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Step Two > infectious disease > Flashcards

infectious disease Flashcards

1
Q

causes of meningitis:

newborn 0-6 months

A

GBS
E coli/ gram negative rods
Listeria

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2
Q

causes of meningitis:

children 6 months - 6 years

A

S pneumoniae
N. meningitidis
H influenzae B
enterovirus

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3
Q

causes of meningitis:

6-60 years old

A

N meningitidis
enteroviruses
S pneumoniae
HSV

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4
Q

causes of meningitis:

60+ years

A

S pneumoniae
Gram negative rods
listeria
N meningitidis

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5
Q

causes of meningitis:

HIV patients

A 
cryptococcus
CMV
HSV
VZV
TB 
toxoplasmosis (brain abscess)
JC virus (PML)
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6
Q

meningitis
< 1 month of age
cause: GBS, E coli/ gram (-) rods, listeria
treatment _______

A

ampicillin + cefotaxime
or
gentamicin

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7
Q

meningitis
1-3 months
cause: pneumococci, meningococci, H influenzae
treatment: ______

A

vancomycin IV + ceftriaxone or cefotaxime

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8
Q

meningitis:
3 months - adulthood
cause: pneumococci, meningococci
treatment_______

A

vancomycin IV + ceftriaxone or cefotaxime

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9
Q

meningitis
> 60 years/ alcoholism/ chronic illness
pneumococci, gram (-) bacilli, listeria, meningococci
treatment: ______

A

ampicillin + vancomycin + cefotaxime or ceftriaxone

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10
Q

causes of brain abscesses

A

strep
staph
anaerobes

non-bacterial causes

  • toxoplasma
  • aspergillus
  • candida
  • zygomycosis if immunocompromised

can be polymicrobial

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11
Q

classic triad of brain abscess

A

headache
fever
focal neurologic deficit

note: if fever absent, primary and metastatic brain tumors should be considered in differential diagnosis

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12
Q

dx of brain abscess

A 
CT: ring-enhancing lesions
lab values: 
-peripheral leukocytosis
- increased ESR
-increased CRP

CSF not necessary (don’t want to cause an uncal herniation)

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13
Q

brain abscess treatment

A

initiate broad spectrum antibiotics and surgical drainage (if < 2 cm, can often do medically)

antibiotics:

  • third generation cephalosporin + metronidazole +/- vancomycin (IV therapy for 6-8 weeks)
  • serial CT/ MRIs

can give dexamethasone with taper to decrease cerebral edema
can give IV mannitol to decrease ICP
can give prophylactic anticonvulsants

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14
Q

HIV
CD4 count > 200
opportunistic infections:

A 
bacterial infections
tuberculosis
herpes simplex
herpes zoster
vaginal candidiasis
hairy leukoplakia
kaposi's sarcoma
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15
Q

HIV
CD4 count > 50 and < 200
opportunistic infections

A 
pneumocystosis
toxoplasmosis
cryptococcosis
coccidioidomycosis
cryptosporidiosis
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16
Q

HIV
CD4 count < 50
opportunistic infections

A

disseminated MAC infection
Histoplasmosis
CMV retinitis
CNS lymphoma

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17
Q

HIV-related opportunistic infection

p jiroveci pneumonia

A

indication for prophylaxis:

  • CD4+ < 200
  • prior P jiroveci infection
  • unexplained fever X 2 weeks
  • HIV related oral candidiasis

tx: TMP-SMX

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18
Q

HIV related opportunistic infection

mycobacterium avium complex (MAC)

A

indication for prophylaxis
-CD4+ < 50-100

tx: weekly azithromycin

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19
Q

HIV related opportunistic infection

toxoplasma gondii

A

indication for prophylaxis
-CD4+ < 100 + (+) IgG serologies

tx: double strength TMP-SMX

20
Q

HIV related opportunistic infection

m tuberculosis

A

indication for prophylaxis
-PPD > 5 mm or “high risk”

treatment: INH x 9 months (+ pyridoxine) or rifampin X 4 months

21
Q

HIV related opportunistic infection

candida

A

indication for prophylaxis:
-multiple reoccurences

treatment:

  • esophagitis: fluconazole
  • oral: nystatin swish and swallow
22
Q

HIV related opportunistic infection

HSV

A

indication for propylaxis:
-multiple reoccurences

treatment:
-daily suppressive acyclovir, famciclovir, or valacyclovir

23
Q

HIV related opportunistic infection

S pneumoniae

A

indication for prophylaxis
-all patients

tx: pneumovax
- give every 5 years provided that CD4+ is > 200

24
Q

HIV related opportunistic infection

influenzae

A

indication for prophylaxis:
-all patients

treatment: influenza vaccination annually

25
Q

oropharyngeal candidiasis (thrush)

  • micro
  • dx
  • tx
A

KOH or gram stain

  • budding yeast and/ or pseudohyphae
  • germ tubes at 37C

tx:
- thrush: (nystatin suspension, clotrimazole tablets, or a PO azole such as fluconazole)
- esophagitis: (PO azole therapy)

26
Q

cryptococcal meningitis

  • micro
  • dx
  • tx
A

cryptococcus antigen testing
CSF india ink stain
-5-10 um yeast with capsular halo… narrow-based unequal budding

tx:
-IV amphotericin B + flucytosine X 2 weeks then flucanazole X weeks

27
Q

histoplasmosis

  • buzzwords
  • dx
  • tx
A

spelunking, bird/bat excrement
ohio and mississippi river valley

dx:
- urine and serum polysaccharide antigen testing
- CXR: diffuse nodular densities, focal infiltrate, cavity or hilar lymphadenopthy

tx:

  • mild: support +/- itraconazole
  • chronic cavitary lesions: itraconazole > 1 yr
  • severe or disseminated: liposomal amphotericin B or amphotericin B X 14 days followed by itraconazole X 1 year or longer
28
Q

pneumocystis jiroveci pneumonia

  • micro
  • dx
  • tx
A

silver stain and immunofluorescence: comma-shaped spores
CXR: diffuse bilateral interstitial infiltrates with a ground-glass appearance

tx:
- high dose TMP-SMX X 21 days
- prednisone taper for moderate to severe hypoxemia

29
Q

CMV

  • dx
  • tx
A

dx: viral isolation, culture, tissue histopathology, serum PCR
tx: ganciclovir or foscarnet

30
Q

MAC

  • dx
  • tx
A

dx:
- mycobacterium blood cultures
- Labs: anemia, hypoalbuminemia, increased serum alk phos and increased LDH
- biopsy of bone marrow, intestines or liver: foamy macrophage with acid fast bacilli

tx:
-clarithromycin and consider HAART if drug naive
-second line: ethambutol +/- rifampin
continue > 12 months and until CD4+ > 100 for > 6 months

31
Q

toxoplasmosis

  • buzzwords
  • dx
  • tx
A

ingesting raw or undercooked meat; changing cat litter

dx:

  • serology
  • PCR (indicates exposure and risk of reactivation)
  • CT: hypodense ring-enhancing lesions
  • MRI: predilection for the basal ganglia

tx:

  • high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog to prevent hematologic toxicity) X 4-8 weeks
  • prophylaxis: TMP-SMX or pyrimethamine + dapsone when CD4 < 100 or + toxoplasmosis IgG
32
Q

chlamydia

-tx

A

doxycycline X 7 days
or azithromycin X 1

pregnant patients: azithromycin or amoxicillin

treat sexual partners

33
Q

gonorrhea

-tx

A

ceftriaxone IM or cefixime PO

disseminated: requires IV ceftriaxone for at least 24 hours

treat sexual partners if possible

34
Q

syphilis (treponema pallidum)

  • dx
  • tx
A

dx:
- dark field microscopy
- VDRL/RPR (many false +)
- FTA-ABS

tx:

  • primary and secondary: benzathine penicillin IM X 1 day…… if penicillin allergy: tetracycline or doxycycline X 14 days…… pregnant with penicillin allergy: desensitized and tx with penicillin
  • latent infection: benzathine penicillin (1 dose for early latent and weekly dose for 3 weeks for late latent infection)
  • neurosyphilis: penicillin IV X 10-14 days; penicillin-allergic patients should be desensitized prior to therapy
35
Q

klebsiella granulomatosis

  • dx
  • tx
A

NOT painful
beefy-red ulcer with rolled edge of granulation tissue
granulomatous ulcers

dx: clinical exam and donovan bodies
tx: doxycycline or azithromycin

36
Q

haemophilus ducreyi (chancroid)

  • dx
  • tx
A

painful
irregular deep well demarcated, necrotic
inguinal lymphadenopathy

dx: clinical
tx: azithomycin or ceftriaxone

37
Q

HSV-1 or HSV-2

  • dx
  • tx
A

painful
malaise, myalgias, fever with vulvar burning and pruritus

dx: tzanck smear shows multinucleated giant cells; viral culture, DFA or serology
tx: acyclovir, famciclovir or valacyclovir for primary infection

38
Q

HPV

  • dx
  • tx
A

NOT painful
papule (condylomata acuminata; warts)
irregular pink or white; raised; cauliflower

dx: clinical; biopsy for confirmation

tx: cryotherapy; laser or excision
- topical agents: podophyllotoxin, imiquimod, or trichloroacetic acid

39
Q

common UTI bugs

A 
serratia
e coli
enterobacter
klebsiella pneumoniae
staph saprophyticus
pseudomonas
proteus mirabilis
40
Q

diagnosis of UTI

A

dx by clinical symptoms

urine dipstick / UA:

  • increased leukocyte esterase
  • increased nitrites (bacteria)
  • increased urine pH (proteus)
  • hematuria (cystitis)

microscopic

  • pyuria (> 5 WBC/hpf)
  • bacteriuria

urine culture: gold standard is > 10^5 CFU/mL

41
Q

treatment of UTI

A

uncomplicated:
-PO TMP-SMX or fluoroquinolone X 3 days or nitrofurantoin X 5 days

complicated: same drugs but 7-14 days

pregnant:
-nitrofurantoin or amoxicillin X 3-7 days

urosepsis: IV antibiotics: consider broader coverage

42
Q

pyelonephritis

  • dx
  • tx
A

UA and culture: similar to cystitis but with WBC CASTS
CBC: leukocytosis
imaging: if not responding to therapy in 48-72 hours: CT or MRI (look for obstruction or abscess or complication)

tx:

  • mild: 7-14 days of antibiotics outpatient (fluoroquinones are first line)… encourage fluids
  • serious or systemic: IV antibiotics (fluoroquinones, 3rd or 4th gen cephalosporin, b-lactam/b-lactamase inhibitors, or carbapenen)
43
Q

malaria

  • dx
  • tx
  • prophylaxis
A

dx

  • giesma or wright-stained thick and thin blood film
  • CBC: normochromic normocytic anemia with recticulocytosis
  • serologic tests if available

tx:

  • uncomplicated: chloroquine
  • P vivax and P ovale: chloroquine + primaquine (to eradicate hyponozoites)
  • severe: IV quinidine

prophylaxis:
-mefloquine (first line for chloroquine resistant malaria)

44
Q

infectious mononucleosis (EBV, CMV, toxoplasmosis, HIV, HHV-6)

  • diagnosis
  • tx
A

diagnosis

  • heterophil antibody (may be (-) in first few weeks)… aka mono spot test
  • EBV specific antibodies can be ordered if (-) mono spot test…. if still (-) think CMV
  • CBC: thrombocytopenia, lymphocytosis, >10% atypical T lymphocytes
  • CMP: elevated transaminases, alk phos and total bilirubin

tx:

  • support
  • can use corticosteroids if airway compromise
45
Q

Borrelia burgdoferi

  • dx
  • tx
A

dx:

(1) ELISA
(2) confirm with Western blot

tx:

  • doxycycline
  • amoxicillin if children < 8 years old or pregnant patient
  • advanced disease: ceftriaxone
46
Q

rickettsia rickettsii
(carried by american dog tick: Dermacentor variables)
-dx
-tx

A

dx:
-clinical… confirm with biopsy and indirect immunoflourescense

tx:

  • doxycycline
  • if pregnant: chloramphenicol
47
Q 
anthrax 
(spore-forming gram (+) bacterium Bacillus anthracis)
-dx
-tx
-post-exposure prophylaxis
A

dx:

  • culture isolation or
  • two non culture supportive tests (PCR, immunohistochemical staining or ELISA)

-CXR for inhalational: widened mediastinum and pleural effusion

tx:

  • ciprofloxacin or doxycycline PLUS 1-2 additional antibiotics for at least 14 days (for inhalation disease or cutaneous disease of face, head or neck)
  • other cutaneous disease: treat 7-10 days

postexposure prophylaxis:
-ciprofloxacin (prevent inhalation anthrax… continue for 60 days)

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