learning objectives we didn't learn Flashcards
opportunisitic pathogen part of the normal GI and GU flora?
candida albicans
manifestations of candidiasis?
1) oral thrush: nystatin
2) esophagitis: think HIV
3) vaginal candidiasis: curd-like discharge
4) intertrigo: beefy red with satellite lesions
5) fungemia: BAD; usually with indwelling catheters
6) endocarditis: in patients with HIV; treat with amphotericin B
how to diagnose candidiasis?
KOH! budding yeast and branching hyphae
SO, what are the manifestations of candidiasis mostly seen in patients with HIV?
esophagitis and endocarditis!
when you hear pigeon/bird droppings, think…
cryptococcosis (YEAST)
what is the most common cause of fungal meningitis?
cryptococcosis
when may cryptococcosis show up in a patient with HIV/AIDS?
CD4
diagnosis and treatmente of cryptococcosis?
india ink stain of CSF
tx: amphotericin B
how do we treat cryptococcosis prophylactically in AIDS?
fluconazole
when you hear soil contaminated by bird/bat droppings, think…
histoplasmosis!
when does histoplasmosis typically present in AIDS patient?
CD4
how does histoplasmosis present in immunocompetent vs. immunosuppressed?
immunocompetent: asymptomatic or flu-like symptoms
immunocompromised: disseminated! OROPHARYNGEAL ULCERS, adrenal insufficiency, bloody diarrhea
histoplasmosis can also cause an atypical case of….
pneumonia!
how do we treat histoplasmosis in immunocompromised?
same as candidiasis and cryptococcosis because they are all yeasts!
amphotericin B if severe
what is THE most common opportunistic infection in patients with HIV?
pneumocystis pneumonia! caused by pneumocystis jiroveci (fungus)
what is interesting about the treatment of pneumocystic pneumonia?
it is caused by a fungus but does NOT respond to anti-fungals!
how do we treat and prophylax against pneumocystic pneumonia?
treat with bactrim!
prophylax with bactrim if CD4
what is key to diagnosing pneumocystic pneumonia/.
get chest xray!
bilateral diffuse interstitial infiltrates
how does one acquire acute rheumatic fever?
2-3 weeks post untreated strep pharyngitis (caused by group A strep AKA strep pyogenes)
complication of acute rheumatic fever?
rheumatic valve disease!
most common is mitral valve then aortic
what is the jones criteria associated with?
acute rheumatic fever
drug of choice for treating strep?
penicillin
patient presents with diplopia, dry mouth, dysphagia, dysarthria, dysphonia, decreased muscle strength, dilated fixed pupils…….
botulism!
clostridium botulinum (gram positive spore forming rods)
pathogenesis of botulism?
neurotoxin inhibits acetylcholine release at neuromuscular junction causing weakness and flaccid paralysis
potential for respiratory arrest
common causes of botulism in:
1) adult
2) baby
3) active person
1) ingestion of canned/smoked/vaccuum packed foods
2) ingestion of honey
3) traumatic injury
treatment of botulism?
antitoxin and respiratory support if respiratory failure!
antibiotics ONLY in wound botulism
when you hear “rice water” diarrhea, think…
cholera
it is grey, turbid, without odor, blood, or pus
pathophysiology of cholera?
vibrio cholera; ingestion of fecally contaminated food or water.
toxin is produced that causes hypersecretion of water and chloride ion and massive diarrhea
complications of cholera?
dehydration, hypotension, electrolyte imbalance, death
diagnosis & treatment of cholera?
stool culture
oral or IV rehydration!
antibiotics reserved for severe cases: tetracycline, bactrim, fluoroquinolones
will alcohol disinfect water?
no!
patient presents with friable grey/white membrane on pharynx that bleeds when scraped…diagnosis?
diptheria
these are pseudomembranes
how does one acquire diptheria?
inhalation of respiratory secretions; the exotoxin induces inflammatory response
treatment of diptheria?
diptheria antitoxin (horse serum) and erythromycin x 2 weeks
should you treat close contacts of an individual with diptheria?
yes! and keep them in isolation until they have 3 negative cultures
other manifestations of diptheria
bull neck, fevers, nasopharyngeal symptoms, myocarditis & neuropathy
how to prevent diptheria?
vaccine given at: 2 months 4 months 6 months 15 months
booster at age 4-6
what are the three manifestations of salmonellosis?
1) enteric (typhoid) fever
2) gastroenteritis: most common
3) bacteremia
enteric (typhoid) fever is characterized by what presentation?
“pea soup” diarrhea
malaise, HA, fever, splenomegaly, bradycardia, abdominal distention
how to diagnose typhoid fever due to salmonella?
stool is unreliable! blood culture during 1st week only
treatment of typhoid fever?
ampicillin, chloramphenicol, and bactrim x 2 weeks
what will the diarrhea of salmonellosis gastroenteritis look like?
bloody!
fever, nausea, vomiting, cramping as well
how do we treat gastroenteritis due to salmonella?
self-limiting
ABX only for severe cases
what is bacteremia secondary to salmonella?
prolonged, recurrent fevers and local infection of bone, joints, pleura, pericardium, or lungs
COMMON IN IMMUNOSUPPRESSED
how do we treat bacteremia due to salmonella?
same as enteric (typhoid!) ampicillin, chloramphenicol, and bactrim x 2 weeks
what will the diarrhea be like with shigellosis?
mixed blood AND mucous
diarrhea, cramps, TENESMUS, fever, chills, anorexia
shigellosis is linked with what type of systemic manifestation?
reactive arthritis!
what is the difference in onset between salmonellosis vs. shigellosis?
salmonellosis is insiduous, shigellosis is ABRUPT
how to diagnose shigellosis?
stool culture for leukocytes, RBC, and culture
sigmoidoscopy: punctate lesions and ULCERS
treatment of shigellosis?
replace fluid volume!
bactrim
where is clostridium tetani found? how does it infect us?
it is ubiquitous in the soil; germinates through puncture and crush wounds
what is the pathogenesis of clostridium tetani?
blocks release of acetylcholinesterase, leading to Ach-mediated sustained contractions at neuromuscular junction
early symptoms & late symptoms of tetanus?
early: local muscle spasms, neck/jaw stiffness, dysphagia, hyperirritability
late: trismus (lockjaw), drooling, muscle rigidity in DESCENDING fashion
treatment of tetanus?
metronidazole or penicillin + tetanus immune globulin
prophylaxis of tetanus?
Tdap vaccine given every 10 years
or if major cut occurs >5 years since last booster)
