ITE Infectious Disease Flashcards by Laurence Lenz

Abx of choice for Campylobacter?

Azithromycin

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Immunocompromised patient would need what type of vaccinations?

Hep A if traveling and non-live/live-attenuated

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Polyoma BK virus can cause what organ dysfunction?

primarily kidneys in renal transplant patients

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Fulminant C diff infection happens in what 4 scenarios ?

1) hypotension
2) shock
3) ileus
4) megacolon

if it sounds serious (ICU criteria), they get fulminant C diff treatment

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If ileus is present in C diff infection, what alteration can you make in treatment regimen?

instead of oral vancomycin, you can have rectal vancomycin

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treatment of fulminant c diff

oral vanc

IV flagyl

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treatment of CMV infection in immunosuppressed

severe: IV ganciclovir

non-severe: oral valganciclovir

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Foscarnet and cidofovir are used in what context?

severe CMV infection; if IV ganciclovir fails

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Flu diagnostic test of choice?

nucleic acid amplification test (rapid)

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“undulant fever” fever/chills, severe headache, joint and back pain, malaise, lethargy; depression; location: Mediterranean countries, as well as, Middle East/South and Central Asia

Physical Exam: hepatosplenomegaly and lymphadenopathy

Labs: cytopenia and abnormal liver enzymes

Brucellosis

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What pathology can develop with Q fever? (Think long-term)

endocarditis

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Developed from inhalation of soil contaminated with excrement/birth products from infected goats, sheep and cattle

causes mild, self-limited febrile illness with pneumonia and hepatitis

Q fever (Coxiella burnetti)

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How to manage cryptococcal meningitis?

Combination: amphotericin B and flucytosine

MOST IMPORTANT: lumbar puncture to relieve ICP

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Groups with flu-like illness and diarrhea who have been exposed to a common water source?

Legionella; always be suspicious even if Urine legionella is negative (only tests serogroup 1)

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Mycobacterium avium (MAC) should not be suspected in HIV patients with CD4 cell counts above what?

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What is the ID differential for a patient with fever, headache, myalgia, arthralgia, malaise?

Labs: leukopenia (lymphopenia), thrombocytopenia, and elevated liver transaminases

Ehrlichiosis or Heartland virus infection

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How to distinguish between Ehrlichiosis and Heartland Virus infection?

Ehrlichiosis will respond to Doxycycline; if no improvement in 48 hours with doxy, you have to test for Heartland virus via CDC

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How to treat herpes zoster outbreak in a patient who is immunocompromised?

IV anti-virals: IV acyclovir or others

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If patient is NOT immunocompromised, what is the treatment of choice for herpes zoster?

oral acyclovir, valacyclovir, famciclovir

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How to treat CAP in an otherwise healthy outpatient?

Amoxicillin or Doxycycline

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Guidelines recommend that TB screening be repeated in persons with HIV when the CD4 cell count rises to what level?

200; you would order a repeat interferon-gamma release assay (IGRA)

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A patient with fever, tremors, parkinsonism, myoclonus, and a maculopapular rash in the SUMMER months

West Nile virus

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How to diagnose West Nile virus?

CSF fluid or serum: IgM for West Nile

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MRI findings of brain for West Nile Virus?

enhancement in basal ganglia

How to diagnose HSV encephalitis ?

CSF fluid: HSV PCR

Nonspecific symptoms like fever, weight loss, fatigue and lymphadenopathy in post-transplant patient would be a cause for concern for what virus?

Epstein-Barr Virus (EBV); also think of CMV

The most appropriate first step in management of brain abscess in immunocompetent patient would be?

stereotactic brain aspiration; will need Gram stain and cultures before initiating abx?

A reaction of __ mm or greater to a tuberculin skin test indicates a positive result?

15mm or greater

If there is a positive TB skin test but, no evidence of active infection, what is the treatment regimen?

Latent TB treatment: shorter = better so, Isoniazid and Rifampin for 3 months 2nd Line Treatment: Isoniazid for 6-9 months

What is the most common cause of aseptic meningitis in the US?

HSV-2!!

How to differentiate HSV-1 and HSV-2 with brain infections?

HSV-1: encephalitis (seizures, FND) HSV-2: meningitis (stiff neck, photophobia) follow the alphabetic order (HSV-1 = E; HSV-2 = M)

What is Ramsay Hunt Syndrome? What are the symptoms?

Herpes Zoster reactivation (oticus); facial nerve palsy (VII) with erythematous vesicular rash (EAR) and/or lesions on the mouth/tongue

Differential Diagnosis for an infectious cause of peripheral facial nerve palsy includes what?

1) HSV-1 2) Lyme disease 3) Varicella-Zoster virus

Posttransfusion fever and hemolysis on labs would point to what infection?

Babesiosis

Posttransfusion illness with fever, absolute lymphocytosis, and thrombocytopenia (no evidence of anemia though)

CMV

Profound and prolonged neutropenia, especially in association with hematopoietic stem cell transplantation or chemo, is a risk factor for what?

invasive aspergillosis

What diagnostic tests are indicated with suspicion of invasive pulmonary aspergillosis?

bronchoalveolar lavage and serum galactomannan assay

Empiric antibiotic therapy for Health Care-Associated Ventriculitis or Meningitis (HCAVM)

Vancomycin, and either, Cefepime or Meropenem (can also use Ceftazidime); must take out shunt though

What are the preferred agents for patients with Pelvic inflammatory disease who need to be hospitalized? (2 different regimens)

1) Clindamycin and gentamicin | 2) Cefotetan/Cefoxitin and doxycycline

Post exposure prophylaxis is not useful after how long?

72 hours

What causes up to 30% of seizure events in endemic regions (Central/South America, India, sub-Saharan Africa)?

neurocysticercosis

Findings of neurocysticercosis on head imaging?

parenchymal cyst

Treatment of neurocysticercosis?

1) Manage seizures and increased ICP (glucocorticoids) | 2) anti-parasitics

Severe C diff infection?

WBC: >15,000 | Serum Cr: >1.5

Treatment of severe c diff infection?

regardless if severe or non-severe, oral fidaxomicin or oral vancomycin

C diff treatment when fulminant? (ICU, shock, megacolon)

oral vancomycin and IV metronidazole plus surgery consultation

Treatment of C diff infection with ileus present on radiography?

oral and rectal vancomycin plus IV metronidazole

When is pulsed and tapered vancomycin used in C diff infections?

if initial C diff episode was treated with oral vancomycin or oral fidaxomicin

What is considered a complicated UTI?

UTI while pregnant

What abx are indicated in UTI during pregnancy?

Cephalosporins; single dose of fosfomycin; avoid nitrofurantoin, TMP-SMX and fluoroquinolones

Pre-exposure prophylaxis for HIV? Post-exposure prophylaxis for HIV?

PrEP: tenofovir-emtricitabine Post-exposure: tenofovir-emtricitabine AND raltegravir (or dolutegravir)

The 4 D's of botulism: ?

diplopia (double vision), dysphonia (hoarse voice), dysarthria (slurring speech), dysphagia (unable to swallow); deficits start high and fall down

Other signs of botulism?

UE weakness that goes downward GI: constipation (no bowel sounds)

HIV/AIDS patients with CD4 counts less than 50 should be prophylactically treated with what abx? (for what disease)?

TMP-SMX (pneumocistis j)

What cutoff do you use to prophylactically treat someone for pneumocystis jiro?

CD4 less than 200

Traveler's diarrhea: when is prophylaxis indicated? What do drug do you use?

Immune compromised, inflammatory bowel disease, CKD; daily rifaximin

Summer/Fall months with myalgia, sore throat, cough, and maculopapular rash along with meningitis?

Enterovirus meningitis

How to differentiate enterovirus meningitis and HSV-2 meningitis?

There will be genital lesions preceding meningitis by ~7 days

Untreated syphilis that shows up positive from testing should be treated with what?

benzathine penicillin once weekly for three doses