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infectious disease > spirochete and tick borne disease > Flashcards

spirochete and tick borne disease Flashcards

1
Q

a flexible spirally twisted bacteria
- trepan pallidum syphilis
- borrelia relapsing fever and Lyme disease

A

spirochete

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2
Q
  • complex disease cause by the bacterial spirochete treponema pallidum
  • almost always transmitted by sex
  • can affect any organ or tissue in the body (varied presentation)
A

syphilis

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3
Q

primary
secondary

A

early (infectious) syphilis

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4
Q
  • symptoms free period that lasts up to a year after initial infection
    -infectious lesions can recur
A

early latent syphilis

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5
Q
  • after the first year of latent syphilis
  • noninfectious except transplacental
A

late latent

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6
Q

tertiary or neurosyphilis

A

late syphilis

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7
Q

how to prevent syphilis

A
  • avoid infectious contact
  • use condoms
  • MSM screened every 3-6 months or more
  • screening in pregnant patients:
    –> first prenatal visit, third trimester, and at delivery if high risk*
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8
Q
  • includes primary lesions of chancre
  • lymphadenopathy
  • can occur 10-90 days after inoculation
  • painless superficial ulcer
  • enlargement of regional lymph nodes (painless)
A

syphilis: early infectious primary

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9
Q

hallmark of syphilis: early infectious primary

A

painless chancre

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10
Q

how to diagnose syphilis: early infectious primary

A
  1. nontreponemal tests (detects Ab to lipoidal antigens) –> VDRL and RPR
    –> but this is not specific so you have to do:
  2. treponemal tests (to confirm) –> TPPA and FTA-ABS
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11
Q

how to diagnose syphilis: early infectious primary
(reverse algorithm)

A
  1. treponemal test
  2. EIA enzyme immunoassay
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12
Q

syphilis: early infectious primary treatment

A

IM penicillin G 2.4 million units in one dose

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13
Q

<1 year usually highly infectious
can convert to secondary syphilis if not adequately treated

A

early latent syphilis

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14
Q

early latent syphilis treatment

A

IM penicillin G 2.4 million units in one dose

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15
Q
  • usually a few weeks or up to 6 months after chancre
  • systemic signs: fever, lymphadenopathy
  • infectious lesions distant from the site of inoculation
  • most common manifestations are skin and mucosal lesions
    –> non pruritic, macular, papular, pustular, or follicular- NOT vesicular*
A

early infectious syphilis
–> secondary syphilis

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16
Q

hallmark of secondary syphilis

A
  • rash on palms and soles
  • dark skin annular lesions that look like ringworm
  • mucous patches of mucous membranes
  • condylomata lata
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17
Q

how to diagnose syphilis: early infectious secondary

A

serologic tests are almost always positive at this stage

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18
Q

early infectious secondary syphilis treatment

A

IM penicillin G 50,000/kg

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19
Q

what is common with syphilis: early infectious secondary treatment

A

The Jarisch–Herxheimer reaction is the abrupt onset of fever, chills, myalgia, headache, tachycardia, hyperventilation, flushing, and mild hypotension 1–2 hours after treatment of a spirochetal infection with penicillin or other antimicrobial agents.

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20
Q
  • > 1 year after 1st year noninfectious to sex partner
  • still transmissible to fetus
  • can only diagnose this without evidence of tertiary disease or neurosyphilis
  • can last a lifetime
A

late latent syphilis

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21
Q

late latent syphilis treatment

A

IM penicilli G: 3 doses of 2.4 million units each at 1 week intervals

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22
Q
  • may occur any time after secondary
  • 1 to > 20 years after initial infection
    1. Gummas (infiltrative tumors of skin, bones, liver)
    2. neurosyphilis (HA, meningitis, dementia, hearing/vision loss, incontinence, psychosis) (argyle-robertson pupil small irregular pupil that constricts to accommodation, but not light)
    3. CV syphilis: aortitis, aneurysms, aortic regurg
A

syphilis: late tertiary stage

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23
Q

hallmarks of syphilis: late tertiary stage

A
  • gummas
  • argyll robertson pupil (no pupil response to light but pupil will constrict when object moves towards nose)
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24
Q

syphilis: late tertiary stage treatment

A

IM penicillin G 2.4 million units/week IM for 3 weeks

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25
Q
  • can occur at any stage of syphilis infection
  • can be disabling and life threatening
  • CNS signs
A

neurosyphilis

26
Q

how to diagnose neurosyphilis

A
  • same serologic tests
  • if CNS signs present –> CSF study
27
Q

neurosyphilis treatment

A

High dose IV PCN
18-24 million units/day for 10-14 days

28
Q
  • variable findings at birth
  • many have no signs for several weeks
  • rash, condylomas, mucous membrane patches, nasal discharge
  • intellectual disability and/or failure to thrive
A

congenital syphilis

29
Q

conditions from untreated congenital syphilis

A

Hutchinson’s teeth
saddle nose
TORCH syndrome

30
Q
  • MSK, neurologic, and skin disease
  • most common tick borne disease in US
  • caused bye borrelia burgdorgeri
  • tick must be attached for 24-36 hours for transmission
    -I scapularies ticks in the midwest and northeast are infected with spirochete
A

Lyme disease

31
Q
  • early localized
  • erythema migraines bullseye rash
  • viral like illness
    –> myalgias, arthralgias, fatigue, HA
A

stage 1 of Lyme disease

32
Q

hallmark of stage 1 of Lyme disease

A
  • erythema migrans bullseye rash
33
Q
  • early disseminated infection
  • days/weeks later
  • hematogenous spread*
  • viral like illness common
  • fatigue can last for months
  • most common neuro finding: aseptic meningitis
  • CN7 palsy (facial nerve palsy)
  • cardiac issues: myopericarditis, arrhythmias, heart block
A

stage 2 Lyme disease

34
Q
  • months/years later
  • MSK, neurologic, skin manifestations
  • mono or oligoarticular joint pain/swelling-knee or other large joints
A

stage 3 Lyme disease

35
Q

how to make a diagnosis for Lyme disease

A
  1. exposure in an endemic area + erythema migrans within 30 days
    or
  2. one late manifestation of disease + laboratory confirmation
36
Q

labs for Lyme disease

A

two test diagnostic approach is recommended:
- ELISA antibody test
- confirmed with western blot

37
Q

Lyme disease treatment

A

doxycycline for 10 days

38
Q

Lyme disease treatment if pregnant

A

amoxicillin for 14 days

39
Q

what to do for any known tick bite in pt presenting with symptoms regardless if mild or severe

A

tick panel should be ordered

40
Q

when to admit pt for Lyme disease

A

CNS or cardiac manifestations

41
Q
  • illness that comes/goes in discrete episodes over several weeks
  • caused by spirochete of genus borrelia
  • ticks in mountainous west
  • abrupt onset of fever, chills, tachycardia, N/V, arthralgia, severe HA
  • hepatomegaly and splenomegaly
  • high fever and delirium
A

relapsing fever

42
Q

relapsing fever labs

A
  • CBC: usually normal
  • blood smear: large spirochetes are seen with wright gems stain
  • hematuria is common
  • anti borrelia antibodies develop
43
Q

relapsing fever treatment

A

post exposure prophylaxis with doxycycline

44
Q

relapsing fever treatment for tick borne disease without nervous system involvement =

A
  • IV PCN G or IV ceftriaxone
  • then tetracycline or erythromycin for 10 days
45
Q

relapsing fever treatment for CNS involvement

A

IV PCN or ceftriaxone

46
Q

-illness caused by bacteria rickettsia rickettsii
- ticks must be attached for 6-10 hours
- causes vascular permeability (petechiae)
- classic: sudden high fever
- small, blanching pink macule that spread into petechiae
- facial flushing, conjunctival injection, hard palatal lesions

A

Rocky Mountain spotted fever

47
Q

classic triad for Rocky Mountain spotted fever

A

fever
HA
rash
with history of tick bite

48
Q

hallmark of Rocky Mountain spotted fever

A
  • rash starts at wrists/ankles and spreads centrally over the next 2-3 days
  • involvement of palms/soles
49
Q

how to diagnose Rocky Mountain spotted fever

A
  • hyponatremia, elevated liver enzymes, elevated bilirubin, and thrombocytopenia
  • acute phase: skin biopsy with immunohistologic or PCR demonstration or R rickettsii
  • second week: Ab serologic studies can confirm
50
Q

Rocky Mountain spotted fever treatment

A

doxycycline 100 mg BID x 5-7 days

51
Q

Rocky Mountain spotted fever treatment if pregnant

A

chloramphenicol
–> but not as effective

52
Q

usual cause of death of Rocky Mountain spotted fever

A

pneumonitis with respiratory or cardiac failure

53
Q
  • tick borne illness that infects monocytes or granulocytes
  • found most in Missouri, Arkansas, Oklahoma
  • reservoir: white tail deer, mice*
  • caused by lone star tick*
A

ehrlichiosis

54
Q

clinical syndromes of monocyte infection of ehrlichiosis

A

prodrome: malaise, rigors, nausea
then high fever and HA
pleomorphic rash (different stages –> ulcer, blister, papule)

55
Q

complications of ehrlichiosis

A
  • acute respiratory failure and ARDS
  • neurologic complications
  • acute kidney disease
  • hemophagocytic syndrome
  • multi organ failure
56
Q

how to diagnose ehrlichiosis

A
  • history of tick exposure and characteristic illness
  • Labs: leukopenia, lymphopenia, thrombocytopenia
  • peripheral smear with stain: intraleukocytic vacuoles
  • confirmation: PCR
57
Q

ehrlichiosis treatment

A

doxycycline
–> with high clinical suspicion do not delay treatment for confirmation

58
Q

ehrlichiosis treatment if pregnant

A

rifampin

59
Q
  • delayed form of anaphylaxis caused by red meat consumption
  • IgE mediated allergic reaction against oligosaccharide galactose-alpha-1,3-galactose
  • carbohydrate allergy
A

alpha gal syndrome

60
Q

alpha gal syndrome other offenders

A
  • vaccines (measles, mumps, rubella, zoster)
  • cetuximab
  • porcine heart valve prostheses
  • antivenoms
  • gelatin and dairy products
61
Q

how to confirm alpha gal

A
  • serologic testing for alpha gal specific IgE
  • skin prick tests
  • intradermal tests
62
Q

alpha gal treatment

A
  • treat anaphylaxis
  • avoid mammalian meats and medications/devices that contain alpha-gal

infectious disease (12 decks)

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