learning objectives we didn't learn

Question 1

opportunisitic pathogen part of the normal GI and GU flora?

Answer 1

candida albicans

Question 2

manifestations of candidiasis?

Answer 2

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

Question 3

how to diagnose candidiasis?

Answer 3

KOH! budding yeast and branching hyphae

Question 4

SO, what are the manifestations of candidiasis mostly seen in patients with HIV?

Answer 4

esophagitis and endocarditis!

Question 5

when you hear pigeon/bird droppings, think…

Answer 5

cryptococcosis (YEAST)

Question 6

what is the most common cause of fungal meningitis?

Answer 6

cryptococcosis

Question 7

when may cryptococcosis show up in a patient with HIV/AIDS?

Answer 7

CD4

Question 8

diagnosis and treatmente of cryptococcosis?

Answer 8

india ink stain of CSF

tx: amphotericin B

Question 9

how do we treat cryptococcosis prophylactically in AIDS?

Answer 9

fluconazole

Question 10

when you hear soil contaminated by bird/bat droppings, think…

Answer 10

histoplasmosis!

Question 11

when does histoplasmosis typically present in AIDS patient?

Answer 11

CD4

Question 12

how does histoplasmosis present in immunocompetent vs. immunosuppressed?

Answer 12

immunocompetent: asymptomatic or flu-like symptoms
immunocompromised: disseminated! OROPHARYNGEAL ULCERS, adrenal insufficiency, bloody diarrhea

Question 13

histoplasmosis can also cause an atypical case of….

Answer 13

pneumonia!

Question 14

how do we treat histoplasmosis in immunocompromised?

Answer 14

same as candidiasis and cryptococcosis because they are all yeasts!

amphotericin B if severe

Question 15

what is THE most common opportunistic infection in patients with HIV?

Answer 15

pneumocystis pneumonia! caused by pneumocystis jiroveci (fungus)

Question 16

what is interesting about the treatment of pneumocystic pneumonia?

Answer 16

it is caused by a fungus but does NOT respond to anti-fungals!

Question 17

how do we treat and prophylax against pneumocystic pneumonia?

Answer 17

treat with bactrim!

prophylax with bactrim if CD4

Question 18

what is key to diagnosing pneumocystic pneumonia/.

Answer 18

get chest xray!

bilateral diffuse interstitial infiltrates

Question 19

how does one acquire acute rheumatic fever?

Answer 19

2-3 weeks post untreated strep pharyngitis (caused by group A strep AKA strep pyogenes)

Question 20

complication of acute rheumatic fever?

Answer 20

rheumatic valve disease!

most common is mitral valve then aortic

Question 21

what is the jones criteria associated with?

Answer 21

acute rheumatic fever

Question 22

drug of choice for treating strep?

Answer 22

penicillin

Question 23

patient presents with diplopia, dry mouth, dysphagia, dysarthria, dysphonia, decreased muscle strength, dilated fixed pupils…….

Answer 23

botulism!

clostridium botulinum (gram positive spore forming rods)

Question 24

pathogenesis of botulism?

Answer 24

neurotoxin inhibits acetylcholine release at neuromuscular junction causing weakness and flaccid paralysis

potential for respiratory arrest

Question 25

common causes of botulism in: 1) adult 2) baby 3) active person

Answer 25

1) ingestion of canned/smoked/vaccuum packed foods 2) ingestion of honey 3) traumatic injury

Question 26

treatment of botulism?

Answer 26

antitoxin and respiratory support if respiratory failure! antibiotics ONLY in wound botulism

Question 27

when you hear "rice water" diarrhea, think...

Answer 27

cholera it is grey, turbid, without odor, blood, or pus

Question 28

pathophysiology of cholera?

Answer 28

vibrio cholera; ingestion of fecally contaminated food or water. toxin is produced that causes hypersecretion of water and chloride ion and massive diarrhea

Question 29

complications of cholera?

Answer 29

dehydration, hypotension, electrolyte imbalance, death

Question 30

diagnosis & treatment of cholera?

Answer 30

stool culture oral or IV rehydration! antibiotics reserved for severe cases: tetracycline, bactrim, fluoroquinolones

Question 31

will alcohol disinfect water?

Answer 31

no!

Question 32

patient presents with friable grey/white membrane on pharynx that bleeds when scraped...diagnosis?

Answer 32

diptheria these are pseudomembranes

Question 33

how does one acquire diptheria?

Answer 33

inhalation of respiratory secretions; the exotoxin induces inflammatory response

Question 34

treatment of diptheria?

Answer 34

diptheria antitoxin (horse serum) and erythromycin x 2 weeks

Question 35

should you treat close contacts of an individual with diptheria?

Answer 35

yes! and keep them in isolation until they have 3 negative cultures

Question 36

other manifestations of diptheria

Answer 36

bull neck, fevers, nasopharyngeal symptoms, myocarditis & neuropathy

Question 37

how to prevent diptheria?

Answer 37

``` vaccine given at: 2 months 4 months 6 months 15 months ``` booster at age 4-6

Question 38

what are the three manifestations of salmonellosis?

Answer 38

1) enteric (typhoid) fever 2) gastroenteritis: most common 3) bacteremia

Question 39

enteric (typhoid) fever is characterized by what presentation?

Answer 39

"pea soup" diarrhea malaise, HA, fever, splenomegaly, bradycardia, abdominal distention

Question 40

how to diagnose typhoid fever due to salmonella?

Answer 40

stool is unreliable! blood culture during 1st week only

Question 41

treatment of typhoid fever?

Answer 41

ampicillin, chloramphenicol, and bactrim x 2 weeks

Question 42

what will the diarrhea of salmonellosis gastroenteritis look like?

Answer 42

bloody! fever, nausea, vomiting, cramping as well

Question 43

how do we treat gastroenteritis due to salmonella?

Answer 43

self-limiting ABX only for severe cases

Question 44

what is bacteremia secondary to salmonella?

Answer 44

prolonged, recurrent fevers and local infection of bone, joints, pleura, pericardium, or lungs COMMON IN IMMUNOSUPPRESSED

Question 45

how do we treat bacteremia due to salmonella?

Answer 45

same as enteric (typhoid!) ampicillin, chloramphenicol, and bactrim x 2 weeks

Question 46

what will the diarrhea be like with shigellosis?

Answer 46

mixed blood AND mucous diarrhea, cramps, TENESMUS, fever, chills, anorexia

Question 47

shigellosis is linked with what type of systemic manifestation?

Answer 47

reactive arthritis!

Question 48

what is the difference in onset between salmonellosis vs. shigellosis?

Answer 48

salmonellosis is insiduous, shigellosis is ABRUPT

Question 49

how to diagnose shigellosis?

Answer 49

stool culture for leukocytes, RBC, and culture sigmoidoscopy: punctate lesions and ULCERS

Question 50

treatment of shigellosis?

Answer 50

replace fluid volume! bactrim

Question 51

where is clostridium tetani found? how does it infect us?

Answer 51

it is ubiquitous in the soil; germinates through puncture and crush wounds

Question 52

what is the pathogenesis of clostridium tetani?

Answer 52

blocks release of acetylcholinesterase, leading to Ach-mediated sustained contractions at neuromuscular junction

Question 53

early symptoms & late symptoms of tetanus?

Answer 53

early: local muscle spasms, neck/jaw stiffness, dysphagia, hyperirritability late: trismus (lockjaw), drooling, muscle rigidity in DESCENDING fashion

Question 54

treatment of tetanus?

Answer 54

metronidazole or penicillin + tetanus immune globulin

Question 55

prophylaxis of tetanus?

Answer 55

Tdap vaccine given every 10 years or if major cut occurs >5 years since last booster)