Infectious Disease 8

Question 1

How does one contract Leptospirosis?

What are the 6 main symptoms of Leptospirosis?

Answer 1

Eating food/water contaminated by urine/feces or infected animal. Animal exposure.

Symptoms:

1. constitutional symptoms (F, myalgia, HA)
2. Abd pain, N/V
3. Hepatosplenomegaly
4. Jaundice **
5. Renal Failure **
6. Conjunctival suffusion (red sclera) **

Question 2

How do you diagnose LEPTOSPIROSIS?

TRX?

Answer 2

DX gold standard = MAT (Microscopic agglutination test) = serologic testing

TRX: Ceftriaxone or Penicillin

Question 3

Disseminated Gonorrhea occurs when the organism spreads into blood stream from urogenital tract:

Other than systemic symptoms (fever, malaise) what are the TRIAD of symptoms in disseminated Gonorrhea?

Answer 3

1. SKIN –> Painless pustules on extremities
2. Tenosynovitis –> Swelling and pain with passive moment of multiple tendons.
3. Polyarthitis–> Assymetric large and small joints.

Question 4

How do you DX and TRX Disseminated Gohorrhea?

Does treatment change if pregnant?

Answer 4

DX = Presumptive dx made IF symptoms +ve urogenital NAAT.

TRX = IM Ceftriaxone X1 and IM Azithromycin X1 (same as urogenital Gonorrhea)

NO, same trx for pregnant women.

Question 5

What ophthalmologic and MRI finding distinguish TB meningitis from other meningitis?

Answer 5

EYES –> Choroidal tubercles (white yellow nodules near optic disc)

MRI –> Basilar meningeal enhancement.

Question 6

How do you diagnose TB meningitis?

Answer 6

ACID FAST stain and culture of CSF

Question 7

How do you TREAT TB meningitis in Adults?

How does treatment in Children differ?

Answer 7

1. 4 Drug therapy for 2 months:
   - INH
   - Rifampin
   - Pyrazinamide
   - Ethambutol
2. INH and Rifampin for 9-12 months
3. STEROIDS 8 weeks (initial trx can cause significant CNS inflammation as bugs die)

CHILDREN : replace Ethambutol with either IV AG (Streptomycin) or IV Fluoroquinolone (Levofloxacin, Moxifloxacin)

Question 8

What can happen if you misdiagnose Infectious MONONUCLEOSIS and give Ampicillin or Amoxicillin?

Answer 8

Can cause maculopapular rash of face and trunk.

Question 9

MONO presents with fatigue, fever, exudative pharyngitis, ant/cervical lymphadenopathy and Splenomegaly …

How do you dx?

Answer 9

DX:
Adults –> Monospot test –> detects IgM heterophile Abs
Children –> EBV titers –> bc might not mount sufficient heterophiles Abs.

Question 10

What is immune reconstitution inflammatory syndrome?

How do you manage IRIS?

Answer 10

Transient worsening of infectious symptoms several weeks AFTER patient is started on HAART, due to recovery of immune system. Often patients will start to feel better and then feel worse for couple weeks.

TRX = None, transient and self limiting.

Question 11

After 6 months of HAART HIV viral load is expected to be below what?

Answer 11

< 50

IF > 200, suggest either non-compliance OR drug resistance

Question 12

What are the most common organisms causing Pediatric SEPSIS in:

Babies < 28 days old? What is choice Empiric Abx coverage?

Babies > 28 days old? What is choice Empiric Abx coverage?

Answer 12

< 28 days old:

• E. coli
• Group B strep
• Ampicillin + Gentamicin or Cefotaxime

> 28 days old

• Strep PNA
• Neisseria Meningitides
• Cefriaxone or Cefotaxime + Vanc (if NM is suspected)

Question 13

What is the next step in management, IF Cdiff toxin (PCR/EIA) negative, but clinical suspicion is very high?

Answer 13

Limited Colonoscopy or Sigmoidoscopy –> pseudomembranes are diagnostic.

Question 14

3 ABXs that are most implicated in C. Diff?

Answer 14

1. CLINDAMYCIN
2. FLUORQUINOLONES (Ends in “floxacin” ciprofloxacin, levofloxacin ext)
3. CEPHALOSPORINS (Starts with “Cef” “Ceph” or “Kef”)

Question 15

Other than HIV patients with CD4 < 200, what other group of people tend to be susceptible to PCP PNA?

Answer 15

Organ transplant patients.