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infectious diseases > spirochetal diseases > Flashcards

spirochetal diseases Flashcards

1
Q

Borrelia burgdorferi

Transmitted by a___ – it takes between ___ hours to transfer the bacteria.

This is found in high grass or wooded areas

A

Lyme disease Transmitted by a deer tick bite – it takes between 36 and 48 hours to transfer the bacteria.

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2
Q

lyme disease stage 1 (4)

A

Early localized stage (about 1 week after the bite)

Erythema Migrans – Bull’s eye rash (about 1 week after bite) Fever

Malaise

Flu like symptoms

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3
Q

lyme disease stage 2 (6)

A

Early disseminated stage (weeks)

*cardiac and neuro symptoms in 20% of cases

  • Muscle and joint pain
  • Facial or Bell’s palsy
  • Severe headaches and neck stiffness: due to inflammation of the spinal cord (meningitis) -Pain and swelling in the large joints (such as knees)
  • Pericarditis, arrhythmias
  • Shooting pains that may interfere with sleep
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4
Q

lyme disease stage 3 (7)

A

Late disseminated stage (months)

Arthritis most commonly in the large joints

Shooting pains

Polyneuropathy

numbness and tingling in the hands or feet

Mood changes and memory loss

Fatigue

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5
Q

describe lyme disease rash

A

Erythema Migrans – A small, red bump may appear at the site of the tick bite, which later the redness expands forming a rash in a bull’s–eye pattern, with a red outer ring surrounding a clear area.

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6
Q

Erythema Migrans – A small, red bump may appear at the site of the tick bite, which later the redness expands forming a rash in a bull’s–eye pattern, with a red outer ring surrounding a clear area.

A

lyme disease

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7
Q

lyme disease tests(3)

A

*Enzyme-linked immunosorbent assay (ELISA) test. Detects antibodies to B. burgdorferi. False negatives in the early stage of Lyme disease

*Western blot test. Done following a positive ELISA test detects antibodies to several proteins of B. burgdorferi.

*Polymerase chain reaction (PCR) This has been MOST HELPFUL in joint fluid

Blood tests (there are many cross reactive disease processes)

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8
Q

lyme disease treatment (3)

VACCINATION?

A

Doxycycline -Not for kids under 8 or pregnant woman use amoxicillin Ceftriaxone – administered intravenously

NSAIDs for pain

Vaccination is no longer in production

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9
Q

untreated lyme disease

A

Untreated disease can have significant cognitive and psychological manifestations

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10
Q

Erythema Migrans – Bull’s eye rash (about 1 week after bite) Fever

Malaise

Flu like symptoms

A

Early localized stage (about 1 week after the bite) of lyme disease

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11
Q

*cardiac and neuro symptoms in 20% of cases

Muscle and joint pain

Facial or Bell’s palsy

Severe headaches and neck stiffness

Pain and swelling in the large joints (such as knees) Pericarditis, arrhythmias

Shooting pains that may interfere with sleep

A

Early disseminated stage (weeks) of lyme disease

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12
Q

Arthritis most commonly in the large joints

Shooting pains

Polyneuropathy

numbness and tingling in the hands or feet

Mood changes and memory loss

Fatigue

A

Late disseminated stage (months) of lyme disease

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13
Q

Rickettsia rickettsii

Can cause serious damage to ___

More common in the ___ part of the US

A

Rocky Mountain Spotted Fever

A wood tick borne disease -

-Can cause serious damage to internal organs and even be lethal

–More common in the Southeastern part of the US

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14
Q

Rickettsia rickettsii Borrelia burgdorferi -which one is lethal?

A

rickettsia: Rocky Mountain Spotted Fever(LETHAL)

Borrelia burgdorferi: lyme disease

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15
Q

Initial symptoms in Rocky Mountain Spotted Fever (5) -occurs when

A

Initial symptoms 2-14 days after exposure

High Fever

Nausea / vomiting

Severe headache

Muscle pain

Cough

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16
Q

Initial symptoms

High Fever

Nausea / vomiting

Severe headache

Muscle pain

Cough

A

Rocky Mountain Spotted Fever

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17
Q

Later signs and symptoms

Conjunctiva injected

Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spread to trunk

Petechial rash

Abdominal pain

Joint pain

Forgetfulness

A

Rocky Mountain Spotted Fever

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18
Q

Rocky Mountain Spotted Fever Later signs and symptoms (6)

A

Later signs and symptoms

Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spread to trunk

Petechial rash

Abdominal pain

Joint pain

Forgetfulness

Conjunctiva injected

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19
Q

Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spread to trunk

A

Rocky Mountain Spotted Fever Later sign

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20
Q

Severe cases Jaundice Hepatosplenomegaly Acute respiratory distress

A

Rocky Mountain Spotted Fever Later sign

21
Q

Rocky Mountain Spotted Fever PE severe cases (3 findings)

A

Jaundice

Hepatosplenomegaly

Acute respiratory distress

22
Q

Rocky Mountain Spotted Fever tests (2) -blood tests show could show what 3 things -CSF shows what

A

-Serum blood tests – low platelet count, low blood sodium concentration, or elevated liver enzyme levels -

Antibody titers —CSF: pleocytosis and glycorrhachia

23
Q

Rocky Mountain Spotted Fever treatment (3)

A

Doxycycline is the first line treatment in anyone older than 8 and not pregnant.

–Amoxicillin may be used in those cases.

Chloramphenicol – alternative medication

24
Q
  • pleocytosis - glycorrhachia
A
  • think Rocky Mountain Spotted Fever
  • pleocytosis- an increased cell count particularly an increase in white blood cell count, in a bodily fluid, such as cerebrospinal fluid.
  • glycorrhachia- Presence of sugar in the cerebrospinal fluid.
25
Q
  • describe Rocky Mountain Spotted Fever rash
  • % of people
A

Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spread to trunk

10% of people have no rash

26
Q

Rocky Mountain Spotted Fever and lyme disease rash occurs when

A
  • Rocky Mountain Spotted Fever: Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spread to trunk
  • lyme disease: Erythema Migrans – A small, red bump may appear at the site of the tick bite, which later the redness expands forming a rash in a bull’s–eye pattern, with a red outer ring surrounding a clear area (7-10 days after bite)
27
Q

What is the organism that causes Lyme disease?

A maculopapular rash beginning on the wrists and ankles. What is the most likely diagnosis?

What is the first line treatment for rocky mountain spotted fever?

What antibiotic is good alternative to doxycycline in a young child or a pregnant woman?

A

What is the organism that causes Lyme disease? Borrelia burgdorferi

A maculopapular rash beginning on the wrists and ankles. What is the most likely diagnosis? Rocky mountain spotted fever

What is the first line treatment for rocky mountain spotted fever? Doxycycline

What antibiotic is good alternative to doxycycline in a young child or a pregnant woman? Amoxicillin

28
Q

In July a six year old buy from a rural town is brought in to your office by his mother. She is concerned because he has developed a rash. It started on his wrists a few days ago and now it seems to be moving up his arms. He has had a mild fever and he is complaining of abdominal pain. What is the best treatment plan for this boy?

A

Amoxicillin

29
Q

A highly contagious sexually-transmitted disease, including oral and anal sex

Caused by the spirochete bacterium Treponema pallidum

subspecies pallidum

M>F

A

syphillis

30
Q

syphillis organisim

gender

A

Caused by the spirochete bacterium Treponema pallidum subspecies pallidum M>F

31
Q

Primary – typically acquired by direct sexual contact with the infectious lesions of another person. Development of lesions

Secondary – occurs approximately four to ten weeks after the primary infection

Latent – having serologic proof of infection without symptoms of disease

Tertiary – occur approximately 3 to 15 years after the initial infection.

A

syphillis

32
Q

syphillis - Primary (2 POINTS)

  • Secondary – occurs approximately ___ after the primary infection

Latent – having ____ (with or without) symptoms of disease

Tertiary – occur approximately ___ after the initial infection.

A

Primary – typically acquired by direct sexual contact with the infectious lesions of another person. Development of lesions

Secondary – occurs approximately four to ten weeks after the primary infection

Latent – having serologic proof of infection WITHOUT symptoms of disease

Tertiary – occur approximately 3 to 15 years after the initial infection.

33
Q

Tertiary syphillis and 4 further classifications

A

Tertiary – occur approximately 3 to 15 years after the initial infection.

Classified further into:

Gummatous syphilis

Late neurosyphilis

Cardiovascular syphilis

Congenital syphilis – transmission from mother to fetus during pregnancy

34
Q

I came in to see my physician assistant because of…

Primary (3 days – 3 months after contact)

Chancre sores – lesions where the bacteria appears at the point of contact

A single, firm, **painless**, non-itchy ulceration. It has a clean base and clear borders

Macule > Papule > Ulcer Lymph nodes enlargement

Secondary (4 – 10 weeks after primary)

A

syphillis

35
Q

**Symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles of the feet. It is a maculopapular rash**

A

syphillis

36
Q

describe syphillis rash

A

**Symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles of the feet. It is a maculopapular rash**

37
Q

Fever

Sore throat

Malaise

Weight loss

Hair loss

Headache

A

other syphillis symptoms

38
Q

Physical exam findings

Presence of a chancre sore

Symmetrical maculopapular rash on trunk, extremities and palms and soles of feet.

A

syphillis

39
Q

A question mentions dark field microscopy. What is the likely diagnosis?

A

Syphilis

40
Q

syphillis

  • what is diagnostic
  • cannot be what
  • order what else
A

**Dark field microscopy** is diagnostic, but technically difficult

Can not be cultured

-order blood tests

41
Q

syphillis -

  • primary symptoms occurs how long after contact
  • describe primary lesions
  • secondary symptoms occur when

painless or painful?

A

Primary (3 days – 3 months after contact)

Chancre sores – lesions where the bacteria appears at the point of contact A single, firm, **painless**, non-itchy ulceration.

It has a clean base and clear borders

Macule > Papule > Ulcer

Lymph nodes enlargement

Secondary (4 – 10 weeks after primary)

42
Q

syphillis Nontreponemal test

A

*Nontreponemal – positive at 4-6 weeks and during primary and secondary, but are negative during tertiary phase.

43
Q

Testing for tertiary syphilis (3)

A

Lumbar puncture

Joint aspiration

Tissue biopsy

44
Q

*Venereal Disease Research Laboratory (VDRL)

-Rapid Plasma Reagin Tests (RPR) Treponemal

*Treponema Pallidum Particle Agglutination (TPHA) used after VDRL to confirm results of a positive test *

Fluorescent Treponemal Antibody Absorption Test (FTA-Abs)

A

syphillis blood tests

45
Q

syphillis medications (4)

A

**Benzathine Penicillin G – administered intramuscularly, single dose, during the early stage of infection

Doxycycline, Tetracycline, Ceftriaxone

46
Q

syphillis non medication part of treatment

A

Sexual abstinence and treatment of all sexual partners

Syphilis needs to reported to the CDC

Jarisch – Herxheimer reaction It is an immune response to the materials released by the destruction of the spirochetes

Fever / chills, Muscle pain, Headache

No need to stop treatment

Resolves in 24 hours

47
Q

Jarisch – Herxheimer reaction

  • definition
  • symptoms (4)
  • stop treatment?
  • resolves when
A

-syphillis It is an immune response to the materials released by the destruction of the spirochetes

Fever / chills

Muscle pain

Headache

No need to stop treatment

Resolves in 24 hours

48
Q

It is an immune response to the materials released by the destruction of the spirochetes Fever / chills Muscle pain Headache

A

Jarisch – Herxheimer reaction for syphillis

No need to stop treatment

Resolves in 24 hours

infectious diseases (7 decks)

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