Flashcards in ID Deck (192):
TMP-SMX. Carbapenem if brain involved (6-12 months)
Penicillin for 12 weeks
Tx. malignant otitis externa?
Think pseudomonas. IV ciprofloxacin (fluoroquinolones). Those resistant to quinolone do anti-pseudomanl penicillin or cephalosporin (pipercillin and ceftazidime/cefepime)
Another name for S. bovis type one?
How to differentiate HSV encephalitis vs pure encephalitis?
HSV has meningeal signs
HSV encephalitis gold standard diagnosis and tx.?
CSF w/ viral DNA on PCR and start IV acyclovir after CSF fluid
Testing for Parvovirus B19?
Acute infection immunocompetent-B19 IgM antibodies
Acute infection immunocompromised-NAAT (nucleic acid amplification testing).
Immunity and previous infection-B19 IgG antibodies
Diagnosis and tx rubella virus?
Anti-rubella IgM and IgG. Supportive care
Rubella congenital vs. child presentation?
Congenital-"can't see, can't hear, can't beat, can't think" Cataracts, sensorineural hearing loss, congenital cardiac anomalies, intellectual disability, "blueberry rash"
Child-Coryza/conjunctivitis, cervical lymph, cephalocaudal spread of rash (spares palms and soles)
Molluscum contagiosum concern and presentation and tx.?
Presence with HIV. Hundreds of widely distributed papules with testing if large >1cm, numerous, or widespread. tx. curretage, cryo, topical (podophyllotoxin)
How to differentiate CMV from EBV?
No cervical lymphadenopathy, no pharyngitis, negative monospot.
Infectious diarrhea best initial/most accurate test?
Best initial-Blood and/or fecal leukocytes (lactoferrin if presents as answer choice)
Most accurate-Stool culture
Tx. cryptosporidium cystoisospora?
Tx underlying AIDS or nitazoxanide
C. perfringens diarrhea assoc?
Reheated/refrigerated foods (eg reheated meat)
Salmonella diarrhea assoc?
Vibrio vulnificus diarrhea assoc?
E coli diarrhea assoc?
Undercooked beef or foods contaminated with bovine feces (O157:H7)
What should you avoid if you suspect EHEC?
Antibiotics b/c increased risk of HUS
Shigella diarrhea assoc?
Contaminated food or water with travel outside of US
Two bacterial causes of bloody diarrhea?
Shigella and campylobacter
What drug besides abx has increased risk of C diff?
PPI (prolonged gastric suppression risk factor)
Serious complication of C diff?
Tx. of cysticercosis and neurocysticercosis?
Cysticercosis (T solium)-Praziquantel
Hyatid cyst with echinococcus granulosus or echinococcus multiocularis definite, intermediate and dead end accidental intermediate host?
Definite-dogs feces that have eggs, intermediate-sheep, and humans-dead end accidental intermediate
Hyatid cyst imaging and tx.?
"Eggshell" calcification on CT scan (most commonly found in liver than lung). Tx. albendazole w/ surgical resection (ethanol or hypertonic saline injection before removal). Do not aspirate b/c risk of anaphylaxis
What should all PPD + HIV patients be given prophylactically?
Isoniazid and pyroxidine for 9 months
Two most common organisms of epiglottitis?
H influenzae and S pyogenes
Tx. hepatitis B and indication?
1) Interferon-younger pt., compensated liver dz
2) Lamivudine-HIV patient b/c high drug resistance
3) Entecavir-decompensated cirrhosis
4) Tenofovir-most potent w/ limited resistance (preferred in countries that have it)
Hep B post exposure prophylaxis protocol?
Immunized-reassurance, but if no HbsAb + immunity can give Hb booster vaccine
No immunized-vaccine and Ig ASAP
Tx of cryptococcal meningoencephalitis?
IV amphotericin B and flucytosine for 2 weeks followed by 8 weeks fluconozole and maintenance therapy >1 year.
Empiric antibiotics for meningitis age 2-50 and most common organism?
N. meningitidis and S. pneumoniae. Vancomycin and third gen cephalosporin
Empiric antibiotics for meningitis age >50
S. pneumoniae, N. meningitis, Listeria. Vancomycin and ampicillin and 3rd gen cephalosporin
Empiric antibiotics for neurosurgery/shunt or penetrating skull trauma?
Gram neg rods, S. aureus, and coagulase-negative streptococcus. Vancomycin and cefepime
Empiric antibiotics immunocompromised?
Pneumococcus, N. meningitidis, Listeria, gram neg rods. Vancomycin plus ampicillin plus cefepime
Alternate drugs to cefepime?
Ceftazidime or meropenem
Alternate drugs to ampicillin for listeria?
Trimethoprim and sulfathizole
Natalizumab or rituximab.
Unique features of HIV that differentiate from mono?
Maculopapular rash, painful mucocutaneous lesions, and diarrhea
Best initial/confirmatory screening HIV?
Best initial-HIV p24 antigen and HIV antibodies screening assay
If positive-testing with HIV-1/HIV-2 antibody differentiation immunoassay
CD4 count at risk Prophylaxis P. jirovecii?
Less than 200. TMPSMX and corticosteroids
CD4 count at risk Prophylaxis and tx. T. gondii?
Less than 100. Prophylaxis TMPSMX. Tx. sulfadiazine and pyrimethamine
CD4 count at risk, prophylaxis and tx. MAC?
Less than 50. Azithromycin and clarithromycin. Azithromycin
CD4 count and prophylaxis histoplasma?
Less than 150. Itraconazole
CD4 count and prophylaxis and tx. cryptosporidium
Less than 180. Filtering water. Nizazoxanide
What CD4 level is esophagitis a complication of HIV?
Less than 100
If patient has more pain with swallowing (severe odynophagia) without dysphagia, what type of esophagitis is more common?
When is HAV vaccine indicated?
IVDU, MSM, chronic liver disease (including HBV and HCV)
When is HBV vaccine indicated?
No documented immunity
When is HPV indicated?
men and women 9-26
When is influenza indicated?
Annually for all patients
When is meningococcus indicated?
All patients 11-18. large groups in proximity (college, military, incarcerated)
When is pneumococcus indicated?
PCV13 once, PPSV23 8 years later, than every 5 years
When is Tdap indicated?
Tdap once and repeat if pregnant, Td every 10 years after Tdap
What are live vaccines and when are they contraindicated?
MMR, varicella, zoster, live attenuated influenza and if CD4
HIV prophylaxis protocol?
Two NRTI PLUS integrase inhibitor or protease inhibitor or NNRTI
Ddx of any BMT recipient with lung and intenstinal involvement?
What should be done before therapy is started for HIV associated diarrhea?
Rule out other possible causes! Stool culture, ova and parasite examination and test for C.diff toxin
Primary syphillis tx and if allergic what tx.?
IM penicillin 1 dose. 14 days doxycycline
Secondary syphillis tx. and if allergic what tx.?
IM penicillin 1 dose. 14 days doxycycline
Latent syphillis tx. and if allergic what tx?
IM penicillin 3 dose. 28 days doxycycline
Tertiary syphillis tx. and if allergic what tx?
IV penicillin G 14 days. 14 days ceftriaxone
Pregnancy syphilis tx. and if allergic what tx.?
Penicillin. Desensitize and administer penicillin
Diagnosis and Treatment disseminated gonococcal infection?
Nucleic acid amplification. IV ceftriaxone (1 g/day) for 7-14 days. Azithromycin (single 1 g) OR doxycycline for 7 days of concomitant chlamydial infection. Tx. sexual partners
Diagnosis and tx of trachoma?
Diagnosis-giemsa stain from conjunctival scrapings. Tx. Topical tetracycline OR oral azithromycin
Urethritis diagnosis and tx?
Diagnosis-nucleic acid amplification/first catch. Azithromycin OR doxy and ceftriaxone if gonococcus not ruled out
Gold standard diagnosis malaria?
Thin and thick peripheral blood smears (gold standard)
Atovaquone and azithromycin
Malaria tx for sensitive and resistant?
IV nafcillin or cefazolin
How do you differentiate peritonsillar abscess from epiglottitis?
Peritonsillar abscess has uvula deviation and unilateral lymphadenopahty
Diagnosis for influenza and post-influenza complications
Nasal swab for influenza antigens. S. aureus infection that must be treated with anti-staphylococcal abx
Cause of osteo from history of nail puncture?
What is febrile neutropenia and what is management?
Diagnosis and tx of leprosy?
Diagnosis: Acid fast bacilli on skin biopsy
Treatment: Tuberculoid (dapsone and rifampin). Lepromatous (Dapsone and rifampin and clofazimine)
PEP for rabies?
Healthy appearing domesticated: Observe animal for 10 days w/o PEP b/c incubation period can be long after bite for animals
Unvaccinated individuals: PEP (rabies Ig and rabies vaccine) is example of passive-active immunity
Most common valvular abnormality in patients with infective endocarditis?
MVP with coexisting mitral regurg
Best initial: Blood culture
Most accurate: TEE
Vancomycin empiric initial and subsequent based on cultures
Modified duke criteria endocarditis?
Major-+culture (viridans, aureus, enterococcus), +valvular lesion ECHO
Minor-fever, IV drug, predisposing cardiac lesion, emboli, + blood culture
Definite: 2 major OR 1 major and 3 minor
Possible: 1 major and 1 minor OR 3 minor
MCC healthcare associated IE and assoc. conditions and tx.?
S. aureus. Prosthetic valves, Intravascular catheters, implanted devices, IV drug. vancomycin
MCC community associated IE and assoc. conditions and tx.?
Viridans (S. mitis, sanguis, mutans, salivarius). Dental procedures and procedures involving incision and biopsy of resp. tract. aqueous penicillin G.
culture - bacteria that can cause endocarditis due to poor dentition or periodontal manipulation?
E corrodens is gram - that is part of normal oral flora and HACEK organism
Tx. uncomplicated pyelo
Mild: ORAL Fluoroquinolone, TMP-smx
Severe: IV Ceftriaxone, fluoroquinolone, TMP-sMX
Tx. complicated pyelo
Mild to moderate (Ceftriaxone, cefepime, fluoroquinolone)
Severe (Ampicillin-sulbactam, ticarcillin/piperacillin-cavulonate/tazobactam, meropenem, imipenem, aztreonam)
IV ceftraxone +/- gentamicin, aztreonam
Acute vs chronic prostatitis tx.?
Acute-tmp-smx or fluoroquinolones, chronic-fluoroquinolines
Cause of erysipelas and location?
Group A B-hemolytic strep (S. pyogenes) commonly found on legs
Giardia vs E. histolytica (amebiasis) presentation, test, and tx.?
Giardiasis (bloating, flatulence, foul smelling fatty diarrhea)
Amebiasis (dysenteray, RUQ pain, liver abscess)
Giardiasis-stool for trophozites. E. histolytica-serology b/c stool microscopy insensitive when localized liver abscess formed.
Tx. Metro for giardiasis. metro (liver cyst) and paromycin (intestinal colonization) for amebiasis
How do identify difference in bacillary angiomatosis vs kaposi sarcoma?
Bacillary angiomatosis-neutrophil infiltrate. Be careful with tissue biopsy b/c hemorrhage risk
Kaposi -lymphocyte infiltrate
Tx of bacillary angiomatosis?
MCC ventilator assoc. pneumonia?
Most common causes of secondary bacterial superinfection after viral infection?
S. pneumo, S. aureus, H influenzae
Specific findings of MAC in addition to nonspecific fever, cough, abdominal pain, and diarrhea?
Splenomegaly and elevated Alk phos
Tx for lyme disease sequence?
1) Doxy (if not pregnant or not child)
2) Amoxy (best pregnant or >8 year child)
*Ceftriaxone if neuro or cardiac involvement
Histopalsmosis location, cause, presentation, testing, and tx.?
Location-ohio/missippi, bird and bad droppings in soil. Pulmonary (immunocompetent)-mediastinal and hilar lymph nodes with arthralgias and erythema nodosum
Dissminated-lymphadenopathy, pancytopenia, hepatosplenomegaly
Tx. itraconazole (first line)/fluconazole oral for local and IV amphotericin B dissminated
How can you tell sarcoidosis from histo?
Condition worsens after immunosuppression (eg steroids)
Blastomycosis location, cause, presentation, testing, and tx.?
South central states, Upper midwest and great lakes states, soil or rotting wood contact. Inflammatory lung disease that can disseminate to skin (wartlike lesions, violaceous nodules) or bone (osteomyelitis)., Culture(broad based budding), Tx.Tx. itraconazole/fluconazole oral for local and IV amphotericin B dissminated
Coccidiomyocosis location, cause, presentation, testing, and tx.?
Southwestern US. Earthquake/dust storms where spores thrown into air and can be inhaled. that can dissmeinate to bone (arthralgias) and skin (erythema nodosum). tx. is itraconazole/fluconazole and IV amphotericin B
Clenched fist bite injury tx?
Tx of enterobius vermicularis (pinworm)
Albendazole OR pyrantel pamoate
Prophylaxis for cat or bite?
Concern for pasteurella multocida so tx with amoxicillin/clavulanate
Didanosine side effect?
Abavavir side effect?
NRTI side effect?
NNRTI side effecT?
NEvirapine side effect?
Until what aminotransferase level can you take RIPE drugs?
PPSV23 alone vs PCV13 and PPSV23 5 yrs after 19-64 age group
PPSV23-chronic lung, heart, or liver disease. Diabetes, alcoholics, or smokers
PCV13 and PPSV23-cochlear implants, CSF leaks, sickle cell, asplenia, immunocompromised, CKD
Recommended vaccine north africa?
Hep A, B, typhoid and polio
Recommended vaccine sub saharan africa?
Yellow fever, meningococcal
Recommended vaccine asian?
Recommended vaccine south america?
Recommended vaccine chronic liver disease?
Tdap once for Td booster, than Td every 10 years, influenza annually, PPSV23 then regular regimen once 65, Hepatitis A, Hepatitis B
Recommended vaccines for asplenic adult patients?
Pneumococcus (PCV13 and PPSV23 8 wks later. PPSV23 5 yrs later and at 65, H influenzae, Meningococcus (revaccinate every 5 years), Infleunza, HAV and HBV, Tdap
Meningococcal vaccination series?
Primary-11-12 (or 13-18) or 19-21 (if not previous vaccinated high risk paitnets and first year college or incarceration)
Booster-16-19 if primary vaccination before 16th Bday
What vaccines recommended post transplant?
TMPSMX, influenza, pneumococcus, Hep B
Main organism bronchitis and empirical abx?
Virus. Moraxella, H. influenzae. Generally none maybe doxy or macrolide
Main organism pneumonia (typical) and empirical abx?
S. pneumo. H. influenzae. Azithromycin or Third gen cephalosporin
Main organism pneumonia (atypical) and empirical abx?
Mycoplasma, Chlamydia. Macrolide or doxycycline
Osteomyelitis main organism and empirical abx?
S. aureus or salmonella. Oxacillin, cefazolin. Vanco
Cellulitis main organism and empirical abx?
Streptococci. Staphylococci. Cephalexin or dicloxacillin. TMP-SMX, doxy, or clindamycin
Meningitis (neonate) main organism and empirical abx?
Strep. E.coli, Listeria. Ampicillin and aminoglycoside (usually gentamicin); expanted third gen cpehalosporin if gram - suspected
Meningitis (child/adult)main organism and empirical abx?
S. pneumoniae. Neisseria meningitidis. Cefotaxime or ceftriaxone+vancomycin
Endocarditis (native valve)main organism and empirical abx?
Staph or strep. Antistaph penicillin+aminoglycoside
Endocarditis (prosthetic valve)main organism and empirical abx?
Vancomycin + gentamicin+ cefepime or a carbapenem
Sepsismain organism and empirical abx?
Gram negative organisms, streptococci, staph. Third gen penicillin/cephalosporin+aminoglycoside, or imipenem
Septic arthritis main organism and empirical abx?
S. aureus. Gram neg bacilli. Gonococci. Vanco (staph aureus). Ceftazidime or ceftriaxone (gram neg bacilli). Ceftriaxone, cipro, or spectinomycin (gonococci)
Gram negative coccobacilli?
Gram negative diplococci?
Plump gram negative rod with thick capsule (mucoid appearance)
Gram positive rods that form spores
Clostridium and bacillus species
Differentiating chlamydia and mycoplasma pneumonia because both have similar presentation?
Chlamydia has a negative cold-agglutinin antibody titers
Pneumonia in patients with silicosis is what?
Cause of squamous cell bladder cancer in middle east or africa?
Worm infection in children, diagnosis, and tx?
Enterobius species, perianal itching with positive tape test. Treat with mebendazole or albendazole
Azithromycin or levofloxacin
Burn wound with blue-green color?
Presentation of rocky mountain spotted fever and tx.??
Hx of tick bite 1 week before development of high temp/chills, severe headache, and severe malaise. Rash 4 days later starts on palms/wrists and soles/ankles and spreads rapidly to trunk and face. Tx. doxy and chloramphenicol as second choice.
Dicloxacillin, cephalexin, or clindamycin. Topical mupirocin may also be used
Most common neurologic sequalae of meningitis?
Kaposi sarcoma tx.?
Antiretroviral and chemo in severe cases
Cutaneous larvae migrans bug and tx?
Ancylostoma braziliense (dog and cat hookworm). bendazoles or pyrantel pamoate
Swelling of submandibular and sublingual spaces with fever, dysphagia and odynophagia cause and diseasE?
Infection of tooth with streptococcus or anarobes causing bacterial cellulitis known as ludwig angina
Most common behavioral risk factor of TB in US?
Substance abuse (tobacco and IV drug abuse)
Recommended vaccines HIV?
HAV, HBV, Tdap, Pneumococcus (PCV13 now and PPSV23 8 months and later and every 5 years later), MMR if over 200.
Chronic UTI with alkaline urine cause?
Proteus. Urease alkalinizes urine and chronic infection from struvite stone where bacteria grown inside releasing bacteria. Chronic indwelling catheter have chance of being infected with urease producing organisms
Trichinosis cause and presentation?
Undercooked meat (usually pork).
1) Intestinal stage (within 1 week) is asymptomatic or include abdominal pain, nausea, vomiting, and diarrhea from gastric acid releasing larvae that reproduce in small intestine
2) Muscle stage (up to 4 weeks after)-myositis, fever, periorbital edema, conjunctival and retinal hemorrhages. where female worms migrate and encyst striated muscle
Patient has high fever, headache, myalgias and chills after camping in the south with no rash. Leukopenia and thrombocytopenia common. What is cause and tx?
Human monocytic ehrlichiosis, Doxy or chloramphenicol
Patient has high fever and severe polyarthralgias with maculopapular rash, lymphopenia, thrombocytopenia, and elevated liver enzymes after a trip to the carribbean?
Tx. for chloroquine reistant P falciparum?
Atovaquone, Doxy, Mefloquine (choice in pregnant)
What areas are w/o P. falciparum and tx?
South america, mexico and tx. with primaquine
Tx of diphyllobotrium latum?
Any patient with CMV needs what examination and tx.?
Ocular exam to rule out concurrent retinitis. Valganciclovir
PCV13 vs PCV23 immunologic response?
T cell dependent B cell response for 12 and T cell independent B cell response for PCV23
Cause of perisistent nonbloody diarrhea that is >2 weeks in travelers?
Cryptosporidium due to poor water sanitation
Tx. candida albicans?
Oral/esophageal-nysatin, caspofungin, or fluconazole
Systemic-fluconazole/voriconazole, caspofungin, or amphotericin B
Aspergillus manifestation and tx.
ABPA-type I hypersensitivity. avoid exposure and corticosteroids may be beneficial
Pulmonary aspergilloma-inhalation of spores to lungs assoc with TB and may cause massive hempotysis with lobectomy needed
Invasive-hyphae invade typically in immunosuppressed causing bilateral pulm infiltraties and can have hematogenous spread to sinuses, orbits, or brain. Tx. IV amphotericin B, voriconazole, or caspofungin
Negative PPD in patient who has never had PPD before next best step?
If PPD is positive next test?
CXR to rule out active disease
1st line tx for active TB?
Isolation until sputum negative for AFB
Primary-1st line alveolar macrophages eat acid fast bacilli. 2nd line surviving TB is walled off by granulomas in apex of lung. Usually asymptomatic
Secondary-weakened immunity leads toclinical manifestation of TB leads to poossible hematogenous or lymphatic spread. Classic symptoms here
Extrapulm leads toweakned has lymphatic and organ spread with reticulonodular infiltrate
Difference in anaphylaxis vs anaphylactoid?
Anaphylaxis needs preceeding sensitization to antigen before repeat exposure b/c IgE related. Anaphylactoid clinically identical but not IgE related so no preceeding sensitization to antigen. Antigen directly binds to mast cells here
Classic 4 symptoms anaphylaxis?
Hypotension, Tachy, SOB/wheezing, Rash
Condition causing angioedema underlying and characteristics?
C1 esterase inhibitor deficiency. Swelling of eyes, airway, face, tongue
Best initial test and tx of angioedema?
Test-decrease C2/C4 in complement and deficiency of C1 esterase inhibitor
Tx. 1) ABC, 2) FFP/Ecallantide 3) Androgens: Danazol and stanazol (increaes c1 esterase liver production)
Antihistamines: hydroxyzine, diphenhydramine, fexofenadine, loaratidine, cetirizine, ranitidine or leukotriene receptor antagonists including montelukast or zafirlukast
Tx allergic rhinitis?
Remove trigger followed by intranasal corticosteroid followed by antihistamines or intranasal anticholinergic
Common Variable Immunodeficiency Defect, presentation, and findings, testing, and tx.?
B cell differentiation. Recurrent sinopulmonary infections in adults (bronchitis, pneumonia, sinusitis, and otitis media). Increased risk autoimmune disease, bronchiectasis, lymphoma. Decreased number of all Ig and decreased response to antigen stimulation of B cells. IVIG regular infusion for maintenence
X-linked (bruton) agammaglobulinemia Defect, presentation, and findings, testing, and tx.?
B cell maturation defect b/c tyrosine kinase defect. more present in males w/ absent or scant lymph nodes, adenoids, tonsils, and spleen. Recurrent sinopulmonary infections after 6 months (decrease maternal IgG). Absent B cells in peripheral blood and decreased Ig. IVIG regular infusion for maintenence
Selective IgA deficiency Defect, presentation, and findings, testing, and tx.?
No IgA. Airway and GI infection (spruelike infection), Autoimmune, Atopy, Anaphylaxis to transfusion from normal IgA levels. Recurrent sinopulmonary infections. Decreased serum IgA. Blood from IgA deficient donors. No IVIG becasue trace IgA in product is too insignificant to be therapeutic.
SCID Defect, presentation, and findings, testing, and tx.?
Deficiency B cells and T cells. Recurrent sinopulm infection as early as 6 month age (B cell defect). T cell defect (infection like AIDS: PCP, varicella, Candida). No thymic shadow (CXR), No germinal center (lymph node biopsy), no t cell (flow cytometry) and no gammaglobulin. Tx. BMT
Hyper IgE defect, presentation, and findings, testing and tx?
STAT3 mutation. FATED (coarse Facies, cold staph Abscesses, retained primary Teeth, increase IgE, Dermatologic (eczema). Tx dicolacillin or cephalexin
WisEkott Aldrich Syndrome defect, presentation, and findings, testing and tx?
Mutation in WAS gene. WATER (Wiskott Aldrich, Thrombocytopenic purpura, Eczema, Regurrent infection). Increase IgE/IgA, Decrease IgM/IgG. Tx. BMT
CGD defect, presentation, and findings, testing and tx?
NADPH oxidase. Increae suceptibility to catalase + (Need PLACESS). Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E coli, S. aureus, Serratia. Lymph nodes with purulent material leaking out. Aphthous ulcers and inflammation of nares common/ Granulomas obstructing GI or uinary tract. Abnormal nitroblue tetrazolium testing means defect in NADPH oxidase. Lifelong pphx with TMP-SMX and itraconazole. IFN gamma for severe phenotype to boost intracellular killing
Example of Type II hypersensitivity?
IgG and IgM autoantibody mediated. Cytotoxic. AIHA and Good pasture
Hyper IgM defect, presentation, findings, testing, and tx?
Defect in CD40L Th cells with class switching. Severe pyogenic infection early and pneumocystis, cryptosporidium, and CMV. Increase IgM and decrease IgG, IgE, and IgA
Triad of SCID?
Recurrent viral, fungal, or opportunistic (Pneumocystis) infections, failure to thrive, chronic diarrea
Problemc causing chronic granulomatous disease?
Deficiency in NADPH oxidase preventing phagocytic oxidative burst impairing intracellular phagocytic killing
Leukocyte adhesion deficiency, presentation, findings, testing, and tx?
Defect LFA-1 integrin on leukocytes, which normally allow neutrophils to adhere to vascular endothelium and migrate to areas of infection or inflamation leads to impaired neutrophil migration. Recurrent skin and mucosal bacterial infection with NO PUS along with poor wound healing. delay umbilical cord separation (>30 days) and marked peripheral leukocytosis and neutrophilia
Mechanism of Cyclosporine and side effects?
calcineurin inhibitor binds cyclophilin preventing IL-2 transcription that blocks T-cell activation. Nephrotoxic, Neurotoxic, ginigval hyperplasia, hirsutism, hyperlipidemia
Mechanism of tacrolimus and side effects?
calcineurin inhibitor binds FKBP preventing IL-2 blocking T-cell activation. Nephrotoxic, Neurotoxic, hyperlipidemia
Mechanism of sirolimus and side effects?
mtor inhibitor lbocking T-cell activation and preventing IL-2 response. Anemia, thrombocytopenia, leukopenia, insulin resistance
Azathioprine mechanism and side effect?
antimetabolite of 6MP preventing nucleotite synthesis. Diarrhea, leukopenia, hepatotoxicity
Mycophenalate mechanism and side effect?
IMPDH inhibitor limiting de novo purine synthesis. Bone marrow suppression
How to recognize chediak higashi?
Giant granules in neutrophils, infections, and often oculocutaneous albinism
When to start antiretroviral therapy for HIV?
Bactrim allergy or intolerance agent used? (ie sulfa)
Dapsone, aerosolized pentamidine, atovaquone
Two pathogens that can cause chronic diarrhea only in AIDS?
Cryptosporidium and isospora
C5-C9 deficiency cause recurrent infection with what genus of bacteria?