Infectious Disease, part 2

Question 1

Salmonella

Answer 1

Gram neg bacilli and a leading cause of bacterial foodborne illnesses involving undercooked beef, poultry, and eggs

Question 2

Presentation of salmonella

Answer 2

Usually causes a self-limiting gastroenteritis over 3-7 days
Fever- usually resolves within 48 hrs
Abdominal cramping
Diarrhea (no blood)
Chills
HA
Myalgia

Question 3

Work up of salmonella

Answer 3

If clinical presentation is suspicious for salmonellosis- dx can be made with stool cultures

Question 4

Tx of salmonellosis

Answer 4

Supportive with fluids and electrolytes if needed

Abx do not shorten the illness and could prolong the duration. They are only used for pts at high risk for bacteremia

Question 5

Hookworms

Answer 5

Acquired in soil contaminated by human feces thru the feet (rash on skin)
Larvae can embolize the lungs

Question 6

Tx for hookworms

Answer 6

Albendazole 400 mg PO x 1 day

Question 7

Schitosomiasis

Answer 7

Tropical parasitic infection in Africa mostly. Snail host.
Eggs end up in skin, brain muscle, eyes after swimming in infected water
Fever and bloody diarrhea

Question 8

Tx of schitosomiasis

Answer 8

Praziquantel 20 mg/kg PO TID x 1 day

Question 9

Tapeworms

Answer 9

Cattle and pigs can carry them.

Sx are vague and worms are passed during defecation

Question 10

Tx of tapeworms

Answer 10

Albendazole 400 mg BID x 28 days

Question 11

Ascariasis

Answer 11

Roundworm
Most common worldwide, usually asymptomatic and in tropical areas in contaminated soil
Severe infections present with lung migration, dyspnea, wheezing, and chest pain
Abdominal pain and passage of pieces of worms

Question 12

Tx of ascariasis

Answer 12

Albendazole 400 mg PO x 1 day or mebendazole 100 mg BID x 3 days

Question 13

Tirchonosis

Answer 13

Raw or undercooked pork or wild game
Severe infections cause nausea, dyspepsia and diarrhea
High eosinophilia count

Question 14

Tx of trichonosis

Answer 14

Mebendazole 200 mg TID x 3 days

Question 15

Pinworms

Answer 15

Spread by fecal-oral route or through contaminated food, clothing, and bedding
Perianal itching can lead to difficulty sleeping

Question 16

Dx of pinworms

Answer 16

Tape test- sample taken near anus then viewed under microscope

Question 17

Tx of pinworms

Answer 17

Albendazole 400 mg PO x 1, repeat in 2 wks

Treat entire household

Question 18

Transmission of toxoplasmosis

Answer 18

Cats play an important role in the spread of toxoplasmosis. They become infected by eating infected rodents, birds, or other small animals
The parasite is passed in cat’s feces

Question 19

Presentation of toxoplasmosis

Answer 19

Healthy people (nonpregnant) do not usually have sx. Immune compromised pts (HIV pts, those on chemo, or post organ transplant) can have fever, confusion, HA, and seizures
Pregnant pts need to be sure to avoid exposure because damage to an unborn child can be of concern leading to miscarriage or stillborn child

Question 20

Tx of toxoplasmosis

Answer 20

Pyrimethamine 50 mg daily for 1-3 wks, then 25 mg daily for 4 wks

Question 21

Histoplasmosis

Answer 21

These fungal spores live in soil contaminated with bird or bat droppings
Humans become infected by inhalation of airborne spores

Question 22

Presentation of histoplasmosis

Answer 22

Most are asymptomatic. Those who develop sx are immune compromised
Eventually the immune system will usually respond and the inflammatory response will form a fibrinous granuloma around the infection
This can show up incidentally on CXR as pulmonary granulomas or nodules
1-10% of individuals in endemic areas can have ocular findings of infection incidentally found on exam

Question 23

Tx of histoplasmosis

Answer 23

Only if prolonged systemic infection of those that are immune compromised
Initially treat with amphotericin B for 14 days then itraconazole for 1 yr

Question 24

Carriers of Rocky Mountain spotted fever and Lyme disease

Answer 24

Rocky Mountain- American dog tick
Lyme- deer tick
It does take >48 hrs of attachment for the tick to spread this

Question 25

Hx/PE of Rocky Mountain spotted fever

Answer 25

High fever
Severe HA
Myalgias
Nausea
Vomiting and abd pain
Then, 2-5 days after onset:
-Rash appears a s 1-5 mm pink macules on ankles, wrists, and forearms that spread centrally- then petechiae

Question 26

Tx of Rocky Mountain spotted fever

Answer 26

Doxycycline 100 mg BID x 7 days

Question 27

Hx/PE of Lyme disease

Answer 27

Erythema migrans non-tender rash that enlarges at site of tick bite (bullseye rash) appears 3-30 days post-tick bite
Fever
Fatigue
Chills
HA
Muscle and joint aches
Swollen lymph nodes

Question 28

Tx of Lyme dz

Answer 28

Doxycycline 100 mg x 10-14 days

Amoxicillin can be used in young children or cefuroxime

Question 29

Syphilis

Answer 29

Spread by sexual contact with someone infected with Treponema pallidum
The syphilis sore has to come in contact with the person and is usually on the external genitals, vagina, anus, or rectum
Sores can also occur on the lips and in the mouth

Question 30

Stages of syphilis

Answer 30

Primary syphilis- small sore/chancre
Secondary syphilis- rash begins on the trunk, eventually covers the entire body, even the palms and soles
Late and latent states- no sx- can last for yrs, then present as tertiary syphilis. With difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia

Question 31

Dx of syphilis

Answer 31

RPR test and T. pallidum particle agglutination test

Question 32

Tx of syphilis

Answer 32

Single IM injection PCN for those infected < 1 yr