Lecture 4: Infectious disease pt 4 Flashcards
1) The most common parasitic infection in the world is what?
2) What else is it the most common of?
3) Describe the pathophysiology
4) Describe its life cycle
5) Is it reportable?
1) Giardia Lamblia
2) Most common waterborne illness in the US; 15,000-20,000 per year in the US
3) Pear-shaped Flagellated protozoan; transmitted Fecal-oral.
4) Life cycle: Cyst ingested; Trophozoites in colon
5) Yes
Giardia Lamblia:
1) Risk factors
2) Signs/ Sx
3) Labs you need to order?
4) Tx?
1) Poor sanitation or poor hygiene, daycare outbreaks, oral-anal sex, water supply from shallow well, wilderness travel with ingestion of contaminated water
“Beaver Fever”
2) Diarrhea 1-3 weeks, fatty greasy stools, foul smelling
3) Stool Giardia Antigen PCR
4) Tinidazole 2 gm orally x 1
Malaria:
1) Etiology? (incl. species)
2) Epidemiology?
1) Plasmodium parasite inside the Anopheles mosquito.
-Species: P. falciparum (most virulent), P. malaria, P. ovale, P. knowlesi, P. vivax
2) Epidemiology: Africa, Asia, Latin America. endemic in most tropics, ~229 million cases & ~409K deaths worldwide in 2019, >94% in Africa
Malaria:
1) Describe its signs/ Sx.
2) Describe 2 stages
3) What labs would be abnormal? (3)
1) Fever, sweats, headache, periodic chills every 3 days (paroxysms). Hepatosplenomegaly
2) Liver stage: asymptomatic, then
-Erythrocyte stage: symptomatic
2) Atypical lymphocytes, decreased platelet count, elevated lactate dehydrogenase level
Malaria:
1) How is it diagnosed?
2) Tx?
3) Prevention?
4) Is it reportable?
1) Gimesa stain peripheral smear; thick and thin blood smears
2) Chloroquine/Hydroxychloroquine
3) Antimalarial drugs before, during and after travel Personal mosquito protection (barrier nets)
4) Yes
Amebiasis: Entamoeba Histolytica-
1) Epidemiology?
2) Risk factors?
3) What are its two forms? Describe each
1) 10% world wide
Asymptomatic cyst carrier 90% of cases
Fatalities per year 100,000
2) Mental health institutions, crowded living conditions, poor sanitation, travel to endemic areas: Asia, Africa and Latin America
3) Cyst: Can survive weeks in moist environment
Trophoziote: Moves toward colon (results in enterocolitis)
Amebiasis: Entamoeba Histolytica-
1) S/Sx?
2) Labs?
3) Tx?
1) Bloody profuse Diarrhea, fever, dehydration, weight loss, LIVER ABSCESS
-Can also go to the lung or brain
2) Stool PCR: Sensitivity 87%, Specificty >90%
-Liver function tests
-Alkaline phosphatase increased in 75% of cases
3) Asymptomatic: Paromomycin x 7 days
-Mild diarrhea: Metronidazole oral 7-10 days
-Severe Disease: Metronidazole IV x 10 days
Helminths: Define it and its classifications
1) Infections caused by worm-like parasites; defined by shape & host organ inhabited
2) Classified by external & internal morphology of egg, larval, & adult stages
Helminths:
1) Flukes (trematodes)
2) Tapeworms (cestodes)
3) Roundworms (nematodes)
1) Leaf-shaped flatworms (ie, schistomomiasis, fascioliasis)
2) Adult flatworms that inhabit intestinal lumen (larvae inhabit extraintestinal tissues (ie, beef, pork, fish, dwarf, cysticercosis).
3) Roundworms inhabiting intestinal & extraintestinal sites (ie, ascariasis)
Describe the pathologic stages of flukes, tapeworms, and roundworms
1) Flukes: Egg+, larva+, adult+
2) Tapeworms: Egg-, larva+, adult+
3) Roundworms: Egg-, larva+, adult+
Schistosomiasis:
1) Also called what?
2) Epidemiology?
3) Sx?
4) Complications?
1) “Snail Fever”
2) 252 million cases per year
3) Abdominal pain, diarrhea, bloody stool, blood in the urine
4) Liver damage, kidney failure, infertility, bladder cancer
Schistosomiasis:
1) How is it Dx’d?
2) Tx?
3) Prevention?
1) Finding eggs in the urine or stool, antibodies in the blood
2) Praziquantel (4-6 weeks after exposure)
3) Access to clean water
Where do you contract tapeworms?
From pig/ cow muscle (undercooked)
Cysticercosis:
1) Etiology?
2) Epidemiology?
1) Taenia Solium
2) Immigrants from Central America and South America. US natives 15% of deaths.
-Most common cause of acquired epilepsy.
-Endemic to Asia, India, Sub-Saharan Africa, Central and South America.
Cysticercosis: Describe the signs/ Sx
-Can be asymptomatic for years.
-Neurocysticercosis (90% of cases).
-Seizures.
-Headache, parkinsonism, encephalopathy, hydrocephalus, papilledema, chronic meningitis, cranial nerve palsy, eye lesions
Cysticercosis:
1) Describe how it’s Dx’d
2) How’s it treated?
1) -MRI brain. Single <2 cm lesion, no midline shift. Larval sucking parts may be visible (pathognomonic).
-Cysticercal Antibody: Sensitivity>65%, Specificity >67%. Biopsy of infected tissue.
2) Consult! Might need surgical excision. Albendazole with Dexamethasone. Seizure prophylaxis
Describe roundworm infections
-Found in soil
-Human stool as fertilizer
-Famous for migrating to lungs
Ascariasis (type of round worm):
1) Etiology
2) Epidemiology?
1) Ascariasis Lumbricoides
2) Epidemiology: Asia (75%), Africa (10%), Latin America (10%)
Ascariasis (type of round worm): Signs/ Sx?
-Eggs hatch in the intestines and migrate to the lungs.
-Often asymptomatic at first. Lower abdominal pain for days. Might see worms in stool.
-SOB, fever, diarrhea, malnutrition. Intestinal blockage.
-Allergies. Eosinophilia.
Ascariasis:
1) How’s it diagnosed?
2) Tx?
3) Prevention?
1) Identifying the appearance of the worm in eggs or feces. Fecal smears.
2) Albendazole
3) Improved sanitation.
Pinworms (enterobiasis):
1) Definition
2) Etiology
3) Epidemiology
4) Clinical features
1) Definition: most common helminthic infection in U.S. & Western Europe
2) Person-person via ingestion of Enterobius vermicularis (roundworm) eggs (hands, perianal region, food, fomites, bedding, clothing) or autoinfection
3) School-aged children, ~40 million in U.S.
4) Most asymptomatic
m/c symptom: nocturnal perianal pruritis
Insomnia, restlessness, enuresis
What are 3 ways to Dx pinworms (enterobiasis)?
1) Worms or eggs on perianal skin
Eggs usually not found in stool
2) Clear cellophane tape to perianal skin (ideal in early am), then micro exam for eggs
3) Nocturnal exam of perianal or gross exam of stools (adult worms)
How are pinworms (enterobiasis) treated?
1) Single PO mebendazole (alt. albendazole, pyrantel pamoate)
-Repeat Tx in 2 wks due to frequent re-infection
2) Concurrent Tx of infected (& uninfected) close contacts
3) Wash clothes & bedding (kills eggs)
Toxoplasmosis:
1) Etiology?
2) Epidemiology?
1) Intracellular protozoan parasite, Toxoplasma gondii
Infects HIV patients with CDV<50. Pregnant women exposed to cat feces.
2) Worldwide, in U.S. infects ~1.1 million annually (chorioretinitis ~21K & vision loss ~4,800)
1) What are general signs/ Sx of toxoplasmosis?
2) CNS Sx?
1) Acute infection > Asymptomatic but may have lymphadenopathy.
2) Headache, neurological defects, nausea, seizures, AMS, fevers, chills.
Toxoplasmosis:
1) Describe congenital Sx
2) Describe ocular Sx
1) Psychomotor retardation, hydrocephalus, cerebral calcifications, retinochoroiditis, and/or microcephaly.
2) Ocular pain, blurred vision, blindness due to focal necrotizing retinitis.
Toxoplasmosis:
1) How’s it diagnosed?
2) Tx?
1) CT or MRI (best) brain Multiple ring enhancing lesions. Serology for T. gondii antibodies (IgG). Fundoscopy white-yellow cotton-like lesions in a nonvascular distribution
2) Pyrimethamine, sulfadiazine, and Leucovorin (need all three) 2-4 weeks
Trichomoniasis
1) Definition
2) Etiology: Trichomonas vaginalis
3) Epidemiology: worldwide, F>M
4) List 2 clinical Fx
1) GU infection, most common non-viral STI worldwide
2) Trichomonas vaginalis
3) Vaginitis and Non-Gonococcal Urethritis (NGU):
1) Describe Sx of vaginitis
2) Describe the Sx of Non-Gonococcal Urethritis (NGU)
1) Copious, frothy, yellow/green, discharge, vulvovaginal discomfort, pruritis, dysuria, dyspareunia, vaginal wall inflammation, cervix with punctate hemorrhages
2) Usually asymptomatic, discharge more scant (compared to urethritis from GC or chlamydia)
Trichomoniasis
1) How’s it diagnosed?
2) How’s it treated? What’s an alternate?
1) Vaginal or urethral secretions, wet mount shows motile organisms
1) TOC: Tinidazole (or metronidazole) as 2G single oral dose
-Alternate: metronidazole 500 mg PO BID x 7 days
Name a non-reportable STI
Trichomoniasis
Polio:
1) Who is it most common in?
2) How many cases in the 50s? What abt the 60s?
1) Most often in children <15 years
2) 1950s: 15,000 cases per year
1960s: <100 cases per year
Polio epidemiology:
1) How many cases a year in the 1970s?
2) What happened in 1973?
3) What abt 1993?
1) <10 cases per year
2) No wild-type cases onset in US at this time
3) Last internationally imported case of polio in the US
Polio:
1) Risk factors
2) Pathophysiology (hint: 2 routes)
1) Risk factors: Developing world, poor hygienic lignin conditions, under-immunized populations
2) Enterovirus (Picornaviridae)
-Fecal-oral route or respiratory route
Polio:
1) What is the incubation period of non-paralytic polio?
2) What abt paralytic polio?
3) _____% progress to paralytic poliomyelitis
1) 3-6 days
2) 7-21 days from exposure to paralysis
3) 1%
Polio:
1) Describe the S/Sx
2) When does paralysis occur? Describe its spread
1) Fever, pharyngitis, fatigue, headache, nausea, epigastric pain.
2) 5-10 days after prodrome. Meningeal irritation, asymmetric flaccid paralysis.q
-Descending paralysis: Starts proximally in affected limb and progresses distally
1) How is polio diagnosed?
2) How is it managed?
1) Poliovirus PCR: 2 of each source at least 24 hours apart
-Stool Specimens, Throat swabs
2) Supportive care and isolation
-Report to CDC within 4 hours.
How fast do you need to report polio?
Within 4 hours
HPV (Human Papilloma Virus):
1) Etiology (which are more virulent and which are warts?)
2) Epidemiology
3) S/Sx
1) HPV strains most virulent 16, 18,31, 33, 35, 45. Genital warts: 6,11
2) 60% of population
3) May be asymptomatic. Flat pedunculated or popular flesh-colored growths (condyloma acuminatum). Cauliflower-like lesions that can occur anywhere in the genital/anal/perineal area. Post-coital bleeding
HPV:
1) How is it diagnosed?
2) How is it treated?
3) How is it prevented?
1) Clinical diagnosis > whitening with 4% acetic acid application.
-Pap smears test for HPV
2) Trichloroacetic acid, podophyllin or imiquimod
3) Gardasil vaccine (6,11, 16, 18 ) or Gardasil 9 (covers many more)
Most common HPV strain for cancer is ___________ and __________
16 and 18
HPV
1) Mechanisms of ___________ transmission not well understood
2) What has been suggested? Why?
3) What does this suggest?
1) vertical
2) Prenatal transmission has been suggested
Lesions on neonate at time of birth
Found in amniotic fluid prior to ROM
3) Mechanisms of ascending infection rather than transplacental (HPV infection does not result in viremia)
Cytomegalovirus (CMV):
1) Etiology
2) Epidemiology
1) Double stranded DNA HHV-5, lytic virus
2) Often co-infection with HIV. 1 in 200 babies born with CMV. Over 50% of adults will have it by the time they are 40 (asymptomatic or mild)
Cytomegalovirus (CMV) signs and Sx:
1) General Sx
2) Pulmonary
3) GI
4) CNS
5) Hematology
6) Eye
1) Enlarged cells with viral inclusion bodies, commonly asymptomatic, fatigue
2) Pneumonia like symptoms
3) Abdominal pain, splenomegaly, colitis, transaminitis
4) Encephalitis
5) Cytopenia causes anemia/leukopenia
6) Retinitis
Cytomegalovirus (CMV):
1) How do you Dx?
2) Tx?
1) PCR, culture, antigens in serology, elevated IgM (4-fold)
2) PO/IV ganciclovir
Epstein-Barr Virus (EBV):
1) Etiology
2) Epidemiology; __________% of adults are seropositive
1) Double stranded, enveloped, linear, HHV-4
-Causes Mononucelosis; “kissing disease”: Shared by saliva
2) 90%
Epstein-Barr Virus (EBV) (mono):
1) Signs and Sx?
2) How is it diagnosed? (2 ways)
3) Tx?
1) Posterior LAD, fever, malaise, splenomegaly, rash (esp: after ampicillin therapy)
2) Peripheral smear > atypical lymphocytes (Downey cells)
-Monospot test > Heterophilic IgM antibodies
3) Supportive care and avoid contact sports.
What is the EBV/ mono triad?
1) Fever
2) Lymphadenopathy
3) Pharyngitis
Compare/ contrast CMV/ EBV
1) CMV: Encephalitis, meningitis, retinitis, pneumonia, transverse myelitis, prolonged cytopenia, exacerbation of the disease in ITP pts, death + colitis
2) EBV: Bilateral periorbital edema, pharyngitis, pneumonia, gastric carcinoma, febrile neutropenia, exacerbated AIHA, ^ risk of Reiter syndrome in CLL pts, development in HLH
For CMV and EBV, describe their fever, cervical lymphadenopathy, generalized lymphadenopathy, exudative tonsillopharyngitis, & splenomegaly
1) CMV: more protracted fever, both lymphadenopathies less common (cervical <20%), exudative tonsillopharyngitis is rare, splenomegaly is less common.
2) EBV: fever common, both lymphadenopathies more common (generalized >80%), exudative tonsillopharyngitis common, splenomegaly more common
Herpes Simplex:
1) Etiology (what are the 2 types)
2) Triggers?
3) Epidemiology?
1) Human herpesviruses type 1 (“oral”) and 2 (“genital”)
-Transmission from close contact with a person who is shedding the virus
2) Sun, febrile illness, stress, immunosuppression
3) 90% of the population is seropositive
Herpes Simplex:
1) S/Sx (include systemic)
2) How is it diagnosed?
3) Tx?
1) Primarily affects oral/genital areas.
-Finger: Herpetic whitlow
-Small grouped vesicles, accompanied by burning/stinging that crust when healing.
-Systemic: Headache, lymphadenopathy, fever, dysuria
2) Clinical diagnosis, can do serology and PCR. Viral culture is definitive
3) Acyclovir. Can use valacyclovir or Famciclovir but dosing varies.
List some Sx of neonatal herpes (vertical transmission). How is it treated?
1) Encephalitis
2) Blindness
3) Secondary infections
4) Hepatomegaly
5) Seizures
-If positive test, needs admission, lumbar punctures, etc
1) What is the most common cause of fatal encephalitis?
2) What is this cause also called?
1) Herpes simplex
2) Aseptic Meningitis
1) What should you do if you suspect herpes has spread to the nervous system? What will this tell you?
2) What other test do you do?
3) What is the Tx?
1) Lumbar puncture for CSF:
-WBC 10-100(75% lymphs)
-Protein: Normal
-Glucose: May be reduced
-Culture: Negative
2) Have to send out special tests for herpes (PCR)
3) IV acyclovir x14- 21 days
Herpes keratitis:
1) Define it
2) What can it cause?
3) When should you check for it?
1) Infection in the cornea
2) Scarring and blindness
3) With shingles (or with herpes with ocular Sx)
Varicella-Zoster Virus:
1) Is also called what? Etiology?
2) Epidemiology?
1) Human Herpes Virus 3; reactivation in the posterior dorsal root ganglion.
2) Usually older population, decreasing due to vaccinations
Varicella-Zoster Virus:
1) S/Sx?
2) How is it diagnosed?
3) How is it prevented?
1) Painful, lancing, dermatomal distribution followed by a rash within 2-3 days of pain.
2) Clinical evaluation. PCR can confirm. Used to use Tzanck smear to isolate multinucleated giant cells
3) Vaccine. (live)
What syndrome can result from the Varicella-Zoster virus? Give its S/Sx
1) Ramsay Hunt Syndrome
2) Ear pain, facial paralysis, vertigo, vesicles on external auditory canal, loss of taste.
-Ophthalmic: CN V1 distribution (around eye, forehead and tip of nose (Hutchinson sign) Postherpetic neuralgia.
How is Varicella-Zoster Virus treated? (3 ways)
1) Symptomatic. Antivirals: Acyclovir, famciclovir, valacyclovir.
2) Ophthalmic: Emergent referral to ophthalmologist.
3) Postherpetic neuralgia: Gabapentin, TCAs, topical capsaicin/lidocaine
Influenza:
1) Etiology
2) Epidemiology
1) Influenza type A, B or (less common) C. Hemagglutinin on the virus surface allows fusion to the host’s cell membrane
2) Antigenic drift > virus is able to mutate, creating new virulent strains > causes seasonal epidemics.
-Antigenic shift > new combinations of antigens that create a reassortment of the viral genome >causes pandemics
Influenza:
1) S/Sx
2) How is it Dx’d?
1) Sudden onset sore throat, rhinorrhea, non-productive cough, myalgias, GI s/s
2) Clinical, POC PCR tests via nasopharyngeal or pharyngeal sample
Influenza:
1) Tx?
2) Is it reportable?
1) Supportive. Neuraminidase inhibitors (Oseltamivir) within 2 days of symptom onset; vaccination annually.
2) Yes
Erythema Infectiosum:
1) Etiology
2) Epidemiology
1) Parvovirus B19 or HHV-5 “Slapped check rash” “Fifth disease”
2) 5-7 year old in the spring; incubation period 4-14 days.
Describe the S/Sx of Erythema Infectiosum
1) Erythematous, maculopapular rash on cheeks Lacy reticular pattern on extremities or trunk.
2) Fever, coryza, sore throat, headache, abdominal pain. 3) Can suppress erythropoiesis.
Erythema Infectiosum:
1) How is it diagnosed?
2) How is it treated?
1) Clinical. Maybe labs to rule out other diseases.
2) Tylenol for fevers, hydration
Mumps:
1) Etiology?
2) Epidemiology?
1) Paramyxovirus
2) 500,000 cases world- wide, US cases went up in 2017-18
Mumps:
1) Incubation period
2) S/Sx
3) What are less common Sx?
4) Is it reportable?
1) Incubation period: 12-24 days. (late winter)
2) Anorexia, malaise, low grade fever, otalgia.
-Days 2-7 = glandular swelling, high fever, unilateral or bilateral parotitis > orchitis and oophoritis may also develop (can cause infertility)
3) Cranial nerve palsies, pancreatitis, myocarditis
4) Yes
Mumps:
1) How is it diagnosed?
2) Treated?
3) Prevented?
1) Clinical diagnosis. Can use serology or culture PCR. Buccal swab, CSF, urine, seminal fluid as sources
2) Supportive care, Tylenol for fever, hydration
3) MMR Vaccination, live virus, Dose 1: 12-15 months and dose 2: 4-6 years.
Measles/Rubeola:
1) Etiology
2) Epidemiology
1) Paramyxovirus (RNA virus)
2) Very contagious. 13 outbreaks in 2019. Before vaccines, 3-4 million.
Measles/Rubeola:
1) S/Sx?
2) Dx?
1) Fever, coryza, cough, pink eye, Koplik spots, 1-2 weeks later rash on face then travels to trunk, palms and soles
2) Clinical. PCR if needed
Measles/Rubeola:
1) Tx?
2) Prevention?
3) Is it reportable?
1) Supportive Care, +/- vitamin A
2) MMR vaccine; Dose 1: 12-15 months and Dose 2: 4-6 years
3) Yes
Rubella/German Measles:
1) Etiology?
2) Epidemiology?
1) Etiology: Togavirus. Respiratory droplets. Can spread to fetus from mother
2) Children ages 6-9
1) Describe some general S/Sx of Rubella/German Measles
2) What spots are a Sx? Describe them
3) What can measles-related congenital defects (especially with exposure during 1st trimester) lead to? Describe this
1) Days 12-23 incubation period = low-grade fever, sore throat, LAD.
-Days 14-17 = Maculopapular rash that usually starts on the face.
2) Forchheimer spots: Tiny, erythematous petechiae on soft palate that precedes/accompanies the rash.
3) Congenital rubella syndrome: Fetal death, premature delivery, sensorineural hearing loss, congenital heart disease, cataracts
Rubella/German Measles:
1) How is it diagnosed?
2) How is it treated?
1) Clinical diagnosis.
-Labs/virology are done in pregnant woman, neonates or s/s of encephalitis.
-Rubella IgM Ab or detection of viral RNA via PCR of throat/urine/nose
2) Supportive care. Hydration
Rubella/ German measles:
1) How is it prevented?
2) Is it reportable?
1) MMR Vaccination: Live virus; dose 1: 12-15 months and dose 2: 4-6 years
2) Yes
Roseola:
1) Etiology
2) Epidemiology
1) Human herpes virus type 6. “sixth disease”
2) Very common in children 9-24 months. 90% younger than 2 years
Roseola:
1) Signs/ Sx
2) How is it diagnosed?
3) How is it treated?
1) Pink maculopapular rash that is blanchable and lasts two days. Starts on trunk and then spreads to the face. 3 days of high fever.
2) Clinical. Virology usually only if meningitis suspected
3) Tylenol for fever, hydration. If immunocompromised, Foscarnet and Ganciclovir
Rabies:
1) Etiology
2) Epidemiology
1) Rhabdoviridae
2) Canines (dogs, foxes, coyotes) cats, bats, skunks and racoons
Describe rabies signs and Sx
Fatal once symptoms begin; Incubation period:20-90 days
1) Nonspecific: fever, headache malaise.
2) Tingling/burning at bite site.
3) Prodromal period (2-10 days)N/V/D, sore/swollen thrat, fatigue/malaise, excessive salivation.
4) Acute neurologic period (2-7 days)Muscle fasciculations, convulsions.
5) Coma (usually within 10 days of neuro symptoms)
Rabies:
1) How is it diagnosed?
2) How is it treated?
1) Diagnosis: Imaging usually normal. Skin biopsy direct fluorescent Ab testing. PCR of fluid tissue. CSF80% monocytosis. Brain tissue postmortem autopsy reveals Negri bodies.
2) Contact with a bat in any capacity is an absolute indication for postexposure prophylaxis. Postexposure ASAP (100% effective if administered before onset of symptoms)
-4 doses of vaccine IM on days 0,3,7,14 extra dose on day 28 if immunocompromised
COVID-19:
1) Etiology
2) Epidemiology
3) Risk factors
1) (Originated in bats), enveloped, single-stranded RNA novel coronavirus
2) Originally acquired at seafood and live animal market in Wuhan, China in late 2019. Multiple variants. (Alpha, delta, iota, omicron). 500 million confirmed cases. 6 million deaths
3) BMI>35, CKD, DM, Immunocompromised, Pregnancy, age>65, cerebral palsy,
List the Sx of COVID-19 throughout the course of the illness (give the worst case scenario)
Incubation 4-7 days.
Day 0: First symptoms
Day 5: Dyspnea
Day 7: Hospital Admission
Day 8: Acute respiratory distress syndrome (ARDS)
Day 12-18: Death
Give some S/Sx of COVID-19
1) Asymptomatic in 18-33%
2) Fever, chills, myalgias, fatigue, anorexia
3) Pharyngitis, rhinorrhea, conjunctivitis, cough
4) SOB, hypoxia, chest pain, palpiatations
5) Decreased appetite, diarrhea, nausea and vomiting,
6) Headache, encephalopathy, dizziness,
7) Loss of smell (anosmia), altered taste (dysgenusia), rash
8) Pernio-like reactions “covid toes”,
How is COVID-19 diagnosed?
-PCR testing.
-No need to re-test after positive test (may remain positive for weeks).
-Do not need to retest if exposed within the first 3 months.
Describe the sensitivity and specificity of COVID-19 PCR tests
Test Sensitivity:
Day 0: 0%
Day 4: 33%
Day 5: 63%
Day 8-9: 80%
Day 21: 34%
Test specificity: >98%
List additional labs that might be abnormal for COVID-19 pts
1) CBC: Leukopenia. Thrombocytopenia.
2) AST/ALT: mildly increased
3) CRP: elevated
4) Procalcitonin: Increased may suggested additional bacterial infection
5) D-Dimer: >1.5mcg/ml
What does COVID-19 look like on imaging?
1) CXR may be normal in early disease
-When not normal: Typical bilateral & peripheral predominate ground glass opacities (also consolidation, lower lobes/posterior distribution)
2) Lung US
List potential complications of COVID-19
Pulmonary embolism
CHF
Myocarditis
ARDS
Acute coronary Syndrome
CVA
Renal Failure
Describe COVID-19 management
1) Symptomatic and quarantine for most people
2) Prone positioning
3) High Risk patients
-Monoclonal antibodies
-Dexamethasone 6mg up to 10 days
-Albuterol HFA inhaler as needed
-Remdesivir (inhibits RNA synthesis)
1) What are two ways to prevent COVID-19?
2) Is it a reportable disease?
1) Vaccination, quarantine
2) Yes
