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DTMH > Syndrome Flashcards > Flashcards

Syndrome Flashcards

1
Q

DDx acute febrile illness in South India?

A

Dengue
Scrub typhus
Malaria
Leptospirosis
Typhoid

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2
Q

What is the organism that causes Scrub typhus?

A

Orientia tsutsugamushi

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3
Q

What is the vector for scrub typhus?

A

Larval trombiculid mites

-Mite islands in jungle clearings
-Leave schars

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4
Q

Where is scrub typhus endemic?

A

Tsutsugamushi triangle
-Pakistan to Eastern Russia to Northern Australia

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5
Q

Symptoms of scrub typhus?

A

-Fever
-Fatigue
-Frontal headaches
-Myalgia
-Cough
-55% painless eschar
-Delayed generalised maculopapular rash
-Lymphadenopathy
-End organ failure (34%)

Pregnancy - stillbirth and LBW
DDx: Dengue

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6
Q

Patient presents from South India with chills, rigors and splenomegaly. Found to have thrombocytopenia, bilirubinemia, AST and ALT elevation. Likely dx?

A

Malaria (P falciparum)

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7
Q

Pt. from Thailand has body aches, bleeding on presentation. Exam shows rash, petechiae, subconjunctival hemorrhage and HM. Labs show leukopenia and thrombocytopenia. Dx?

A

Dengue

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8
Q

Pt. from Florida presents with myalgias and headache. Found to have conjunctival suffision and subconjunctiva hemorrhage. Leukocytosis, AKI and hepatitis on labs. Dx?

A

Leptospirosis

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9
Q

Pt. from India has eschar, headache and breathlessness. Labs show leukocytosis, thrombocytopenia, and elevated AST and ALT. Dx?

A

Scrub typhus

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10
Q

Pt from India has non-specific fever, chills, abdo pain and confusion. Found to have splenomegaly on exam. RDT for malaria is negative. Dx?

A

Typhoid

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11
Q

Tx of Scrub Typhus?

A

Doxycycline
Azithromycin
Chloramphenicol

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12
Q

How long are you contagious for C. diptheriae for without abx?

A

2-6 wks

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13
Q

How long are you contagious for C. diptheriae for without abx?

A

~48h

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14
Q

Symptoms of diphtheria?

A

Laryngitis or pharyngitis or tonsillitis

AND

Adherent membrane of the tonsils, pharynx and/or nose OR gross lymphadenopathy

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15
Q

Locations to check for pseudomembrane?

A

Tonsils (both)
Uvula
Oropharynx
Nasopharynx

-Simple infection if only one area
-Extensive area if two or more areas

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16
Q

5 key management steps for probable diphtheria case?

A
  1. Isolate patient, droplet and precautions
  2. Give antitoxin (DAT) ASAP
  3. Give abx (penicillin or erythromycin) following DAT ASAP
  4. Monitor for complications (airway, cardiac, neuro, renal)
  5. Vaccinate for diphtheria
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17
Q

Considerations with DAT?

A

-Anaphylaxis <1%
-Febrile rxn 4%
-Serum sickness 9%

Only give if enough people to monitor
Sensitivity test for all candidate patients

Can give to pregnant and breastfeeding women
Dose by severity of disease not of patient

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18
Q

What are the indications for DAT?

A
  • Tonsillar diphtheria/adherent plaques
  • Pseudomembrane
    -Shock and symptomatic signs
19
Q

Dosing for DAT for tonsillar and early signs?

A

20,000 IU

20
Q

Dosing for DAT for nasopharyngeal and extensive oral plaque?

A

40,000 IU

21
Q

Dosing for DAT for systemic symptoms of toxicity and hemodynamically stabilizing with fluid?

A

80,000 IU

22
Q

When not to give DAT?

A

> 7d of symptoms
Unresponsive
Airway compromised and non-salvageable
Shock resistant to appropriate treatment

23
Q

What is the vector for Zika virus?

A

Aedes aegypti (day biting)
Aedes albopictus

24
Q

What makes Aedes aegypti a good vector?

A

Day biting
Well adapted to urban environments
Multiple meals from multiple hosts

25
Q

How is Zika transmitted?

A

Mosquito bite
Sexual transmission
Blood transfusion
Transplacental transmission

26
Q

What are the clinical symptoms of Zika?

A

Inc: 3-12d
Most asymptomatic (80%)
-Rash and fever most common
-Arthralgia/arthritis
-Conjunctivitis + myalgia
-Itching
-Headache
-Back pain

Mild, self-limiting

27
Q

What are the complications from Zika infection?

A

Congenital Zika syndrome
GBS
Neuro - myelitis, encephalitis, optic neuritis

28
Q

What are the features of congenital Zika syndrome?

A

Severe microcephaly (can occur without)
Multi-organ phenotype

Craniofacial disproportion
Pointed occiput
Redundant scalp skin
Arthrogryposis
Cerebral calficiations
R diaphragmatic paralysis

CNS:
-Seizures
-Tremors
-Hypertonia
-Hyperreflexia
-Irritability

Ocular:
-Focal retinal mottling
-Macular scarring
-Cataracts
-Glaucoma
-Optic nerve atrophy

Deafness

29
Q

Zika strains?

A

Asian strain - linked with CZS
African strain - not linked with CZS, results in embryonic death (too severe)

30
Q

How to diagnose Zika virus?

A

PCR - short viremic period (3-5d from onset of symptoms, longer in pregnant women), urine good sample (stays positive longer), semen, CSF, placental and umbilical cord tissue
Serology - IgM (+ after first week of symptoms), repeat for IgG
-May not develop IgM if previous dengue

31
Q

Yellow fever epidemiology?

A

South America
Africa

32
Q

What are the four cycles of Yellow Fever spread?

A
  1. Sylvatic (jungle) cycle
  2. Athropogenic sylvatic cycle
  3. Village epidemic
  4. Urban epidemic
33
Q

What YF cycles do Africa experience?

A

All 4:

  1. Sylvatic (jungle) cycle
  2. Athropogenic sylvatic cycle
  3. Village epidemic
  4. Urban epidemic
34
Q

What YF cycles does South America experience?

A

Only 1 and 4

  1. Sylvatic (jungle) cycle
  2. Urban epidemic
35
Q

What is the clinical picture of Yellow Fever disease?

A

Inc: 3-6d (<21d)
Asymptomatic or mild febrile illness in most
-0.8-7% progress to toxic phase (30-60% CFR)

36
Q

What are risk factors for higher mortality risk for YF?

A

-Older age (>45y)
-Neutropenia
-AST >3500
-Hyperbilirubinemia
-High YFV RNA levels
-Renal dysfunction

37
Q

Prevention for YF?-

A
  • YF-Vaccine (17D) - live attenuated
  • Insect repellant
  • Avoid bites
  • Avoid rainy season
38
Q

Contraindications for YF vaccination?

A

-Aged <6 mo
-Those who had confirmed anaphylactic rxn to a previous dose of the vaccine
-Those who had confirmed anaphylactic rxn to a component of the vaccine
-Those who have had a confirmed anaphylactic rxn to egg
-Those with hx of thymus disorder and thymectomy following this
-Those with primary or acquired immunodeficiency

39
Q

What is a possible treatment for YF?

A

Galidesivir - nucleoside (adenosine) analogue
Sofosbuvir?

40
Q

Equation for transmission of a disease?

A

R0 = C x B x D

C - exposure rate of susceptible to infectious partners
B - probability of HIV transmission given exposure
D - duration of infectious period
R0 - basic reproductive number

41
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42
Q
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43
Q
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DTMH (13 decks)

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