Infectious Flashcards by Denisse Tiangco

Common in cervix, vagina and vulva and penis

3-7 days after transmission

Red papules
Vesicles
Ulcers

Fever
Malaise
tender LN

Herpes simplex

How well did you know this?

Not at all

Perfectly

HSV1

Oropharyngeal

How well did you know this?

Not at all

Perfectly

HSV2

Genital herpes

Sexually transmitted

How well did you know this?

Not at all

Perfectly

Lesions heal in 1-3 weeks and

HSV2 migrates to what nerve ganglia

Dorsal root ganglia

Thoracolumbosacral

Latent infection

How well did you know this?

Not at all

Perfectly

Transmission phase of HSV

Active phase

Latent phase

How well did you know this?

Not at all

Perfectly

Contraceptive that offers limited protection from HSV

Risk of transmission to neonate during birth

Condoms

How well did you know this?

Not at all

Perfectly

HSV Dx

Viral culture

Anti-HSV Ab (indicative of recurrent or latent infection)

How well did you know this?

Not at all

Perfectly

Papsmear HSV

3M (Margination, Molding and Multinucleation)

How well did you know this?

Not at all

Perfectly

HSV DOC

Acyclovir 400mg - first episode, shortens length of initial and recurrent symptomatic phase

Famcyclovir 250 mg

How well did you know this?

Not at all

Perfectly

Congenital herpes in neonate

Blisters
Jaundice
Syphilis

How well did you know this?

Not at all

Perfectly

HSV cell

Cowdry Type A

How well did you know this?

Not at all

Perfectly

Poxvirus infection skin and mucous membrane

2-12 year old via direct contact or shared articles (towels)

Incubation: 6 weeks

Increased in HIV

Molluscum contagiosum

How well did you know this?

Not at all

Perfectly

Pearly, dome-shaped umbilicated papules with dimpled center and central keratin plugs= waxy core

Contains intracytoplasmic viral inclusions

MCV1-4

Most prevalent: MCV1
Sexually transmitted: MCV2

Molluscum contagiosum

How well did you know this?

Not at all

Perfectly

Molluscum contagiosum cell

Henderson-Patterson body

How well did you know this?

Not at all

Perfectly

Pox virus cell

intracytoplasmic inclusion

Guarneri bodies

How well did you know this?

Not at all

Perfectly

Most common cause of vaginal yeast infection

Cottage cheese
Curd-like, milk-like vaginal discharge

Yeasts part of normal flora = disturbance in microbial ecosystem = symptomatic infection

Candida albicans

other
Candida glabrata
Candida tropicalis

How well did you know this?

Not at all

Perfectly

Candida risk factors

DM
antibiotics
Pregnancy
Conditions resulting in compromised cell-mediated immunity

How well did you know this?

Not at all

Perfectly

Cheese vaginal discharge
Swelling and curd-like cottage 
Germ tube test
Vulvovaginal pruritus
Erythema

Candida

How well did you know this?

Not at all

Perfectly

Discharge: watery to homogenously thick

Pseudospores or filamentous fungal hyphae in wet KOH mounts of the discharge or on pap smear

Not an STD

Candida

How well did you know this?

Not at all

Perfectly

Candida Tx

Fluconazole 150mg

Nystatin

How well did you know this?

Not at all

Perfectly

Sexually transmitted

Large, flagellated ovoid protozoan, seen in wet mounts of vaginal discharge or Pap smear of infected patients

Develops in 4 days - 4 weeks

Frothy vaginal discharge, pruritus vulvae

Trichomonas vaginalis

How well did you know this?

Not at all

Perfectly

Yellow, frothy, profuse vaginal discharge, vulvovaginal discomfort, dysuria, dyspareunia

Strawberry cervix

Trichomonas

How well did you know this?

Not at all

Perfectly

Trichomonas Tx

Metronidazole

How well did you know this?

Not at all

Perfectly

Gram neg cocobacillus which causes bacterial vaginosis (vaginitis)

Thin, malodorous (fishy) vaginal discharge

Pap smear: squamous cells covered by a shaggy coat of cocobacilli (clue cell)

Gardnerella vaginalis

How well did you know this?

Not at all

Perfectly

Whiff test positive Addition of KOH: fishy amine like odor Amsel criteria: 3/5 pH >4.5 clue cell >20 + whiff test Homogenous discharge Treatment?

Gardnerella vaginalis Metronidazole

Amsel Criteria | 3/4

A thin, white homogenous discharge >20% Presence of clue cells in microscopic exam pH >4.5 Fish odor to vaginal discharge before or after addition of 10% KOH (whiff test)

Ascending infection that begins in the vulva or vagina spreads upward to involve most of the structures in the female genital system Pelvic pain, adnexal tenderness, fever, and vaginal discharge

Pelvic inflammatory disease

Two most common causes of PID

Gonococcus Chlamydia May be polymicrobial

Endocervical mucosa Vestibular glands initially involved Spread up to FT, tuboovarian regions Marked acute inflammation largely confined to the superficial mucosa Acute suppurative salpingitis, salpingoophoritis Tubo-ovarian abscess or pyosalpinx

PID

PID Sequelae

Chronic follicular salpingitis Hydrosalpinx (dilated, fluid filled) Scarring tube (impenetrable to oocyte leading to infertility or ectopic pregnancy) Hydrosalpinx -> infertility due to lack of flexible finbriae Spreads to abdomen and lead to bacteremia

PID Gold standard for diagnosis

Laparoscopy

Violin string adhesions on Laparoscopy Intraabdominal dissemination of PID Fibrinous exudate on peritoneal surface Perihepatitis R upper quadrant pain

Fitz Hugh Curtis syndrome

PID Fitz Hugh Drug of Choice

Tetracycline | Doxycycline

Mucoid, clear, transluscent liquid Lined by transitional epithelium or squamous low cuboidal mucinous epithelium

Bartholin cyst

Bartholin cyst tx

Marsupialization

Lichen sclerosus

Leukoplakia

Smooth, white plaques macules resembling porcelain or parchment Marked thinning of epidermis, degeneration of basal cells, hyperkerarosis, bandlike lymphocytic infiltrates in the dermis Common in postmenopausal Pathogenesis: Activated T cells Not premalignant but high chance of SCCA

Leukoplakia

Hairly leukoplakia is associated in caused by

Side of tongue of AIDS EBV

Squamous hyperplasia Hyperplastic dystrophy Results from rubbing/scratching Thickening of epidermis (acanthosis) and hyperkeratosis No increase risk of SCCA

Lichen simplex chronicus

Milk and roses hyperkeratosis of palms and soles

Arsenic poisoning

Benign genital warts caused by low oncogenic HPV 6 and 11 Solitary or multifocal Papillary, exophytic, tree like cores of stroma covered by thickened squamous epithelium

Condyloma acuminatum HPV 6, 11

Verucca Plantaris

HPV 1,3,4

Cervical cancer virus

HPV 16,18

Anogenital warts 90% are caused by

Nononcogenic HPV 6,11

External anogenital wart tx

Imiquimod cream Podofilox gel Cryotherapy

Gram negative diploccoci Encapsulated Fermenta maltose and glucose

Neisseria meningitidis

Gram negative diplococci Insignificant capsule Ferments glucose only

Neisserie gonorrhoeae

Gram negative diplococci with flattened sides (kidney-shaped) Oxidase +

Neisseria

Gram negative diplococci with flattened sides (kidney-shaped) Oxidase + ``` Capsulated Vaccine Respiratory Glucose fermenter Maltose fermenter Rare beta lactamase ```

N meningitidis

Gram negative diplococci with flattened sides (kidney-shaped) Oxidase + ``` No capsule No vaccine Genital entry Glucose fermenter Non maltose fermenter Common betalactamase ```

N gonorrhoeae

Urethritis Cervicitis PID acute Arthritis

Neisseria gonorrhoaea

Urethral/vaginal discharge Male urethritis Endocervicitis Infants: opthalmia neonatorum Burning sensation during urination with discharge Dx: intracellular gram negative diplococci in PMN from urethral smear

Neisseria gonorrheae

N gonorrheae Tx

Ceftriaxone

Silver nitrate prophylaxis on eye of newborn

Credes prophylaxis no longer practiced bec chamydia is more common Can cause keratoconjunctivitis

Prophylactic antibiotic for chlamydia opthalmia neonatorum

Erythromycin | Tetracycline

Cervical motion tenderness Salpingitis Endometritis Ectopic pregnancy PID from trachomatis/N gonorrhoaea Also in ectopic pregnancy

Chandelier sign

Pain Amenorrhea Bleeding

Ectopic pregnancy

Chlamydia | Mucopurulent cervicitis

Azithromycin | Doxycycline

Gonorrhoaea | Mucopurulent cervicitis

Ceftriaxone | Cefixime

Motile, corkscrew-shaped prokaryotic bacterium Flexible, helically coiled cell wall String of beads in dark field illumination Darting motility, rotatory motion, flexion, back and forth squiggle

T pallidum

Sexual contact with lesion or body fluids Less commonly: transplacental Rarely: blood transfusion, accidental inoculation or puncture, organ transplantation Incubation period: 2-6 weeks

Syphillis

Declined significantly since 2000 Increased cases of primary and secondary syphilis since 2000 MSM Risk factor: unprotected sex, partners of infected persons Subsaharan Africa, SEA

Syphillis

Primary stage of Syphillis

Chancre 3-12 weeks

Secondary stage of syphillis

Mucocutaneous lesions Organ involvement 4-12 weeks

Early latent stage of syphilis

1 year from contact | Relapsing in 25%

Late latent syphilis stage

More than 1 year 2/3 remission 1/3 CNS, Cardio involvement

T pallidum rapidly penetrates intact mucous membranes or abraded skin then enters the blood and lymphatics Generation time: 30 hours Median incubation: 21 days Average incolum: 500-1000 ave

Syphillis

Women with primary or secondary syphilis more likely to transmit to fetus Can infect any stage of pregnancy Incidence highest during first 4 years after acquiring the infection Risk factors: cocaine

Syphillis

Risk of fetal infection in untreated early maternal syphilis

75-95%

Adequate treatment before this week AOG prevents fetal damage Untreated maternal infections result in fetal loss (40%) Most infected are asymptomatic at birth

Before 16 weeks (4th month)

``` Snuffles Rhinitis Desquamation Mucocutaneous rash Osteochondritis ```

Early congenital syphilis

Most frequently observed osseohs lesion in congenital syphillis Wrist, elbows, ankles, knees Pseudoparalysis of parrot Periostitis of long bones

Osteochondritis

Late manifestation of congenital syphilis | Bec of chronic granulomatous inflammation of bone, teeth and CNS

>2 years

Hutchinson teeth Interstitial keratitis 8th nerve deafness

Hurchinson triad

Linear scars that extend like a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and genitalia

Rhagades

Depression of the nasal root, a result of syphilitic rhinitis destroying adjacent bone and cartilage

Saddle nose

Abnormal 1st lower 6 years molar

Mulberry molars

Bony prominence of the forehead due to persistent recurrent periostitis

Olympian brow

Unilateral or bilateral thickening of the sternoclavicular third of the clavicle

Clavicular or Higoumenaki sign

Convexity along the medial border of the scapula

Scaphoid scapula

Unilateral or bilateral painless joint swelling (usually involving the knees)

Clutton’s joint

``` Saber shin Saddle nose CN VIII deafness Hutchinson teeth Mulberry molars ```

Congenital syphillis

Saddle nose deformity

Wegener granulomatosis

Soft chancre Pain Painful inguinal lymphadenitis H ducreyi

Chancroid

Lues maligna Patchy alopecia Mucous patches

Secondary syphilis

Endarteritis obliterans Aortitis, AR, Saccular Tree bark appearance

Cardiovascular syphilis | Tertiary syphilis

Asymptomatic neurosyphilis Lack neurologic symptoms but have CSF abnormalities RPR titer: >1:32

Neurosyphillis

5 types of syphilis

``` Asymptomatic Meningeal Meningovascular General paresis Tabes dorsalis ```

Affects dorsal columns

Tabes dorsalis

Tabes dorsalis affects this part of spinal cord

Posterior column Vibration and position sense Tabetic gait (ataxia)

The great pretender

Syphilis

Great masquerader

PE | Pheochromocytoma

Posterior uveitis | Panuveitis

Ocular syphilis

Meningeal syphillis Meningovascular syphilis Parenchymatous syphilis General paresis Tabes dorsalis

Neurosyphillis

Tabes dorsalis Gumma Endarteritis obliterans Syphilitic aortitis

Tertiary syphilis

Pupils do not react to light Pupils react briskly to ACCOMODATION duling

Argyll Robertson pupil

Treatment for all stages of syphilis

Benzathine Pen G 2.4 M IM

Hard painless chancre

Primary syphilis

Condyloma lata

Secondary syphilis

If patient is allergic to PCN but has syphilis

Doxycycline Tetracycline Neurosyphilis Ceftriaxone

Gummas Aortitis of vasa vasorum Tabes dorsalis Argyll Robertson Pupil

Tertiary syphilis

Syphilis Dx

Dark field immunoflouresence Treponemal test FTA-ABS TP-PA VDRL RPR

Calcutta antigen

Cardiolipin | Phosphatidylglycerol

``` General malaise Fever Sweating Headache Temporary exacerbation of syphilitic lesions after initial treatmenr ```

Jarisch-Herxhimer reaction

VDRL may turn out false positive in | detects nonspecific Ab that reacts with beef cardiolipin

``` Syphilis Viruses (Mononucleosis, Hepatitis) Drugs Rheumatic fever/Rheumatoid arthritis Lupus&leprosy ```

Standardized for use on cerebrospinal fluid and becomes positive in neurosyphilis Reagin antibodies generally do not reach the CSF from the bloodstream but are probably formed in the central nervous system in response to syphilitic infection

VDRL test

PID is associated with

Recent menstrual flow

Contraceptive associated with least risk for PID

Condom

Patient administered treatment of genital warts

Podafilox | Imiquimod

Provider administered genital wart

Trichloroacetic acid Podophyllin resin Cryotherapy Surgery

CMV is transmitted by

Droplet infection Uteroplacental Coitus

Mucopurulent discharge after menstruation

Chlamydia

Measures antibodies against T pallidum Used to determine if a positive result from a nontreponemal test is truly positive or falsely positive

Treponemal antibody test TPPA T pallidum-particle agglutination T pallidum hemagglutination TPHA Microhemagglutination T pallidum

Uses indirect immunofluoresence to detect reactive antibodies The presence of IgM FTA in the blood of newborns is a good evidence of in utero infection (congenital syphillis)

FTA ABS