Diseases, Clinical Presentation, Time Course, Signs, Symptoms Flashcards

Question

Francisella tularensis | Clinical Presentation

Answer 1

Mimics many other diseases

Answer 2

``` If exposure via flea: bubonic…25% progress to septicemia… leads to secondary pneumonic plague with septicemia (100% fatal if left untreated) ``` If exposure via bioterrorism: Primary pneumonic plague first… then septicemia

Answer 3

Symptoms often confused w/ TB, but rarely involves the lungs Slow moving, chronic infection; but initial infection can be acute may go on for several yrs before treated Long term sequelae sometimes: hepatitis, endocarditis

Answer 4

One-third to one-half asymptomatic ``` Acute febrile illness, atypical pneumonia (lasts 2-4 wks); Sometimes liver and heart involvement; Long-term chronic infections=rare, but may lead to endocarditis or granulomatis hepatitis ```

Answer 5

hallmark of chlamydial infection: most cases have mild to no apparent clinical disease, while some have severe Pneumonia also assoc w/ sinusitis, pharyngitis, bronchitis, exacerbated asthma, coronary heart disease? (interaction of serum lipoprotein w/ circulating C. pneumoniae immune complexes-->atherosclerosis) cause of 35-50% nongonococcal urethritis in men; common cause of cervicitis, PID, & sterility in women **All three serotypes can-->systemic (hemotagenous spread)

Answer 6

usually single, isolated cases--NOT cluster of cases Pontiac Fever usually milder disease and passes in 2-5 days

Answer 7

mild respiratory infections w/ sore throat and pharyngitis in the 1-5yr old group w/ primary atypical pneumonia Upper and lower respiratory illness in all age groups

Answer 8

Localized swelling w/ suppuration, abscess | formation, tissue fibrosis, draining sinuses

Answer 9

95% of infections are asymptomatic or lead to cough and fever minority of infections-->chronic and relapsing pneumonia that resembles TB Fatality rate w/ untreated systemic disease= 80% (25% if treated) (flu like symptoms at first)

Answer 10

``` incubation period of C. pneumoniae is 3-4 wks gradual onset (may be biphasic) symptoms of bronchits or pneumonia may follow URI symptoms (i.e. rhinitis, laryngitis, pharyngitis, sinusitis) in 1-4 wks ```

Answer 11

symptoms usually begin 2-14 days after exposure Pontiac fever: symptoms last for 2-5 days

Answer 12

Gradual, insidious onset of several days to weeks incubation period about 3 wks (in contrast to viral pneumonias, which average few days)

Answer 13

Slow generation time (15-20 hrs) Stage 2 begins 7-21 days after intial infection

Answer 14

Fever Red, swollen, warm, painful skin areas orange, bumpy skin w/ blisters Cough

Answer 15

Typical lesion on biopsy (bone/liver) is | granuloma

Answer 16

pharyngeal erythema w/out exudate | rhonchi and rales (even in mild disease)

Answer 17

high fever, chills, cough

Answer 18

Cutaneous Nocardiosis: ulcers or nodules chronic infection-->draining tracts

Answer 19

sulfur granules

Answer 20

``` Chest pain Dyspnea burning feeling while urinating sleepiness headaches stiff neck ```

Answer 21

Early symptoms (last for 1-2 wks): Runny nose, low-grade fever, mild cough, apnea (in infants) Catarrhal: similar to "common cold" mild cough gradually increases (see above) Paroxysmal: cough persists and incr… paroxysmal attacks…classic cough (long series w/ gagging&cyanosis, whooping) 2-6 wks; complications most likely this stage Convalescent: cough subsides over wks and months; episodic cough may reappear w/ subsequent URIs

Answer 22

fever, chills, joint and muscle pain, headache, weakness, pneumonia--> chest pain, bloody sputum, dyspnea Ulcerglandular tularemia (most common): skin ulcer@site of infection, swollen&pain- ful lymph glands; fever; chills; headache; exhaustion Glandular tularemia: same as ulceroglandular except no skin ulcers Oculoglandular tularemia: eye pain, eye redness, eye swelling and discharge; ulcer on inside eyelid Oropharyngeal tularemia: (digestive tract); fever sore throat; vomiting; diarrhea Pneumonic tularemia: pneumonia signs&symptoms

Answer 23

Bubonic: (60% fatality if untreated); initial infection from flea bite (1-8 day incubation) swollen painful axial/inguinal, femoral lymphnode fever, chills, headache, nausea, vomiting, prostration ulcerous/macular lesion possibly @site of flea bite (not as prominent as in tularemia/anthrax) Septicemic: (w/ or w/out buboes); rapid progression, severe toxemia & general organ failure; vomiting, diarrhea; petechiae to extreme DIC Pneumonic: (100% fatal if not treated); Secondary pneumonic will include septicemia; dissemination from primary infection; productive sputum more bloody and watery than purulent; necrotic

Answer 24

Flu symptoms w/ high fever Relapsing fever (nocturnal w/ night sweats) weakness, generalized symptoms (back ache, etc.) weight loss, fatigue Can be localized… infects bones (esp. lower vertebrae) liver, heart, GI, and genitourinary tracts (orchitis) If inhaled aerosols….dry cough, pleuritic pain (CXR might be negaitve); expected course if bioterrorism

Answer 25

similar to many other forms of pneumonia high fever, chills, cough muscle aches and headaches sometimes Pontiac fever: fever, headaches, muscle aches WITHOUT Pneumonia!

Answer 26

``` Fever Malaise Persistent, slowly worsening dry cough (absence of cough makes Dx unlikely) headache chills, not rigors scratchy sore throat sore chest and tracheal tenderness (due to cough) pleuritic chest pain (rare) ```

Answer 27

``` Pulmonary nocardiosis: blood in sputum fever night sweats weight loss chest pain accompanying ventilation ``` ``` Cerebral nocardiosis: headache confusion general lethargy dissipating neuro function seizures ```

Answer 28

``` Chest pain when taking deep breath Cough w/ sputum Fever Lethargy night sweats shortness of breath weight loss ```

Answer 29

fever night sweats weight loss ``` In immunodeficient individuals/infants: disseminated disease…renal failure, CNS effects (i.e. meningitis, encephalitis) In AIDS: abdominal masses/ ulcers ```

Answer 30

``` fever arthralgia fatigue rash (fatigue can last for wks/months) ```

Answer 31

life-threatening hemoptysis

Answer 32

``` Chills fever (can be very high in infants-->convulsions, nausea vomiting, abdominal pain) headache weakness/fatigue muscle pains general discomfort, body aches runny or stuffy nose sore throat dry cough ``` fever may be absent in elderly/immunocompromised pts (as well as other systemic symptoms) Symptoms of complications: viral pneumonia: preceding flu syndrome-->worsening cough, tachypnea, increasing dyspnea, sometimes bloody sputum Secondary bacteria pneumonia: typical episode of flu w/ recovery-->recurrence of fever, increased respiratory symptoms, productive cough, purulent sputum, dyspnea

Answer 33

``` dryness/irriation of nose sore throat rhinorrhea nasal congestion sneezing headache facial & ear pressure loss of smell and taste Sometimes cough, sometimes hoarseness for up to wk ``` Fever and malaise and other systemic symptoms are usually ABSENT (consider other diagnosis if present)

Answer 34

Respiratory: Cough, fever, runny nose, watery eyes, sore throat Ocular: "sand" in eye, fever, runny nose, sore throat GI: Diarrhea, fever, nausea, vomiting, blood in urine (cystitis)

Answer 35

``` Cold Symptoms (runny nose, sore throat, cough, head- ache, fever, chills, etc.) Enteric infection: (occasionally, mostly in infants< 1yo) nausea, vomiting, diarrhea Neurological syndromes (rare) SARS: Fever is first symptom flu-like symptoms Dry cough, SOB, hypoxia Respiratory failure in 20% of pts GI symptoms Lymphopenia ```

Answer 36

In adults: rhinorrhea, cough, headache, fatigue, fever Initial URT symptoms: similar to common cold w/ progression rapidly in 1-2 days ``` LRT disease Low-grade fever Cough tachypnea polyphonic wheezing rales cyanosis retractions sepsis-like presentation/ apneic episodes in very young ``` May have associated OM (viral OR bacterial) Also should assess infant's hydration status

Answer 37

Broad spectrum, from mild-->severe ``` Similar to RSV, but may include: high fever myalgia rhinorrhea dyspnea tachypnea wheezing ``` ``` May exacerbate asthma or COPD OM pneumonitis flu-like illness CA pneumonia ```

Answer 38

fever nasal congestion pharyngeal erythema nonproductive or minimally productive cough (or cough that may develop into croup…high-pitch, seal- like barking cough w/ stridor) hoarseness If hPIV3 involved, symptoms worsen, bronchiolitis and/ or pneumonia may develop

Answer 39

``` 1st Stage: Fever and chills headaches muscle aches vomiting, diarrhea, abdominal pain sometimes cough, usually dizziness tachycardia tachypnea Usually ABSENT: signs of viral URI (i.e. rhinorrhea and pharygitis) ``` ``` 2nd Stage: A cough w/ secretions SOB Fluid accumulating in lungs Low blood pressure Reduced heart efficiency Symptoms may worsen suddenly as lungs fill w/ fluid ``` "feels like tight band around my chest and pillow over my face"

Answer 40

Histoplasmosis

Answer 41

Blastomycosis

Answer 42

Coccidioidomycosis | Valley Fever

Answer 43

Aspergillosis Seen as allergic sinusitis and allergic bronchopulmonary aspergillosis (ABPA) … in asthma and CF pts Seen as invasive pulmonary infection in immunocompromised pts (Invasive aspergillosis can spread beyond lung-->CNS)

Answer 44

Mucormycosis zygomycosis fungal pneumonia invasive rhinocerbral

Answer 45

Pneumocystic pneumonia (PcP)

Answer 46

Common Cold

Answer 47

Respiratory infection Eye infection GI tract infection ``` Acute febrile disease, pharyngitis, or pharyngoconjunctival fever Bronchitis/bronchiolitis Croup Pneumonia Acute Respiratory Disease (sero. 4& 7) Conjunctivitis Epidemic keratoconjunctivitis Acute hemorrhagic cystitis Acute gastro enteritis (sero. 40& 41) Obesity? (serotypes 36& 37) ```

Answer 48

Respiratory infections enteric infections ``` Common cold (15-395 common cold cases in winter and early spring) ``` Croup in young children Exacerbations of asthma and chronic bronchitis ``` Pneumonia occasionally (infants, elderly, immunocompromised) ``` SARS (can lead to systemic disease--> GI tract, liver, kidney, brain, etc.)

Answer 49

``` Leading viral cause of serious lower respiratory tract infections in infants world wide Most common cause of bronchiolitis and pneumonia in infants < 1yo ``` Recurrent infections w/ increasing age are usually limited to URT (usually more severe than common cold) Does NOT cause systemic infection

Answer 50

Second most commonly identified cause of pediatric lower respiratory illness (behind RSV) Acute respiratory disease (ARDs) (in older children & adults) broad spectrum of respiratory illness (from mild symptoms-->severe cough, bronchiolitis, pneumonia) Does NOT cause systemic infection

Answer 51

``` Croup (hPIV 1, 2, and 3)…(larynx and upper trachea are involved) bronchiolitis (hPIV 3) pneumonia (hPIV3) (hPIV3 second only to RSV as cause of pneumonia and bronchiolitis in infants and young children!!) hPIV4 causes less severe disease, so detected less often Other upper and lower RTIs ``` 30-40% of all acute respiratory tract infections in infants and children Does NOT cause systemic infection

Answer 52

Hantavirus Pulmonary Syndrome | severe, sometimes fatal respiratory

Answer 53

50% of infections are symptomatic least significant= flu-like illness Some cases = acute pneumonia w/ purulent, brown, or bloody sputum chronic lung infections mimics TB or lung cancer b/c formation of mass-like lesions Infection can disseminate despite lung resolution-->warty skin lesions, bone, GU tract prostate 5% AIDS pts will contract meningitis

Answer 54

Disease in 40% of infections Almost all pts fully recover, but w/ lingering fatigue 5% develop progressive pneumonia 1% disseminated infection-->meninges, skin, bone

Answer 55

Pts w/ underlying pulmonary conditions (chronic bronchitis, asthma, TB, etc.) may form "fungal ball" (aspergilloma) at sites of pre-existing lesions Disseminated disease is almost universally fatal

Answer 56

pneumonia: invasive rhinocerbral: headache-->coma-->death (b/c sinus infection erodes straight to brain)

Answer 57

diffuse, interstitial pneumonia w/ little fever-->dyspnea and cyanosis as lung infiltrates appear on x-ray-->reduced O2 saturation-->death by asphyxia

Answer 58

Type C usually asymptomatic, sometimes very mild respiratory, not epidemics usually self-limited and not serious, but can be deadly, esp. due to lower respiratory complications Complications: Pneumonia (most common and most serious) …primary viral pneumonia: abruptly develops and deteriorates w/in 1-4 days …Secondary bacterial pneumonia (super- infection): common; virus damages bronchial epithelium and disrupts mucociliary clearance of bacteria; susceptible pts 5 days after onset (especially pneumococcus, but S. aureus & haemophilus also seen)…Combined bacterial- viral infection (during recovery) vs. Post-flu bacterial pneumonia (after recovery) Sinus & ear infections Reye's syndrome--noninflammatory cerebral edema & fatty infiltration of liver-->severe hepatic dysfunction; usually in children If flu during pregnancy: loss of fetus, congenital heart defects, limb malformations (esp during 2nd &3rd trimesters

Answer 59

Restricted to upper respiratory tract (but may also cause otitis media and sinusitis) (Many pts w/ actue otitis media have rhinovirus present in nasopharyngeal secretions/middle ear fluid) May exacerbate asthma, CF, chronic bronchitis and serious lower respiratory tract illness in infants, elderly persons, immunocompromised

Answer 60

Up to 55% infections may be asymptomatic

Answer 61

Bronchiolitis = most common presentation of | hMPV (w/ or w/out pneumonia)

Answer 62

flu-like symptoms that can progress to life- threatening pneumonia Starts w/ prodrome of fever, muscle aches… rapid onset of interstitial pulmonary edema--> respiratory failure-->cardiogenic shock-->death 2 distinct stages: ….flu-like symptoms difficult to distinguish from influenza, pneumonia, etc. …After 3-7 days, more serious signs and symptoms

Answer 63

``` Virus shedding begins 1 day before onset of illness viral titer peaks w/in 48 hours post infection Little virus shedding occurs after 6-8 days ``` Fever and general systemic complaints usually disappear 3-5 days Respiratory complaints last for wks Short, 2-day incubation period, rapid onset and dissemination of infection

Answer 64

``` 12-72 hr incubation period illness usually begins w/ nose dryness/ sore throat-->then watery rhinorrhea, nasal congesition, sneezing…intensify over next 2-3 days ``` Symptoms generally last 7-11 days

Answer 65

Incubation for SARS is 2-10 days …early sympoms last 2-7 days …dry cough, SOB, hypoxia begin after 3-7 days

Answer 66

``` 1-3 days after infection…cough & low fever develop (w/ possible wheezing) (mild courses don't progress beyond this) ``` Coughing and wheezing progress; infants become dyspneic & tachypnea hypoxemia; may require hospitalization for several wks

Answer 67

Symptoms may develop b/w 1-5 wks | after exposure to urine, droppings, etc.

Answer 68

No erythema, exudate, ulceration | despite sore throat

Answer 69

Acute febrile illness, atypical pneumonia (lasts 2-4 wks) Sometimes liver and heart involvement Long-term chronic infections=rare, but may lead to endocarditis or granulomatis hepatitis

Answer 70

usually asymptomatic sometimes symptoms of bronchitis or pneumonia may follow URI symptoms ``` sputum scant, cough prominent persistent cough malaise Hx of hoarseness headache (common nonclassical finding) fever in first few days esp., usually not reported sinus percussion tenderness (more common than in other pneumonias) ```

Diseases, Clinical Presentation, Time Course, Signs, Symptoms Flashcards

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