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Infectious Disease Flashcards

(40 cards)

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1
Q

Botulism

Bacterial Diseases

A

Clostridium botulinum, Gram+ anaerobic bacilus,

canned food products

Sxs

  • muscle weakness, difficulty swallowing
  • respiratory paralysis “floppy babies”
  • diplopia, eyelid drooping,

Dx

  • Toxin assays or electromyography
  • Foodborne botulism - C. botulinum toxin in stool or serum
  • Would botulism - serum toxin or anaerobic wound

Tx

  • Equine heptavalent antitoxin
  • Wait until baby is 12 mos old before givine honey
  • Heat 120 degrees for 30 mins
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2
Q

Campylobacter jejuni

Bacterial Disease

A

MCC acute bacterial diarrhea

contaminated poultry

Sxs

  • fever, watery-bloody diarrhea, abd pain
    • post campylobactr Guillain-Barre syndrome & reactive arthritis possible

Dx

  • Skirow agar culture at 42 degrees (CAMPing in the heat)
  • Comma or S shaped w/ polar flagella a

Tx

  • azithromycin or FQ
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3
Q

Candidiasis

Fungal Disease

A

Common in opportunistic infx, C albicans

Dx - KOH smear

Esophageal candidiasis

  • linear erosions on endoscopy, tx with flucanozole

Vaginal Candidiasis

  • vulva itching, erythema, white curdy dc
  • tx w/ miconazole cream x7d or fluconazole (diflucan) 150mg PO x1

Oral thrush

  • friable white plaques that bleed if scraped
  • tx w/ nystatin

Intertrigo

  • moist macerated areas, pruritis rash - Beefy red erythema w/ distinct scalloped borders and satellite lesion
  • Tx w/ clotrimazole, ketoconazole, miconazole
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4
Q

Cholera

Bacterial Disease

A

Undercooked shellfish or contaminated water

Vibrio colerae, G-, oxidase positive, comma shaped bacteria

Sxs

  • rice water diarrhea

Dx

  • Stool culture
  • electrolytes, BUN, and Cr measured

Tx

  • _Fluid replacement ***_
  • Doxy, azithromycin, furazolidone, Bactrim, ciprofloxacin
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5
Q

Congenital Varicella Zoster

Prenatal transmission Disorders

A

If infx in first 28 wks => congenital varicella syndrome + risk of developing herpes zoster in first 4 years of life.

Dx - PCR of fetal blood or amniotic fluid for VZV DNA + US

Tx - VariZIG immune globulin for non-immune preg for exposure to VZV w/in 10d

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6
Q

Cryptococcosis

Fungal Disease

A

Cryptococcus neoformans, common in AIDs and IMC

From pigeon/bird droppings transmitted through inhalation

Sxs:

  • Meningoencephalitis - MCC fungal menigitis
    • AMS, HA, meningismus
  • Pna - cough w/ little sputum + pleuritic chest pain

Dx

  • CSF (incr protein, decr glucose) and serum
  • indian ink stain** showing cysts
  • CT ror MRI if + cryptococcoma

Tx

  • Amp B + Flucytosine for 2 wks then Fluconazole x 10 wks
  • prophy CD4 < 100 with Fluconazole
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7
Q

Cytomegalovirus

Viral Diseases

A

DS linear DNA in herpes family HHV5

  • Similar to infectious mononucleosis but no pharyngitis
  • pneumona and inflammation of retina in IMC and transplant pts CD4 <50
  • one of the ToRCH

Dx

  • Tissue biopsy with owl’s eyes inclusion

Tx

  • Ganciclovir, valganciclovir, foscarnet, cidofovir
  • Initial IV then maintenance
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8
Q

Diphtheria

Bacterial Diseases

A

URI w/ thick gray pseudomembrane in the throat that bleeds if scrapped

unvaccinated (2,4,6, and 15-18 mos; booster at 4-6 yo)

Sxs

  • neck swelling = enlarged cervical lympadenopathy (bull neck)
  • pharyngitis
  • low grade fever
  • systemic toxicity + hoarseness, palatal paralysis, stridor

Dx

  • PCR - rapid detection
  • Culture

Tx

  • Diphtheria antitoxin
  • Erythromycin or Penicillin x 2 wks
  • Post exposure Abx - contact monitor for 7d, nasopharyngeal and throat culture
  • Asymptomatic = tx w/ macrolide abx (erythromycine 500 mg PO q6h x 7 or Pencilling G benzathine x1)
  • Vaccine
  • Myocarditis common complication
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9
Q

EBV

Viral Diseases

A

Epstein barr mononucleosis, incubates 30-50d, transmission via oropharyngeal secretions and saliva

Sxs

  • fever + cervical posterior chain lymphadenopathy + pharyngitis
  • maculopapular rash develops in 80% of pts when tx with amox
  • RUQ pain 2/2 splenomegaly for splenic rupture

Dx

  • Monospot or heterophile antibodies test - EB IgM
  • Atypical lymphocytes

Tx

  • Supportive tx, abx not helpful
  • Splenic rupture
  • recover in 1-4 wks
  • Rash after given amoxicillin
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10
Q

Erythema Infectiosum

Viral Diseases

A

Parvovirus B-19

Sxs

  • Slapped cheek rash on face,
  • circumoral pallor 2-4d lacy reticular rash on extremities
  • no prodromal

Dx

  • Clinic - enlarged nuclei
  • Parvo B19 IgM ab and PCR

Tx

  • symptomatic
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11
Q

Genital Herpes Simplex Virus Infection

Congenital Disorders

A

HSV is ToRCH => neonatal herpes

Sxs

  • multiple vesciular lesion on skin, involvement of internal organs or CNS

Tx - antiviral drugs or C section

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12
Q

Hand Foot Mouth Disease

Viral Exanthems

A

Coxsackie type A virus

Children < 10 yo; very contagious in 1st week - spread via direct contact w/ saliva and mucus

Herpangina Is blister located to just the mouth

Sxs:

  • Small, tender, erythematous papules or vesicles on pharynx, mouth, hands, feet
  • Punched out, cratered
  • Irritability
  • Loss of appetite
  • General irritability
  • Feeling unwell

Dx - clinical

Tx

  • clears up in 10 days
  • pain meds for sxs relieve
  • Good hand hygiene
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13
Q

Helminth

Parasitic Infections

A

intestinal infections - worm like parasites

Nematode - GI symptoms and cough

  • pinworm - anal pruritus morning, scotch tape test
  • Ascaris lumbricoide - roundworm - vague abd symp
  • tx w/ mebendazole

Cestodes - tapeworm - cause GI symp and wt loss

  • tx w/ praziquantel

Trematodes - flukes - Schistoma - swimmers itch

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14
Q

Herpes Zoster

A

Varicella (chickenpox) - reactivation causing maculopapular rash along one dermatome

Dx - Tzanck Smear - multinucleated giant cells

Zoster Opthalmicus

  • shingles w/ CN V - dendritic lesions on slit lamp

Zoster Oticus (Ramsay-Hunt Syndrome)

  • facial n CN 7, otalgia
  • lesion on ears, auditory canal and TM
  • facial palsy auditory symptoms
  • ddx Bell’s palsy

Tx:

  • Acyclovir, valacyclovir, famciclovir - given w/in 72 hrs to prevent post-herpetic neuralgia
    • Disseminated IV acyclovir
  • Post herpetic Neuralgia pain > 3 mos- parethesias or decreased sensation
  • Vaccine - Shingrex (not live) > 50yo, 2x shot
  • Zostavax - live attenuated virual vaccine
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15
Q

Histoplasmosis

Fungal Disease

A

Histoplasma capsulatum;

  • HIV pts low grade fevers = CD4 < 150
  • _bat droppings, bat caves, Mississippi and Ohio River valley_s; inhalation of fungal spores

Sxs

  • low grade fevers
  • cough
  • hepatosplenomegaly
  • tongue ulceration

Dx

  • Fungal staining
  • ele Alkaline phosphatase and LDH

Tx

  • Ampho B
  • Itraconazole PO - mild to mod dz
  • no need for prophy
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16
Q

HIV

A

AIDS = CD4 < 200 ;suspectible to many opportunistic infx

Sxs

  • Acute HIV syndrome: mononucleosis like illness - rash and mucocutaneous ulceration**

Dx

  • EIA = 4th gen antigen/antibody combo HIV 1/2 immunoassy - measure HIV antibodies and antigen
  • confirmatory HIV Viral Load
    • detect ​sooner exposure
  • ELISA and confirmed by Western blot

Tx

  • HAART if CD4 <350 or viral load PCR RNA > 55,0000
  • 2NRTIs + NNRTI or PI
    • NRTI - Emtricitabine, and Tenofovir
    • NNRTI - Efavirenz - can cause CNS disengagement*
    • PI - Darunavir
  • NRTIs + INSTI
    • INSTI - Raltegravir, Dolutegravir
      • can cause lipodystrophy + metabolic SEs (lactic acidosis and N/V/D)
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17
Q

HPV

Viral Diseases

Study These Flashcards
A

DS DNA,

Cervical intraepithelial neoplasia - 16, 18, 21, 33 are cancerous

Condyloma acuminatum - genital warts, 6 & 11 w/ kiocytes

Condyloma lata - 2/2 syphillis

Cutaneous warts - 1, 2, 4

Dx

  • Shave or punch biopsy
  • Koilocytic squamous epithelia cells in clumps
  • HPV DNA on cervical swabs

Tx

  • Skin warts - self limited or podofilox or cryotherapy
  • Gardasil quadrivalent vaccine against 6, 11, 16, 18
    • M and F 11 to 12 and approved through 9 to 26
18
Q

Influenza

Study These Flashcards
A

Viral respiratory infx by orthomyxovirus (three strains A, B, C)

sxs

  • fever, coryza, cough, headache, malaise

Dx

  • rapid antigen test in clinic
  • rapid serology more accurate
  • CXR - bilateral diffuse infiltrates

Tx

  • symptomatic for most
  • antivirals w/in < 48-72 hrs
    • Tamiflu/Oseltamivir or Zanamivir/Relenza for influ A & B
    • hospitalized pts
    • outpt with severe progressive illness
    • high complications risk
      • IMC
      • chronic med conditions
      • >65yo
      • pregnant or 2 wks pp
19
Q

Lyme Disease

Study These Flashcards
A

Borrelia burgdorferi from Ixodes/deer tick

Sxs

  • Early localized - 7 to 10d after bite, erythema migrans rash “bullseye”
  • Early Disseminated - 1-12 wks after bite
    • flu-like syndrome (malaise, fatigue, chills, fever, HA, stiff neck, myalgias, arthralgias)
  • Late Disease - persistent synovitis and arthritis, AV block

Dx - ELISA + by 3rd week

Tx - Doxycycline 200 mg x 1d w/in 72 hrs

20
Q

Malaria

Parasitic Infections

Study These Flashcards
A

Plasmodium vivax, p. malaria, p. ovale, p. falciparum (most virulent), knowlesi (new)

transmitted by anopheles mosquito

Sxs

  • Periodic chills, fever, and sweats (fever every 3 days)
  • Splenomegaly > 4d of sxs
  • travel hx

Dx

  • Giemsa stain peripheral smear
  • thick/thin blood microscopy

Tx

  • Chloroquine,
    • chloroquine resistance - atovaquone-proguanil> mefloquine (night terrors, nightmares)
  • Primaquine - P. Vivax but G6PD
21
Q

MRSA

Bacterial Diseases

Study These Flashcards
A

Common in diabetics, hospitals, prisons, IVDU, nursing homes = people with open wounds, invasive devices (catheters) and weakened immune systems

Sxs:

  • Boil or pimple type lesion = spider type lesion
  • “pustule on erythematous base”
  • transmission via direct contact

Dx - culture

Tx

  • Irrigation and debridement
  • Mupirocin 2% = small lesions
  • PO Abx for bigger lesion = Bactrim, Doxy, clinda
  • IV Abx for severe = Vanco, linezolid,
22
Q

Mumps

Viral Diseases

Study These Flashcards
A

Paramyxovirus family; transmitted w/ respiratory droplets

incubats 12-14 d;

Sxs

  • parotitis
  • orchitis
  • aseptic meningitis
  • MCC of pancreatitis in children

Dx:

  • Clinical, PCR if needed
  • amylase ele if +inflammation of salivary gland

Tx:

  • supportive; lasts 7-10 days
  • Contagious up to 9d after onset
  • isolate pt 5 days
  • MMR vaccine 12 -15 mos, then 4-6yo
23
Q

Mycobacterial

Fungal Disease

Study These Flashcards
A

Mycobacterium avium complex (MAC) - CD4 <50

  • fever, diarrhea, wt loss, anemia
  • present in soil and water
  • dx w/ AFB and culture
  • Tx w/ clarithromycin + ethambutol for at least 12 mos
  • Prophy w/ azithro or clarithro if CD4<50

Tuberculosis - Mycobacterium tuberculosis

  • cough, nt swts, wt loss, IMC
  • XRay cavitary lesion, infiltrates ghon complexes
  • Acid fast bacilli, caseating granulomas
  • Mantoux Skin test - check TB slide in pulm
  • tx
24
Q

Pinworms

Parasitic Infections

Study These Flashcards
A

Enterobiasis vermicularis

Sxs

  • perianal itching at night
  • eggs transmitted via food or surfaces

Dx

  • scotch tape test - eggs under microscopy

Tx

  • Mebendazole or albendazole
25
**Pneumocystis** Fungal Disease
**P. jiroveci** - transmitted by aerosol route, no disease in IMC pts **CD4\< 200** Sxs * Subactue fever, SOB, non productive cough - exam often not consistent w/ degree of hypoxia Dx * CXR - diffuse, **bilateral perihilar infiltrates** * gold std - silver stain vs PCR * ele LDH Tx * **Bactrim** * if allergic tx with pentamidine * add prednisone if PaO2 \< 72mmHg * proph bactrim CD4\<200
26
**Rabies** Viral Diseases
CNS infection with **RNA Rhabdovirus** transmission via dogs, raccoons, skunks, bats, fox, coyote Incubate 1-3 mos Sxs * **Hydrophobia\*\*** * pharyngeal spasms, aerophobia (fear of drafts of fresh air) * Hyperactivity Dx * **Negri bodies -** eosinophilic inclusion bodies, found in brain of dead bodies * animals observed for 7-10d Tx * Once sxs occur, patients rarely survive * Post exposure prophy * **HDCV (Rabies vaccine) given day 0, 3, 7, 14 PLUS** * **rabies Immune globulin 1/2 injected into wound, 1/2 IM** * If previous exposure or vaccine - rabies vaccine day 0 and 3 w/o immune globulins
27
**Rheumatic Fever** Bacterial Diseases
Inflammatory reaction to GABHS pharyngitis w/ **formation of antistreptolysin antibodies (ASO)** =\> reacts with synovium, myocardium, and heart valves Sxs * initial sxs 2-4 wks after strep infection Dx * GAS culture or ASO, ESR, CRP * EKG * **_Jones Criteria (2 major criteria, 1 major + 2 minor)_** * Major * J - joint involvementpolyarthritis * O - myOcarditis * N - subcut nodules * Erythema marginatum * Sydenham Chorea - rapid involuntary movement on face, hands and feet * Minor * CRP incr * Arthralgia * Fever * ESR incr * Prolonged PR invtl on EKG Tx * **pen G benzathine** 1.2mil units IM q 3-4 wks * if \< 27kg, 600k unites IM q 3-4wks
28
**Rocky Mountain Spotted Fever** Bacterial Diseases
**Rickettsia rickettsii**, spread by American **dog tick** Sxs * 2-14 days after tick bite =\> develop **flu like** symptoms * fever, chills, myalgias, headache * red maculopapular rash on **starts** **wrists and ankles** (palms and soles) **spread centrally over 2-3 days. face is spared** Dx - Indirect fluorescent antibody (IFA) Tx - 1. **doxycycline or** 2. chloramphenicol 2nd line for preg
29
**Roseola (6th Disease)** Viral Diseases
**Caused by HHV 6 and 7;** Between 6mos-2yo Sxs: * Sudden **high fever** (102-104) * Red rash appears as fever subsides * **blanching** maculopapular rash - neck/trunk =\> face =\> extremities * rash lasts for 1-2 days Dx - clinical Tx - bed rest, fluids, antipyretics
30
Rubella (German's Measles)
Rubella virus - spreads through sneezing/coughing Contagious 1-2 wks before sxs Teratogenic in 1st Trimester Sxs: * Erythematous, discrete maculopapular exanthem * First on face, spreads to trunk and extremities; generalized w/in 24 hrs * lasts for 3 days * Fever * Lymphadenopathy Dx - * EIA * Serological assays * Rubella specific IgM abs remain + for \> 1 year. * **MMR vaccine - 12-15mos, then 4-6yo**
31
**Measles (Rubeola)** Viral Diseases
Paramyxovirus via respiratory droplets Sxs: * 10-12 days incubation * Prodrome * **1-3 d; 3 C's** * Cough, Coryza, Conjunctivitis * Enanthem * 48 hrs before Exanthem * **Koplik's spots -** red/white/blue spots In mouth * Exanthem * 4 days after fever onset * Morbilliform - maculopapular, blanching rash * Cephalocaudal - head to extremities spread Dx: Clinical, Measles IgM abs Tx: * supportive, anti-inflammatories, isolate 1 wk after rash onset * **MMR vaccine - 12-15mos, then 4-6yo**
32
**Salmonellosis** Bacterial Disease
**Typhoid & Enteric fever vs Gastroenteritis;** transmitted via fecally contaminated food Sxs **Enteric/ Typhoid fever** - salmonella typhi = flu like bacterial infection * Constitution sxs, HA, rose spots on abd, constipation or diarrhea, **returning traveler** * **Tx FQ or ceftriaxone 1g IM or IV q 12h for 14 d** **Gastroenteritis** * egg yolk or improperly handled food * GI symptoms "**pea soup diarrhea**", HA * **tx w/ FQ** Dx * Leukocytosis, low plts * Stool culture
33
Sepsis
Systemic Inflammatory Response Syndrome (SIRS) in repsonse to toxins RF - increased aged, immunosuppressed, prolonged hospitalization Sxs * fever, hypotension, incr WBC, change in LOC, Tachycard/pnea **Severe Sepsis** * poor organ function or insufficient blood flow, evident with low blood pressure, high blood lactate, or low UO **Septic Shock** * low BP d/t sepsis that does not improve with IV fluids Quick SOFA - predict mortality * new or worsened mentation * RR \>/=22 * Systolic BP = 100 mmHg Tx * IV fluids/pressors * empiric abx, send blood cultures * remove all existing lines
34
**Shigellosis** Bacterial Disease
Gram neg bacteria; crowded conditions - daycare, transmission via direct person-person or contaminated foods and water Sxs * Diarrhea, lower abd cramps, tenesmus * fever, chills, anorexia, headache, malaise * Stools loose and mixed with blood, mucus * Dehydration common Dx * HLA-B27 Tx * Fluid resus * Abx - **Bactrim** \> Cipro \> FQ Loperamide, or diphenoxylate
35
Syphilis
Treponema pallidum - 3 phases, 3 weeks incubation **Primary syphilis** * painless chancre in genital or groin region = 3-6 weeks **Secondary syphilis** * erythematous rash on _palms and soles_ * condyloma lata **Tertiary syphilis (latent)** * major vessel change (aorta), neurosyphilis or _gummas_ **Neurosyphilis - years later** * _Tabes dorsalis - slow degen of nerve fibers_ * small nonreactive pupils, sensory ataxia, lancinating pain Dx - **RPR/VDR**L confirmed with treponemal antibody-absorption test (**FTA-ABS**) Tx * **IM Penicillin G**
36
**Tetanus** Bacterial Disease
Clostridium tetani - anaerobic toxin; neurotoxin that interferes with neurotransmission; uncontrolled spasms and exaggerated relfexes; usu from puncture wounds; incubation - 5d to 15 wks Sxs * pain and tingling at inoculation site - spasticity of muscles nearby * **Jaw and neck stiffnes**s, dysphagia, irritability * Hyperreflexia & muscle spasms **(trimus)** develop * Painful tonic convulsions, glottis spasms, respiratory muslces, asphyxia Dx * Culture but can have false negative Tx * post exposure prophy - **Vaccination Td, Tdap** * **Hyperimmune human globulin (TIG)** neutralizes toxin * Metronidazole or penicillin = high mortality * **spasmolytic drug** - diazepam
37
Toxoplasmosis
Toxoplasma gondii - parasitic protozoan **pregnant female exposure to** **cat feces** Sxs: * encephalitis + chorioretinitis + intracranial calc in AIDS pts CD4 \<100 Dx * **ring enhancing lesion** * **toxo IgG and IgM** * part of ToRCH syndrome Tx * Prophy CD4 \< 100 with **_bactrim_**
38
**Trichomoniasis** Parasitic Infections
Sexually active women foul smelling, greenish dc Vaginal pH \> 4.5 strawberry cervix motile flagellated protozoa **Tx metronidazole 2g PO x 1**
39
**Zika Virus** Congenital Disorders
SS RNA transmitted through Aedes mosquito; screen pregnant women 1st and 2nd trimester Sxs * Macular pruritic rash * arthralgia, conjunctivitis, low grade fever, and miscarriage * Fetus w/ **microcephaly, Intracranial calcifications,** cerebral malformation Dx * Serum or urine Zika virus IgM w/ real time PCR for confirmatory Tx * self limited, conservative and supportive care * avoid aspirin and NSAID
40
Coccidioides ## Footnote **Fungal**
Western US ## Footnote Non-remitting cough, not responding to usu treatment Dx - EIA for IgM and IgG Tx - **fluconazole and itraconazole**

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