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Infectious Disease Flashcards

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1
Q

When do you see pneumocytis jiroveci pneumocytosis?

A

Common in AIDS when <200 CD4 cells

most common opportunistic infection in AIDS patients

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2
Q

Presentation of pneumocytis jiroveci?

A

Subacute (more indolent) fever, dyspnea, tachypnea, nonproductive cough
-interstitial infiltrates

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3
Q

Dx of pneumocytis jiroveci?

A

PCR of sputum > DFA > more sensitive than silver stain

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4
Q

Tx of Pneumocytis jiroveci?

A

TMP-SMX

-add prednisone taper over 21 days if PaO2 <70

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5
Q

Tx of vaginal candidiasis

A

-conzaole cream x 1-7 days
OR
fluconazole 100-200mg PO x 1

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6
Q

What happens before esophageal candidiasis?

A

Usually ABX, steroid & or chemo exposure
-dx via EGD w/ biopsy
Tx = IV fluconazole

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7
Q

Most common causes of malaria?

A

(these two cause >90% of US cases)
-plasmodium vivax
**falciparum is most virulent
(transmitted by female mosquitos)

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8
Q

Presentation of Malaria

A

periodic chills, fever, sweats
headache, myalgia, splenomegaly possible
(travel history is vital)

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9
Q

How is malaria diagnosed?

A

Thick/thin blood microscopy smears

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10
Q

Malaria prophylaxis =

A

Nets & Repellants PLUS

  • Chloroquine or if resistance use atovaquone-proguanil
  • if endemic w/ p. vivax use Primaquine
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11
Q

How is varicella zoster virus transmitted

A

Mostly by respiratory secretions

less w/ direct contact of vesicular or pustular lesions

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12
Q

When does varicella-zoster virus present?

A

When adults age, cell mediated immunity wanes, or when they are stressed!
-so if <40-50 w/ flare you should ask more questions about HIV etc

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13
Q

Sequelae to varicella zoster virus?

A

increased CVA events within 6 mo of herpes zoster

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14
Q

Treatment of Herpes Zoster?

A

mild to mod = valcyclovir or famciclovir (PO)

severe/ disseminated = acyclovir (IV)

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15
Q

Who should get zostavax?

A

Single dose for all immunocompetent people > 50-60 years old INCLUDING those w/ previous episode of zoster (but lesions must be healed)

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16
Q

About Zostavax (type)

A

Live attenuated viral vaccine

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17
Q

HIV should be suspected in?

A

Anyone who is sexually active or injects drugs is at risk for HIV infection
HIV is a retrovirus

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18
Q

What is Acute HIV Syndrome?

A

An initial manifestation of HIV.

  • Mono-like illness usually more severe and needing hospitalization
  • rash in 40-80% (no exposure to aminopenicillins)
  • *mucocutaneous ulceration is a distinctive feature
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19
Q

Most common presentation of HIV?

A

Patient is asymptomatic and found via screening but not uncommon to find advanced disease

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20
Q

Routine screening for HIV =

A 
New = enzyme immunoassay (ELISA) then viral load test
Old = ELISA then confirm w/ western blot
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21
Q

HIV screening recommendation

A

Routine non-risk based opt-out HIV screening in all pts 13-64

  • all pts initiating tx for TB
  • all pts seeking tx for STDs
  • all pregos should be screened
  • Pts at high risk for HIV should be screened > or = 1 yr
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22
Q

Med Regimens for HIV

A

Regimen = 3 meds (2 NRTIs + 1NNRTI or 2NRTIS + 1 PI)

1) Nucleoside Reverse Transcriptase Inhibitors **these will always have ()
- Emtricibine (FTC)
- Tenofovir (TDF)
2) Non-nucleosdie Reverse Transciptase Inhibitors
- Efavirenz
3) Proteause Inhibitors
- fosamprenavir
- lopinavir
- atazanavir
- darunavir

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23
Q

Protease Inhibitor SE

A

Lipodystrophy and metabolic side effects

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24
Q

Prophylaxis when CD4 <200

A

for Pneumocystosis = TMP-SMX

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25
Prophylaxis when CD4 <100
for Toxoplasmosis = TMP-SMX
26
Prophylaxis when CD4 <50
for Mycobacterium avium complex = Azithromycin
27
What causes lyme disease?
Borrelia burgdorferi **spirochete** (the only two spirochetes are lyme dz and syphilis) **most common vector borne disease in US**
28
Progression of Lyme Dz
1: (Early) constitutional symp + erythema migrans (small red papule w/ centrifugal spread & central clearing) 2: (Disseminated) - Cardiac symp (5% develop varying degrees of AV block) - Neuro symp (Bell's Palsy) 3: (Late) - chronic arthritis may occur in up to 60% of people (the longer the infection goes on, the harder it is to treat)
29
Screening tests in Lyme Dz
Antibody assay may take 4-6 weeks to turn positive after infection. Confirm w/ western blot if screen is positive or equivocal.
30
Tx of Lyme Dz
Doxycycline (if > 8 y/o) Amoxicillin or cefuroxime (if < 8 y/o) Ceftriaxone if more serious manifestations (i.e. neuro)
31
What causes Rocky Mountain Spotted Fever? Manifestation?
Rickettsia rickettsii -presents as influenza prodrome and then red macular rash on 2nd-6th day of fever **1st on wrists/ankles and then spreading centrally (then turns petechial in 50%)
32
Tx of Rocky Mountain Spotted Fever
Treat w/ Doxycycline (EVEN KIDS)
33
Gonorrhea bacteria characteristics and presentation
Neisseria gonorrhoeae = gram NEG DIPLOcocci | yellow, creamy, profuse discharge (may be asymp)
34
Dx of gonorrhea
Nucleic acid amplification test NAAT of discharge or urine
35
Tx of gonorrhea
Ceftriaxone 250mg IM x 1 plus azithromycin 1g PO X1 | use combo therapy even if NAAT is negative for chlamydia
36
Chlamydia characteristics & presentation
- most common REPORTABLE sti - Men may be asymptomatic or urethritis or dysuria - Women commonly asymptomatic * **both sexes can present w/ reactive arthritis (Reiter's)
37
Chylamdia Tx
Azithromycin 1g PO x 1 or Doxycyline 100mg PO BID x 7days | **must retest for cure in pregnancy**
38
Syphilis bacteria characteristics
Treponema pallidum (corkscrew shaped spirochete)
39
Syphilis Staging
* *great imitator** 1) Active - Primary = chancre - Secondary = generalized MP rash on palms and soles - Tertiary = neurosyphilis 2) Latent - Early latent if < 1 yr - Late latent if > or = 1 yr
40
Early syphilis dx
Darkfield exam of lesion exudates
41
Later syphillis dx
1) Traditionally = RPR and confirm w/ fluorsecent treponemal antibody absorbed (FTA-ABS) 2) Reverse Seq = treponemal enzme immunoassay (EIA) if positive then do RPR w/ titer
42
Tx of syphilis
Benzathine Penicillin G (if PCN allergy = ceftriaxone or doxycycline) **treatment failures occur though, so serologic testing should be repeated 6 and 12 mo after initial treatment. Follow-up is mandatory.
43
Most common cause of genital ulcer in US
HSV
44
OTHER Common clinical manifestations of HSV
- meningoencephelitis - esophagitis/proctitis * *HSV-1 associated w/ Bell's Palsy (facial muscle weakness; CN VII palsy)
45
Diagnosis of HSV
Tzanck smear is the historical test = intranuclear inclusions and GIANT MULTINUCLEATED CELLS Cell culture or PCR is preferred **PCR is test of choice for detecting HSV in spinal fluid
46
Low risk types primarily benign anogenital warts
6, 11
47
High risk types primarily anogenital cancers
16, 18
48
Most common non-reportable STI =
HPV
49
Who should get Gardasil?
Boys and girls between age of 9-26y/o | prevents 6, 11, 16, 18
50
Who should get cervarix?
Girls ONLY between age 10-25 (prevents 16, 18)
51
Most common cause of infectious arthritis
S. aureus (transient bacteremia > other source of infection) Tx: antistaph abx & joint drainage
52
Most common cause of infectious arthritis in young sexually active people
n. gonorrhea | Tx: ceftriaxone + doxy
53
What bacteria do you think of in acute presentation of endocarditis
s. aureus
54
What bacteria do you think of in sub-acute presentation of endocarditis
strep and enterococci
55
Gold Standard orders in endocarditis
Blood cultures X2-3 | Echo
56
Empiric Abx in Endocarditis
Vanco + ceftriaxone | Vanco + gentamicin
57
Endocarditis prophylaxis abx =
Amoxicillin 2g PO 1hr BEFORE procedure | Cephalixin 2 g PO or clindamycin PO 1hr BEFORE procedure if penicillin allergy
58
Bacterial Meningitis bugs in preterm to 1 mo
s. agalactiae | e. coli
59
Bacterial Meningitis bugs in >1mo to 50yrs
s. pneumo n. meningitidis h. influenzae
60
Bacterial Meningitis bugs in >50 y/o
s. pneumo
61
Aseptic Meningitis bugs
enteroviruses (coxsackie and echovirus common) | -usually in fall or summer
62
Bacterial Meningitis CSF
``` high opening pressure increased cell count 100-1000 cell differentiation = PMNs usually decreased glucose increased protein ```
63
Aseptic Meningitis CSF
normal or min elevated opening pressure cell count 10-100s cell differentiation = lymphs usually glucose often normal
64
Empiric therapy in meningitis pts 1mo to 50y
ceftriaxone + vanco +/- ampicillin (if concern for listeria) **listeria is a rod that is not gram negative Add dexamethasone
65
Meningoencephalitis Causes
``` Sporadic = HSV1 > Varicella zoster virus Seasonal = est nile ```
66
West nile virus meningoencephalitis presentation
muscle weakness, flaccid paralysis "polio like virus"
67
Pathognomic for HSV meningoencephalitis
temporal lobe abnormalities on MRI
68
Tx of Meningoencephalitis
Empiric Acyclovir
69
Erysipelas cause, symp, tx
strep species (s. progenes) >> staph rapid onset red, glistening demarcated skin Tx: anti staph abx (cefazolin, clindamycin, vanco)
70
Cellulitis cause, symp, tx
step species >> staph | erythema less intense than erysipelas; fever, chills, erythema, induration
71
Furuncle cause, tx
s. aureus | Tx: warm compresses, I&D, anti-staph abx
72
Necrotizing fascitis cause, symp, tx
Classically = group A strep (s. pyogenes) but most are polymicrobial presents like cellulitis but exam findings (systemic toxicity, pain) are out of proportion Tx: surgical emergency (extensive debridement)
73
Non-Inflammatory Diarrhea characteristics
- large volume, watery stool - no blood or PMNs (mucus) - nausea/flu-like symp are common
74
Differential Dx of non-inflammatory diarrhea
- viral (norovirus) - bacterial (s. aureus, b. cereus, v. cholerae) - protozoal (giardia, cryptospordium) * *anti-peristaltics are usually ok**
75
Inflammatory Diarrehea characteristics
small volume, frequent bloody/mucus stools abdundant PMNs Fever, chills, abdominal pain
76
Differential dx for inflammatory diarrhea
e. coli, c. diff, shigella, campylobacter, salmonella
77
Most common cause of gastroenteritis in US
Norobirus
78
Food poisoning
Usually staph N/V/D 1-6 hr later Tx = supportive
79
Bacteria if food poisoning from rice
bacillus cereus
80
Cholera
``` contaminated food or H20 caused by vibrio cholera ***rice water stool*** Dx w/ stool culture Tx: lots of fluids; azithromycin or doxy decreases duration of dz ```
81
Giardia
``` Giardia Lamblia -most common parasitic etiology of infectious diarrhea in US -associated w/ camping/hiking *most cases asymptomatic Dx w/ stool antigen test Tx: metronidazole or tinidazole ```
82
Cryptospordiosis
fecal oral transmission cholera-like diarrhea Dx: stool antigen test
83
E. coli diarrhea
initially associated w/ undercooked hamburger, now associated w/ almost any fresh food often afebrile **35% of blood diarrhea Dx: stool culture and fecal toxin testing Tx: supportive
84
Complication of e.coli diarrhea
HUS - acute renal failure - thrombocytopenia - hemolytic anemia
85
Tx of c. dif
metronidazole (if mild) vancomycin (moderate to severe) **remember = barnyard smell**
86
Shigellosis
presents abruptly w/ bloody diarrhea, abd pain, tenesmus, systemic toxicity *associated w/ daycare centers* Tx: fluoroquinolone for adults; azithromycin for kids
87
Campylobacter
gram negative s shaped rod **most common bacterial cause of infectious diarrhea** fever, watery-bloody diarrhea, and abdominal pain Tx: Azithromycin
88
Complications of campylobacter infection
- Guillain Barre Syndrome | - Reactive arthritis
89
Salmonellosis (Gastroenteritis pattern)
-raw egg or chicken ingestion -presents like campylobacter Tx: fluoroquinolone
90
Slamonellosis (enteric fever)
any salmonella species can cause but most s. typhi is most common
91
Typhoid fever=
enteric fever secondary to s. typhi -Constitutional symp, HA, GI symp (constipation or diarrhea) and generally in a ****returning traveler*** -dx w/ stool culture Tx: FQ or ceftriaxone (vaccine is available)

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