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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IgM

A

early response; detected 5-10 days before sx onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

IgG

A

later response

long term

made after exposure (secondary response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

hepatitis B transmission

A
  • blood & bodily fluids (tattoo, needles, razors, saliva, semen)
    • NO BREAST FEEDING
  • can cause acute and CHRONIC hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • surface antigen HBsAg: -
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: +
A

immune from natural infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • surface antigen HBsAg: -
  • core antibody anti-HBc: -
  • surface antibody anti-HBs: +
A

immune due to hep b vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • surface antigen HBsAg: +
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: +
  • IgM anti-HBs: -
A

acute infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • surface antigen HBsAg: +
  • core antibody anti-HBc: +
  • surface antibody anti-HBs: -
  • IgM anti-HBs: -
A

chronically infected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

first lab indicator of hepatitis B infection?

A

elevation of hepatitis B surface antigen and elevated ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

hepatitis C and D, HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hepatitis C transmission

A

blood =

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

hepatitis c diagnostic

A

+ HCV antibody and + HCV RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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 +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
if mom is pregnant with hep c, when do you check child for hep c?
at 18 months
26
can you breastfeed with hep c?
yes
27
when is AIDS dx?
CD4 \< 200
28
what is the 4th generation HIV test?
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
acute HIV sx's
* 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
early treatment of HIV to
decrease transmission, decrease viral load continue indefinitely of 3 ART (2 nucleosides and integrate strand transfer inhibitor)
31
important considerations when someone is diagnosed with HIV
* 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
HIV + mom concerned about unborn child. with effective therapy, risk of transmission
lowered to \< 2 % after delivered, baby started on AZT for 4-6 wks to prevent HIV infxn
33
steps to prevent HIV transmission from mom to baby
* 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
is infant's blood is taken day 1 and at 2 week mark and is + for HIV, this means
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
How should the HIV status of the infant be determined?
Viral load by PCR at 2-3 weeks, 1 to 2 months, and 4 to 6 months
36
HIV and pneumococcal vaccine?
ok to admin 1st dose of pneumococcal vaccine series now (if CD4 \>100) but make sure its inactivated
37
HIV sx's in children
Recurrent or severe infections AOM, sinusitis, pneumonia, bacteremia Growth failure • Pubertal delay • Anemia, thrombocytopenia, neutropenia • Hepatomegaly, splenomegaly • Opportunistic infections • Candidiasis • Diarrhea
38
HIV med monitoring
osteopenia infections cancer depo and progestin pills interactive higher cardiovascular risk
39
highest risk of TB reactivation is
first 2 yrs
40
ghon focus
white spots when infected tissue dies in lungs from tb
41
risk factors that increase risk of latent to active TB
\< 5 yrs old diabetes immunosuppression highest rates: \> 65 yrs, lowest: 5-14 yrs old
42
latent TB
* 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
active tb sx's
* 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
TB can affect what areas
lungs, lymphatic system, the pleura, the bone and joint, and peritoneal, GU, and meningeal.
45
TB gold standard analysis
sputum culture but takes few weeks to come back
46
preferred method for TB testing children \< 5? what is preferred if they got a BCG vaccine?
TB Skin test interferon gamma release assay
47
TB management
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
how does the TB skin test work
return in 48-72 hrs, measure induration
49
interpreting skin test positive \>15mm, \>10mm, \>5mm?
\>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
when would you do a IGRA (quantiferon gold) over a Mantoux test?
* 5 yrs+ * unlikely to f/u * poor transportation * + PPD in past * treated for latent TB
51
TB management
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
how is Lyme disease ticks transmitted
via deer ticks must be attached for at least 36 hrs to be transmitted; will fall off after 5 days
53
lyme prevention
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
lyme tick testing/serology
NOT recommended esp with a pt with primary erythema migrans dx based on presentation and give doxy! best thing is educate and prevent
55
lyme dz diagnosis factors
* clinical characteristics: erythema migrans \> **5**cm with central clearing * epidemiologic link (possible tick exposure in an endemic area * start doxycycline for 10 days * no test of cure
56
lyme stage 1 early localized
erythema migrans - bulls eye rash no pain or itchy, fever, fatigue, myalgia
57
lyme stage 2 early disseminated
* Cardiac sxs: carditis and AV block * Ceftriaxone IV then switch to oral doxycycline * Flu like sx, lymphadenopathy, neuro: facial nerve palsies, **arthralgies** (common)
58
lyme stage 3 late disseminated and post Lyme disease syndrome / chronic lyme
* 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
anaplasmosis sx's and tx
**NO rash** **GI symptoms (n/v/d)\*\*** fever, chills, thrombocytopenia if suspected, give doxycycline x 10 days (can use in preggos)
60
ehrlichiosis sx's and tx
rash, fever, chills, leukopenia start doxy asap!
61
babesiosis sx's
* 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
Babesiosis diagnostics and management
* 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