavirus (HPV) infections (Level 2) s/s?

A

Common/plantar warts: Firm papules with red-brown punctuations
(thrombosed capillaries are pathognomonic)
○ Flat warts: Numerous, small flesh colored papules
■ Typical on hands, face
○ Genital: Small, painless papules evolve into soft, fleshy cauliflower like
lesions May persist for months

133
Q

Human papillomavirus (HPV) infections (Level 2) DX?

A

Clinical appearance

○ Mucosal: Whitening of lesion with acetic acid application

134
Q

Human papillomavirus (HPV) infections (Level 2) Tx?

A

Most warts resolve spontaneously within 2 years if immunocompetent
○ Common/plantar: Topical salicylic acid, cryotherapy
○ Genital: Cryotherapy, podophyllin

135
Q

Human papillomavirus (HPV) infections (Level 2) Prevention?

A

HPV vaccine against strains 6,11,16,18 and new HPV vaccine

also covers 9, 31, 33, 45, 52, 58

136
Q

HIV infection (Level 1)

A

HIV is a retrovirus that converts viral RNA into DNA via reverse transcriptase; Spectrum – time from infection to symptomatic disease averages 10 years but quite
variable

137
Q

HIV infection (Level 1) Transmission?

A

Mucosal contact with infected blood, needle stick injuries, sexual
intercourse, IV drug use, mother to child during childbirth/breastfeeding

138
Q

HIV infection (Level 1) s/s

A

Acute seroconversion: Flu-like symptoms, fever, malaise, generalized rash,
lymphadenopathy
○ AIDS: CD4 count < 200 or development of AIDS defining illness

139
Q

HIV infection (Level 1) opportunistic infections?

A

CD4 > 500 LN
○ CD4 500-200 Tuberculosis, Kaposi sarcoma, oral candidiasis (thrush),
herpes zoster Salmonella, C diff colitis, HSV
○ CD4 ≤200 Pneumocystis pneumonia (PCP) or Pneumocystis jiroveci
pneumonia; Candidiasis, HIV encephalopathy, AIDS dementia. , Non-Hodgkin B-cell lymphoma
○ CD4 ≤150 Histoplasmosis
○ CD4 ≤100 Toxoplasmosis, Cryptococcus
○ CD4 ≤50 Mycobacterium Avium Complex (MAC), CMV retinitis

140
Q

HIV infection (Level 1) dx?

A

Rapid HIV tests now available
○ ELISA test : Detects anti-HIV antibody in blood
■ Can take up to 6 mo to appear after exposure
■ High sensitivity, moderate specificity
○ Western blot: Confirmatory
○ HIV RNA PCR: Detects viral load
■ Used to monitor infectivity and treatment effectiveness
○ CD4+ count
■ Indicates degree of immunosuppression

141
Q

HIV infection (Level 1)Tx ?

A

Combinations of NNRTI, NRTI, PI (non-nucleoside reverse transcriptase
inhibitors, nucleoside reverse transcriptase inhibitors, protease inhibitors

142
Q

Hiv post exposure prophylaxis ?

A

Post exposure prophylaxis: Start within 72 hours of exposure

143
Q

NRTI Drugs?

A

Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC),
Stavudine (Zerit), Lamivudine (Epivir), Abacavir
(Ziagen)

144
Q

NRTI Drugs?

nucleoside reverse transcriptase inhibitor

A

Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC),
Stavudine (Zerit), Lamivudine (Epivir), Abacavir
(Ziagen)

145
Q

NNRTI

A

Nevirapine (Viramune), Delaviridine (Rescriptor),

Efavirenz (Sustiva)

146
Q

NNRTI nonnucleoside RTI drugs?

A

Nevirapine (Viramune), Delaviridine (Rescriptor),

Efavirenz (Sustiva)

147
Q

PI drugs? proease

inhibitor

A

Saquinavir (Invirase), Ritonavir (Norvir), Inidinavir
(Crixivan), Nelfinavir (Viracept), Lopinavir/ritonavir
(Kaletra

148
Q

PI s/e ?

A

Headache, GI,

Crixivan – kidney stones

149
Q

Entry inhibitor drugs?

A

Enfuviritide (Fuzeon)

150
Q

Entry inhibitor s/e?

A

Injection site pain,

allergic rxn

151
Q

Lyme disease (Level 2

A

Borrelia burgdorferi ; gram-neg spirochete

● Vector: Ixodes (deer) tick

152
Q

Lyme disease (Level 2

A

Borrelia burgdorferi ; gram-neg spirochete

● Vector: Ixodes (deer) tick; Most common vector borne disease in the USA

153
Q

Lyme disease (Level 2) typically located in what part of the country?

A

EAST -Northeast, Midwest, Mid-Atlantic

154
Q

Lyme disease (Level 2) -Stage 1

A

Erythema migrans (EM): Expanding warm annular red rash with
central clearing, “bull’s eye” in appearance
● Usually appears within 1 mo of bite
● Expands slowly days to weeks
■ Viral-like syndrome, fatigue, HA, lymphadenopathy

155
Q

Lyme disease (Level 2) Stage 2

A

1-12wks
■ Arthritis in large joints, HA, CN palsies especially VII( ESPECIALLY IF YOU SEE BL BELL’S PASLY THINK LYME) AV block,
pericarditis, weakness

156
Q

Lyme disease (Level ) stage 3

A

Persistent synovitis and neuro symptoms, subacute encephalitis

157
Q

Lyme disease (Level 2) Dx ?

A

ELISA followed by Western Blot; Presence of EM, h/o tick bite, arthritis
■ May be seronegative early even with EM

158
Q

Lyme disease (Level 2) Tx?

A

Early: Doxycycline, azithromycin/erythromycin
■ Amoxicillin if <8y, pregnancy
○ Late/severe: IV Ceftriaxone if AV heart block, syncope, dyspnea, meningitis; Doxycycline 200 mg x 1 within 72 hours of tick removal, if tick attached for
≥36hr and >20% of ticks infected in area

159
Q

Rocky Mountain Spotted Fever (Level 2)

A 
Rickettsia ricketsii (gram neg)
● Vector: Dermacentor andersoni/variabilis (wood/dog tick
160
Q

Rocky Mountain Spotted Fever (Level 2) located where in us?

A

South-east/South-central US

161
Q

Rocky Mountain Spotted Fever (Level 2) located where in us?

A

South-east/South-central US; ● Mostly Eastern US

162
Q

Rocky Mountain Spotted Fever (Level 2) dx?

A

Don’t wait for serology
○ Clinical picture: H/o tick bite, fever, rash
○ Serology: indirect immunofluorescent antibody test
■ 4x ↑ in titers = acute disease
○ Skin biopsy
○ CSF

163
Q

Rocky Mountain Spotted Fever (Level 2) Tx?

A

Ideal to start within 5 day of symptom onset
○ Doxycycline; even in kids <8y
■ Benefits outweigh risk in kids of permanent teeth staining (<8y)
○ Chloramphenicol in pregnancy
■ Associated with gray baby syndrome in 3rd trimester

164
Q

Syphilis (Level 2)

A

Treponema pallidum; a spirochete

165
Q

Syphilis (Level 2) Incubation period?

A

Incubation period: “Remember the 3s”

○ 3 days to 3 months and there are 3 phases

166
Q

Syphilis (Level 2) Transmission period?

A

Direct contact of infected lesion during sexual activity and/or
contact with lesions on mucous membranes

167
Q

Syphilis (Level 2) Primary

A

Chancre: Painless ulcer at/near inoculation site with raised edges, resolves
usually in 3-4 weeks with no medical management
○ Nontender lymphadenopathy near chancre for 3-4 weeks as well

168
Q

Syphilis (Level 2) 2nd

A

Weeks to months after primary
○ Diffuse maculopapular rash typically on palms/soles
○ Condyloma lata: Moist wart-like lesion usually near chancre site, highly
contagious
○ Fever, lymphadenopathy, arthritis, headache

169
Q

Syphilis (Level 2)3rd

A

Late, may be > 20 years after initial or latent infection
○ Non cancerous granulomas of skin called gummas
Neurosphylis. Argyll-Robertson pupil: Small, irregular pupil that does not constrict/react
to light but constricts normally to near accommodation
○ Aortitis, aortic regurgitation, aortic aneurysms

170
Q

Syphilis (Level 2)-neurosphyilis

A

HA, dementia, Tabes dorsalis (demyelination of posterior

column causing ataxia, areflexia, weakness)

171
Q

Argyll-Robertson pupil:

A

Small, irregular pupil that does not constrict/react
to light but constricts normally to near accommodation; learning aid: like a prostitute they
accommodate but do not react)

172
Q

Syphilis (Level 2)-Latent

A

Defined as asymptomatic infection with normal physical exam and positive
serologic testing

173
Q

Syphilis (Level 2)-Congential

A

Hutchinson teeth (notches noted on teeth)
○ Hearing loss
○ Saddle-nose deformity
○ ToRCH syndrome

174
Q

Syphilis (Level 2)Dx

A

Dx: RPR/VDRL, confirm with FTA-ABS (because there are lots of false positives)

175
Q

Syphilis (Level 2) Tx?

A

Penicillin G
■ Desensitization for penicillin allergic patients
● Doxycycline, macrolide, ceftriaxone if unable to give PCN but
not as effective
■ S/E of Pen tx: Jarisch-Herxheimer reaction
● Acute febrile response to rapid spirochete destruction
● Myalgias, HA
● Give antipyretics in first 24 hr of treatment to reduce
incidence; Followup
○ Clinical and serologic reexamine at 6 and 12 mo
○ If not a 4x ↓ in titers at 6 mo, considered a treatment failure or reinfection
scenario

176
Q

Tuberculosis (Level 2)

A

Mycobacterium tuberculosis

● High mortality in untreated 50-80%, <5% when treated

177
Q

TB high risk populations?

A

High risk populations
○ Health care workers with close contact with TB patients = ↑ exposure risk
○ Immigrants from high prevalence countries, homeless =↑ infection risk
○ Immunodeficiency = ↑ risk to have active TB infection

178
Q

Tuberculosis (Level 2) transmission ?

A

Transmission: Airborne droplets

179
Q

Tuberculosis (Level 2) primary?

A 
1º TB is usually self limiting
● Primary rapidly progressive TB
○ Active infection with clinical progression, common in kids < 4y in endemic
areas
○ Contagious
180
Q

Tuberculosis (Level 2) primary?

A 
1º TB is usually self limiting
● Primary rapidly progressive TB
○ Active infection with clinical progression, common in kids < 4y in endemic
areas
○ Contagious
181
Q

Tuberculosis (Level 2) Chronic latent infection ?

A

90% of patients control primary infection via granuloma formation
○ Caseating granulomas have central necrosis and low O2 which make it
hostile for Mycobacterium to live/grow PPD positive after 2-4 weeks
○ Not contagious

182
Q

2nd reactivation of TB?

A

2º reactivation
○ Reactivation of latent TB due to waning immune defenses
■ HIV, elderly, steroid use
○ PE: Cavitary lesions seen in apex/upper lobes
○ Contagious

183
Q

TB s/s of Pulmonary?

A

Chronic productive cough, pleuritic chest pain, hemoptysis with
advanced disease
■ Night sweats, fever/chills, fatigue, weight loss
■ Consolidation near apices on physical exam

184
Q

TB s/s of Extrapulmonary TB?

A

Extrapulmonary TB can affect any organ
■ Vertebral involvement: Pott’s disease
■ Lymph nodes (scrofula)
■ Meningitis, pericarditis

185
Q

TB Screening ?

A

Skin PPD read within 48-72h
○ Positive PPD criteria
■ If ≥ 5mm in HIV/immunocompromised, in close contacts of active TB,
with CXR showing old TB
■ If ≥ 10mm in all other high risk populations
■ If ≥ 15mm in everyone else with no risk factors
○ False positive if within 2-10 yrs of BCG vaccine

186
Q

TB dx?

A

Acid fast smear gold standard and sputum culture x 3 days
■ TB ruled out after 3 negative smears
○ CXR to exclude active TB with positive PPD, yearly as screening with
patients with known positive PPD
■ 1º TB also seen middle/lower lobe
■ Reactivation seen in apices
■ Miliary: Small “millet seed” 2-4 mm nodules
■ Granuloma: Evidence of healed TB
○ Interferon gamma release assay
■ Blood test, ↑specificity, not affected by BCG

187
Q

TB Tx for active?

A

Active TB treated with 4 drugs x2 mo, then 2 drugs x additional 4mo (total
treatment 6 mo or 3 mo after negative sputum culture)
■ Isoniazid (INH) + Rifampin (RIF) for full 6 mo, Pyrazinamide (PZA) +
Ethambutol (EMB) for first 2 mo
● INH, RIF, PZA are hepatotoxic; LFTs at baseline and during
therapy
● May need individual case management with direct observed
therapy (DOT) to ensure compliance of meds
Respiratory precaution/isolation: Patients are no longer contagious 2
weeks after meds started
○

188
Q

TB tx for Latent TB?

A

Latent TB
■ INH, Pyridoxine x9 mo or x12 mo if HIV positive
■ To be latent: Positive PPD plus no symptoms plus no evidence of
active infection on CXR/CT

189
Q

Vaginal candidiasis (Level 2)

A

Culprit: Candida albicans overgrowth

● Risks: DM, recent antibiotic or steroid use, pregnancy

190
Q

Vaginal candidiasis (Level 2) s/s ?

A

/S: Pruritus, vaginal discharge, dysuria, dyspareunia

● Discharge: Thick, white, “cottage cheese” texture with no odor

191
Q

Vaginal candidiasis (Level 2) dx?

A

Hyphae, yeast on KOH prep

192
Q

Vaginal candidiasis (Level 2) tx?

A

Fluconazole PO x 1, intravaginal antifungal creams

193
Q

Pinworm infestation (Level 2)

A

Culprit: Enterobius vermicularis; Demographic: Common in kids

194
Q

Pinworm infestation (Level 2)

A

Culprit: Enterobius vermicularis; Demographic: Common in kids, Humans are the only host

195
Q

Pinworm infestation (Level 2) Transmission? Life cycle?

A

Transmission: Fecal-oral (ex hands, fomites, food-swallow eggs ); Life cycle-Adult worms attach to cecal mucosa, gravid female migrates distally and lays eggs on
perianal skin causing itching → hand to oral ingestion → eggs hatch in duodenum Eggs are viable for 2-3 weeks

196
Q

Pinworm infestation (Level 2) dx?

A

Scotch tape test to look for eggs

197
Q

Pinworm infestation (Level 2) ?

A

Albendazole, Mebendazole, Pyrantel pamoate

198
Q

Measles (Level 2)

A

Culprit: Paramyxovirus family

● Incubation period: 10-12 days

199
Q

Measles (Level 2) Transmission?

A

Respiratory droplets, airborne, person to person

200
Q

Measles (Level 2) s/s?

A

The “3 Cs”: Cough, coryza, conjunctivitis
○ Fever coincides with rash
○ Koplik spots: Small red spots on buccal mucosa with blue/white pale center
■ Precedes rash by 1-2 days
○ Rash characteristics: Brick red maculopapular begins on face and moves to
extremities
■ Darkens and coalesces
■ Usually lasts 7 days, fades from top to bottom

201
Q

Measles (Level 2) tx?

A

Supportive, anti-inflammatories

202
Q

Measles (Level 2) complications? prevention?

A

Otitis media, diarrhea, pneumonia; Prevention: MMR vaccine

203
Q

Mumps? Incubations time?

A

Culprit: Paramyxovirus family; 12-14 days

204
Q

Mumps Transmission?

A

Respiratory droplets
○ Incidence ↑ in spring
○ Infectious for 48 hours before and 9 days after parotid swelling

205
Q

Mumps s/s ?

A

Low grade fever, myalgias, headache then painful parotid gland swelling

206
Q

Mumps Dx?

A

Serologies, ↑amylase

207
Q

Mumps tx?

A

Supportive, illness last about 7-10 days

208
Q

Mumps complications?

A

Orchitis, Most common cause of pancreatitis in kids

○ Deafness, infertility; Prevention: MMR vaccine

209
Q

Toxoplasmosis

A

oxoplasma gondii (Protozoa)
● Infects all warm blooded animals
● One of the most common focal brain lesions in patients wit AIDS (ring enhancing
lesions on CT)
● Congential sydrome: causes birth defects

210
Q

Toxoplasmosis life cycle? Transmission?

A

Lifecycle
● Cat eats infected rodent → cysts in feces → into soil/litter box → oral intake after
gardening or cleaning the litter
● Ingestion of cysts in raw meat or from handling raw meat/utensils/cutting board
Transmission
● Raw pork/lamb/venison (ingestion of toxoplasma cysts), cat feces (lives up to 1 year in
the environment

211
Q

Toxoplasmosis presentation?

A

Primary: mild or asymptomatic, unless pt is pregnant → worst in early pregnancy
● Causes premature birth, eye/CNS/skin deformities, jaundice, splenomegaly
● Reactivation: HIV pts → encephalitis, focal brain lesions, retinal damage

212
Q

Toxoplasmosis treatment?

A

Pyrimethamine

213
Q

Malaria

A

Falciparum is the worst
● Common worldwide
● Anopheles mosquito transmits

214
Q

Malaria Lifecycle?

A

Mosquito bites you with organism in saliva which migrates to your liver and then your
RBCs where it multiples and then causes RBC rupture… leading to anemia

215
Q

Malaria Presentation? Dx? Tx?

A

chills, sweats, myalgias, headache
● Dx: by blood smear stains (not easy)
● Tx: chloroquine
● Prevention is key

216
Q

MRSA Infection

A

Methicillin-resistant Staphylococcus aureus (MRSA) → defined as oxacillin minimum
inhibitory concentration (MIC) ≥ 4 μg/mL
o Hospital-associated MRSA (HA-MRSA)
o Community-associated MRSA (CA-MRSA)

217
Q

MRSA Infection ? Gram stain?

A

Methicillin-resistant Staphylococcus aureus (MRSA) → defined as oxacillin minimum
inhibitory concentration (MIC) ≥ 4 μg/mL
o Hospital-associated MRSA (HA-MRSA)
o Community-associated MRSA (CA-MRSA); gram positive cocci occurring in clusters

218
Q

MRSA Infection Skin & soft tissue

A

Cellulitis, abscess, necrotizing fasciitis, diabetic foot ulcer

219
Q

MRSA Infection Bone & joint:

A

Osteomyelitis, septic arthritis (native & prosthetic joints)

220
Q

MRSA Infection Pneumonia:

A

Necrotizing pneumonia following influenza infection, hospital-acquired &/or
ventilator-associated pneumonia

221
Q

MRSA Infection Bacteremia:

A

ICU pts with central line placement

222
Q

MRSA Infection Endocarditis:

A

Right-sided endocarditis commonly associated with IV

drug use

223
Q

MRSA Infection Clinical evaluation:

A

Initial gram stain & culture
o DNA polymerase chain reaction (PCR): most sensitive test
o DNA PCR from nares: used to r/o colonization

224
Q

MRSA Infection Treatment: & Prevention

A

Removal of source if feasible (vascular catheters, etc)
o Oral: trimethoprim/sulfamethoxazole, tetracyclines, clindamycin
o Parenteral: vancomycin, daptomycin
● Prevention:
o Hand hygiene (hand washing), contact precautions (gloves, gown), isolation, screening
for MRSA colonization in outbreaks

225
Q

Prenatal Transmission of HPV ? s/s?

A

Maternal → fetal vertical transmission of human papilloma virus (HPV) occurs in juvenile
laryngeal papillomatosis, infection of conjunctival, oral & genital mucosa
o Usually due to direct fetal contact with infected maternal cells during vaginal or
cesarean section delivery
o In utero & transplacental transmission can also occur;; most HPV infections are asymptomatic

226
Q

Prenatal Transmission of HPV Treatment ?

A

usually none; most individuals clear infection within 12-24 months
o However, rates & determinants of perinatal transmission or of persistent infection,
and long-term sequelae in children are not known

227
Q

Zika Virus organism?

A

Arthropod-borne flavivirus transmitted by mosquitos

228
Q

Zika Virus transmission?

A

Transmission: infected mosquito bite (most common), maternal-fetal, sex, blood products,
organ/tissue transplant
o Zika RNA can be detected in: CSF, saliva, blood, urine, semen, ♀genital tract
secretions, amniotic fluid & breast milk

229
Q

Zika Virus CM ?

A

Occurs in ~20-25% of infected adults; incubation: 2-14 days; usually mild dz lasting
2-7 days followed by immunity
o S/Sx: acute onset low-grade fever, maculopapular pruritic rash, arthralgia &
conjunctivitis; fetal loss may occur during pregnanc

230
Q

Zika Virus RF?

A

travel advisories to locations <6,500 ft where Zika occurs; in the US,
includes Florida & Texas (check CDC website for current information)

231
Q

Zika Virus Dx?

A

Sx ≤14 days, nucleic acid test (NAT) for Zika virus RNA
o (serum, urine, or whole blood); if negative or ≥14 days, Zika
o virus serology (IgM)

232
Q

Zika Virus tx?

A

symptomatic (rest, fluids, acetaminophen)

233
Q

Zika Virus prevention

A 
mosquito protection (eg. repellent), environmental control (eg. standing
water), sexual protection or abstinence; currently, Ø vaccine
234
Q

Zika Virus Main complications ?

A

In babies born to women infected during pregnancy → congenital Zika syndrome
(microcephaly, facial disproportion, irritability, hypertonia/spasticity, hyperreflexia,
seizures, sensorineural hearing loss, limb & ocular abnormalitiesGuillain-Barré, myelitis, meningoencephalitis

235
Q

Prenatal Transmission of Zika Virus

A

Maternal → fetal vertical transmission of Zika virus can occur throughout pregnancy in
mothers with/without s/sx of dz
o Greatest risk to fetus: 1st & 2nd trimester infection (serious sequelae can occur in any
trimester)
o Mother’s dz severity or viral load do not predict infant outcomes

236
Q

Prenatal Transmission of Zika Virus Pathogenesis:

A

Maternal infection → infection & injury of placenta
o Virus crosses placenta → targets fetal neural progenitor cells
o Affects neuronal growth, proliferation, differentiation & migration

237
Q

SIRS/Sepsis

A

Systemic inflammatory response syndrome (SIRS)
o ± infection → dysregulated inflammatory response
o Non-infectious etiologies: autoimmune dz, pancreatitis, vasculitis, trauma, burns,
surgery

238
Q

SiRS

A

Systemic inflammatory response syndrome (SIRS)
o ± infection → dysregulated inflammatory response
o Non-infectious etiologies: autoimmune dz, pancreatitis, vasculitis, trauma, burns,
surgery

239
Q

SIRS/Sepsis Risk Factors?

A

ICU admission, nosocomial infection, bacteremia, ↑ age,

immunosuppression, previous hospitalization, CAP

240
Q

SIRS/Sepsis CM?

A

(high mortality rate):
o Sepsis: s/sx specific to infectious source (eg. cough), hypotension, tachycardia,
tachypnea, fever, leukocytosis, left shift, organ dysfunction (eg. oliguria)
o Septic shock: requirement of vasopressors despite adequate fluid resuscitation, ↑
lactate, multiple organ dysfunction syndrome (ARDS, AKI, AMS, DIC)

241
Q

SIRS/Sepsis TX?

A

Sepsis: early administration of appropriate antibiotics
o SIRS/septic shock: aggressive fluid resuscitation, vasopressor agents; SIRS – specific
tx directed at underlying cause

PANRE (15 decks)

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