Week 8 Infectious Disease Flashcards
A 48-year-old female is diagnosed with chronic hepatitis C virus (HVC). What will the provider tell the patient about managing this illness?
Several medications are available based on the type of hepatitis C
The provider should inform the patient that there are several medications available based on the type of hepatitis C the patient has. HCV rarely has a rapidly fulminant course, although cirrhosis is likely after years of infection. Immunoglobulin therapy is given for HBV. The disease is not self-limiting.
Which of the following serology findings indicate a chronic hepatitis B infection?
A Positive hepatitis B surface antigen (HBsAg) and total hepatitis B core antibody (anti-HBc), negative IgM antibody to hepatitis B core antigen (IgM anti-HBc) and hepatitis B surface antibody (anti-HBs)
B Positive hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and IgM antibody to hepatitis B core antigen (IgM anti-HBc), negative hepatitis B surface antibody (anti-HBs)
C Negative hepatitis B surface antigen (HBsAg), and positive total hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs)
Positive hepatitis B surface antigen (HBsAg) and total hepatitis B core antibody (anti-HBc), negative IgM antibody to hepatitis B core antigen (IgM anti-HBc) and hepatitis B surface antibody (anti-HBs)
Negative hepatitis B surface antigen (HBsAg) and positive total hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) indicates immunity from past infection. Positive hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) and negative hepatitis B surface antibody (anti-HBs) indicates acute infection.
Which of the following statements about hepatitis A are correct?
A Most adults with hepatitis A infection are symptomatic
B Children under age 6 years often have symptomatic infection
C Antiviral therapy is effective if given early in the illness
D Hepatitis A vaccine is contraindicated in patients with liver disease
Most adults with hepatitis A infection are symptomatic
>70% of adults with hepatitis A are symptomatic. <30% of children under age 6 have symptoms. Treatment for hepatitis A is symptomatic. Patients with chronic liver disease should be vaccinated for hepatitis A.
Who should be screened for hepatitis C? Select all that apply.
Per the CDC, all patients 18 and older should be screened at least once. Pregnant women should be screened during each pregnancy. Any person who requests screening should be tested, regardless of disclosure of risks, because many patients may be reluctant to disclose stigmatizing risks. Since 1992, all blood products have been universally screened for hep C in the US. Although HCV infection is primarily associated with IDU, high-risk behaviors (e.g., anal sex without using a condom), primarily among persons with HIV, are also important risk factors for transmission
An adult patient who has human immunodeficiency virus (HIV-1) infection has been on antiretroviral therapy (ART) for 18 months and has had normal CD4 counts and viral loads for past year. What will the provider recommend?
A. Allow for periods of time off from ART medications
B Begin monitoring viral load and CD4 counts every 6–12 months
C Consider beginning highly active antiretroviral therapy (HAART)
D Switch the medication regimen so the patient does not develop resistance
B Begin monitoring viral load and CD4 counts every 6–12 months
In patients who are clinically well and highly adherent, who have normal CD4 counts and viral loads, monitoring may begin at 6-month intervals and sometimes annually. Those with risk factors such as homelessness, however, must continue to be monitored every 3 to 4 months. ART medications should never be interrupted unless there are medical reasons for doing so. HAART is given only by clinicians with significant training and experience in its use to patients who meet specific criteria. The patient is stable and on ART for 18 months, he does not require a change in regimen
A provider is concerned that a 4-year-old child may have latent tuberculosis infection (LTBI). Which test will be performed initially to screen for this infection?
Mantoux test
A 25-year-old asymptomatic male has a tuberculosis (TB) skin test which reveals an area of induration of 12 mm. He is a recent immigrant from Mexico and lives in a homeless shelter. He did not receive the BCG vaccine and this is his first TB skin test. His chest x-ray is normal. What is the recommended treatment for this patient?
Begin isoniazid (INH) therapy
Patients younger than 35 who have any risk factors for TB and with an area of induration ³10 mm should be considered for INH preventive therapy. This patient is an immigrant from Mexico and lives in a homeless shelter, so TB preventive therapy is acceptable. BCG vaccine is not helpful. The patient does not have signs or symptoms of active TB so a sputum culture is not needed
A patient with mild symptoms of babesiosis is diagnosed with a positive polymerase chain reaction (PCR) assay. What is the recommended treatment for this patient?
A Atovaquone and azithromycin for 7–10 days
B Clindamycin and quinine for 10–14 days
C Intravenous clindamycin and hospitalization
D Symptomatic therapy with observation
A Atovaquone and azithromycin for 7–10 days
Patients with mild to moderate symptoms and a positive PCR assay should be treated. Atovaquone plus azithromycin is the treatment of choice. Clindamycin and quinine are effective but have more adverse effects. IV clindamycin is given for severe symptoms. Patients without positive assays who have mild symptoms may be observed.
A parent brings a child to clinic and reports pulling a tick off the child after being outdoors that day. The parent is concerned that the child may have Lyme disease. What will the provider tell this parent?
A A laboratory test today will help identify the presence of the disease
B Antibiotic prophylaxis is necessary to prevent development of symptoms
C Transmission of the organism only occurs with prolonged attachment of the tick
D Unless the child develops systemic symptoms, treatment is not indicated
Transmission of the organism only occurs with prolonged attachment of the tick
To transmit the spirochete to humans, the tick must be attached for an extended period of time of at least 36 hours. Serologic testing early in the disease may not be helpful. Antibiotic prophylaxis is not recommended. Treatment may begin with the presence of a localized rash.
An adult patient presents with multiple annular rashes, fatigue, fevers, joint pain, and swelling in her knees. The patient most likely has
Early localized: Erythema migrans that slowly expands, may be associated with flu like symptoms. Rash may not be present.
Late disseminated: not associated with rash, but neurological signs such as peripheral neuropathy and arthritis are present
Post Lyme or chronic Lyme diagnosis is controversial
What does an anti-HCV test indicate?
detects presence of antibodies to the hep C virus
+ = exposure to virus
what is an HCV RNA test used for?
qualitative “negative” or “not detected”
used to distinguish between current and past infection
may be ordered after treatment to see if virus is eradicated
What childhood infection does the rash come AFTER the fever?
roseola
caused by HSV
6 mos to 2 years
“pink colored”
appear on trunk first then extremities
What will labs look like for an acute hep b infection?
positive hep b surface antigen
positive core antibody
positive IgM antibody
What will labs look like for chronic hep B infection?
Positive hep b surface antigen >6 months
Positive core antibody
NO IGM***
NO SURFACE ANTIBODIES
What do labs look like for someone that recovered from acute hep B?
positive surface antibody
positive core antibody (lifelong)
*now considered to have natural immunity life long*
What does a positive Hep A IgM antibody mean?
Active Hep A infection
