ID Flashcards
(168 cards)
0
Q
Other manifestations of parvovirus
A
Arthritis
Aplastic crisis
Fetal hydrops (2-6% risk of fetal demise)
Papulopurpuric glove and socks syndrome = contagious!
1
Q
Attack rate of parvovirus
A
50% household contacts
20-30% school exposure
2
Q
HHV 6 manifestations
A
Fever followed by rash Occipital adenopathy GI symptoms Bulging fontanelle Febrile seizures (15%
3
Q
Risk factors for peripartum transmission of HIV
A
Advanced maternal disease
Prolonged ROM
Obstetric complications
First-born twin
4
Q
Diagnosis of HIV in infants
A
PCR
5
Q
HIV prophylaxis
A
Oral zidovudine for mother in 2nd trimester
IV zidovudine during delivery
Oral zidovudine for infant for 6 weeks
6
Q
HIV and c-section
A
C/S decreases risk of transmission but effect for mothers with low viral load uncertain
7
Q
PCP prophylaxis in HIV
A
Bactrim
Start at 4 to 6 weeks for all HIV exposed infants
Children 1 to 5 years if CD4 < 500
Children > 5 years if CD4 < 200
8
Q
Vaccination in HIV
A
MMR - unless < 15% CD4; 2nd dose after 4 weeks
Varicella - normal CD4 count
9
Q
HIV prophylaxis (other)
A
TB if PPD +
Varicella and measles Ig if exposed
10
Q
Histoplasma epidemiology
A
Ohio and Mississippi River valleys; bat/bird droppings; caves
11
Q
Histoplasma findings
A
95% asymptomatic
Pulmonary - mediastinal mass
Severe disease - erythema nodosum, HSM
Disseminated disease in immunosuppresed
12
Q
Histoplasma infection in infants
A
Fever, HSM, lymphadenopathy, pancytopenia
13
Q
Histoplasma treatment
A
Amphotericin B
14
Q
Coccidioides epidemiology
A
Southwest US
15
Q
Coccidioides findings
A
60% asymptomatic
Pulmonary - flu-like illness to severe pneumonia, pleural effusions
Hypersensitivity reactions - erythema nodosum
16
Q
High risk for disseminated coccidiosis
A
Infants, Filipinos, African Americans, Hispanics
17
Q
Most common form of disseminated coccidiosis
A
Meningitis
18
Q
Treatment of coccidiosis
A
Amphotericin B
Fluconazole for CNS infections
19
Q
Cryptococcosis findings
A
Meningitis ONLY in immunocompromised hosts
20
Q
Cryptococcosis epidemiology
A
Pigeon roosting sites
21
Q
Cryptococcosis treatment
A
Amphotericin B and flucytosine
22
Q
Risk factors for invasive aspergillosis
A
Corticosteroids
Neutropenia
Chemotherapy
Acute organ rejection
23
Q
Complications of acute invasive pulmonary aspergillosis
A
Invasion of blood vessels, infarction, hematogenous spread
24
Cause of rhinocerebral disease in DKA
Mucormycoses
25
What is latent TB
+PPD with negative CXR and normal exam
26
TB meningitis findings
```
Gradual onset (2-3 weeks)
Fever, listlessness, nuchal rigidity, CN palsies (III, VI, VII), seizures
```
27
TB screening
Yearly: HIV+, incarcerated adolescents
Immediate: contact, clinical or X-ray findings, immigrants
28
PPD is considered positive when...
> 15 mm if > 4 years old and no risk factors
> 10 mm if < 4 years old or risk factors (travel, contact with high risk adults)
> 5 mm if close contact, clinical or X-ray evidence, immunocompromised
29
What percentage of healthy children with TB have negative PPD
10%
30
Latent TB treatment
9 months on INH (12 if HIV positive)
31
TB medication side effects
INH - hepatitis, peripheral neuropathy
Rifampin - orange body fluids, flu-like reaction, hepatitis
Pyrazinamide - hyperuricemia, hepatotoxic
Streptomycin - vestibular and auditory toxicity, renal toxicity
Ethambutol - optic neuritis
32
Treatment of non-TB mycobacterium
Excision
34
Exclusion of pregnant woman from workplace with parvovirus
NOT recommended
35
RMSF etiologic agent
Rickettsia rickettsii
36
RMSF epidemiology
Southeastern and south central US
37
RMSF findings
vasculitis!
fever, headache, myalgias, MS changes
rash = maculopapular/petechial, begins on wrists and ankles
38
RMSF treatment
Doxycycline (regardless of age)
| Start w/in 6 days --> low mortality
39
Ehrlichiosis etiologic agent
Monocytic - E. chafeensis
| Granulocytic - Anaplasma phagocytophilia, Ehrlichia ewingii
40
Ehrlichiosis epidemiology
E. chafeensis - SE and south central US
| Anaplasma - WI, MN, CN, NY
41
Ehrlichiosis findings
Similar to RMSF but rash is less common
42
Ehrlichiosis diagnosis
Intraleukocytic inclusions, serology
43
Ehrlichiosis treatment
Doxycycline (regardless of age)
44
Tularemia transmission
Most often = tick bite
Also - direct contact, aerosolization, ingestion
rabbits = reservoirs
45
Tularemia gram stain
small gram-negative coccobacillus
46
Tularemia epidemiology
AK, MO, TN, TX
47
Tularemia findings
Olceroglandular form = most common
| Fever, regional lymphadenopathy, ulcer/papule at site of inoculation
48
Tularemia treatment
Streptomycin
49
Leptospirosis transmission
contaminated farm bonds and animal slaughterhouses
50
Leptospirosis findings
Most often subclinical
Anicteric (milder) - abrupt fever, HA, myalgia, subconjunctival suffusion
Icteric - Weil syndrome = liver and renal failure, myocarditis
51
Weil syndrome
severe leptospirosis
52
Leptospirosis treatment
severe disease - IV PCN
| mild disease - amoxicillin, doxycycline
53
Lyme disease clinical manifestations
```
Early localized (3d to 4 wks) - erythema migrans
Early disseminated (4 to 8 wks) - flu-like, aseptic meningitis, carditis
Late disease (2 mo to years) - arthritis
```
54
Most common form of neuroborreliosis
CN VII palsy
55
Rat bite fever etiologic agent
Streptobacillus moniliformis
56
Plague etiologic agent
Yersinia pestis (gram negative coccobacillus)
57
Plague epidemiology
Western US
58
Plague transmission
Fleas, rodents
59
Plague treatment
Streptomycin
60
P. falciparum findings
Potentially rapidly fatal course, hyperparasitemia (> 5%), cerebral malaria, severe anemia, multi-organ failure
61
P. vivax and P. ovale findings
Anemia, hypersplenism, relapse (latent hepatic stage)
62
Malaria diagnosis
Thin and thick smear
63
Malaria treatment
Severe disease - Quinidine
| Chloroquine resistant - Atovaquone, Mefloquine
64
Malaria findings
Paroxysms of fever, chills, HA, nausea, vomiting, abdominal pain, pallor, jaundice
65
Babesiosis microbiology
Intraerythrocytic protozoa
66
Babesiosis transmission
Ticks (Ixodes scapularis - same as Lyme disease)
67
Babesiosis findings
Fever, malaise, HA, mild HSM, conjunctival injection
| Symptoms more likely in asplenic, immunocompromised
68
Babesiosis treatment
Clindamycin + quinine
| Atovaquone + azithromycin
69
Most common helminthic infection
Ascariasis
70
Loffler syndrome
ascariasis pneumonitis
71
Ascariasis complications
abdominal pain, obstruction, pancreatitis, malnutrition
72
Hookworm agent
Necator americanus
73
Common cause of iron-deficiency anemia in the developing world
Hookworm (N. americanus)
74
Hookworm findings
Pruritic dermatitis at entry site, anemia, hypoproteinemia, growth delay, neurodevelopmental delay
75
Whipworm agent
Trichuris trichiuria
76
Whipworm findings
Dysentery syndrome (diarrhea!), chronic colitis, rectal prolapse
77
Pinworm agent
Enterobius vermicularis
78
Pinworm transmission
Fecal-oral (childcare, school)
79
Trichinella findings
```
1-2 weeks after ingestion - gastroenteritis
Tissue phase (2-8 weeks after ingestion) - fever, bilateral peri-orbital edema, conjunctival/subungual hemorrhages
```
80
Larva migrans agent
Toxocara canis, Toxocara cati
81
Larva migrans transmission
Contaminated sandboxes, playgrounds
82
Larva migrans diagnosis
Hypereosinophilia, hypergammaglobulinemia, elevated isohemagglutinin to A/B blood groups
83
Tapeworm agent
Pork tapeworm - Taenia solium
| Larvae - Cysticercus cellulosae
84
Definitive host for tapeworm
Human
85
Tapeworm epidemiology
Most cases imported from Latin America or Asia
86
Indication for Varicella Ig
Neonates whose mother develop infection 5d before or 2d after delivery
87
Measles rash
Begins on neck/head/face; spreads to trunk; becomes confluent
88
Rubella findings
Adolescents
Pinpoint rash that begins on face and spreads to trunk
Post-auricular/post-occipital tender adenopathy
89
C. trachomatis pneumonia
Develops in 10-20% of infants born to women with C. trachomatis
30-50% of infants have h/o conjunctivitis
90
AOM bacteria resistance
S. pneumoniae - altered PCN binding protein
| H. flu, M. catarrhalis - beta-lactamase
91
Patients with mono and this disorder are at risk for ALF
XL lymphoproliferative disorder
92
Pathophysiology of SSSS
Exfoliative toxin of S. aureus
93
Most likely location to recover organism responsible for SSSS
Nasopharynx
94
Most likely location to recover organism for bullous impetigo
Skin lesion
95
Treatment of SSSS vs. bullous impetigo
SSSS - systemic anti-staph abx
| Bullous imeptigo - topical abx
96
Poor prognostic factors in children with meningococcemia
Hypotension
Petechial lesions w/in 12 hours of presentation
WBC < 10 K
Absence of meningitis
97
Most common infectious cause of E. nodosum
Streptococcal infection
98
GAS
S. pyogenes
99
Ecthyma gangrenosum agent
Pseudomonas (signifies pseudomonal sepsis in immunocompromised patient)
100
Bullous impetigo lesions
Localized, Nikolsky sign absent
101
Enteric organisms transmitted in childcare settings
Bacteria - Shigella, E. coli
Virus - Rota, HAV
Parasites - Giardia, crypto
102
AOM agent least likely to remit spontaneously
S. pneumonia (15-20%)
103
Most common cause of VP shunt infection
Coagulase negative staph
104
Classic CXR findings of inhalation anthrax
Widened mediastinum (hemorrhagic mediastinal lymphadenitis)
105
Salmonella transmission
Poultry, pork, eggs, dairy, turtles, iguanas
| Childcare center transmission = uncommon
106
Enteric fever agents
Salmonella typhi, Samonella paratyphi
107
Enteric fever findigns
fever, abdominal pain, HSM, AMS, bradycardia, "rose spots"
108
Indications for antibiotics in Salmonella infection
Gastro in pt at high risk for bacteremia/suppurative infections
Bacteremia/Meningitis/Osteo
Enteric fever
109
Salmonella treatment
Cefotaxime or ceftriaxone
110
Most common complication of Shigella
Seizures (10-45% of hospitalized children)
111
Indications for antibiotics in Shigella infection
Severe symptoms, dysentery, underlying conditions
112
Shigella treatment
Cefotaxime or ceftriaxone
113
Infections that require negative stool culture prior to return to school
Shigella
| EHEC
114
Most common cause of traveller's diarrhea
Enterotoxigenic E. coli (ETEC)
115
E. coli transmission
Ground beef, unpasteurized milk, raw vegetables, petting zoos
116
Rate of HUS in patients with E. coli O157:H7
5-10%
117
Campylobacter transmission
Poultry, meets, unpasteurized milk
| Child care transmission = uncommon
118
Complications of Campylobacter
GBS, reactive arthritis, Reiter syndrome
119
Campylobacter treatment
Azithromycin
120
Yersinia transmission
Uncooked pork, unpasteurized milk, untreated water
121
Yersinia treatment
AG's, cefotaxime, Bactrim
| Treatment indicated in severe disease
122
Most common cause of gastroenteritis
Rotavirus
123
Transmission of caliciviruses
Shellfish, contaminated water (CCC and cruise ships)
124
Most common protozoal infection in the US
Giardia
125
Patients at highest risk for giardia
Hypogammaglobinemia, HIV
126
Treatment for giardia
Metronidazole (recurs in 10-20%)
127
Cryptosporidium transmission
Person-to-person, contaminated water, farm livestock
128
Groups at risk for Cryptosporidium
Children 6-24 months, day care centers, farmers, T-cell immunodeficiencies
129
Treatment of cryptopsoridium
Nitazoxanide
130
Complications of Amebiasis infection
Intussusception, perforation, strictures, liver abscess
131
Most common parasitic infections causing death
1. Malaria, 2. Schistosomiasis, 3. Amebiasis
132
Amebiasis treatment
Asymptomatic - iodoquinol
| Symptomatic - metronidazole
133
Organisms in preseptal cellulitis
Trauma - s. aureus, GAS
| S. pneumo most likely if hematogenous or direct extension
134
Most common causes of orbital cellulitis
Ethmoid sinusitis
135
Most common organism in buccal cellulitis
S. pneumo
136
Tenosynovitis-dermatitis syndrome
Adolescent with N. gonorrhoeae infection affecting smaller joints (wrist, hand, fingers)
137
Seizures in meningitis
Occur in 30%
| If occur w/in 3 days of diagnosis they are of NO prognostic significance
138
Pneumococcal meningitis outcome
10-15% mortality, 30% long-term sequelae
139
Meningococcal meningitis outcome
3-5% mortality, 10% long-term sequelae
140
Meningitis prevention indication
Meningococcal - indicated for all close contacts (not HCW unless exposed to oral secretions)
Hib - households with patient < 4 yo and incompletely immunized
141
Meningitis prevention medication
Rifampin
142
Findings in HSV-1 encephalitis
Focal involvement of temporal lobes, hemorrhagic CSF
143
Brain abscess organisms
Usually polymicrobial (Viridans strep, anaerobes, gram negatives)
144
Brain abscess in neonates
Citrobacter species
145
Brain abscess treatment
3rd generation cephalosporin and metronidazole
146
Other manifestations of mycoplasma infection
Pharyngitis, EM, arthralgias, hemolysis
147
Prophylaxis for diptheria exposure
IM pencillin G or oral erythromycin
148
Granulomatosis infantisepticum
faint erythematous rash with small, pale nodules
associated with neonatal Listeria
maternal symptoms - GI and fever
149
Treatment of measles exposure in unimmunized children
Immunoglobulin
150
Causes of nongonococcal urethritis
C. trachomatis (23-35%), ureaplasma, mycoplasma, T. vaginalis
151
Treatment of nongonoccoal urethritis
1 g of azithromycin (or 100 mg doxycycline BID x 7d)
152
Rate of co-infection with Gonorrhea for patients with Chlamydia
15-50%
153
Cell culture findings in Chlamydia
intracytoplasmic inclusions
154
Gonorrhea treatment
Cefixime/Ceftriaxone AND treatment for Chlamydia (Azithromycin)
155
PID etiology
polymicrobial
156
Treatment of PID
A: Cefoxitin + Doxycycline
B: Clindamycin + Gentamicin
157
Syphilis presentation
Primary - nontender inguinal adenopathy, painless chancre
| Secondary - systemic sx, rash (palms/soles)
158
False positive RPR
EBV, HBV, HSV, mycoplasma, mycobacteria, SLE, Hashimoto's, pregnancy
159
Chancroid etiology
Haemophilus ducreyi
160
Chancroid findings
multiple purulent ulcers with tender inguinal adenopathy
161
Chancroid treatment
azithromcyin
162
HSV virus types
1 = oral, 2 = genital
163
Lymphogranuloma venereum findings
one papule/vesicle or pustulre, tender lymphadenopathy
164
LGV treatment
doxycycline
165
Trichomonas vaginalis treatement
metronidazole
166
Trichomonas vaginalis findings
bubbly, malodorous, yellow/gray/green discharge, strawberry cervix
167
BV diagnosis
gray/white discharge, pH > 4.5, + whiff test, clue cells
168
BV treatment
metronidazole
