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NURP 532 > Week 8 Infectious Disease > Flashcards

Week 8 Infectious Disease Flashcards

1
Q

HIV screening guidelines

A

13 and 64 yrs get tested for HIV at least once

if higher risk, getting tested at least once a year.

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2
Q

IgM

A

early response; detected 5-10 days before sx onset

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3
Q

IgG

A

later response

long term

made after exposure (secondary response)

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4
Q

hepatitis A transmission and sx’s

A

fecal oral transmission

high risk: IV drugs, homeless, chronic liver dz

fever, jaundice, anorexia, nausea, malaise, myalgia

most children < 6 yrs are asymptomatic

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5
Q

hepatitis A management

A
  • supportive care
  • hydration
  • antiemetics
  • no etch
  • vaxx HH / sex partners, high risk (MSM, liver problems, homeless, hepatitis b/c, high risk settings)
  • recover in 2 months
  • does NOT develop chronically! acute only
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6
Q

when would hep A need hospitalization?

A
  • Intractable vomiting
  • severe electrolyte or fluid imbalance
  • altered mental status
  • INR > 1.5
  • evidence of fulminant disease
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7
Q

hepatitis B transmission

A
  • blood & bodily fluids (tattoo, needles, razors, saliva, semen)
    • NO BREAST FEEDING
  • can cause acute and CHRONIC hepatitis
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8
Q
  • surface antigen HBsAg: -
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: +
A

immune from natural infection

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9
Q
  • surface antigen HBsAg: -
  • core antibody anti-HBc: -
  • surface antibody anti-HBs: +
A

immune due to hep b vaccination

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10
Q
  • surface antigen HBsAg: +
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: +
  • IgM anti-HBs: -
A

acute infection

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11
Q
  • surface antigen HBsAg: +
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: -
  • IgM anti-HBs: -
A

chronically infected

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12
Q

who is at risk for hepatitis B?

A
  • Hemodialysis pts
  • highest risk: Infants (born from infected moms)
  • Sex parters , house hold contats
  • occupational (health care workers)
  • MSM
  • Iv drug users
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13
Q

Hep B sx’s

A
  • Fatigue, fever, n/v
  • Arthraliga
  • Similar to hep A
  • > 60 yrs = severe fxn
  • < 5 yrs = asx
  • > 5 yrs = sx’s
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14
Q

first lab indicator of hepatitis B infection?

A

elevation of hepatitis B surface antigen and elevated ALT

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15
Q

if have hepatitis B, what else should you screen for?

A

hepatitis C and D, HIV

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16
Q

when to treat hepatitis B?

A
  • only in active phase: ALT doubled,
  • chronic hep B when hep B ‘e’ antigen is + and DNA viral level > 20k
  • entecavir or tenofovir safe and effective x 12 months after HBsAg is - and HBV DNA is undetectable
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17
Q

if mother has chronic hepatitis B (hep B surface antigen +) after an infant is born…

A

infant should get hep B vaccine and immunoglobulin within 12 hours of birth

if not, 90% of infants will get chronic hep B

test infant in 6-9 months for antigen and antibody

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18
Q

hepatitis C transmission

A

blood =

IV drug use, vertical transmission, razors, toothbrushes, IV, piercings

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19
Q

hepatitis c diagnostic

A

+ HCV antibody and + HCV RNA

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20
Q

What if hepatitis C antibody is negative and RNA positive?

A
  • Acute infxn
  • If asymptomatic, screening for hep C
    • Hard to tell acute or chronic but if they have sx’s the most likely acute
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21
Q

Hepatitis C antibody and RNA are positive?

A
  • When was last test? If - in past 12 months, this is a new acute infxn if now +
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22
Q

Hepatitis C antibody positive and RNA is negative and asymptomatic ?

A

had hep C and recovered (don’t go onto chronic)

OR

false + so repeat in a few weeks

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23
Q

who should get tested for hepatitis c?

A

every adult at least once 18+ , every pregnant women, those with risk factors regularly

one time test regardless of age or high risk: HIV, hemodialysis, organ transplant before 1992

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24
Q

if pt tests positive for Hep C 2 yrs ago, has + antibody test, RNA +, next step is?

A

order RUQ ultrasound to assess for evidence of cirrhosis and carcinoma

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25
Q

if mom is pregnant with hep c, when do you check child for hep c?

A

at 18 months

26
Q

can you breastfeed with hep c?

A

yes

27
Q

when is AIDS dx?

A

CD4 < 200

28
Q

what is the 4th generation HIV test?

A

combines antigen (in blood as early as 15 days after exposure) and antibody test (takes 30 days to be detected)

screens HIV 1 & 2

  • if antigen reactive: do viral load/NAAT = if + = reactive
  • if - initial test was false +
29
Q

acute HIV sx’s

A
  • Mono like illness
  • Fatigue
  • Fever
  • Sore throat
  • Cervical lymphadenopathy
  • Night sweats
  • Diarrhea
  • Skin rash
    • Trunk NOT itchy
  • Headache
  • Arthralgia
  • Myalgia
  • Oral or genital ulcers
  • leukopenia, or anemia, or thrombocytopenia, and also elevation in the liver transaminase.
30
Q

early treatment of HIV to

A

decrease transmission, decrease viral load

continue indefinitely of 3 ART (2 nucleosides and integrate strand transfer inhibitor)

31
Q

important considerations when someone is diagnosed with HIV

A
  • Have partner start Prep
  • Up to date with hep, flu, pneumoc, covid vaccines
  • Monitoring labs and side effects of ART
  • Assessing adherence
  • Discuss meaning of viral load and HIV spread
  • Screen for STI, TB, osteopenia (from long term use of ART)
  • Screen for cervical cancers bc HPV risk malignancies
  • No evidence of opportunistic infections (PE)
  • Other high risk behaviors like IVDU
32
Q

HIV + mom concerned about unborn child. with effective therapy, risk of transmission

A

lowered to < 2 %

after delivered, baby started on AZT for 4-6 wks to prevent HIV infxn

33
Q

steps to prevent HIV transmission from mom to baby

A
  • mom with HIV take HIV medicines during pregnancy and childbirth.
  • Their babies are given HIV medicine for 4-6 weeks after birth.
  • Goal: lower viral load < 1000 in mom = dec transmission to baby
  • Women with a high or unknown level of HIV in their blood may have a C-section
  • No breastfeeding
  • Newborn need RNA/DNA check at 2 wks, repeat 1-2 months, then 4-6 months, then 12-18 months.
  • Negative HIV antibody confirms bb not infected
  • If mom has < 1000 viral load, can do vag delivery
  • If mom has high viral load, C section considered
34
Q

is infant’s blood is taken day 1 and at 2 week mark and is + for HIV, this means

A

we don’t know!

we expect to see antibodies up to 6 months bc it crosses the placenta so we have to test for HIV antibodies up to 6 months.

test viral load at birth, at 1-2 weeks, then 1-2 months, then 6 months

if 2 RNA are + = confirms dx

35
Q

How should the HIV status of the infant be determined?

A

Viral load by PCR at 2-3 weeks, 1 to 2 months, and 4 to 6 months

36
Q

HIV and pneumococcal vaccine?

A

ok to admin 1st dose of pneumococcal vaccine series now (if CD4 >100) but make sure its inactivated

37
Q

HIV sx’s in children

A

Recurrent or severe infections

AOM, sinusitis, pneumonia, bacteremia

Growth failure • Pubertal delay •

Anemia, thrombocytopenia, neutropenia

• Hepatomegaly, splenomegaly • Opportunistic infections • Candidiasis • Diarrhea

38
Q

HIV med monitoring

A

osteopenia

infections

cancer

depo and progestin pills interactive

higher cardiovascular risk

39
Q

highest risk of TB reactivation is

A

first 2 yrs

40
Q

ghon focus

A

white spots when infected tissue dies in lungs from tb

41
Q

risk factors that increase risk of latent to active TB

A

< 5 yrs old

diabetes

immunosuppression

highest rates: > 65 yrs, lowest: 5-14 yrs old

42
Q

latent TB

A
  • infected but doesn’t develop sx’s and don’t feel sick bc healthy immune system
  • (if compromised immune syste, wil be active TB)
  • Not contagious
  • If not tx, can lead to active TB
43
Q

active tb sx’s

A
  • pulmonary disease, cough, fever, night sweats, hemoptysis, weight loss, and loss of appetite.
  • Symptoms in children are typically more severe.
  • So extrapulmonary TB is more common in children.
44
Q

TB can affect what areas

A

lungs, lymphatic system, the pleura, the bone and joint, and peritoneal, GU, and meningeal.

45
Q

TB gold standard analysis

A

sputum culture but takes few weeks to come back

46
Q

preferred method for TB testing children < 5?

what is preferred if they got a BCG vaccine?

A

TB Skin test

interferon gamma release assay

47
Q

TB management

A

Referral to TB specialist, DPH

  • Empiric treatment
  • 4 drug for 6 months:
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ethambutol
  • Observation or call to make sur compliance
  • Many SE’s
  • Med compliance
  • Monitor SE
  • CBC, renal, liver
  • Paraesthesia common SE
  • Screen for HIV
48
Q

how does the TB skin test work

A

return in 48-72 hrs, measure induration

49
Q

interpreting skin test positive >15mm, >10mm, >5mm?

A

>15mm: general pop

>10mm: high risk, < 4 yrs old, job, IVDA, chronic dz, recent immigrant

>5mm: immunosuppressed/HIV, recent TB contact, children suspected to have TB, organ transplant recipients

if +, want to r/o active TB but asking for sx’s and chest x ray. if all negative = latent TB

can have a false + if BCG vaccine recent or had TB in past

50
Q

when would you do a IGRA (quantiferon gold) over a Mantoux test?

A
  • 5 yrs+
  • unlikely to f/u
  • poor transportation
    • PPD in past
  • treated for latent TB
51
Q

TB management

A

if have HIV = refer

r/o active TB by asking sx’s and chest xray

defer tx in preg til after delivery

tx 4-6 months- 9 months

educate SE’s

admin vitamin B12

52
Q

how is Lyme disease ticks transmitted

A

via deer ticks

must be attached for at least 36 hrs to be transmitted; will fall off after 5 days

53
Q

lyme prevention

A

DEEP

doxy prophylaxis if > 8yrs old and IF have tick bite, live in endemic area , tick ON for 36 hours, pt removed tick w/in 72 hrs or tick engorged with blood

54
Q

lyme tick testing/serology

A

NOT recommended esp with a pt with primary erythema migrans

dx based on presentation and give doxy!

best thing is educate and prevent

55
Q

lyme dz diagnosis factors

A
  • clinical characteristics: erythema migrans > 5cm with central clearing
  • epidemiologic link (possible tick exposure in an endemic area
  • start doxycycline for 10 days
  • no test of cure
56
Q

lyme stage 1 early localized

A

erythema migrans - bulls eye rash

no pain or itchy, fever, fatigue, myalgia

57
Q

lyme stage 2 early disseminated

A
  • Cardiac sxs: carditis and AV block
    • Ceftriaxone IV then switch to oral doxycycline
  • Flu like sx, lymphadenopathy, neuro: facial nerve palsies, arthralgies (common)
58
Q

lyme stage 3 late disseminated

and post Lyme disease syndrome / chronic lyme

A
  • 60% arthritis
  • Peripheral neuropathy
  • encephalopathy/myelitis
  • Dx is controversial
  • Fatigue, joint pain after tx for lyme
  • No benefit for long term antib use and can cause harm. Evaluate if it’s something else that’s not lyme dz
59
Q

anaplasmosis sx’s and tx

A

NO rash

GI symptoms (n/v/d)**

fever, chills, thrombocytopenia

if suspected, give doxycycline x 10 days (can use in preggos)

60
Q

ehrlichiosis sx’s and tx

A

rash, fever, chills, leukopenia

start doxy asap!

61
Q

babesiosis sx’s

A
  • invades erythrocytes = hemolytic anemia/tissue hypoxia
  • Blood transfusions or deer tick
  • May be asymptomatic
  • Flu-like symptoms
    • Fatigue
    • Nausea and vomiting
    • Thrombocytopenia
    • Hemolytic anemia
    • Elevated liver enzymes
    • Proteinuria or hematuria
62
Q

Babesiosis diagnostics and management

A
  • have viral like illness, was outdoors in babesial endemic area, dx with lyme dz
  • PCR
  • Blood smears
  • CBC/diff
  • LFT’s
  • Management
    • Asymptomatic = no tx
    • When treated, expect improvement in 3 days
    • Mild to moderate
      • Oral atovaquone plus azithromycin
    • Severe
      • Hospitalization with IV antibiotics (older, comorbidities, immunoc)
      • RBC exchange transfusion
        • High grade parasitemia

NURP 532 (13 decks)

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