Infectious Disease 5 Flashcards
(19 cards)
If a mom has ACTIVE HBV, how to you prevent vertical transmission after delivery?
1) HBV vaccine + Immunoglobulin <12 hours of birth
2) Complete HBV vaccination series (0, 2, 6 mths)
3) Check serology at 9 months, if negative, transmission did not occur.
What is most directly correlated to increased risk of vertical transmission of HBV from mom to baby?
Viral load. (High = high risk of transmission).
- What organism causes Sporotrichosis?
- What is the classic presentation of Sporotrichosis “Rose Gardener’s Disease”
- How do you DX
4 TRX?
- Sporothrix Schenckii (dimorphic fungi)
- PAINLESS papule/nodule that appears at site of inoculation. –> Later ulcerates and drains NON-PURULENT/NON-ODOROUS fluid. –> Similar lesions pop up along proximal Lymphatic chain.
- DX with culture of fluid.
- TRX –> ITRACONAZOLE 3-6 months.
How to you manage Asymptomatic Bacturia in Pregnancy?
TREAT, as it decreases likelihood of progression to UTI and complication to fetus (preterm birth)
What Four antibiotics are first line for trx of UTI/asymp bacturia in pregnancy?
1) Cephalexin
2) Amoxacillin-Clavulanate
3) Fosfomycin
4) Nitrofurantoin
(use only one.)
How do you manage Pyelonephritis in a pregnant woman?
1) Admit to Hospital to start IV Broad Spectrum B-lactam ( IV Ceftriaxone or IV Cefepime )
2) IV abx until afebrile, then PO abx for 10-14 days.
3) Chronic abx with (Cephalexin, Amox-Clavulanate, Fosfomycin or Nitrofurantoin) until 6 weeks post part.
- What population gets gets Ecthyma Gangrenous?
- What is the pathophysiology of Ecthyma Gangrenosum?
- How does Ecthyma Gangrenosum present?
- Only seen in immunocompromised.
- Pseudomonas bacteremia –> perivascular invasion of bacteria, causing ischemic necrosis of overlaying skin.
- Signs of bacteremia + Painless red macule that eventually becomes a pustule –> rapidly processing to a hemorrhagic bulla –> eventually bursting open to a gangrenous ulcer. Uniquely NOT painful.
How do you treat Ecthyma Gangrenous?
Empirical coverage using two anti- Pseudomonas ABX.
Most commonly a B-lactam (Piperacillin-Tazobactam) + Aminoglycoside (Gentamicin).
- In USA, what two animals are most implicated in Rabies?
2. How to you contract rabies?
Bat> Raccoon
Bite, scratch or inhaling aerosolized viral particles.
what is the schedule for pre-exposure ppx for Rabies?
Rabies Vaccine day 0, 7, 21, and 28. (4 over 1 month)
Rabies has no treatment and leads to death 100% of the time, but you can give post exposure ppx if there is concern for Rabies transmission PRIOR TO ONSET OF SYMPTOMS.
- What is the ppx regimen if you were never vaccinated?
- What is the ppx regimen if you previously completed vaccination series?
- Rabies Immunoglobulin + Vaccine days 0, 3, 7, 14 (4 over 2 weeks)
2) Vaccine days 0 and 3 (2 doses)
Other than non-specific symptoms of fever and malaise..What 6 main symptoms do you see in Rabies?
(May not see all of these, depending on how advanced the disease is.)
- Pharyngeal spasms
- Hydrophobia (pathopneumonic)
- Aerophobia
- AMS
- Alternating stupor and agitation
- Ascending paralysis
In what six situation is breast feeding contraindicated?
1) Active TB infection
2) HIV (regardless of trx)
3) Active Varicella infection
4) Herpes on breasts
5) Current Chemo/radiation therapy
6) Active substance use.
How do you prevent transmission of HIV to baby during labor and after birth?
- IF mom’s viral load is >1,000
- IV Zidovudine (added to HAART)
- C- section - IF mom’s viral load <1,000
- Cont HAART
- Vaginal birth ok - After Birth baby get Zidovudine for at least 6 weeks + serial HIV testing.
What six groups are considered “high risk” and therefore should be offered HBV vaccine as long as no evidence of prior {Anti-HBsAG +ve and HBsAg -ve} or current {HBsAg +ve} infection.
- Health care workers
- MSM
- Multiple Sexual partners/prior STD
- CKD, HIV or Hep C
- IVDU
- Prisoners
Oseltamavir can be given to treat Influenza. What is the time frame in which it should be given to be effective.
Within 48 hours of symptoms. Beyond that it is not helpful.
How do you treat Active TB in Pregnancy?
How do you treat Latent TB in Pregnancy?
ACTIVE: 3 drug regimen: - Isoniazid 9 mths - Rifampin 9 mths - Ethambutol 2 months (don't use Pyrazinamide bc unknown teratogenicity)
LATENT: Usually don’t need to treat until after birth.
What three agents are used for PPX against Malaria when you travel to an endemic region?
Which is preferred in Pregnancy?
- Mefloquine: Neuropsychiatric effect, sinus bradycardia and QT prolongation
- Atovaquone-Proguanil
- Doxycycline: Less preferred of the three.
MEFLOQUINE preferred in pregnancy.
- How do you diagnose Malaria?
2. What two drugs are used to treat Maria Infection?
- Blood smear –> “rings” in RBC.
2. Quinine AND Doxycycline
