Flashcards in Infectious Disease Deck (71):
Which anti fungal should you use in a pulmonary patient with a presentation concerning for aspergillosis
voriconazole or ampho B
What infection do patients with AML have a greatly increased chance of catching?
Patients with acquired humoral deficiencies are predisposed to infections with which organisms?
encapsulated organisms, gram negative rods, and giardia
splenectomy and functional asplenia increase the risk of infection with which types of organisms?
encapsulated, malaria, and babesiosis
What type of infections do you see in patients with IgA deficiency?
recurrent sinopulmonary disease from encapsulated organisms, recurrent giardiasis, and food/respiratory allergies.
What kind of infections do you see with C1, C2, and C4 classical pathway complement deficiencies?
recurrent sinopulmonary infections, otitis media with encapsulated bacteria (strep pneumo, h influenza, n meningitidis).
- Associated with development of systemic SLE at an early age
Seeing what bacteria in the blood should make you think of an underlying GI malignancy?
1. Strep bovis
2. Clostridium septicum
What important bacteria do cephalosporins have no activity against?
Enterococci and Listeria
Name 3 bacteria that are common causes of food poisoning
1. Bacillus cereus
2. Clostridium perfringens
3. Staph aureus
Name 2 infectious diseases for which aminoglycocides are the treatment of choice
1. Plague (Yersinia pestis)
What 2 causes lead to bell's palsy?
1. HSV and 2. Lyme disease
What's a rare cause of neutrophilic meningitis?
Nocardia or fungus
Vulvovaginal candidiasis can be a sign of what?
Undiagnosed diabetes or HIV
When you find proteus bacteria in the urine, what should you be thinking about?
Order imaging to look for stones
Name the only 2 fungal diseases that cause peripheral eosinophilia.
1. Coccidioidomycosis and 2. Allergic Bronchopulmonary Aspergillosis
Rhizopus (a type of mucormycosis) is seen in what 3 medical conditions?
1. DM 2. hemochromatosis 3. severely immunosuppressed
What fungus other than aspergillosis can cause a necrotizing, cavitating pneumonia?
1. Zidovudine (ZDV's) (azidothymidine AZT)
3. The D's (ddI and d4T)
7. All PI's
10. Boosted saquinavir
1. bone marrow suppression and myopathy
2. potentially fatal hypersensitivity reaction
3. pancreatitis, peripheral neuropathy, mitochondrial toxicity
4. azotemia and a fanconi like syndrome
6. Teratogenic; CNS side effects like bad dreams
7. Lipodystrophy, hyperlipidemia, DM2, osteoporosis
8. indirect hyperbilirubinemia
9. Kidney stones
10. prolonged QT
All patients with HIV should be tested for what other virus?
How would you distinguish Babesia from Plasmodium on a slide?
Babesia (babesiosis) - intra-RBC pear shapes which occasionally form a tetrad appearing as a Maltese cross
What is the toxic shock syndrome triad?
fever, rash, hypotension and involvement of 3 or more organ systems
What are the dreaded organisms that can still thrive in immunosuppressed patients who are receiving very broad-spectrum antibiotics?
Fusarium and Aspergillus
What are some keywords to think about plague?
- Reservoir is wild rodents; transmitted by fleas or direct contact from skinning animals
- Think of for patients like homeless who may have come in contact with rodents
- desert southwest
- Bubonic form causes large, localized lymphadenopathy )buboes) that suppurate (discharge pus)
- Also a pneumonic form that occurs after you inhale the organism via aerosols from infected animals or other humans
Keywords for Brucella
- various strains found in goats, sheep, camels, cattle, pigs, and dogs
- transmitted to humans via unpasteurized milk or cheese or by inhalation (work-related)
Keywords for francisella tularensis
- especially seen in arkansas, missouri, and oklahoma
- irregular ulcer at the site of inoculation and lymphadenopathy
- Can get from:
Tick and deer fly bites
Skin contact with infected animals (rabbits/rodents)
Ingestion of contaminated water
Inhalation of contaminated aerosols or agricultural dusts
Keywords for Bartonella henselae
- cat scratch disease or bacillary angiomatosis in immunocompromised
- painful lymphadenopathy
What are 2 main causes of culture negative endocarditis?
Brucella and Coxiella are both causes of culture-negative endocarditis.
Keywords for Q Fever
- due to Coxiella burnetii infection
- transmitted through inhalation of aerosol released from the infected animal
- Seen in slaughterhouse workers and people exposed to an infected animal's products of conception during birthing
Keywords in vibrio
saltwater; seafood and shellfish
Keywords in EBV infection
- 90% develop a macular rash if treated with ampicillin or amoxicillin
Keywords in bacterial vaginosis
fishy odor (+whiff test)
If a patient is found to have candida fungemia, what's the next test you should order?
An eye exam to eval for endophthalmitis
Keywords for babesiosis
- causes febrile hemolytic anemia
- transmitted via the Ixodes tick from rodents
- Has classic intra-RBC pear shapes called Maltese crosses
Keywords for trichinosis
- due to Trichinella spirali
- Key words: undercooked bear, wild boar, pig meat
What are some of the sources of infection for non-typhoidal Salmonella?
-Spread by frozen food (chicken), milk, and eggs
- Peanut butter and alfalfa sprouts
- Baby chicks, iguanas, turtles, and other exotic pets like snakes are also sources of infections
What part of the country are these found?
- Coccidio - the southwest US and northern Mexico (found in the soil)
- Histo - the Mississippi and Ohio River valleys (bad and bird droppings)
- Blasto - the Mississippi and Ohio River valleys and those near the great lakes and the st. lawrence river (hunting in the Midwest)
What infection should you think of if someone who works around fish tanks develops non healing skin ulcers?
Keywords associated with Nocardia infection
- weakly acid fast
- beaded, branching, filamentous gram positive rod
- starts as a lung infection - a thin walled cavitary lesion
- causes focal brain abscesses and chronic neutrophilic meningitis
- nodular skin lesions are common
What are 2 causes of bloody diarrhea that may not present with fever? What are 2 causes that may present with fever?
Non febrile - campylobacter and EHEC
Febrile - salmonella and shigella
Key words for histoplasmosis
Farm buildings, caves, bird-roosting locations, bat guano, and “spelunking” (cave exploration) with exposure to the southeast and south central U.S (Mississippi and Ohio river valleys)
If I see a pneumonia on the exam associated with a bird exposure, what should I think of?
1. Hypersensitivity pneumonitis - recurrent PNA's
2. Psittacosis from Chlamydia psittaci - acute illness after one exposure
If I see a pneumonia case with splenomegaly and a bird exposure, what should I consider?
What 4 things define measles?
cough, coryza, conjunctivitis, koplik spots
Bacteria that gardeners, especially those who are pricked by a thorn, get.
What should I think if I see a description of disseminated skin lesions with central necrosis in an immunosuppressed person
ecthyma gangrenosum and Pseudomonas bacteremia
What diarrhea is seen with chitlins?
What diarrhea is seen with brown gravy and meats?
What mimics strep pharyngitis in a younger patient?
Arcanobacterium haemolyticum; usually has an erythematous rash
What infection should you think of in an an uncontrolled diabetic with multiple episodes of DKA?
The zygormycosis such as mucormycosis
What bacteria do you find with animal bites?
staph aureus, eikenella, and pasteurella multocida
Between the 2, which do you treat with abx and which don't you treat with abx?
Shigella - treat
Salmonella - don't treat unless very young, very old, or immunocompromised
What are some characteristics of CMV retinitis in an HIV+ patient?
floaters). His funduscopic exam shows large hemorrhages and exudates consistent with CMV retinitis
- See if CD4
They give you a question with geography of new england?
Babesiosis - spread by ticks
Which fungus cavitate?
Histo and aspergillus
Hawaii, triathlon or Ironman
Leptospirosis - tx with doxy
PAS positive foamy macrophages
Arkansas/Missouri/Oklahoma, tick bite, LAD, no pancytopenia
tularemia due to Francisella tularensis
"box car" Gram positive rods
vibrio vulnificans has ______ lesions
A nail through a tennis shoe
Nasal polyp in young person with recurrent sinus and bronchial infections
Think CF, especially if infected with pseudomonas
Palatal ulcer in an HIV patient
What do you think about if someone has recurrent bacteremia with salmonella or strep pneumo?
fever, headache, and,conjunctival suffusion and an obstructed jaundice picture
- think swimming with animal in infected water
- Hawaii/recreational water exposure
- heavy rain and flooding
hearing loss in a sexually active young person
An ampicillin/amoxicillin induced rash should make me think of?
Mono (EBV); also has palatal petechiae and exudative pharyngitis
e coli 0157:h7
What states are tularemia and ehrlichia?
Arkansas, Missouri, Oklahoma
What states have plague?