Infx Dz Flashcards
botulism sx
symmetric descending flaccid paralysis
12-36h after exposure
dec or absent DTR
D: diplopia, dilated fixed pupils, dry mouth, dysphasia, dysarthria, dysphonia, dec DTR, descending
urinary retention
botulism etiology
toxin inhibits Ach release
botulism tx
antitoxin
CDC
abx only in wound botulism: Pen G
infant botulism sx
constipation
symmetric descending paralysis (floppy baby)
poor gag reflex, pooled oral secretion
poor feeding, diminished suck, dec vision
infant botulism tx
IV botulism IG: equine if <1yo, human if >1yo
avoid honey during first year of life
gas gangrene etiology
clostridium perfringens
traumatic injury or IVDU
gas gangrene sx
sudden onset pain and edema, shock
brown/blood tinged watery exudates w/ skin discoloration around area
crepitus/gas in tissue on PE
gas gangrene tx
IV penicillin + IV clindamycin, debridement
listeriosis found in
deli meat
unpasteurized dairy
listeriosis sx
bacteremia in infants <2mo and elderly
pregnancy: associated w/ premature labor and stillbirth
listeriosis tx
IV ampicillin TOC
anthrax CXR
widening of mediastinum
anthrax tx
ciprofloxacin for tx and exposure
MC bacterial diarrhea in US
campylobacter jejuni
campylobacter jejuni complications
GBS
reactive arthritis
campylobacter jejuni sx
frequent bloody watery diarrhea
N/V/F
gold standard campylobacter jejuni
stool culture
campylobacter jejuni tx
supportive
severe: azithromycin
chlamydia etiology
C. trachomatis
chlamydia tx
azithromycin single dose or doxy
pregnant/sx: PCN/cephalosporin. test of cure after 3wks
chlamydia conjunctivitis in neonate tx
PO erythromycin: associated w/ pyloric stenosis in infants
neonatal chalmydia pneumonia sx
infant between 3-16wks old
gradual staccato cough
afebrile
pharyngitis, sinusitis
neonatal chlamydia pneumonia tx
1st line: macrolide (azithromycin)
2nd line: doxy
cholera type of diarrhea
non inflammatory
cholera sx
watery diarrhea w/ mycys
rice water stools
fever rare
cholera definitive test
stool culture
cholera tx
supportive
mod-sev: cipro or doxy, azithromycin if child or pregnant
diptheria sx
URI sx, low fever
bull neck, cervical lymphadenopathy
grey pseudomembrane on pharynx (grains of salt, bleed when scraped)
myocarditis: arrhythmia/heart failure
diptheria confirm test
pharyngeal cultures
diptheria tx
hospital and isolation
ASAP equine serum antitoxin
IM PCN G or PO/IV erythromycin
diptheria prophylaxis
penicillin benzathine G or erythromycin
DTap schedule
5 doses: 2mo, 4mo, 6mo, 5-18mo, 4-6yo
booster at 11yo
gonorrhea tests
NAAT
gram stain and culture: gr negative diplococci
gonococcal tx
uncomplicated: ceftriaxone IM and azithromycin PO (for chlamydia)
complicated: sub in doxycycline
fitz- hugh curtis syndrome
disseminated acute peri hepatitis
gonococcal urethritis tx
ceftriaxone IM and azithromycin PO (or doxy)
HUS caused by
E. coli O157:H7 (shiga like toxin)
HUS sx
MC in children <5yo
abd pain, N/V
bloody diarrhea, seizures
MCC acute kidney injury in children
HUS
HUS labs
triad: hemolytic anemia, renal failure, thrombocytopenia
HUS tx
supportive
avoid ABX
MRSA bacteria shape
gram positive bacteria cocci in cluster
MRSA tx
isolation
tx for both sx and no sx
vancomycin or linezolid first line
psittacosis MCC
parrot fever
chlamydia psittaci
h/o bird exposure
psittacosis sx
high fever
HA, myalgia
nonproductive couth
HEPATOSPLENOMEGALY
psittacosis CXR
patchy peri-hilar or lower lobe infiltrates
psittacosis tx
supportive and first line: doxy
2nd line: azithromycin (kids or pregnant)
RMSF etiology
rickettsia rickettsia: gr negative coccobacilli
RMSF sx
abrupt onset, severe HA, N/V/F
maculopapular rash on palms and soles –> petechiae
RMSF test confirm
skin bx
RMSF complications
encephalitis
myocarditis
pulmonary edema
RMSF tx
doxy, even in children
chloramphenicol if pregnant or AE
chloramphenicol AE
gray baby syndrome in 3rd trimester
MCC of osteomyelitis in children w/ sickle cell
salmonella
salmonella sx
fever, bloody diarrhea
pea soup
typhoid salmonella sx
bradycardia
hepatosplenomegaly
rose colored rash
salmonella tx
rehydration
severe: ciprofloxacin, FQ
shigella sx
high fever
watery bloody mucoid diarrhea
seizures
dehydration
shigella tx
FQ adults
azithromycin in kids
avoid anti motility
complication of shigella
bacteriemia
sepsis
HUS
reactive arthritis
seizures
Q fever etiology
coxiella burnetii
from sheep, goats, wool
Q fever sx
Acute: pneumonia. severe HA, hepatitis, or encephalopathy
chronic: culture neg endocarditis. persistent low grade fever, rash (septic thromboembolism)
Q fever test
acute: immunofluorescence IFA MC
chronic: phase I IgG immunoglobulins
Q fever tx
doxycycline TOC
rifampin for chronic disease
plague etiology
yersinia pestis
infected rodents and their fleas
bubonic plague sx
MC form of plague
swollen, warm, red, painful nodes in groin, axilla, and cervical regions (buboes)
septicemic plague sx
DIC: extensive purpura (Black Death)
gangrene (acral): distal extremities, nose, penis
no buboes
pts die from pneumonia or meningitis
pneumonic plague sx
tachypnea, cyanosis
productive cough
frothy blood tinged sputum
red death
plague gram stain
bipolar staining: safety pin appearance of organisms
plague tx
streptomycin or gentamicin 1st line
doxycycline 2nd line
plague post exposure prophylaxis
doxycycline or tetracycline
Bactrim alternative
tetanus etiology
clostridium tetani
gram + rod
tetanus prevention
Tdap
tetanus sx
risks sardonicus: joker smile
opisthotonos: arched back
trismus: lock jaw
descending paralysis
inc DTR
spatula test
tetanus: touch oropharynx causes reflex biting d/t masseter spasm
tetanus tx
metronidazole or single IM dose of human tetanus IG
alternative: Pen G
benzo (diazepam) to decrease spasms
tetanus prophylaxis
prior immunization >3 doses, uncertain, or <3 doses: dT if low risk wound and >10y since last dose
high risk wound: dT if >5y since last dose + 25ou IM TIGa
cryptococcus CD4
<100
MCC fungal meningitis in immunocomp adults
cryptococcus
cryptococcus sx
meningitis
N/V
photophobia
histoplasmosis sx
flu like sx —> pneumonia
secondary infx w/ TB like sx
histoplasmosis CXR
hilar/mediastinal lymphadenopathy
patchy nodular pulmonary infiltrates
occasional cavitations
histoplasmosis labs
inc ESR
anemia, pancytopenia
tissue bx: granulomas, fungi visualization
histoplasmosis tx
itraconazole or amphotericin B
CS
pneumocystis CD4
<200
pneumocystis pathogen
pneumocystis jiroveci (PCP)
pneumocystis sx
gradual fever, dyspnea on exertion
dry cough, wheezing, SOB
hypoxia w/ ambulation
pneumocystis test
BIT: sputum culture
CXR: bilateral diffuse infiltrates, bat wing appearance, ground glass opacities, apical regions spared and progress peripherally
inc LDH
+ silver stain
pneumocystis definitive test
bronchoalveolar lavage
pneumocystis tx
bactrim TOC
dapsone if allergic
prednisone if hypoxic
pneumocystis prophylaxis HIV tx
bactrim
M. Avium intracellular (MAC)
atypical mycobacterial disease MC assoc w/ AIDS
M. avium (MAC) sx
fever, swollen lymph nodes
diarrhea, fatigue, WL, SOB
African trypanosomiasis
African sleeping sickness: tsetse fly
painless chancre at bite signs, winter bottom sign (posterior cervical lymphadenopathy)
daytime sleepiness followed by nighttime insomnia
infx disease consult
trichinosis
pork, undercooked meat
myositis, palpebral or circumorbital edema
eosinophilia hallmark
muscle bx: larvae in striated muscle
self limited if mild, albendazole + CS if severe
leishmaniasis
female sandfly
small erythematous papules w/ ulceration or dry indurated plaque w/ satellite pustules
raised bordered scar, regional lymphadenopathy
hepatosplenomegaly
infx dz consult
ehrlichiosis
from ixodes or lodestar tick
high F, toxicity, myalgia, HA, splenomegaly
no rash usually
PBS/buffy coat: morale in WBC, mulberry shaped aggregates
thrombocytopenia, leukopenia
tx w/ doxycycline
mycobacterium avium complex (MAC) CD4
<50
mycobacterium avium complex sx
pulmonary infx in immunocomp: cough w/ sputum, F, WL, bronchiectasis
disseminated in HIV pts: sweat, WL, fatigue, diarrhea, dyspnea, RUQ pain
lymphadenitis in children: cervical submandibular/ maxillary
mycobacterium avium complex tx
clarithromycin + ethambutol for 1 year
HIV prophylaxis CD4 <50
mycobacterium avium complex
clarithryomycin, azithromycin
rifabutin 2nd line
leprosy etiology
mycobacterium leprae
affects superficial tissues (skin and peripheral nerves)
leprosy sx
lepromatous: nodular plaque or papular skin lesions (lepromas) w/ poorly defined border. symmetric nerve involvement (sensation preserved). paresthesias in affected peripheral nerves. hypo pigmented areas in cooler parts of body
tuberculoid: hypo pigmented macular lesions numb to touch
mononeuritis multiplex: nerve damage (clawing, foot drop)
leprosy test
acid vast bacillus smear from skin bx
leprosy tx
lepromatous: dapsone, rifampin, clofazimine for 2-3y
tuberculoid: dapsone + rifampin for 6-12mo followed by dapsone 2yrs
Ranke complex
ghon complex that has been calcified
if TB spreads, its called
systemic military TB
Pott dz
TB spread to lumbar vertebrae
TB hallmarks
longhand giant cell: horsehoe shape, multi nuclei, Schumann bodies, astroid bodies
caseating: tissue in middle of granuloma dies –> ghon focus
Ghon focus + hilar lymph node: ghon complex
TB sx
primary: F, night sweat, cough, hemoptysis
erythema nodusum: flat, firm, hot red, painful lumps on shins
tb dx and tests
BIT: PPD
CXR: apical cavitary lesions –> granulomas
IGRA
sputum culture: bright red
bx of nodule
CXR TB types
classic: ghon complex w/ calcification
secondary: cavitation and scarring in upper lobes
military: numerous small nodules throughout lungs
latent TB tx
bacteria in body but doesn’t cause sx
not contagious, +PPD
9mo of isoniazid + B6
latent and prophylaxis TB tx
isoniazid + B6 9 mo
monitor LFT
B6
pyridoxine
tx TB
Rifampin
Isoniazid + B6
Pyrazinamide
Ethambutol
for 6mo
rifampin AE
orange urine/tears
hepatotoxic
isoniazid ae
peripheral neuropathy: add B6 (pyridoxine)
hepatotoxic
pyrazinamide ae
hepatotoxic
hyperuricemia (gout)
ethambutol AE
optic neuropathy
red-green color blindness
hyperuricemia (gout)
hepatotoxic
amebic liver abscess MCC
entamoeba histolytica
feco-oral
h/o camping
amebic liver abscess sx
RUQ pain, tender to palpation
bloody diarrhea, F
jaundice, cough, sweating
amebic liver abscess tests
BIT: US
confirm: serology
amebic liver abscess tx
metronidazole, even if asx
paromomycin
hookworm etiology
necator americanus
hookworm sx
intermittent diarrhea
cough, wheezing
rash @ site of infx
hookworm labs
eosinophilia
iron deficiency anemia
hookworm tx
mebendazole, albendazole
iron replacement
pyrantel if pregnant
roundworm MCC
ascaris lumbricoides
roundworm sx
cough, wheezing
abd pain, diarrhea
roundworm tx
albendazole
babesiosis etiology
babesia microti: attacks RBC, NE US
hx of tick bite
babesiosis sx
F, chills, hemolytic anemia
jaundice, arthralgia, myalgia
babesiosis pathognomonic
PBS: parasites within RBC in tetrads (Maltese cross)
babesiosis tx
atovaquone + azithromycin or quinine + clindamycin
chagas dz MCC
protozoa trypanosoma cruzi
MC in children
from bug bite
leading cause of CHF in latin america
chagas dz
chagas dz sx
acute: 3w-3m F, unilateral periorbital edema (Romanas sign), lymphadenopathy, edema at site of bite, hepatosplenomegaly
chagoma: inflammatory nodule at bite site
latent: cardiomyopathy, CHF, megacolon, megaesophagus
chagas dz test
PBS or culture
serology or muscle bx in latent phase
echo: cardiomegaly w/ apical atrophy/aneurism
chagas dz tx
benznidazole or nifurtimox for 90-120d
MCC malaria
P falciparum: coma, dark urine, renal failure
malaria sx
cyclic fevers, night sweats, splenomegaly, jaundice (hemolytic anemia), AMS, coma
malaria dx
geimsa stain
confirm: PBS shows trophozoites, diamond ring appearance
malaria tx
uncomplicated: chloroquine
complicated: quinidine + doxycycline
areas of high resistance: mefloquine
chloroquine AE
hemolytic anemia
G6PD
pinworm etiology
enterobius vermicularis
pinworms tx
albendazole
mebendazole
pyrantel pamoate
ToRCH syndrome
toxoplasmosis
rubella
cytomegalovirus
HSV2
blueberry muffin rash (TTP)
toxoplasmosis etiology
toxoplasma gondii
transplacental or exposure to cat feces
toxoplasmosis sx
flu sx
congenital: bilateral ventriculomegaly, hydrocephalus, hepatoplenomegaly, hearing loss
toxoplasmosis for HIV pts
CD4 <100
encephalitis
chorioretinitis
toxoplasmosis test
toxoplasma IgG ab
ELISA
CT/MRI: ring enhancing lesions
toxoplasmosis tx
acute: pyrimethamine
sulfadiazine/clindamycin
spiramycin if pregnant
toxoplasmosis prevention tx
bactrim DOC for CD4 <100
congenital rubella sx
deaf, blueberry muffin rash
heart dz w/ murmur (PDA, ASD/VSD)
congenital rubella test
fetal US during pregnancy: heart abnormality, splenomegaly, microcephaly, growth retardation
confirm: rubella specific IgM in fetal blood or amniotic fluid
congenital rubella tx
supportive
vaccinate MMR before pregnancy
neonatal herpes simplex virus from
HSV2 via birth canal passage
neonatal herpes simplex virus sx
asx mother or multiple vesicular genital ulcers
neonate: keratoconjunctivitis, vesicular skin rash, seizures, meningitis, sepsis, respiratory distress, impaired neurodevelopment
zika virus sx
low grade f
maculopapular rash pruritic
arthralgia of small joints
non purulent conjunctivitis
zika test
PCR/ serology
zika tx
supportive
zika complications
microcephaly
GBS
zika prevention
virus is problem for pregnant women bc of fetal complications
use contraception in males for 3m, females for 2m. both partners= 3mo
sepsis sx
F, tachycardia
hypotension, tachypnic,
AMS
sepsis tx
vasopressors (dopamine, NE)
empiric abx w/in 1hr: vanco, zosyn
toxic shock syndrome pathogen
S. aureus
Group a strep
from tampon use
toxic shock syndorme sx
F, hypotension
diffuse macular or necrotizing rash including palms and soles
diarrhea, pharyngitis
toxic shock syndrome tx
admit
IV fluids
GAS: PCN G and clindamycin
S. aureus: vancomycin and clindamycin
West Nile virus
flavivirus from mosquitoes
flu like sx, pharyngitis
supportive tx
severe acute respiratory syndrome (SARS)
coronavirus, causes atypical pneumonia
stool is first to be positive, CT
supportive management
hantavirus (hemorrhagic fever)
from rodent feces or urine, in SW US
prodromal febrile phase, cardiopulmonary phase + renal failure
supportive tx, ICU
tularemia etiology
francisella tularensis: rodents and rabbits
tularemia sx
ulceroglandular (MC): single papule at site, ulceration of papule w/ central eschar and tender regional lymphadenopathy
glandular: lymphadenopathy w/o lesions
oculoglandular: splashed in the eye, pain, photophobia, tearing
pharyngeal: ingestion, F, sore throat
typhoidal: ingestion: G, GI sx
pneumonia, meningitis, pericarditis
tularemia tx
streptomycin DOC
diseases w/ eschar
tularemia
anthrax
leishmaniasis
coccidiomycosis
mucormycosis
brucellosis
from cattle, ingestion of infected unpasteurized milk and cheese
low grade/no fever, nonspecific sx
tx w/ rifampin + doxycycline
lyme etiology
borrelia bugdorferi spirochete
Ixodes tick from white tail deer
congenital syphilis sx
Hutchinson teach
saddle nose deformity
ToRCH syndrome
syphilis tx
benzathine PCN G
Doxycycline if allergy
monitor RPR q 6-12mo
AE PCN G
Jarish herxheimer reaction: acute fever in response to lysis
use antipyretics in the first 24h
cytomegalovirus etiology
HHV5
immunocompromised (DM, HIV/AIDS, post transplant)
cytomegalovirus sx
infectious mono: mono spot neg
congenital: premature birth, hearing loss, low birth weight, hepatosplenomegaly, seizures, respiratory distress
cytomegalovirus tests
+CMV IgM
PBS: owl eye appearance
cytomegalovirus tx
ganciclovir TOC
cytomegalovirus infx reactivation
retinitis: scrambled egg/ketchup appearance (pizza pie)
esophagitis
CD4 <50
EBV sx
F, posterior cervical lymphadenopathy
pharyngitis, tonsillitis
splenomegaly
rash w/ amoxicillin tx
erythema toxicum
in neonates
small erythematous macules/papules 3-5d after birth
does not involves palms or soles.
self limited, resolves in 1-2w
erythema infectiosum etiology
fifth disease
MC in children
parvovirus B19
erythema infectiosum sx
low fever, coryza
slapped cheek, lace like
spares palms and soles
erythema infectiosum tx
supportive
erythema infectiosum complications
transient aplastic crisis from dec EPO
sickle cell: aplastic anemia
HSV infection test
tzanck smear
PCR most sensitive and TOC
rubeola etiology
paramyxovirus
rubeola sx
cough, coryza, conjunctivitis
koplik spots
exanthema starts at face and spreads down
rubeola gold standard
anti measles IgM
rubeola complication
OM, pneumonia, croup, diarrhea
panencephalitis/meningitis/vision loss
child under 2: subacute sclerosing panencephalitis (mood changes, seizures, coma)
mumps etiology
paramyxovirus
MCC pancreatitis in children
mumps
mumps complication
orchitis
cat scratch disease etiology
bartonella henselae
cat scratch disease sx
F, HA, lymphadenopathy 1-7wks after scratch
cat scratch dz tx
mild: self limited
moderate: azithromycin 1st line or doxycycline
severe: rifampin, gent, ciproflox
doxy if optic neuritis or neuro dz
smallpox (variola) etiology
orthopox virus
smallpox sx
flu prodrome: abrupt high F, severe head/back pain
skin eruptions that crust over in 2 wks
palmar and plantar lesions common, trunk to extremities
smallpox tx
supportive
CI to smallpox vaccine
eczema
dermatitis
burns
rabies etiology
rhabdovirus from animal bite
rabies sx
F, fear of water ingestion
foaming at the mouth
alternating mania and stupor
ascending flaccid paralysis
rabies post mortem brain bx
negri bodies
rabies tx
rabies IG (day 0, 3, 7, 14) + rabies vaccine IM
roseola etiology
sixth disease
HHV6 and HHV7
roseola sx
1st: high abrupt fever
2nd: rose colored rash starts on trunk –> back. spares face
scarlet fever etiology
GABHS
scarlet fever sx
F, chills, pharyngitis
rash: sandpaper. MC starts in groin and axilla and spreads to trunk then extremities. spares palms and soles. flushed face w/ circumoral pallor and strawberry tongue
pastas lines
pastias lines
scarlet fever
linear petechial lesions seen at pressure points, axillary, antecubital, abdominal or inguinal areas
scarlet fever tx
pen G or VK first line
macrolide if PCN allergic
can return to school 24h after abx initiation
rubella sx
low fever, pink light red spots last 3d. starts of face spread to body
lymphadenopathy: retroauricular, posterior cervical, posterior occipital
forchheimer spots
forchheimer spots
seen in scarlet fever and rubella
rose colored spots on soft palate
rubella complication
congenital rubella syndrome: teratogenic esp in 1st trimester
sensorineural deafness, cataracts, TTP
mental retardation, ToRCH syndrome
varicella infection etiology
VZV HHV3
varicella infection complication
secondary bacterial infection (staph/strep)
reyes syndrome (ASA CI)
encephalitis
Ramsey hunt syndrome
varicella zoster in ear
MC etiology cat/dog bite
pasteurella
MC etiology human bite
eikenella
bite tx
initial: wound healing
PO augmentin
tetanus or rabies prophylaxis
abx of choice in pregnant women
amoxicillin
1st gen cephalosporin AE
cefazolin, cephalexin
disulfiram like rxn
dont take w/ alcohol (N/V, flushing, tachycardia)
cross rxn w/ penicillins
only cephalosporin effective against MRSA
ceftaroline (5th generation)
vancomycin AE
thrombophlebitis
red man syndrome
nephrotoxic
ototoxic
carbapenems AE
severe CNS toxicity
seizures
imipenem nephrotoxic unless used wl cilastatin
when using imipenem, need to use
cilastatin
due to nephrotoxicity
bacitracin AE
nephrotoxic if given systemically
tetracycline + isotrentinoin
pseudotumor cerebri
azithromycin AE
QT prolongation
1st gen FQ AE
nalidixic acid
QT prolongation
tendon rupture
1st gen FQ CI
nalidixic acid
pregnancy
nursing mothers
children <18yo
