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EM RAP-Becoming a badass ER PA > infectious stuff > Flashcards

infectious stuff Flashcards

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1
Q

HIV and Aids Related Infections

Ophthalmologic illnesses

A

*CMV Retinitis

  • Blurry or worsening vision
  • Eye pain
  • Treat with ganciclovir
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2
Q

HIV and Aids Related Infections

GI/Diarrheal illnesses

A
  • Cryptosporidium
  • Isospora
  • Oral/Esophageal candida
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3
Q

HIV and Aids Related Infections

Neurologic illnesses

A
  • Cryptococcus
  • Headaches
  • AMS
  • High opening pressure on LP
  • Diagnosed with India Ink or Ag titer
  • Treat with Amphotericin B +/- Flucytosine
  • Toxoplasmosis
  • More focal neuro symptoms
  • CT with “ring enhancing lesions”
  • Treat with Pyrimethamine + Sulfadiazine + Folinic Acid
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4
Q

HIV and Aids Related Infections

Pulmonary illnesses

A

-Not always PCP!
-Most common sources for pneumonia are still the common bugs (Strep pneumo and H. flu)
- With AIDS also consider:
— TB
—Pneumocystis pneumonia
———-Bilateral “ground-glass” opacities on CXR
High LDH on labs
———-Treat with TMP-SMX
———-Add steroids if very unwell

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5
Q

HIV and Aids Related Infections

Oncologic illnesses

A

*Kaposi Sarcoma

  • Most common cancer in AIDS patients
  • Subcutaneous, red/brown or red/blue nodules on face and extremities
  • Can also occur within GI tract
  • Call Oncology
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6
Q

Many adverse drug reactions related to HIV/AIDS therapy including

A
  • Didanosine → pancreatitis
  • Indinavir → kidney stones
  • Efavirenz → psychosis
  • Pentamide → hypo/hyperglycemia
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7
Q

Bacterial food poisoning

Reheated fried rice
what kind of bug?

A

Bacillus cereus

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8
Q

Bacterial food poisoning

Traveler’s diarrhea
what kind of bug?

A

E. coli

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9
Q

Bacterial food poisoning

Contaminated meat and poultry
what kind of bug?

A

Clostridium perfringens

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10
Q

Bacterial food poisoning

  • Contaminated water or shellfish
  • Watery diarrhea
  • Dehydration
  • Metabolic acidosis
  • Rehydration therapy

what kind of bug?

A

Vibrio cholera

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11
Q

Bacterial food poisoning

  • Tuna, mackerel, and mahi-mahi
  • Histamine release
  • Metallic or peppery taste

what kind of bug?

A

Scombroid

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12
Q

Bacterial food poisoning

  • Snapper, barracuda and grouper
  • Paresthesias
  • Reversal of hot/cold perception

what kind of bug?

A

Ciguatera

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13
Q
  • Potentially fatal neuroparalytic syndrome caused by Clostridium botulinum
  • Descending motor neuron process, no sensory component
  • Neurotoxin acts at motor end plate → weakness → affects diaphragm → causes respiratory failure
A

Botulism

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14
Q

_________ is spread by:

  • Foodborne
  • Improper canning techniques
  • Honey ingestion before age of 1

*IV drug users contract it in wounds

  • Spectrum of disease in infants
  • Constipation → Poor feeding → Weak cry → Floppy baby
A

Botulism

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15
Q

Botulism treatment

A
  • Treatment based on clinical presentation- don’t wait for test results
  • Treat with immunoglobulin
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16
Q

Febrile Traveler

Africa

A
  • African Sleeping Sickness
  • Spread by tsetse fly
  • Present with lethargy, sometimes psychosis
  • Treat with pentamidine or suramin
  • Ebola
  • Spread via direct contact with blood or bodily fluids/tissues of infected animals/people
  • Supportive treatment
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17
Q

Febrile Traveler

Central or South America

A

*Chagas Disease

  • Reduviid “kissing” bug
  • Edema, cardiac and GI problems
  • Treat with anti-trypanosomals (benznidazole or nifurtimox)
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18
Q

Febrile Traveler

Southeast Asia and Australia

A

*Leptospirosis

  • Animal vectors, contaminated soil, water
  • Severe forms of illness cause pulmonary hemorrhage
  • Treat with doxycycline or ceftriaxone
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19
Q

Febrile Traveler

Tropics in general

A

*Dengue

  • Aedes mosquito
  • Fever, rash, and joint pain
  • Supportive treatment
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20
Q

African Sleeping Sickness

treatment:

A

Treat with pentamidine or suramin

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21
Q

Ebola

treatment:

A

Supportive treatment

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22
Q

Chagas Disease

treatment:

A

Treat with anti-trypanosomals (benznidazole or nifurtimox)

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23
Q

Leptospirosis

treatment:

A

Treat with doxycycline or ceftriaxone

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24
Q

Dengue

A

Supportive treatment

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25
Q

what kind of fungal infection?

  • Rhizopus fungus, aggressive infections
  • Nasopharynx of immunocompromised patients
  • Prompt surgical debridement
A

Mucormycosis

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26
Q

what kind of fungal infection?

  • Pulmonary disease most common
  • Increased risk if have asthma or COPD
  • Cavitary lesions
  • Consider chronic form in patients whose respiratory symptoms do not respond to prolonged antibiotic therapy
A

Aspergillosis

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27
Q

Mucormycosis

Treatment:

A

Prompt surgical debridement

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28
Q

what kind of fungal infection?

  • Southwest USA, aerosolized spores from soil
  • Pulmonary disease
  • Synovitis
  • Hepatosplenomegaly
  • Meningitis leading to hydrocephalus
  • Treat with “azoles”, amphotericin B if disseminated
A

Coccidioidomycosis

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29
Q

Coccidioidomycosis

Treatment:

A

Treat with “azoles”, amphotericin B if disseminated

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30
Q

what kind of fungal infection?

  • Ohio, Missouri and Mississippi River Valleys, bird droppings in damp soil
  • Pulmonary disease to disseminated disease
  • Disseminated form includes GI, cardiac, ocular and CNS effects
  • Treat with “azoles”
A

Histoplasmosis

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31
Q

Histoplasmosis

Treatment:

A

Treat with “azoles”

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32
Q

what kind of fungal infection?

  • Great Lakes region, inhalation of spores
  • Pulmonary disease
  • Skin lesions- sharply demarcated, grey to violet verrucal lesions, irregular borders
  • Lytic bony lesions
  • Prostatitis
  • Treat with “azoles”
A

Blastomycosis

33
Q

Blastomycosis

Treatment:

A

Treat with “azoles”

34
Q

what kind of gangrene?

  • “Mummified” appearance
  • Poor vascular supply
  • Not infected
  • Toes/fingers often auto-amputate
  • Well-demarcated regions
A

Dry gangrene

35
Q

what kind of gangrene?

  • Bacterial infection
  • Poor blood supply
  • Malodorous
  • Erythema
  • Drainage
  • Ulceration
  • Aggressive antibiotic therapy
  • Can cause sepsis
A

Wet gangrene

36
Q

what kind of gangrene?

  • Gas forming bacterial infection (Clostridium, Strep, Vibrio)
  • Necrotizing soft tissue infection
  • Crepitus on palpation
  • Gas on X-ray
  • Aggressive resuscitation and early surgical debridement
  • Immunocompromised patients are at high risk
A

Gas gangrene

37
Q
  • South West USA, spread via aerosolized mouse urine
  • Non-specific viral prodrome → respiratory failure/ ARDS/cardiovascular collapse
  • Supportive treatment
A

Hantavirus

38
Q
  • Sudden onset high fever, myalgias, sore throat
  • Pediatric population often present with GI symptoms
  • Risk of primary influenza pneumonia or secondary bacterial pneumonia
  • Treat with antivirals for high risk groups
A

Influenza

39
Q
  • Water-borne (plumbing, sprinklers) intra-cellular bacteria
  • Does not spread person-to-person
  • Usually pneumonia PLUS one or more of the following
  • GI symptoms
  • Hyponatremia
  • Proteinuria
  • Hematuria)
  • CXR may look atypical
  • Confirmatory test is urine legionella Ag
  • Treatment is azithromycin/quinolone
A

Legionella

40
Q

Legionella

treatment:

A

Treatment is azithromycin/quinolone

41
Q
  • Spirochete Borrelia that uses deer tick as host
  • Tick must be attached approx. 72 hrs. or longer to transmit disease
  • Lyme disease progresses in stages (days-months-years)
  • Classic case description:
  • Pennsylvania hiker (Northeast USA)
  • Erythema migrans (target lesions) spreading out from bite within days
  • Bell’s palsy (bilateral in particular)
  • AV block within months
  • Treat with doxycycline, or ceftriaxone for the ixodes tick
  • No doxycycline if under age 8 or if pregnant
  • Jarisch-Herxheimer reaction
  • Spirochete deaths → SIRS-like response (usually syphilis, but so see in Lyme)
A

Lyme Disease

42
Q

Lyme Disease

treatment :

A

*Treat with doxycycline, or ceftriaxone for the ixodes tick

43
Q

Malaria

Test

A

Thick and thin peripheral blood smear

44
Q

Malaria

Treatment

A
  • Depends on type of malaria and where contracted

* Antimalarials (quinidine, artemisinins) and/or antibiotics such as doxycycline or clindamycin

45
Q
  • Animal reservoirs
  • Raccoons
  • skunks
  • foxes
  • bats
  • coyotes
  • Spread via bites/scratches from these animals
  • If bat found in house, residents should be treated for rabies (bats = high risk reservoir)

*Bite/scratch injects virus into muscle from where it travels into CNS

  • Presentation
  • Viral prodrome → Furious stage (agitation) → “Dumb” stage (incoordination, paralysis) → Death
A

Rabies

46
Q

Rabies

treatment:

A
  • Inject as much rabies IG as possible directly into bite (depends on bite size and location)
  • Inject remaining amount via IM route in thigh
  • Initiate rabies vaccine series
47
Q
  • Toxoplasma gondii from cat feces
  • If immunocompetent might have flu-like illness, not usually severe presentation
  • Immunocompromised patients at higher risk of more serious illness, including
  • CNS infections
  • Retinitis
  • Myelopathy
  • Primary infection during pregnancy can cause severe congenital infections
  • Ring enhancing lesions on head CT/MRI
  • See IgM (early) and IgG (late)
A

Toxoplasmosis

48
Q

Toxoplasmosis

Treatment:

A

Treat with pyrimethamine or TMP-SMX

49
Q

*Mosquito-borne

  • Clinical features
  • Usually flu-like illness
  • 1% develop meningoencephalitis
  • Labs
  • CSF pleocytosis
  • Send for West Nile Ab
  • CSF negative gram stain
  • CSF high protein count
A

West Nile Virus

50
Q

West Nile Virus

treatment:

A
  • Start treating immediately, don’t wait for cultures
  • Antibiotics and steroids
  • Antivirals
51
Q

what kind of worm?

  • Perianal itching, worse at night
  • “Scratch then ingest” cycle
  • Scotch tape tes
A

Pinworm

52
Q

what kind of worm?

  • GI infection → bloodstream → lungs → GI tract
  • Can cause eosinophilia
A

Roundworms (common roundworm, hookworm, strongyloides)

53
Q

what kind of worm?

  • Elephantiasis
  • River blindness
  • Pulmonary problems
A

Flukes from soil and stool cause

54
Q

what kind of worm?

  • Pork variant → cysts in muscles and brain → seizures
  • Fish variant → B12 deficiency
A

Tapeworms from raw pork/beef/fish

55
Q

Worms

tx:

A

Albendazole and mebendazole for most; ivermectin for river blindness

56
Q

*Hospital-acquired Device infections Indwelling lines

  • Community-acquired “Spider bite”o PVL gene association in the bacteria itself People living in close quarters
  • Members of sports teams
  • I&D if abscess
  • Clindamycin, TMP-SMX, or vancomycin
  • If recurrent infections, consider decolonization protocol (mupirocin in nose and skin cleaning for one week)
A

MRSA

57
Q

MRSA

tx:

A

Clindamycin, TMP-SMX, or vancomycin

58
Q

*Group A Strep, Staph aureus or polymicrobial most common

  • Clinical Features:
  • Erythema with poorly defined regions
  • Edema extends beyond regions of erythema
  • Hemorrhagic bullae
  • “Dishwater fluid”
  • Crepitus
  • Pain out of proportion
  • Hyponatremia
  • Leukocytosis
  • Lactic acidosis
  • High CRP
  • Gas in soft tissues on X-ray or CT
  • May exhibit “la belle indifference” where they are clearly severely ill but don’t seem to care
  • Requires early and aggressive surgical debridement
  • Clindamycin or broad-spectrum antibiotics
A

Necrotizing Fasciitis

59
Q
  • Usually secondary to Candida albicans
  • Newborns and immunocompromised patients are more susceptible
  • White/gray plaques in mouth/throat that can be scraped off
  • Swab shows yeast and micro-hyphae
  • Treatment
  • Nystatin swish and swallow QID
  • If treating breastfeeding newborn treat the mother’s breasts as well
A

Oral Candidiasis (Thrush)

60
Q

Oral Candidiasis (Thrush)

treatment:

A
  • Nystatin swish and swallow QID

* If treating breastfeeding newborn treat the mother’s breasts as well

61
Q

*Bordetella pertussis, highly contagious acute respiratory infection

  • Different phases of Bordetella pertussis
  • Catarrhal (URI) → Paroxysmal (cough and whoop) → Convalescent (weeks to months)
  • Serious complications
  • Secondary bacterial/viral pneumonias or other infection
  • Neonates can present with apneic, seizures/encephalitis/ICH
  • Supportive treatment unless secondary bacterial pneumonia, then antibiotics
  • Admit neonates
  • Macrolides to shorten illness and for post-exposure prophylaxis
  • Vaccinations and involve public health
A

Pertussis

62
Q
  • SIRS criteria = at least 2 of the following:
  • Temp >38º (100.4º) or <36º (96.8º)
  • RR >20 bpm (or PaCO2 <32)
  • HR >90 bpm
  • WBC >12,000 OR <4,000 OR >10% bands
  • Sepsis = SIRS + confirmed Infection
  • Severe Sepsis = Sepsis + 1 or more signs of organ dysfunction
  • Septic Shock = Severe Sepsis + hypotension refractory to fluids
A

Sepsis & Bacteremia

63
Q

Sepsis & Bacteremia

treatment:

A
  • Fluids
  • Antibiotics
  • Pressors
64
Q

Sepsis & Bacteremia

Treatment Goals

A
  • MAP >65
  • Urine output >0.5-1cc/kg/hr
  • Central venous pressure >8mm Hg
  • Central venous O2 sat >70%
  • Decreasing serum lactate levels
65
Q
  • Haemophilus ducreyi (gram negative rod)
  • Highly infectious genital ulcerative disease
  • Increases risk of HIV transmission (as do all ulcerative STIs)
  • Don’t confuse with HSV
  • Chancroid ulcerations and inguinal lymphadenitis
  • Ulcers and bubos usually present at same time
A

Chancroid

66
Q

Chancroid

Treatment

A

Options include azithromycin, ceftriaxone, ciprofloxacin or erythromycin

67
Q

*Wide range of clinical presentations (e.g. discharge, cervicitis, pelvic pain, dysuria)

  • Fitz-Hugh-Curtis syndrome
  • Ascending PID infection, presents with RUQ pain
  • “Violin string” adhesions around liver capsule

*NAAT test (urine or vaginal swab)

A

Chlamydia

68
Q

Chlamydia

Treatment

A

Azithromycin or doxycycline

69
Q

*Common co-infection with chlamydia

  • Common sites of infection
  • Oral
  • Pharyngeal
  • Conjunctival
  • Anorectal
  • Cervical
  • Urethral
  • Disseminated Gonococcal Infection (DGI) has two common presentations (that may overlap)
  • Arthritis-dermatitis syndrome
  • Purulent arthritis without skin findings
  • May not have mucosal symptoms at time of presentation with DGI
  • Tenosynovitis and skin lesions are common in DGI but rare in other forms of infectious arthritis
A

Gonorrhea

70
Q

Gonorrhea

Treatment:

A
  • Ceftriaxone IM PLUS azithromycin or doxycycline (for likely co-infection with Chlamydia)
  • Longer course of treatment for DGI
  • DGI may need repeated surgical wash-outs
71
Q
  • HSV-1 and HSV-2
  • Common viral syndrome in children
  • Clinically see:
  • Grouped vesicles, sometimes painful or tingling rash
  • Viral prodrome
  • Classic anatomical presentations:
  • Gingivostomatitis/pharyngitis-Oral infections
  • Herpetic whitlow-Infections on fingers (do not I+D these!)
  • Herpetic keratitis-Periorbital infections (Ophtho consult!)
  • Herpetic gladiatorum-Lesions on head, neck or trunk (think wrestlers)
  • Neonatal HSV-After transmission from active maternal infection during delivery
  • Eczema herpeticum-With supra-infection of eczematous lesions (potentially fatal!)
  • Urogenital outbreak
  • Can cause urinary retention (always check the genital region!)
A

Herpes Simplex

72
Q

Herpes Simplex

Labs

A

Tzanck smear

73
Q

Herpes Simplex

Treatment

A

Acyclovir or other antivirals

74
Q

*Bacteria usually Staph or Strep

  • Contracted from:
  • Prolonged use of tampons
  • Nasal packing
  • Burns
  • Surgical sites
  • Secondary infection

*Classic sign is erythroderma

  • If Staph
  • Diffuse rash with erythroderma/desquamation
  • Mucosal hyperemia
  • Septic shock
  • Rule out necrotizing soft tissue infection
  • High mortality
A

Toxic Shock Syndrome

75
Q

Toxic Shock Syndrome

Treatment:

A
  • Aggressive resuscitation
  • Fluids
  • Antibiotics
76
Q
  • Unilateral dermatomal rash - “dew drops on a rose petal”
  • Patients may get neuropathic pain preceding rash
  • Post-herpetic neuralgia can occur and can be hard to control
  • Treat with antivirals if rash has been present for < 72 hours of rash
  • Hutchinson sign
  • If see lesions on tip of nose, look for dendritic pattern on cornea
  • If corneal lesions, consult Ophthalmology urgently
A

Varicella Zoster

77
Q
  • 8th cranial nerve

* Ipsilateral facial paralysis, ear canal/pinna lesions, ear pain and vertigo

A

Ramsay Hunt Syndrome

78
Q

Ramsay Hunt Syndrome

Treatment

A
  • Antivirals
  • Steroids
  • Pain meds

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