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ID Boards > Misc 2 > Flashcards

Misc 2 Flashcards

1
Q

Yellow Fever Vaccine Complications

A
  • vaccine-associated encephalitis
    • inversely a/w with age
  • yellow fever vaccine-assoc neuro disease
    • 4-23 days post vaccine
    • HA, F ⇒ confusion, focal deficits, GBS, coma
    • complete recovery expected
  • yellow fever vaccine-assoc viscerotropic disease
    • 2-7 days post vaccine
    • fever, MOF
    • death >60% of cases
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2
Q

Malaria ppx

A

For ALL malaria spp in ALL malaria areas: atovaquone/proguanil

alt (all spp): mefloquine, doxy

Chloroquine in sensitive malaria areas

**chloroquine and proguanil are safe in pregnancy

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3
Q

Returning traveler with:

linear, pruritic serpiginous skin lesions that slowly advance

A

cutaneous larva migrans (Ancylostoma spp)

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4
Q

Returning traveler with:

urticarial linear lesions moving faster

A

cutaneous migration of Strongyloides filariform larvae (larva currens)

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5
Q

Returning traveler with:

fever w/ maculopapular rash

A

consider:

  • arbovirus (dengue, chik)
  • measles, rubella
  • parvo
  • EBV, CMV
  • HIV, syphilis
  • VHF
  • rickettsial infection
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6
Q

Returning traveler with:

nodular migratory panniculitis (SE Asia, Africa, occ Latin America)

A

think gnathostomiasis

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7
Q

Returning traveler with:

painful boil-like lesions (Africa, S Am)

A

myiasis

Africa - cordylobia

Latin - Dermatobia hominis

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8
Q

Returning traveler with:

generalized pruritic papular dermatitis

Sub-Saharan Africa

A

onchocerciasis

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9
Q

Returning traveler with:

destructive ulcer w/ undermining edges

A

buruli ulcer (Mycobacterium ulcerans)

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10
Q

Returning traveler with:

necrotic ulcer surrounded by edema

A

anthrax

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11
Q

Returning traveler with:

itchy, painful, red/purple nodule (2-5cm) which ulcerates

w/ surrounding edema and assoc LAD

(often after a fly bite)

A

trypanosoma brucei rhodesiense

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12
Q

Returning traveler with:

chronic, painless ulcer (unless superinfected)

heaped-up margins on exposued skin surfaces

L America, Mediterranean, Middle East, Asia, Africa

A

cutaneous leishmaniasis

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13
Q

Returning traveler with:

eschar/dark, scabbed lesion at site of insect bite

A

Rickettsial infection (e.g. African tick-bite fever, scrub typhus)

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14
Q

papule develops at site of inoculation w/ fever onset

becomes vesicular/pustular, then ulcerates

tender, a/w painful LAD

A

ulceroglandular tularemia

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15
Q

Returning traveler + eos

+ fever/respiratory symptoms

A
  • acute schisto
  • cocci/paracocci
  • loeffler’s syndrome (ascaris, hookworms, strongy)
  • paragonimiasis
  • tropical pul eosinophilia (Wuchereria bancrofti, Brugia malayi)
  • visceral larva migrans
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16
Q

Returning traveler + eos

GI sx

A
  • ascariasis
  • hookworms (ancylostoma duodenale, necator americanus)
  • schisto
  • strongy
  • tapeworms (T solium, T saginata)
  • trichinellosis
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17
Q

Returning traveler + eos

RUQ pain

A
  • fascioliasis
  • liver flukes (Clonorchis sinensis, Opisthorchis)
  • liver hydatid disease
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18
Q

Returning traveler + eos

neuro sx

A
  • cocci (chronic meningitis in IS pts)
  • eosinophilic meningitis (angiostrongy, gnathostoma)
  • neurocysticercosis
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19
Q

Returning traveler + eos

  • intermittent pruritic edematous SQ swellings
  • calabar swellings
  • lymphadenitis and edema
  • diffuse pruritic dermatitis
  • larva currens
A
  • gnathostomiasis
  • loiasis
  • lymphatic filariasis
  • onchocerciasis
  • strongy
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20
Q

Abx frequently a/w CDI

A
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21
Q

S pneumoniae PCN breakpoints

A

Meningeal (unchanged) _<_6

Non-meningeal in image

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22
Q

New tetracyclines (review table)

A
23
Q

Alt abx options for MRSA PNA (if unable to use vanc)

A
  • linezolid/tedizolid
  • clinda
  • ceftarloine
  • omadacycline
  • delafloxacin (meh)
24
Q

Big important SE of linezolid

A
  • Serotonin syndrome (beware of use with MAOIs)
  • Also lactic acidosis
  • peripheral/optic neuritis
25
Q

Cephalosporin toxicities

A
  • hypersensitivity reactions
  • GI upset - (CRO = GB sludge, pseudocholecystitis)
  • Heme: eos, hemolytic anemia (+Coombs)
  • Hepatotoxicity
  • Nephro: interstitial nephritis
  • Neurotoxicity (worse w/ renal failure)
26
Q

lobsterman (or any sort of fish worker)

GPR, catalase-negative

erythema, warmth, pain in hand

A

erysipelothrix rhusiopathiae

27
Q

vanc MIC that demonstrates resistance with Enterococcus (usually faecium)

A

> 32

vanA or vanB mediated

28
Q

what to think about with macrolide resistance

A

if arises from alteration in ribosomal target:

co-resistance to clinda - constitutive or inducible

D-test looks for inducible clinda resistance

29
Q

Tests for carbapenemase production

A

carba NP test –> B-lactam ring hydrolyzed by carbapenemase –> dec pH (color change from red to yellow)

30
Q

Typical susc pattern of ESBL-producer

A

R to cephalosporins

Susc to carbapenems

31
Q

Typical susc pattern of KPC-producer

A
32
Q

which organisms may not have the best sensitivity on meningitis/encephalitis panel

A
  • HSV
  • crypto (CRAg > PCR from panel)
33
Q

which organisms are typically not on GI path panel

A
  • aeromonas (O&P may be helpful)
  • microsporidia
34
Q
A

Strongy

feces placed on plate and detection of migrating larvae with trail of bacterial colonies

35
Q

Causes of sporotrichoid lesions

  1. gardening, soil, splinters, animal bites/scratches
  2. gardening, soil, splinters in IC hosts
  3. aquarium, fish handling, water exposure
  4. living/traveling in endemic regions
A
  1. sporothrix
  2. nocardia brasiliensis
  3. M marinum
  4. Leishmaniasis
36
Q

lesions in both lung and brain

A
  • actinomyces
  • aspergillus
  • endemic mycoses
  • MTB
  • nocardia
  • infectious emboli
  • Lemierre syndrome (Fusobacterium)
  • toxo (and T cruzi)
  • tumors
37
Q

sulfur granules, filamentous anaerobe

dental procedures, aspiration, IUD

erosive mass, ignores tissue planes

A

actinomyces

38
Q

SE Asia

soil/water exposure (rainy season, post-tsunami)

PNA + severe sepsis/shock or multiple abscesses

can be yrs after exposure

safety pin on Gram stain

A

melioidosis

trans via inhalation/incolutation

39
Q

Dx and Tx melioidosis

A

Dx: cx

Tx:

  • mild - IV mero or ceftaz x2wks, followed by eradication via PO TMP/SMX x3-6mos
40
Q

PNA/sepsis-shock in SE Asia or N Australia (can look like TB presentation)

can see skin ulcers/abscess

RF: DM, EtOH, chronic renal/lung disease

A

Melioidosis

41
Q

What organism?

What else can look like this?

A

Y pestis

Safety pin appearance

  • vibrio
  • B mallei, pseudomallei
  • Hameophilus ducreyi (chancroid)
  • Kleb granulomatous (granuloma inguinale)
42
Q

Facultative intracellular GNR

oxidase positive

safety pin on bipolar staining

S and SE Asia, N Australia, China (esp NE Thailand and N Australia)

A

Melioidosis (Burkholderia pseudomallei)

43
Q

short GP rod (coccobacillus)

cavitary PNA (hemoptysis)

salmon pink colonies

advanced HIV, SOT

horse/manure exposure

A

rhodococcus

44
Q

Dx and tx of rhodococcus

A

Dx: Blood culture (+ in >25%). Tissue - gram stain shows necrotizing granulomatous reaction, microabscesses

Tx: 2-3 rx: vanc + imi/mero + fluoroquinolone or rifampin x2-3wks, then –> PO FQ + azithro/clari or rifampin

45
Q

indolent PNA in IC host

fever, cough, hemoptysis

nodules, thick-walled cavities

farm, soil, manure, or horse exposure

aerobic GP, coccobacillary, salmon-pink colonies

weakly acid-fast

A

Rhodococcus

(mistaken for Nocardia, but no branching)

46
Q

(The B’s)

Beaded

Branching

Brain + lung

Bactrim

A

nocardia

47
Q

tx of nocardia

A

TMP/SMX = mainstay (skin = monotx)

Empiric: amikacin + imi/mero + TMP/SMX

alt: CRP, linezolid

based of susc testing

48
Q
A

NOCARDIA

  • small lung nodules, small R pleural effusion
  • subcarinal LAD
  • solitary RLL mass - single focus of cavitation w/ surrounding GGO
49
Q

dx of nocardia

A
  • suggestive rads - nodules, cavities, GGO, consolidations/effusions. MRI brain - single/multiple abscesses
  • Blood, BAL culture or bx
  • MALDI ID
50
Q
A

nocardia

51
Q

clinical features of nocardia

A
  • seen in IC pts (esp SOT)
  • mos-yrs post-tx
  • slowly progressive PNA - cough, dyspnea, F
  • can disseminate to any organ
  • co-infections w/ aspergillus do occur
  • 10% w/ skin manifestations from direct inoculation (tropical region, gardens/walks barefoot) - sporotrichoid lesions
  • mycetomas - chronic, progressive, LEs. Draining sinuses
52
Q
A

nocardia

  • beaded, branching, GP
  • partially acid-fast
53
Q

Immunocompromised patient

LLL nodular consolidation w/ central cavitation

GP filamentous organism (beaded, branching), partially acid-fast

A

Nocardia

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