Inf 1 Flashcards by Nadia Wajdi

Infectious mononucleosis causes prolonged fever, pharyngitis, fatigue, and lymphadenopathy and is diagnosed by the

heterophile antibody ( monospot test )

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Triad of tenosynovitis, dermatitis, migratory polyarthralgia

Disseminated gonococcal infection

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Purulent monoarthritis

Disseminated gonococcal infection

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Disseminated gonococcal infection treatment

3rd-generation cephalosporin IV AND oral azithromycin

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Disseminated gonococcal infection causes

high fever, chills, tenosynovitis, polyarthralgia, and pustular lesions on the trunk and extremitie

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Pharyngitis, fever, and lower abdominal pain in a sexually active patient are caused by………………… , …………………… is due to orogenital contact.

gonococcal pharyngitis and associated pelvic inflammatory disease. , Gonococcal pharyngitis

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We treat herbes zoster by

It is treated with antiviral agents (eg, acydovir, famciclovir, valacyclovir).

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Treatment of HSV encephalitis

Acyclovir

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Brain MRI: temporal lobe hemorrhage/edema

HSV encephalitis

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Diagnostic findings of …………
CSF analysis:
o ⬆️WBCs (lymphocytes), ⬆️RBCs
o ⬆️Protein, normal glucose
o HSV DNA on PCR

HSV encephalitis

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Clinical findings
. Fever
• Headache
• Seizure
• Altered mental status (eg, confusion, agitation)
• ± Focal neurologic findings (eg, hemiparesis, cranial nerve palsies, ataxia)

HSV encephalitis

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Septic pulmonary emboli occur in up to 75% of patients with……… endocarditis, most commonly due to……… in IVDU with IE

tricuspid , Staphylococcus aureus

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………… is not often associated with a rash (<30% in adults) and is described as “Rocky Mountain spotted fever (RMSF) without the spots.

Ehrlichiosis

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……… can present with cerebrospinal fluid findings of elevated white blood cell count with a lymphocytic predominance

Viral encephalitis

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…………… is the most likely diagnosis in this patient from Mississippi who was initially thought to have sarcoidosis (cough, hilar adenopathy, erythema nodosum, and non-caseating granulomas in an African American individual) but deteriorated following high-dose corticosteroid therapy

Histoplasmosis

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Histoplasmosis caused by

Histoplasma capsulatum

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pulmonary histoplasmosis should be considered when pulmonary symptoms are accompanied by ……………… or by arthralgias and erythema nodosum.

mediastinal or hilar lymph nodes (or masses)

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Histoplasma urinary antigen testing, are used for diagnosis of

Pulmonary Histoplasmosis

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………………… is required in patients with HIV who develop progressive disseminated histoplasmosis (PDH). After 1-2 weeks of clinical improvement, patients are often transitioned to oral …………… for >1 year of maintenance therapy.

Amphotericin B , itraconazole

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Infectious mononucleosis, most commonly due to ………… infection, presents with prolonged fever, malaise, and sore throat.

Epstein-Barr virus (EBV)

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Infectious mononucleosis, most commonly due to EBV infection, presents with

prolonged fever, malaise, and sore throat.

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Patients may develop autoimmune …………… up to 2-3 weeks after the onset of initial symptoms of infective mononucleosis

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Clinical manifestations of ………………… include fatigue, sore throat, fever, lymphadenopathy, and splenomegaly. Atypical lymphocytes on peripheral smear are characteristic; heterophile antibodies, while specific for Epstein-Barr virus infection, may be negative early in the illnes

infectious mononucleosis

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is a Gram-negative anaerobe and a common constituent of normal human oral flora

Eikenella corrodens

is the most common complication of influenza and is the result of either secondary bacterial infection ( eg, Streptococcus pneumoniae) or direct viral attack (influenza pneumonia).

Pneumonia

accounts for about 50% of cases of pyogenic spinal osteomyelitis

Staphylococcus aureus

exquisite focal tenderness on percussion at the posterior spinous process of the affected vertebra

Osteomyelitis

Kaposi sarcoma is

vascular tumor due to co-infection with HIV and human herpesvirus-8, and is most common in men who have sex with men.

Commonly involved regions of kaposi sarcoma include

legs, face, oral cavity, and genitalia, and KS can also be seen in the gastrointestinal tract and lungs.

lesions of KS typically begin as…………… , and later develop into …………… The color can change from light brown to…………… , and patients often have multiple lesions.

papules , plaques or nodules. violet

causes pneumonia in patients with AIDS who have CD4 cell counts <200/mm3 . Although extrapulmonary disease may present as papules and nodules in the ear canal, it is uncommon.

Pneumocystis jiroveci

………… causes diffuse mucocutaneous lesions associated with systemic symptoms beginning 1-3 months after the initial infection.………… can occur years after the initial infection, and is characterized by nodular or ulcerating lesions with necrosis and scarring.

Secondary syphilis , Tertiary gummatous syphilis

patient's recent oral infection (likely thrush) and history of intravenous drug use suggest…………

HIV

The lesions usually appear as multiple violaceous papules

Contaminated water

Legionella pneumonia

Treatment of Legionella pneumonia

Respiratory fluoroquinolone or newer macrolide

an intracellular, gram-negative organism commonly spread by aerosols or droplets from cvntaminated water supplies

Legionella pneunmphila

Clinical clues of legionella pneumonia

• Fever >39 C (1022 F) • Bradycardia relative to high fever • Neurological symptoms (especially confusion) • Gastrointestinal symptoms (especially diarrhea) • Unresponsive to beta-lactam & aminoglycoside antibiotics

Laboratory clues of legionella pneumonia

• Hyponatremia • Hepatic dysfunction • Hematuria & proteinuria • Sputum Gram stain showing many neutrophils, but few or no microorganisms

Entamoeba histolytica Risk factors

• Developing nations (travel/residence) • Contaminated food/water • Fecal-oral, sexual transmission (rare)

Liver abscess (RUQ pain, fever) seen in

Entamoeba histolytica

Diagnosis of entsmoeba Histolytica

Stool ova & parasites, stool antigen testing (colitis) E hislolytica serology (liver abscess

Treatment of entamoeba histolytica

Metronidazole followed by paromomycin to eradicate intestinal colonization.

.Macular, anesthetic skin lesions with raised borders • Nodular, painful nearby nerves with loss of sensory/motor function

Leprosy الجذام ر

الجذام يعالج ب

Dapsone + rifamp

Manifestations of leprosy include

chronic, anesthetic, macular (often hypopigmented) skin lesions with raised, well-demarcated borders. Nearby nerves often become nodular and tender, and segmental demyelination may result in loss of sensation and motor function.

Lyme disease due to

Borrelia burgdorferi

The hallmark feature is erythema migrans (EM), a flat, annular macule at the tick bite site that slowly expands outward as the spirochete moves through the dermis.

Lyme disease

bull's-eye appearance.

Lyme disease

Empiric treatment of Lyme disease with

a 14-day course of oral doxycycline is curative in most patients.

Treatment of Lyme disease In pregnant women

oral amoxicillin doxycycline is more controversial (eg, possible risk of fetal tooth discoloration and retardation of skeletal development) and is generally only considered on a case-by-case basis

Nocardia is

filamentous, aerobic, gram-positive bacteria that is partially acid-fast. It causes pulmonary or disseminated disease (particularly to the brain) in immunocompromised hosts

The treatment of choice for Nocardia is

trimethoprim-sulfamethoxazole.

is a tapeworm transmitted to humans by the ingestion of undercooked, contaminated pork.

Taenia solium

Neurocysticercosis typically manifests as an

adult-onset seizure

Treatment of Neurocystocercosis ( tenea solium )

antiepileptics (eg, phenytoin) antiparasitics (eg, albendazole) corticosteroids (for brain inflammation).

Complications of malaria

• Children: Seizure, coma, hypoglycemia, metabolic acidosis • Adults: Jaundice, acute renal failure, acute pulmonary edema

Thin & thick peripheral blood smears

Malaria

Protection from malaria

• Hemoglobinopathies (Hgb S, Hgb C, thalassemia) • Partial immunity from previous malarial illness

Prevention for malaria

Antimalarial drugs Insecticide-treated nets Household insecticide residual spraying

Antimalarial drugs

• Atovaquone-proguanil • Doxycycline • Mefloquine • Chloroquine • Hydroxychloroquine

Atovaquone-proguanil

Antimalarial drugs

The hallmark is cyclical fever, coinciding with

Plasmodium-induced RBC lysis.

Antiretroviral therapy should be initiated in all patients with …………… (usually 2 weeks after antifungal treatment).

HIV who develop PDH

Necrotic invasion of palate, orbit, brain

Rhino-orbital-cerebral mucormycosis*

Rhino-orbital-cerebral mucormycosis* treatment

Surgical debridement Liposomal amphotericin B Elimination of risk factors eg, ⬆️glucose, acidosis)

Risk factors of Rhino-orbital-cerebral mucormycosis*

Diabetes mellitus (ketoacidosis) • Hematologic malignancy • Solid organ or stem cell transplant

Mucormycosis is a

highly destructive fungal infection

Rhino-orbital-cerebral mucormycosis is usually caused by

Rhizopus species

(sulfur granules) on or near the jaw ?

Actinomyces

Complications of Meningococcal meningitis

Shock Disseminated intravascular coagulation Adrenal hemorrhage

Meningococcal meningitis treatment

Ceftriaxone

………… is a 4- generation cephalosporin that covers most of the major organisms of bacterial meningitis (eg, Streptococcus pneumoniae, Neisseria meningitidis, group B streptococci, Haemophilus influenzae) as well as Pseudomonas aeruginosa.

Cefepime

provides coverage against cephalosporin resistant pneumococci,

Vancomycin

covers Listeria monocytogenes.

ampicillin

Streptococcus pnewnoniae, Neisseria meningitidis at age 2-50 treated by

Vancomycin + 3rd-generation cephalosporin

S pnewnoniae, N meningitidis, Listeria >50 years old treated by

Vancomycin + ampicillin + 3rd-generation cephalosporin

lmmunocompromised pt. Infected by S pnewnoniae, N meningitidis, Listeria, gram negative rods treated with

Vancomycin + ampicillin + cefepime

Neurosurgery/penetrating skull trauma infected by staphylococci , Gram-negative rods, MRSA, coagulase-negative treated with

Vancomycin + cefepime

Alternatives to cefepime

ceftazidime or meropenem

Alternative to ampicillin

trimethoprim-sulfamethoxazole for Listeria

Cryptococcal meningoencephalitis treatment

Amphotericin B with flucytosine initially Fluconazole maintenance

Transparent capsule seen with India ink stain

Cryptococcal meningoencephalitis

Headache, fever & malaise • Develops over 2 weeks (subacute) • Can be more acute & severe in HIV

Presentation of Cryptococcal meningoencephalitis

Ecthyma gangrenosum occurs primarily in immunocompromised patients with………… bacteremia/sepsis.

P aeruginosa

multiple nonenhancing brain lesions with no mass effect (edema).

Progressive multifocal leukoencephalopathy

asymmetric white matter lesions; no enhancement/edema

Progressive multifocal leukoencephalopathy

Lymphocyte-predominant leukocytosis

Pertussis Pertussis

Fifth disease

Parvovirus B19 infection

Diagnosis of Parvovirus B19 infection

• Acute infection o B19 lgM antibodies in immunocompetent patients o NAAT for B19 DNA in immunocompromised patients • Previous infection: B19 lgG antibodies (documents immunity) • Reactivation of previous infection: NAA T for B19 DNA

Erythema infectiosum (fifth disease): Fever, nausea & "slapped cheek" rash (more common in children)

Parvovirus B19 infection

To prevent Pneumocystis pneumonia , most patients receiving prolonged glucocorticoid therapy are prescribed

primary prophylaxis with TMP-SMX

Diffuse bilateral reticulonodular infiltrates on pulmonary imaging

Pneumocystis pneumonia

Manifestations of Pneumocystis pneumonia

• Indolent (AIDS) or acute respiratory failure (immunosuppressive treatment) • Dyspnea, hypoxia, dry cough, fever • j Lactate dehydrogenase level • Diffuse bilateral reticulonodular infiltrates on pulmonary . . imaging

This patient's history of multiple sexual partners and evidence of oropharyngeal thrush (white mucosa! plaques) raise strong suspicion for underlying…………… The presence of subacute pulmonary symptoms (dyspnea, dry cough, fever}, tachypnea, hypoxemia, and bilateral interstitial infiltrates indicates likely ……………

HIV infection. ,, Pneurnocystis pneumonia (PCP},

patients with PCP often have significant……… and a……… alveolar-arterial oxygen gradient

hypoxia , large

Indications for corticosteroids in pat with pneumocystis pneumonia

, a Pa02 < 70 mm Hg , an alveolar-arterial (A-a) gradient > 35 mm Hg, or , pulse oximetry <92o/o on room air.

tick-borne illness caused by Rickeltsia lickettsii

Rocky Mountain spotted fever

Can develop complications of encephalitis, pulmonary edema, bleeding, shock

Rocky Mountain spotted fever

Clinical features of Rocky Mountain spotted fever

Nonspecific fever, headache, myalgia, arthralgia Macular & petechial rash on wrists/ankles

JC virus reactivation

Progressive multifocal leukoencephalopathy