HIV, STI, Atypical Mycobacterial And Fungal Diseases Flashcards

Question

Cytomegalovirus (Tx)

Answer 1

No curative treatment for CMV, generally healthy adults and children not treated, but immunocompromised will get antivirals Prevention is key! Personal hygiene, avoid contact with body fluids/passing body fluids to others, appropriate disposal of infected items, don’t share glasses/kitchen utensils, safe sex

Answer 2

Sexually transmitted infection (STI) caused by Neisseria Highest rates among teens, young adults and African Americans

Answer 3

sexual contact or via childbirth

Answer 4

Symptoms vary Men may be asymptomatic, experience dysuria or have a penile discharge (1-14 days after exposure) Can develop epididymitis if untreated, and rarely, sterility

Answer 5

typically asymptomatic or low-grade symptoms like dysuria, increased vaginal discharge or bleeding between periods Potentially serious complications if left untreated – PID/abscess and be at increased risk for ectopic pregnancy, infertility

Answer 6

Anal infections May be asymptomatic, or have bleeding, burning, discharge Throat infections May be asymptomatic or have sore throat Can occasionally get disseminated infection of bloodstream or joints (arthritis), potentially life-threatening May disseminate infection to blood stream and joints (arthritis)

Answer 7

Increased risk of transmitting or being infected with HIV Chlamydia

Answer 8

Testing – anyone who is sexually active is at risk (vaginal, anal, oral) Those with symptoms, pregnant women or those with a partner who has recently tested positive Those with a positive test need to be tested for other STIs Chlamydia testing often done in conjunction

Answer 9

Tests: culture, gram stain, DNA probe with amplification Screening (including pregnant women) or diagnostic Specimen: swab of discharge or secretion: cervix, urethra, penis, anus, or throat Testing for Chlamydia trachomatis typically done concurrently since similar symptoms If positive, partner also needs testing/treatment In NC, law allows EPT – “expedited partner treatment”

Answer 10

Antibiotic treatment for those with positive tests Antibiotic resistant strains of gonorrhea increasing so if still symptomatic after a few days of treatment, may need to f/u with provider Fluoroquinolone resistance has developed Oral cephalosporins no longer recommended as a single drug for treatment;

Answer 11

Bacterial STI caused by Treponema pallidium AKA “ the great imitator” Stages classified as primary, secondary and late/latent

Answer 12

Transmission: direct contact with a syphilis lesion Vagina, penis, anus, rectum, mouth Can also be transmitted by pregnant woman to child Not spread by contact with inanimate objects

Answer 13

Heralded by “chancre”, a firm, round, painless lesion, which may be single (entry point) or multiple Incubation 10-90 days (median: 21) Chancre/s typically heal w/o treatment in 3-6 weeks, but infection progresses if not treated

Answer 14

Development of non-pruritic body rash after chancre heals Appearance of rash varies from faint to reddish brown spots, but unlike many rashes, affects palms of hands and soles of feet May have associated symptoms: fever, lymphadenopathy, sore throat, patchy hair loss, headaches, weight loss, muscle aches, fatigue Will resolve with or without treatment but will progress to late/latent stage

Answer 15

Without treatment of infection, will develop latent disease (asymptomatic but seropositive) About 15% will go on to develop late syphilis, may occur 10-20 years after initial infection acquired Manifestations: internal organ damage: brain, CNS, eyes, heart & vascular system, liver, bones, and joints Dementia, paralysis, gradual blindness, coordination difficulty, …can cause death

Answer 16

Screening: Venereal Disease Research Lab (VDRL) or rapid plasma reagent (RPR) tests Diagnosis: Fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum particle agglutination assay (TPPA) Specimens: scraping from chancre, blood, or CSF (latent syphilis) sample depending on test and stage of disease

Answer 17

2-5 X increased risk for HIV infection | Chancre increases risk to transmit infection to others or to be exposed from a HIV+ person

Answer 18

Treatment – parenteral penicillin (dose & type depends on stage) Can become re-infected, no immunity after infection Prevention is key Condoms can help, but may not cover infected area Avoid drug/alcohol use that may lead to risky behavior

Answer 19

Bacterial STI caused by Chlamydia trachomatis

Answer 20

Transmission – oral, anal or vaginal sex or via vaginal childbirth when pregnant woman infected Increased risk with greater number of partners Teen girls and young women at greatest risk due to immature (open) cervix

Answer 21

Women: asymptomatic, or may depend on infection: vaginal discharge, dysuria or if spreads to fallopian tubes may develop fever, abdominal pain, low back pain, nausea, pain during intercourse, bleeding between periods Can spread to rectum Men: penile discharge, dysuria, pain or pruritus around meatus Male to male receptive sex: rectal pain, discharge bleeding with chlamydial infection Either men or women can develop oral chlamydia

Answer 22

Specimen: sample or secretion from the infected area, such as the cervix, urethra, penis, anus, or throat (or urine for molecular testing) Preferred: nucleic acid amplification tests (NAAT) due to high sensitivity & specificity of molecular testing Other: direct fluorescent antibody (DFA) stain, DNA probe (less sensitive than NAAT), rapid test being evaluated for widespread use Typically done in conjuction with n. gonorrhoeae testing

Answer 23

Untreated infection in women can lead to PID, ectopic pregnancy, infertility Also increases risk of developing HIV if exposed Recommended annual screening for all women Chlamydial pneumonia (PNA), and conjunctivitis, could result in premature delivery in pregnant women

Answer 24

Treatment: Azithromycin (single dose) or doxycycline (1 week course) Sex partners need treatment In NC, can provide expedited partner treatment Recommended that retesting occur 3 months after treatment, even if partner treated Tx chlamydia alone, but for gonorhhea, treat both chlamydia and gonorhhea

Answer 25

Herpes Virus family 50+ different viruses 4 are pathogenic to humans HSV, VZV, EBV, CMV ``` Herpes simplex HSV-1: mouth & lips HSV-2: anogenital Herpes Whitlow (infection under culture as a result of contact with oral lesion) Other: buttocks, trunk ```

Answer 26

Dx: grouped small & uniform vesicles on erythematous base that Vesicles typically preceded by 1-2 days of tingling, burning, itching. May have low grade fever & malaise Commonly recurs in same area; rate recurrence varies UV light, trauma & systemic changes may predispose Viral shedding occurs until crusted in 4 -7 days, contagious until lesions healed Course is 5 -14 days per episode, typically heal without scarring Fluid in lesion is contagious, not the lesions

Answer 27

clinical signs & symptoms, PCR or culture Differential diagnosis: Herpes Zoster Impetigo (cold sore- like lesions) Apthous ulcers

Answer 28

Symptomatic – goal is to relieve discomfort and promote healing Antivirals: Acyclovir (zovirax) Available in topical, oral or IV, depending Acyclovir MOA: decrease viral shedding, new lesion formation & promotes healing Complications: Can disseminate in immunocompromised Pregnant women Neonatal disseminated disease

Answer 29

Varicella Zaoster virus (chicken pox) this is a.k.a. shingles. Rash follows nervous pathway Most common in people over 60

Answer 30

Pain/ itching, fever, headache, fatigue before presentation of rash Rash follow never paths (dermatomes)

Answer 31

Clinically Dx PCR, Dircet fluorescence antibody (DFA) test Differential Herpes symplex , insect bites, need to rule out HIV

Answer 32

Self-limited, pain relief, anti-viral to shorten the course, tx of secondary infections, oral and antibacterials for secondary infections. Vaccine preventable (after the age of 60)

Answer 33

Human Papilloma Virus Most common STI in the US 40 types that can affect males and females 90% of the cases will clear within 2 years May cause cancer (warts, cervical, anal, (mouth, throat in males)

Answer 34

Sexual contact including oral and genital

Answer 35

Vaccine preventable in children Gardicill protects against cervical cancer, warts, and other cancers in males and females. Cervarix protects against cervical cancer There is a new Gardicil 9 that protects against everything. Currently no to, but warts and lesions can be treated

Answer 36

N test for males

Answer 37

Greater recognition due to improvement of diagnostic testing which can distinguish Mycobacterium tuberculosis from other mycobacterium Increased infections with HIV Non-tuberculous mycobacteria (NTB) classified on growth rates Rapidly growing further classified as pigmented or non-pigmented M. fortuitum reservoirs – soil, water, mammals, marine life

Answer 38

Most commonly causes skin, bone and joint disease In both immunocompetent and immunosuppressed Also: nosocomial disease outbreaks (e.g., sternal wound infections, plastic surgery wound infections, post-injection abscesses) & pseudo-outbreaks Rarely, pulmonary disease

Answer 39

Diagnosis: recovery of organism from wound or tissue w/o alternative explanation For pulmonary disease: sputum for acid fast bacteria X 3, CXR evidence

Answer 40

Guided by antimicrobial susceptibility

Answer 41

Disease typically chronic but progressive.

Answer 42

Mycobacterium Avium Complex (MAC) M. avium and M. intracellulare Several different syndromes: In children, cervical lymphadenitis In HIV+ persons, disseminated disease Less commonly: In immunocompetent persons, pneumonia Incidence unknown, not nationally reportable but decreasing incidence with HIV disease due to HAART therapy and antimicrobial prophylaxis

Answer 43

``` Etiology: environmental Air, food, water Many types of animals can be infected Cows, dogs, pigs, chickens, birds, etc. Not spread between persons ```

Answer 44

Symptoms: may include night sweats, weight loss, abdominal pain, fatigue, diarrhea, and anemia Typically affects HIV+ persons when CD4

Answer 45

Diagnosis: usually culture | AFB smear and CXR showing lymphadenopathy may be added as needed

Answer 46

Includes at least 2 antimicrobials, one of which should be either clarithromycin or azithromycin Second drug is usually ethambutol

Answer 47

Helminth infections caused by soil-transmitted helminths (STHs) are common infections in poverty ridden area Most common in Americas, China, E. Asia and Sub-Saharan Africa 4 most common STHs are: roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and the anthropophilic hookworms (Necator americanus and Ancylostoma duodenale) Iron deficiency anemia and protein malnutrition linked to hookworm disease

Answer 48

Disproportionate burden: most people have a few worms, 20% of populations carries 80% worm burden Children disproportionately infected, except for hook worms which are more common in adults

Answer 49

transmission via soil contaminated with egg-carrying feces, association with poverty, poor sanitation, and lack of clean water Endemic areas factors: warmth & moisture Risk factor for adults with hookworms: agricultural occupations

Answer 50

Treatment: period deworming with antihelminth drugs: mebendazole and albendazole High re-infection rates Education & improved sanitation are key prevention factors, use of latrines, good personal hygiene Periodic deworming of populations necessary to help minimize morbidity and mortality Often administered in schools, “simplicity and safety”

Answer 51

Caused by Enterobius vermicularis Incidence: common! Estimated to be 40 million infections in US annually Most commonly occurs in 5-10 year olds, though can occur in anyone

Answer 52

Human is only natural host, not animals May be spread in crowded living conditions, between family members Can get under fingernails and spread to others, and objects which may indirectly spread infections, can also become infected by ingestion of eggs

Answer 53

Most common symptom: itching around anus, worse at night, inflammatory response, can get secondary infection at times Rarely can migrate to vagina or urinary tract Do not see systemic symptoms

Answer 54

Diagnosis: visual identification | Yellow white “thread”,

Answer 55

Treatment: albendazole or mebendazole Initial dose, and then repeated X 1 to prevent reinfection from eggs Often treat based on symptoms, don’t need lab confirmation Often treat entire families at same time Also need to launder bedding and toys every 3-7 days for 3 weeks, careful washing of hands after using the bathroom, daily laundering of pajamas/underwear for 2 weeks

HIV, STI, Atypical Mycobacterial And Fungal Diseases Flashcards

(79 cards)