Respiratory Illness, Systemic Infection, and Fungus Flashcards
Diphtheria Cytomegalovirus(CMV) Mononucleosis Epstein-Barr virus Seasonalinfluenza Candidiasis Cryptococcosis Histoplasmosis
1
Q
Diphtheria
A
Immediately
2
Q
Cytomegalovirus
A
Nope
3
Q
Mononucleosis
A
Nope
4
Q
Epstein-Barr Virus
A
Nope
5
Q
Seasonal influenza
A
pediatric mortality- one work day
Influenza novel- immediately
6
Q
Cryptococcosis
A
nope
7
Q
Histoplasmosis
A
nope
8
Q
What causes Diptheria
A
Corynebacterium diphtheria
9
Q
What does Diphtheria usually attack?
A
Respiratory tract
10
Q
What does the toxin produced by Diphtheria produce?
A
myocarditis and neuropathy
11
Q
Who predominantly gets Diphtheria?
A
<15 years and poorly immunized adults
12
Q
What are two risk factors for Diphtheria?
A
- crowded living conditions
- Inadequate immunization
13
Q
In which symptoms should Diphtheria be suspected?
A
- severe sore throat
- Difficulty swallowing
- Low grade fever
- GRAYISH adherent membrane on the nasopharynx
14
Q
What does the Diphtheria toxin induce?
A
formation of coalescing pseudomembrane
15
Q
As the pseudomembrane spreads it causes what?
A
Tonsillopharyngeal
16
Q
Where does the membrane in diphtheria extend?
A
any portion of the respiratory tract
17
Q
When does Diphtheria myocarditis begin?
A
as local respiratory symptoms are improving
18
Q
When does diphtheria result in neurologic toxicity?
A
w/ severe diphtheria
19
Q
What nerves are involved in diphtheria cranial neuropathies?
A
usually oculomotor and ciliary,
followed by facial or laryngeal paralysis
20
Q
Severity of disease =
A
severity of membrane formation
21
Q
How is diphtheria diagnosed?
A
Culture
22
Q
What special culture is used for diphtheria?
A
tellurite media
23
Q
What is ordered to isolate diphtheria toxin?
A
Elek test
24
Q
How do you prevent diphtheria?
A
w/ active immunization w/ diphtheria toxoid
25
What treatment is used for diphtheria?
- diphtheria antitoxin - 1st suspicion
| - antibiotics (erythromycin and procaine penicillin G)
26
What is cytomegalovirus a member of?
Herpesvirus family
27
What are the 3 recognizable clinical syndromes in CMV?
1. Perinatal disease and CMV inclusion disease
2. Diseases in immunocompromised persons
3. Diseases in immunocompetent persons
28
What is important in diagnosing CMV?
distinguishing between infection and disease
29
What diseases are seen in CMV?
- CMV retinitis
- CMV neurologic
- Gastrointestinal hepatobiliary
- Respiratory CMV
30
What is diagnosis for CMV in immunocompromised?
Initial diagnosis may be based on characteristic findings- Retinitis
31
How is CMV confirmed in immunocompromised?
CMV quantitative PCR (viral load/CMV replication) assay
| CMV pp65 antigenemia (antigen)
32
What are two specific symptoms of CMV in immunocompetent?
- Exudative pharyngitis
| - Cervical lymphadenopathies
33
How is CMV diagnosed in immunocompetent?
-Strep test, monospot, and CBC in febrile pts wth pharyngitis, adenopathy, and fatigue
34
What is seen in the first week of CMV in immunocompetent?
Leukopenia
35
What serologic studies are used in diagnosing CMV?
- Detection of CMV specific IgM
| - Fourfold rise in CMV IgG
36
How is CMV treated in immunocompetent?
Ganciclovir or Foscarnet (IV med for severe cases (colitis or esophagitis))
37
What causes infectious mononucleosis?
Epstein-Barr Virus
38
What strain of Epstein-Barr Virus is the most ubiquitous human virus?
HHV-4 (human herpes virus-4)
39
Which age is prone to Epstein Bar virus?
ages 10 and 19 yrs
40
What persists asymptomatically for life in nearly all adults?
Epstein-Bar Virus
41
What human herpes virus is associated with malignancies?
HHV-4 (Epstein-Bar Virus)
42
How is Epstein Bar virus transmitted?
by saliva
43
What 3 symptoms are initially seen in acute infectious mononucleosis?
Malaise
Headache
Low grade fever
44
What are prominent pharyngeal symptoms in acute mono?
Tonsillitis and/or pharyngitis
45
What can be out of proportion to pharyngeal symptoms?
lymph node enlargement
46
What is the most frequent symptom seen in mono?
mild hepatitis
47
What is the highest complication we worry about in mono?
Splenic rupture
48
If patient has sore throat, fever, headache, rash, cough and nausea lasting no more than 1 month, what do they likely have?
acute infectious mononucleosis
49
What develops after the admin of ampicillin?
morbilliform rash
50
What can develop due to intense EBV replication?
Oral hairy leukoplakia
51
What is the biggest malignancy that we worry about with mono?
Nasopharyngeal and other head and neck carcinomas
52
What is seen in the initial phase of acute mono?
granulocytopenia
53
Diagnosis of mononucleosis?
Monospot (IgM response)
54
What is used to diagnosis mono in high risk or high concern pts?
Viral capsid specific IgM and IgG
55
What is the treatment for Mononucleosis?
Self limited
56
What symptomatic relief is used for mono?
- NSAIDS or acetaminophen
- Throat lozenges or sprays
- gargling w/ 2% lidocaine
- Warm saline gargles 3 or 4 times daily
57
What is considered early in the illness to reduce fever and pain for mono?
Corticosteroids
58
When are corticosteroids not given for mono?
- Impending airway obstruction from enlarged lymph nodes
- Hemolytic anemia
- Severe thrombocytopenia
59
influenza is what type of virus?
orthomyxovirus
60
How is influenza transmitted?
respiratory route (droplets)
61
What causes acute respiratory illness?
Influenza A or B
62
What causes minor respiratory illness?
Influenza C
63
What undergoes antigenic drift?
Influenza A and B
64
What undergoes antigenic shift?
Influenza A
65
What is the biggest complication of influenza?
Necrosis of the respiratory epithelium
66
What is associated with aspirin use in the management of viral infections in young children?
Reye syndrome
67
What diagnostics can be used to distinguish influenzas and is used during beginning and end of flu season?
Rapid immunofluorescence assays and enzyme immunoassays
68
What is the Gold Standard diagnosis for influenza?
Virus culture
69
What has high sensitivity and very high specificity in diagnosing influenza?
PCR
70
What is used for public health surveillance for influenza?
Virus culture and PCR
71
When is antiviral medication used for influenza?
if the likelihood of influenza is high and the pt presents within 24 hrs of symptom onset
72
What is the treatment for influenza?
largely supportive
73
What antivirals are used to treat influenza?
Oseltamivir or zanamivir
74
What is side effect we worry about with Zanamivir?
bronchospasm
75
Who recommends the yearly influenza vaccine?
ACIP
76
What are the influenza vaccine options?
2A and 1B OR 2A and 2B
77
What are 3 contraindications to influenza vaccine?
- Hypersensitivity to eggs and/or vaccine components
- Hx of vaccine-associated Guillain-Barre syndrome
- Persons w/ an acute febrile illness until symptomatic improvement
78
What causes candidiasis?
Candida albicans
79
What does immunodeficiency predispose in candidiasis?
mucocutaneous disease
80
If a pt has persistent oral or vaginal candidiasis what does that suggest?
increased suspicion of HIV infection
81
What are 6 candidiasis infections?
- Oropharyngeal candidiasis
- Esophagitis
- Vuvovaginitis
- Balanitis
- Chronic mucocutaneous candidiasis
- Mastitis
82
What causes thrush?
oropharyngeal candidiasis
83
How is thrush diagnosed?
Potassium hydroxide (KOH) prep
84
What is a AIDS defining ilness
Esophagitis
85
What is the most common mucosal candidiasis?
Vulvovaginitis
86
What is often associated with invasive focal or systemic infections?
candidemia
87
What occurs pretty much anywhere?
invasive focal infections
88
What is also called chronic disseminated candidiasis
Hepatosplenic candidiasis
89
What is the treatment for Candidiasis?
oral - fluconozole, Itraconazole
90
What is the treatment for severely ill candidiasis?
Intravenous amphotericin B
91
What are topical treatment for Candidiasis?
Clotrimazole and Miconazole
92
How is vulvovaginal candidiasis treated?
one 150mg oral dose of fluconazole
93
How is candidial funguria treated?
w/ discontinuance of antibiotics
94
What causes cryptococcosis?
C. neoformans and C. gattii
95
What is the most common cause of fungal meningitis?
C. neoformans and C. gattii
96
Where is cryptococcosis transmitted from?
soil and dried pigeon dung
97
Who are most pts with cryptococcal infections?
immunocompromised
98
How do you diagnose meningoencephalitis?
Lumbar puncture
99
What do you do prior to lumbar puncture?
CT or MRI to check for papilledema
100
What causes bacterial meningitis?
- Tuberculous meningitis
| - Partially treated bacterial meningitis
101
What is the txt for cryptococcosis?
Amphotericin B + Flucytosine for at least 2wks followed by Fluconazole
102
What causes Histoplasmosis?
Histoplasma capsulatum
103
What disease is linked to bird droppings and bat exposure?
Histoplasmosis
104
What two river valleys is histoplasmosis found?
Ohio River and Mississippi River valleys
105
What is the most common clinical problem in Histoplasmosis?
Respiratory illness
106
What is not a symptom of Histoplasmosis?
NO coryza or pharyngitis
107
Where is progressive disseminated histoplamosis seen?
In endemic areas- pts taking TNF blocking agents
108
Miliary pattern is seen in what?
Histoplasmosis
109
How is histoplasmosis diagnosed?
Chest xray and CT
110
How is histoplasmosis treated?
- under 4 weeks and stable- NO TREATMENT
- Itraconazole
- Amphotericin B
111
What is the lifelong suppressive therapy for histoplasmosis?
Itraconazole
