Infectious Disease Flashcards
(36 cards)
1
Q
3 Criteria for Virulence of Infection
A
- inflict serious harm
- go unrecognized my immune system
- spread efficiently
2
Q
Diagnostic Aids for Infection
A
- CBC
- Platelet count
- C-reactive protein
- Procalcitonin
- Erythrocyte sedimentation rate
- Cultures and stains
- DNA/RNA
- Immunoserology
- Imaging (MRI)
3
Q
What can a CBC tell you about infection?
A
- Leukocytosis: bacterial
- Leukopenia: viral
- Differential further focuses diagnosis
4
Q
What can a C-reactive protein tell you about infection?
A
- Acute-phase reactant
- Increases in presence of acute inflammation
- Nonspecific
5
Q
What can a platelet count tell you about infection?
A
Thrombocytosis in active phase of infection
6
Q
What can procalcitonin tell you about infection?
A
- Biomarker for differentiating some viral from serious bacterial infections
- Increased in bacteremia/ can reflect severity
7
Q
What can Sed-Rate tell you about infection?
A
- Acute-phase reactant; nonspecific
- Useful to evaluate therapy when antibiotics used
8
Q
Typical Infections in Child Care Setting
A
- Hand foot mouth
- Erythema infectiosum
9
Q
Physical Examination of Hand Foot Mouth Disease
A
- Skin: macular-papular; urticarial, vesicular, petechial
- Vesicles
- Febrile more than 3 days
- Mild URI
10
Q
Physical Examination of Erythema Infectosium
A
- Prodrome: mild fever, myalgia, HA, malaise, URI symptoms
- Rash: 7-10 days after prodrome
- “slapped cheek” with circumoral pallor
- lacy, maculopapular rash (may last a month)
11
Q
Clinical Findings for West Nile Virus
A
- Mimics influenza, GI infection
- Mild symptoms will resolve in 1 week
- Severe - neuroinvasive involvement
12
Q
Diagnostics for West Nile Virus
A
MAC - ELISA
13
Q
Tick-Bourne Diseases
A
- Lyme Disease
- Rocky Mountain Spotted Fever
14
Q
Stage 1 of Lyme Disease
A
- erythema migrans (bulls eye rash)
- may resemble nummular eczema
- some may have flu like symptoms
15
Q
Stage 2 of Lyme Disease
A
- early disseminated disease
- secondary annular lesions
- neurologic signs
- cardiac signs
- generalized manifestations (may last 2 weeks to 2 years)
16
Q
Stage 3 of Lyme Disease
A
- Late disease
- Pauciarticular arthritis weeks to months after bite
17
Q
Diagnostics Studies for Lyme Disease
A
- No other tests are needed if erythema migrans is present
- IgM antibodies not positive for 2-4 weeks
- IgG antibodies not positive for 4-6 weeks
- High rate of false positives
- CDC: ELISA - if neg then no more tests; IgG and IgM Western blot if having symptoms over 30 days
18
Q
Management of Lyme Disease
A
- Prophylactic doxycycline/amoxicillin
- Amoxicillin or doxycycline in early localized disease
- Early or late disseminated disease - consult ID
19
Q
Clinical Findings for Rocky Mountain Spotted Fever
A
- Fever, chills, myalgia, GI symptoms, photophobia, AMS
- Focal neurologic deficits with disease progression
- Maculopapular rash: wrists, forearms, ankles –> spreads to trunck
20
Q
Diagnostics Studies for Rocky Mountain Spotted Fever
A
- PCR testing or IFA
- Thrombocytopenia, hyponatremia, leukocytosis, anemia
21
Q
Management of Rocky Mountain Spotted Fever
A
- Antibiotics prior to onset of rash
- Disease may progress rapidly
- Doxycycline for 7-10 days for all ages
22
Q
Complications of Rocky Mountain Spotted Fever
A
- Neurologic deficits
- 20% fatality if untreated
- Prevention: tick precautions
23
Q
Bacterial Infections in Children
A
- Community-Acquired MRSA
- Cat Scratch Disease
- Meningococcal Disease
- Group A Strep (GAS)
24
Q
Clinical Clues for Community-Acquired MRSA
A
- Boil, abscess without pus; rapid onset
- Other family members have similar infections
- Neonate with skin/soft tissue infection
- Hx of recurrent small, non-tender, maculopapular lesions; multiple lesions
- Ethnic minority or lower socioeconomic status
- Hx of hospitalization in past year
- Attends day care; is less than 2 years old
25
Management of Community-Acquired MRSA
1. Superficial skin lesions - topical antibiotic
2. Widespread impetigo - oral/IV antibiotics
3. Warm compresses to localize pus in nonfluctuant
4. Cultures for non-draining fluctuant abscess
**Refer immunocompromised patients to ID specialist
26
Clinical Findings for Cat-Scratch Disease
1. 3-5 mm erythematous papules which heal; lymphandenopathy in 1-4 weeks; persists up to 1 year
2. Parinaud oculograndular syndrome - painful non-supportive conjunctivitis/preauricular lymphadenopathy in small percentage
3. In immunocompromised patients - recurrent fevers, bacteremia, weight loss
27
Diagnostic Studies for Cat Scratch Disease
1. IFA for serum antibodies
2. CBC - mild leukocytosis
3. ESR/CRP elevated early
28
Management of Cat Scratch Disease
- Most resolves spontaneously
- Antibiotics only if concerns for systemic CSD
- Treatment for immunocompromised patients: oral agents and parenteral gentamycin
29
Complications of Cat-Scratch Disease
1. Small percentage have systemic illness with high fever, malaise, fatigue, anorexia
2. Enlarged mediastinal nodes - pleurisy, obstruction
3. Splenic/hepatic abscesses
30
Clinical Findings for Meningococcal Disease
1. Occult bacteremia - febrile URI or GI infection; may resolve without intervention
2. Meningococcemia - rapid progression over several hours: fever, septic shock, petechiae to purpura fulminans, hypotension, DIC, adrenal hemorrhage, organ failure, coma: death in 12 hours
3. Meningococcal meningitis - fever, HA, stiff neck
31
Diagnostic Studies for Meningococcal Disease
1. Positive culture/Gram stain from CSF, blood, or synovial fluid
2. PCR assays useful if antibiotics given
32
Management of Meningococcal Disease
- hospital is mandatory
- IV antibiotics pending cultures
- chemoprophylaxis within 24 hours of index case regardless of immunization status
- Prophylaxis during outbreak: vaccination and chemoprophylaxis
33
Clinical Findings of Group A Streptococcus (GAS)
1. Respiratory tract infection - peritonsilar abscess, cervical lymphadenitis, GABHS
2. Scarlet fever
3. Bacteremia
4. Vaginitis and TSS
5. Perianal streptococcal cellulitis
6. Skin infections
7. Rheumatic fever
8. Necrotizing fasciitis
34
Clinical Findings Scarlet Fever
- erythogenic toxin
- abrupt illness with sore throat
- fever
- vomiting
- HA
- chills
- malaise
- erythematous tonsils/exudate
- strawberry tongue
- sandpaper rash
35
Management of GAS
Antibiotics
36
Complications of GAS
Pediatric autoimmune neuropsychiatric disorders
1. OCD
2. Tic disorders
3. Tourettes
