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ID & Immunizations Flashcards

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1
Q

Lyme Disease - bug and tick name

A
  • Borellia burgdoferi
  • Ixodes deer tick (black-legged tick)
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2
Q

Malaria Prophylaxis

A
  • malarone
    • 1 day before to 7 days after (daily)
    • don’t use in preg
  • chloroquine
    • weekly, 1 week before to 4 weeks after
    • OK in preg
  • mefloquine
    • 1 week before to 4 weeks after
    • OK in preg
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3
Q

Travel immunizations

A

Twinrix – Hep A/B

  • Regular schedule : day 0, 30 and 180
  • Accelerated schedule: day 0, 7, 21 and 365

Typhoid Fever – Salmonella

  • Typherix: single dose and repeat in 3 years
  • Typhim Vi: single dose and repeat in 3 years

Traveller’s Diarrhea - ETEC/V.cholera

  • Dukoral: two doses q weekly starting 2 weeks ac travel (6 years to adults) three doses q weekly starting 3 weeks ac travel (2 to 6 years)
    • Booster - if all pts have had their last dose within 5 years a single oral booster dose is needed; if the last dose was > 5 years then a complete primary vaccination series as per age is indicated

Tetanus/diphtheria

  • All travelers should have this UTD
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4
Q

Modified Centor Criteria

A

Presence of tonsillar exudates: 1 point

Tender anterior cervical adenopathy: 1 point

Fever by history: 1 point

Absence of cough: 1 point

Age less than 15 years,* add 1 point to total score

Age more than 45 years,* subtract 1 point from total score

0-1 = no treatment, no testing

2-3 = RAT, treat if +ve, send culture if -ve (in kids only)

4 = treat, send culture

If no RAT

0-1 = no treatment

2 = no treatment unless outbreak, or known recent gabs exposure

3-4 = treat

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5
Q

Treatment for GABS strep Pharyngitis

A

Peds: Amoxicillin 50 mg/kg PO daily X 10 days (max 1000 mg)

or Amoxicillin ER tablet 775 mg PO daily X 10 days (children >12)

Adult: Pen V 300 mg PO TID X 10 days

or

Peds: Clindamycin 20-30 mg/kg/day PO divided TID X 10 days

Clindamycin 300 mg PO TID X 10 days

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6
Q

Indications for Abx prophylaxis for IE

A
  1. Invasive Dental Procedure

AND

  1. Prosthetic heart valve, hx IE, or unrepaired congenital cyanotic heart defect
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7
Q

Uncomplicated UTI Tx options

A

Macrobid 100 mg PO BID X 5d

Cipro 250 mg PO BID X 3d

TMP-SMX (Septra DS) i tab PO BID X 3 d

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8
Q

Pyelonephritis (Inpatient) Treatment

A

Ceftriaxone 1-2g IV

or

Gentamicin 5 mg/kg IV

or

Cipro 400 mg IV

*add ampicillin 1-2 g IV if enterococcus suspected

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9
Q

Pyelonephritis (Outpatient) Treatment

A

Cipro 500 mg PO BID X 7d

or

Septra DS i tab PO BID X 10-14d

*add ampicillin 500 mg PO TID if enterococcus suspected

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10
Q

Pyelonephritis Tx in Pregnancy

A

Inpatient: Amp + Gent or Ceftriaxone

Outpatient: TMP/SMX* or Keflex

*Not for late third trimester due to risk of kernicterus

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11
Q

Outpatient Pneumonia Treatment

A

Amox/Clav 875/125 mg PO BID X 7d

Pen allergic:

levofloxacin 750 mg PO daily X 5d

or

moxifloxacin 400 mg PO daily X 5d

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12
Q

Pneumonia: Inpatient Treatment

A

Amox/Clav 875/125 mg PO BID +- Azithro 500 mg PO daily

or

cefotaxime 1g Q8h IV or ceftriaxone 1g q24h IV +- Azithro 500 mg IV daily

+- Vancomycin 15-20 mg/kg IV Q12h

Pen allergic:

levofloxacin 750 mg PO/IV daily

or

moxifloxacin 400 mg PO/IV daily

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13
Q

Cellulitis treatment

A

Nonpurulent: Keflex 500 mg PO QID X 5-7d

(levo/moxi/clinda if allergic)

Purulent: Septra DS i BID X 7d

(or doxycycline 100 mg PO BID)

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14
Q

Diabetic foot infections treatment

A

Minor (ulcer : Keflex +- Septra

Moderate to Severe:

Amox/Clav + Septra

or

Ceftriaxone + Flagyl + Vanco

or

Pip-Tazo + Vanco

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15
Q

SIRS Criteria

A

Two of:

T >38.3 or

HR > 90

RR >20 or PCO2

WBC 12,000, or >10% immature forms

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16
Q

Triggers for treating AOM

A

>6 months with otorrhea OR severe (mod otalgia/>48h/T>39) X 10d

6-23 months with bilat AOM X 10d

6-23 months unilat, not severe = Obs or Abx X 10d

>2 years, not severe = Obs or Abx X 5-7d

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17
Q

Persistent Symptoms of AOM after 48-72h

A

Initiate or change Abx therapy, consider IM ceftriaxone, clinda, or tympanocentesis

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18
Q

AOM Abx Choice

A

1st line: Amoxicillin 80-90 mg/kg divided BID or Amox/Clav 90 mg/6.4 mg/kg

Pen Allx: Cefuroxime 30 mg/kg divided BID

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19
Q

Dose of Acyclovir for suspected HSV Encephalitis

A

10 mg/kg IV q8h X 10-14 d (assuming normal renal function)

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20
Q

Stages of Lyme Disease

A
  • first stage: erythema migrans, sometimes malaise/LAN, resolves 3-4 weeks
  • second stage: fever, LAN, neuropathies, heart block, arthralgias, multiple target lesions. Unilateral or bilateral facial nerve palsy.
  • late disseminated stage: months/years later. Chronic arthritis, myocarditis, polyneuropathy, subacute encephalopathy.
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21
Q

What to do with a tick bite?

A
  • no need to test serum or tick if no EM
  • IDSA recommends prophylaxis (200 mg doxy or 4 mg/kg up to 200 mg in children > 8 as single dose) if all of:
    • ixodes tick
    • engorged or > 36 h attached
    • within 72 h of bite
    • if doxy contraindicated, do not offer alternative abx
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22
Q

Rocky Mountain Spotted Fever (read-through)

A
  • rickettsia rickettsii
  • fever, malaise, conjunctivitis
  • rash (80%) days 2-4 of fever
    • small blanching erythematous macules –> becomes petechial
    • begins on hands/feet, centripetal spread up the trunk
  • Labs
    • normal WBC + Hb
    • Low Plt
    • mild + LFTs
    • Low Na
    • acute + convalescent serum
  • Tx
    • Doxy
    • Risk of teeth staining low, recommended for children of all ages
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23
Q

Rabies incubation period

A
  • 20-90 days, but cases up to 5 years
  • stays localized in soft tissues during incubation, but rapidly spreads to CNS thereafter
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24
Q

Rabies Clinical Features

A
  • encephalitis
  • 80% encephalitic, 20% paralytic
  • 50% have hydrophobia - drinking causes choking/spasms
    • aerophobia - grimacing when air blown on face
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25
What does/does not constitute a rabies exposure? Which animals are low/high risk?
* petting a rabid animal or contact with urine/blood/feces is not an exposure (unless fresh wound on skin) * being in same room as bat with no known bite is NNT ~2.7 million, but PEP often still recommended * If asleep, if child, if mentally disabled, then PEP * healthy cat/dog --\> observe animal for 10 days before offering vaccine * 2x vaccinated cat/dog no reported cases * skunks, raccoons, foxes, most carnivores, and bats need prophylaxis * squirrel, rats, rabbits, rodents almost never require prophylaxis (no reported cases)
26
Ehrlichiosis
* tick-borne illness * WBC infection * lone-star tick, southeastern US * 30% get nonspecific rash
27
Anaplasmosis
* tick-borne illness * ixodes tick, common in Lyme endemic areas * fever, malaise * no rash * doxy
28
Tularemia
* *Francisella tularensis* * transmitted by ticks *and* flies * several forms * ulceroglandular (most common) * glandular * typhoidal * oculoglandular * pneumonic * doxy, cipro, gent if severe
29
Babesiosis
* malaria-like parasite * co-infection with lyme common * 7-10 days atovaquone + azithromycin
30
West Nile Virus
* arbovirus * transmitted by mosquitoes * 20% infected develop symptoms, 1% severe infection * Ab testing available, not specific * treatment supportive
31
Anthrax
* *bacillus anthracis* * unsterilized, imported animal hides/raw wool * *pulmonary* * generally fatal inhaled mediastinitis * *cutaneous* * most common * painless macule --\> ulcerative site with serosanguineous vesicles -- \> painless black eschar * untreated mortality 5-20%
32
Brucellosis
* unpasteurized dairy, slaughterhouse workers * endemic in Mediterranean basin * nonspecific symptoms
33
Psittacosis
* chlamydophila psittaci * from birds * pneumonia + endocarditis, hepatitis, CN palsies, AIN
34
Q Fever
* coxiella burnetii (rickettsial infection) * inhalation or arthropod from cattle, sheet, goats
35
Hantavirus
* inhalation from rodents * 3-4 d flu-like illness --\> APE, hypotension, metabolic acidosis * supportive treatment
36
Cutaneous Larva Migrans
* migrating cutaneous hookworm larva from contaminated soil * single-dose ivermectin
37
Disseminated Gonorrhea
38
(painless)
* chancre or primary syphilis
39
Rash of secondary syphilis
* dull red-pink papular * starts on trunk, spreads to flexor surfaces, palms + soles
40
(painful)
* chancroid * *haemophilus ducreyi*
41
(painless chancre ---\> painful LAN)
* lymphogranuloma venereum
42
Nongonococcal Urethritis
* usually chlamydia * sometimes ureaplasma urealyticum, mycoplasma genitalium, HSV, adenovirus (no need to treat) * if WBC \>5/HPF --\> treat for chlamydia * if symptoms persist, culture for trichomonas vaginalis + treat with Flagyl 2 g PO x 1
43
Syphilis
* *treponema pallidum* * primary * painless chancre, indurated borders * secondary * 3-6 weeks after end of primary phase * rash, lymphadenopathy, sore throat/fever/headaches/malaise * dull red-pink, papular * starts on trunk, spreads to palms/soles, flexor surfaces * tertiary * 3-20 years later, in 1/3 of patients * widespread granulomatous lesions (gummata) * meningitis, dementia, neuropathy (tabes dorsalis), thoracic aneurysm
44
Genital Herpes
* genital usually HSV-2, but indistinguishable from HSV-1 * prodrome of pain/tingling x 24h * vesicles heal within 3 weeks * shedding for 10-12 days after onset of rash * to culture, deroof/puncture vesicle and scrape base with swab * first episode (primary) treated longer than second episode
45
Chancroid
* *Haemophilus ducreyi* * painful genital ulcers + lymphadenitis (may lead to buboes if untreated) * dx clinical (cultures poor, no PCR available) * single dose zithromax or ceftriaxone tx
46
Lymphogranuloma Venereum (tropical bubo)
* painless chancre x 2-3 days * unilateral suppurative inguinal LAN 1-3 wks later * scarring linear depressions parallel to inguinal ligament * somtimes rectal ulcers, bleeding, discharge * dx clinical, no great tests * doxy x 21 days
47
Granuloma Inguinale (Donavanosis)
* *Klebsiella granulomatis* * endemic in India, south Africa * painless subcutaneous nodules --\> painless beefy red, fragile ulcers * dx clinical, no great test * doxy x 3 weeks
48
Cognitive Force WBC \> 20
* CXR * Urine * Skin check
49
Sporotrichosis
* *Sporothrix schenckii* fungus * mostly in tropical zones, in soil, common among florists * dx fungal cultures/tissue biopsy cultures * tx itraconazole x 3-6 months
50
Acute Herpetic Gingivostomatitis
* common primary infection at 6 mo. - 5 yrs * 90% HSV 1, 10% HSV 2 * abrupt high fever, drooling, swollen + friable gingiva + vesicular oral lesions, tender cervical LAN * lasts 1-3 weeks * acyclovir 15 mg/kg PO divided 5x/day x 7d
51
Treatment of Varicella + Shingles
* **Varicella** * h/a, malaise, fever * 2-3 crops of lesions focused on torso/face over 1 week * consider PO acyclovir if \> 12 y old, chronic skin or lung disorder, or immunocompromised * acyclovir 20 mg/kg PO QID x 5 days * start within 24h of rash if possible * **pregnancy** * **​**30% varicella pneumonia, mortality 40% * congenital varicella syndrome * usually in first 20 weeks of pregnancy * \<2% risk at \< 20 weeks, lower after * diagnosis * clinical * 4x rise in varicella-specific IgG Ab over 14-21d period * management * if history of chickenpox --\> reassure * if unknown, and able to get results within 96h, draw VZV IgG Ab * if unable to get labs within 96h or if no immunity * give VZIG 625 units IM * if develops severe disease * acyclovir 10 mg/kg IV Q8h or 800 mg PO QID x 5 d * **Shingles** * valacyclovir 1 g PO TID x 5 days for adolescents/adults * maternal HZV not harmful but exposure to HZV without varicella immunity is
52
Poor Man's CD4 Count
* \< 200 is ~ \< 1700 cells/mm^3 total lymphocyte count * \< 200 CD4 and viral load \> 50 k is associated with AIDS-defining illnesses and is common cutoff for antiretroviral therapy
53
oral hairy leukoplakia (OHL)
* oral hairy leukoplakia (OHL) * EBV infection * lateral border tongue white plaques, cannot scrape off * acyclovir
54
HIV Optho Emergency
* CMV Retinitis * low CD4 count (often \< 50) + ssx retinal detachment
55
PJP Pneumonia
* fever, nonproductive cough, SOB * Xrays diffuse infiltrates but 25% neg * sometimes elevated LDH * ABG --\> increase in Aa gradient * walk test --\> desat * septra DS 2 TID x 3 weeks * prednisone 40 mg BID and 21 day taper if PaO2 \< 70 mm Hg or Aa \> 35 mm Hg
56
Endocarditis
Review Evernote
57
Tetanus
Review Evernote
58
Occ Health and HIV PEP
see note "Occ Health"
59
C. Diff Infection
* symptom onset usually 7-10 days post abx, but up to 60d * sometimes two-step test * step 1: test for glutamate dehydrogenase (present in all strains) * step 2: if +ve, test for toxin A/B which is present only in toxic strains, treat if step 2 positive * initial mild episode: Flagyl 500 mg PO TID x 14 d * initial moderate episode: Vanco 125 mg PO QID x 14 d * severe: Flagyl 500 mg IV + Vanco 500 mg PO * Relapse: see stanford * fidaxomicin 200 mg PO BID x 10 d (alternative to vanco for moderate) * treatment does not eradicate, so do not test/treat asymptomatic patients
60
Scombroid Poisoning
* tuna, mackerel, bonito, mahi-mahi * histadine in fish transformed into histamine by bacteria when stored too warm * 30 min-24h after eating * flushing, headache, abdo cramping, vxdx * self-limited * tx with H1 + H2 blockers
61
Ciguatera Poisoning
* large reef predator fish contaminated with Gambierdiscus toxicus --\> ciguatoxin * grouper, snapper, amberjack, barracuda * heat resistant * acts on Na channels causes depolarization * nxvxdx --\> hypesthesias, paresthesias, numbenss, weakness * temperature sensitivity +- heat/cold reversal * supportive treatment
62
Tetrodotoxin
* puffer fish * paresthesias, h/a, vx, ddx, ascending paralysis * death in 4-6 h * anticholinesterases such as neostimine and edrophonium
63
Tetanus Clinical Syndromes
* uncontrolled muscle spasms * may start with mild trisumus --\> risus sardonicus * opisthotonos * hypersympathetic state * HTN, fever, sweating * normal LOC * **localized tetanus** * rigid just muscles prox to wound * may progress to generalized * **neonatal tetanus** * improper stump care, born to unimmunized mother * weak cry, poor suck * **cephalic tetanus** * from HI or otitis * CN 7th and other CN palsies
64
Who needs airborne precautions?
* Measles * Tuberculosis (primary or lanryngeal) * Varicella (airborne + contact) * Zoster (disseminated or immunocompromised patient; (airborne and contact ) * SARS (Contact+airborne )
65
Sexual Assault
See Evernote
66
Treatment of First Stage vs. Second Stage Lyme
See Evernote
67
Asplenic patient with fever
* start broad spectrum abx * consider admission

EM (27 decks)

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