Infectious Disease Flashcards
This deck covers Chapters 121-130 in Rosens, compromising all of infectious disease.
A 62 yo female had a tooth pulled 4 days ago. She now has severe neck pain with swelling. It feels woody on palpation.
Answer the following:
- Diagnosis
- Etiology
- Symptoms
- Treatment
Diagnosis
- Ludwig’s angina
Etiology
- Deep space infection
- Submental, submandibular, sublingual spaces
- Mixed flora (GAS, Bacteroides)
- Typically from intra-oral/intra-pharyngeal sources
Symptoms
- Swelling
- Fever
- Shortness of breath
- Impaired neck mobility
- Toxic appearing
Treatment
- Pip-Tazo + Vancomycin + Clindamycin
- ENT Consult in ED
- Awake fiberoptic intubation, if necessary
You diagnose a 14-year-old female with pertussis. She lives at home with her parents and a 6-month-old brother.
Outline the stages of Pertussis and your management
Stages
- Catarrhal (1-2 weeks) - infectious
- Paroxysmal phase (1-2 months)
- Convalescent phase
Management
- Booster vaccine
- Azithromycin (5 days)
- Notify public health
- Self-isolation for 3 weeks
- All close contacts receive booster vaccine and Azithro
- Household
- Daycare
- Child < 1-year-old
- 3rd-trimester pregnancy
A 35-year-old male presents with a wound. Explain your approach to tetanus prophylaxis
If wound clean and:
- Immunized <10 years ago = do nothing
- Immunized >10 years ago = Td vaccine
- Never immunized = Td vaccine
If wound dirty and:
- Immunized <5 years ago = do nothing
- Immunized >5 years ago = Td vaccine
- Never immunized = Td vaccine + HTIG
- HTIG dose = 250 U IM
Dirty Defined As:
- > 6 hours old
- > 1 cm deep
- Contaminated (dirt, feces, soil, saliva)
- Puncture
- Stellate
- Avulsions
- Denervated
- Ischemic
- Infected
- Missiles
- Crush
- Burns
- Frostbite

A kid comes in walking with a limp. Severe decreased ROM of the hip. He is febrile. You suspect a septic hip.
What criteria can be used to diagnose this?
Kocher Criteria
NEWF
- NWB on the affected side
- ESR > 40
- WBC > 12
- Fever (T >38.5)
Describe the signs and symptoms of Ebola. How long after a possible exposure should you be worried?
Ebola Virus
Transmission
- Human-to-Human
- Direct contact with blood + bodily fluids
Incubation Period
- Up to 3 weeks
Who to suspect it in
- Travel to an endemic country
- Contact with confirmed Ebola patient and symptomatic
Symptoms
- Sudden onset fever, malaise, myalgia, severe H/A
- Conjunctivitis, pharyngitis, N/V/D
- Hepatic + renal impairment
- Maculopapular or petechial rash
- Mucosal bleeding (50%)
- Multiorgan failure, shock, and death
Describe the epidemiology, pathophysiology, and clinical features of Staphylococcal Scalded Skin Syndrome (SSSS)
Epidemiology
- Children (6 months – 6 years)
- Mortality = 3%
- Adults
- Mortality = 50%
Pathophysiology
- Toxin-producing S. aureus
- Epidermolytic toxin A or B
- Acts on Desmoglein 1 protein (Dsg1)
- Results in the separation of the skin
Clinical Presentation
- Positive Nikolsky’s sign
- Erythema
- Blisters, bullae, and vesicles
List FIVE DDx for tetanus
- Strychnine Poisoning
- Dystonic Reaction
- Hypocalcemia
- Status Epilepticus
- Rabies
What is the most common cause of focal intracranial mass lesions in HIV infection?
Toxoplasmosis
- Parasitic disease
- Poorly cooked food w cysts or cat feces exposure
- ½ of people are infected by toxo but have no symptoms
Clinical
- Headache
- Fever
- Altered mental status
- Seizures, focal deficits
CT (with contrast) Features
- Ring enhancing lesions
- Multiple lesions
- Basal ganglia and corticomedullary area
Treatment
- Pyrimethamine 100-200mg PO then 50-100 mg/day
- Sulfadiazine 4-8 g/day PO
- Folinic acid 1 mg/day PO (prevents pancytopenia)
List FOUR clinical and FOUR lab findings that are criteria for severe malaria and poor prognosis
Clinical
- GCS <11
- Weakness
- Seizures (>2/day)
- Pulmonary edema (Hypoxia + RR >30)
- Bleeding
- Shock
Lab
- Hypoglycemia (<2.2 mmol/L)
- Acidosis (Base Deficit >8, Bicarb <15, Lactate >5)
- Anemia (HgB <70 adults, <50 children under 12, HCT <15%)
- Renal impairment (Cr >265, BUN >20)
- Bilirubin >50
- Parasite count >10% (for P. falciparum)
What is the causative agent in RMSF? How does it cause disease? What is the vector?
Rickettsia rickettsii
- Obligate intracellular bacteria
- Invades vascular endothelium causing vasculitis
Vector
- Rocky Mountain wood tick (Dermacentor andersoni)
- Dog tick (Dermacentor variabilis)
List the culprit organisms and treatment regimens for septic arthritis if the Gram’s stain shows:
- Gram + cocci
- Gram – cocci (sexually active patient)
- Gram – bacilli
- Gram + bacilli
Gram + cocci
- S. aureus
Gram – cocci (sexually active patient)
- N. gonorrhea
Gram – bacilli
- E. coli, P. aeuriginosa
Gram + bacilli
- P. acnes
List SIX rashes that can affect hands/soles of feet
- Secondary syphilis
- RMSF
- Coxsackie (HFM)
- Smallpox
- Kawasaki
- Meningococcemia
- Endocarditis
- DIC
What are the TWO pneumococcal vaccines available in Canada? When are they indicated?
PREVNAR-13
- Pneumococcal 13-valent conjugate vaccine
- Used to prevent IPD (invasive pneumococcal disease)
- Indications:
- All infants at 2 mo, 4 mo, 12 mo
PNEUMOVAX-23
- Pneumococcal 23-valent polysaccharide vaccine
- Indications
- All adults ≥ 65 years
- ‘Other’: homeless, alcoholic, smoker, drug user
- Immunocompetent adults + high risk for IPD
- Immunocompromised adults + high risk for IPD
List potential regimens for drug-resistant TB
Usually ‘RIPE’, replace I with a fluoroquinolone.
- Rifamipin
- Pyrazinamide
- Ethambutol
- Fluoroquinolone
List FOUR features of osteomyelitis on plain XR
- Involcrum (Periosteal reaction)
- Lucent areas
- Lytic lesions surrounded by dense sclerotic bone
- Sequestra
- Deep soft tissue swelling & fascial plane separation
- Altered fat interfaces
Provide a differential diagnosis for respiratory infections in HIV+ patients based on CD4 count
CD4 >200
- Regular pneumonia
CD4 <200
- PCP, Histo, Cryptococcus, TB
CD4 <50
- PCP, MAC, CMV, and everything above
What is the typical presentation of septic arthritis (clinical or lab)?
Symptoms
- Fever
- Joint pain
- Malaise
Lab Tests (C’s)
- Cell count (WBC >50 cutoff)
- Crystals
- Chemistry (Lactate, glucose, protein)
- Culture
- Gram stain
What are 5 complications of pertussis? How is it diagnosed?
Diagnosis
- NP swab + PCR (3-7 days for results)
Complications
- Respiratory failure
- Hernias
- Hemoptysis
- Pneumothorax
- Subcutaneous emphysema
Your patient has a parasitemia of 15% and it’s falciparum. Outline your management.
Severe Malaria Treatment (AM QD)
- Option A (‘AM’): Artesunate + Malarone IV
- Preferred
- Option B (‘QD’): Quinidine + Doxycycline IV
- Admit to ICU
How would you treat meningococcemia? Are steroids indicated for bacterial meningitis?
Treatment
- Ceftriaxone 2g IV q12h
- Vancomycin 15 mg/kg q12h
- Dexamethasone 8 mg IV
* Decreased mortality in S. pneumoniae
* Decreased hearing loss in H. influenzae
Outline your management of a patient with tetanus
Supportive Care
- Muscle spasms
- Benzodiazepines (*diazepam is the best-studied)
- Dantrolene (adjunct)
- MgSO4 (improved spasm control)
- Airway Protection (if above fails)
- Avoid sux
- Autonomic instability
- Labetalol or propranolol
Elimination of Tetanospasmin (TS) & Active Immunization
- HTIG 250 IU IM
- Neutralizes any circulating toxin
- Neutralizes toxin at the site of production
- Reduces mortality
- Td 0.5 mL IM
- Give at a separate site
Prevention of further toxin production
- Wound debridement
- Metronidazole 500 mg IV/PO Q6H (drug of choice)
- Avoid PCN which inhibits GABA and synergizes with TS
Discuss Rabies post-exposure prophylaxis
Wound Care
- Scrub with soap/water
Tetanus prophylaxis
- Td 0.5 mL IM (if not vaccinated)
Human Rabies IG (HRIG)
- HRIG 20 IU/kg
- Infiltrate full dose into and around the wound
- Remainder is given IM
Human Diploid Cell Vaccine (HDCV)
- If never vaccinated:
- Days 0, 3, 7, 14, 28 (5 doses)
- If previously vaccinated:
- Days 0 and 3 (2 doses)
Chikungunya. Describe its vector, duration of illness, and complications.
Vector
- Aedes mosquitoes
Symptoms
- Fever - usually ends abruptly after 2 days
- Arthralgia/Arthritis - significant
- Headache
- Insomnia
- Rash
Diagnosis
- Serology, RT-PCR
Treatment
- NSAIDs
Complications
- Myocarditis
- Hepatitis
- Nephritis
- Meningitis
- Guillain-Barré syndrome
- Cranial nerve palsies
What is the causative agent in Diphtheria? Explain the pathophysiology, types of disease, and management.
Etiology
- Corynebacterium Diptherae
Types
- Respiratory Diphtheria
- Greatest toxicity
- Pharyngeal, Nasal, Laryngeal
- Cutaneous Diphtheria
- Least toxic
Pathophysiology
- Produces exotoxin that inhibits cellular protein synthesis
- Affects: Nervous System + Heart + Kidneys
Treatment
- Erythromycin 50 mg/kg/day
- Diphtheria antitoxin
- Vaccinate
- Self-isolation
- Notify Public Health
- Vaccinate close contacts
