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Flashcards in Infectious Diseases Deck (74):
1

Lab methods-

Wright stain = stool WBCS
Fluorescent antibody antigen stain for HSV1/2, VZV, RSV, adenovirus, flu A and B, paaflu
Direct obs/wet mount for fungal, dark-field for syphillis
PCR
Indrect = intradermal skin test for tb and coccioides
Ab testing for EBV, CMV, VZV, HIV, toxo, bartonella, henselae, myco pneumo
Nonspecifics like CRP and ESR

2

High risk groups for fever

Infants under 28 days, older infants w/ high fevers > 39C/102.2 who appear ill, immuno def, sickle cell, hronic disease

3

Eval of fever in infant <3 months

3-10% well appearing and 17% toxic have serious bacterial infec
Why? Transplac, passage through bc, postnatally. Viruses most common
Clin fx= nonspecific, fever, dim app, irritable, cough, rhino, v/d, apnea
Dx- clinical/lab fx- det low vs. high risk (abx recently? focal infection?) do cbc, blood culture, UA/UC, CXR if resp distres, and CSF. Low risk if wbc between 5-15K, bands <5Wbc on stool wright, normal csf.

4

Fever hospitalization for:

all infants <=28 days
Infants 29-3 mo with toxic look, meningitis suspicison, PNA, pyelo, bone/soft tissue infection
Uncertain oupt f/u

5

Abx for fever based on

Infants <28 need IV abx until cultures are negative
Infants 29-3 mo w/ low clin/lab criteri + outpt can get oupt parenteral
High risk older infants need hospitalized parenteral

6

Abx in fever specifics

0-1 mo? GBS, E. coli, List- amp + gent or cefotax
1-3 mo? GBS, Strep pneumo, LM- amp + cef (+ vanco if worried abt bact meningitis)
3 mo- 3 y? Strep pneumo, H flu, neiss men- cef (+ vacno if bact mening)
3- adult? strep pneumo + NM- cef (+ vanco if bact mening)

7

Fever eval, 3-36 mo

Risk bact 3-10%, likelhood bacterimia up w/ up fever/peripheral WBC
Strep pneumo most common
If kid toxic, do complete sepsis eval + iv abx + hospital
Nontoxic and < 2 years, do blood culture all kids or if wbc> 15k, stool culture if blood/mucus/wright stain, CXR if resp issue, empiric abx if WBC> 15k OR all kids. Reeval in24-48 hrs

8

FUO

Fever > 8 days to 3 weeks, with no dx
Usually common illness w/ weird presentation, big ddx
25% resolve spont
Eval- comprehensive hx, ROS, PMH, SH, detailed p/e, CBC w/ diff, ESR, CRP, serum transam (hepatitis), UA/UC, blood cultures (endocarditis), Anti-strep O titer (rheum fever), ANA, RF, stool culture, TB, HIV, lots of imaging
MGMT- hospitalize for eval

9

Bacterial meningitis

Most in first mo. of life, risk if young, immunodef, or anatomic defect (skull frac, vp shunt)
Fx- babies? nonspecific sx, minimal fever, maybe bulging font, older kids?fever, change consciousness, nuchal rigid, kernig/brudzinski(hip/neck), seizure, photophob, emesis, h/a
Dx- high IoS, all kids get LP- pleocytosis w/ neutros, WBC>5K!, low glucos, CSF:serum 3 mo- 3rd gen cephal, + vanco. give corticostreoids w/ or before first abx to down hearing loss
Supportive care- IVF, look at uo, serum sodium

10

Bact meningitis complications

Gram negs have most complications, then S. pneumo, HIB, and Neisseria (5-50% mort dep on bacteria)
Hearing loss is most common, up to 25% pts
Global brain injury 5-10%
SIADH, seizures, hydroceph, brain abscess, cranial nerve palsy, learning disabled, focal neuro deficits

11

Aseptic Meningits

Inflamm w/ CSF lymphocytic pleo, if viral- normal CSF glucose, min elevated CSF protein
Clin fx- mild w/ fever, h/a, emesis or severe
Aseptic TB nonspecific lethargy, 2nd week => cranial nerve deficits, altered LOC, paraplegia, eventual death
Dx- viral mening CSF culture, or PCR for EBV, CMV, HSV, enterovirus, + surface enterovirus in throat/rectum suggestive, can do RPR, India ink for crypto, serum ab for coccidio myco, Lyme disease/cysticerosis

12

TB meningitis

Lymphocytic pleocytosis, low glucose, super high protein, basilar enhancement
Postive acid fast csf stain, or + PCR
50% neg chest XR, tuberculin skin test

13

Simple URI

Etio = rhino, paraflu, coronavirus, respiratory syncytial virus
Clin fx- low grade fever, rhino, cough, sore throat, 7-10 days
Color of nasal discharge does NOT predict sinusitis
Persistent sx or fever prompt for bacterial superinfection
Dx on fx
Mgmt - YDRATION, exclude more serious things, otc, NO ABX

14

Sinusitis

Ethmoid/max sinuses in 3-4 mo gestation, sphenoid sinus 3-5 yo, frontal 7-10
Acute, sub acute, chronic
Dx on clin fx, imaging NOT USEFUl

15

Acute sinusitis

Acute persistent = nasal d/c and cough 10-30 days, h/a bad breath, facial pain, low fever
Etio = s.pneumo, h flu, m. catarrhalis
Mgmt- amoxicillin, amox-clavulanate (augmentin), 2nd gen cephalo 10-14 days
Acte severe- high fever, purulent 2-5 days, same etio, same mgmt

16

Subacute sinustis

Same features, but 30-90 days
etio = same- s.p neumo, h flu, m cat
Mgmt = same

17

Chronic sinusitis

> 90 days!
Etio = maybe underlying CF, allergy, immunodef, s. aureus, anaerobes
Mgmt = trial broad spec abx, ct scan sinuses, iv abx

18

Pharyngitis

Etio = coxsackie, EBV, CMV + same as URI
Bacterial = strep pyogenes (GABHS = strep throat), aracnobact hemoyticum, and diphteria
Clin fx= viral + strep overlap, hard to tell
dx- strep test (antigen test = rapid), 5% has pharynx GABHS
MGMT- viral = supportive, hidration. GABHS = oral penicillin VK (single IM does benza), if allergic oral erythromycin/macrolides
EBV pharyngitis- maybe steroids
Diphteria = oral erythromycin/parenteral penicillin

19

EBV pharyngitis

enlarged posterior cervical LN, malaise, hepatosplenomeg

20

Coxsackie pharyng

Painful vesicles/ulcers on post pharynx and herpangina (soft palate), or hand-foot =-mouth

21

Strep throat

GABHS in 5-15 y/o winter/spring,
Lack of other URI
exudate on tonsil, petachiae on soft palate, strawberry tongue, enlarged tender anterior lymph nodes
Fever
Scarlatiniform rash

22

Diptheria

RARE, gray adherent tonsillar membrane
toxin-med cardiac/neuro compx

23

Acute OM

Acute infec of middle ear
OME = w/ effusion, w/out sx of infection
Etio = s.pneumo, non type h flu, m. cat, URI AOM share bacteria
Clin fx- usually after/during URI, fever, ear pain, less hearing, sx less reliable in lil kids, if tymp membrane perfs, pus/fluid form ear
Dx = identify fluid within middle ear space! neumatic otoscope- fin abnormal mvt of eardrum! Or erythema/loss of tymp membrane landmarks, less reliable. can do tympanocyntesis/perf tymp membrane w/ pus within external aud canal
MGMT- abx for AOM, but controversial b/c will resolve on own. If use, do Amoxicillin- but if in day care or infected in past 1-2 months, then MRSA more likely, so do high dose amox, augmentin or cephalo. Macrolides in penicillin allergy
NO abx for AME

24

Otitis externa

Infection of external auditory canal
Pathog- things that mess up barrier- trauma, cerumen removal, maceration of swin from swimming, moisture
Etio- pseudomonas, staph auerus, candida albicans, or AOM w/ perfed ear drum
Clin fx- pain, itching, draining from ear. Systemic sx absent, hx consistent w/ AOM helps decide if perf
Dx- erythema/edema of EAC, white/purulent material within canal, tenderness on palpation/mvmt of tragus, visualize tymp memb to exclude perf, maybe culture
Mgmt- restore EAC to natural acidic environemtn. Acetic acid in ear if milkd, more severe do topical abx + corticosteroic. Perfed AOM w/ OE- oral/topical abx

25

Cervical Lymphadenitis

Enlarged, inflamed, tender LN
Etio- local bact infection (s. aureus most common, s. pyogen too, mycobact (tb/avium), b/ henselae (cat scratch).
Reactive lymphatd in responsive to infections in larynx/teeth/head/neck soft tissue
Virus EBV, CMV, HIV also
Kawasaki = UNILATERAL cervical lymphad, t. gondii can look like mono
Structural lesions in neck (brach cc or cyst hygroma) 2ndary infec
Fx- mobile, tender, warm LN, single or multiple, maybe systemic
Dx- tests like tb skin, CBC w/ diff, ab titers for b. hensela/gondii if unresponsive, ab titers for EBV/CMB/HIV if diffuse/persistent. Imaging for cervical anatomy/abscess
MGMT= empiric abx to staph/streph (cephalo 1 gen, or anti-staph penicillin 7-10 days, IV if toxic)

26

Parotitis

Inflamm of parotid salivary glands
Etio- mumps/other viruses = bilateral involvedment (CMB, EBV, HIV)
Bact parotitis = s. auerues, s. pyog, m tb, unilateral!! uncommon unless down salivary flow/stones
Clin fx- swelling above angle of jaw, oropharynx with pus from Stensen's duct (parotid duct)
Dx= culture drainage, viral w/ serology, mumps in urine
Mgmt = virus w/ supportive, acute bacterial = abx to staph/strep, maybe i&d
Compx- mumps => meningoenceph, orchitis/epididmytis/pancreatitis
Acute sup parotitis => abscess + osteomyelitis of jaw

27

Impetigo

Superficial skin infection, upper dermis
Staph aureus most common, GABHS also
Fx- honey-colored crust/bullous lesions, commonly on face, esp nares, easy spread
Visual dx, no culture, give topical mupirocin or oral abx (dicloxacillin, cephalexin, clinda)
Compx bacteremia, post strep glomneph, and staph scalded skin

28

Erysipelas

Dermal lymphatics, usually GABHS
Clin fx = tender erythematous skin + distinct border, face and scalp
Visual dx, give systemic GABHS theraphy
Compx = bacteremia, post strep glomneph, nec fasc

29

Cellulitis

Skin infection within dermis
GABHS, s. aureus, break in skin barrier
Cin fx- warm, red, tender, indistinct border
Dx visual inspection, rarely postive blood culture, if agressive, biopsy/culture leading edge
Mgmt = oral/IV abx w/ cephalo first gen or anti-staph penicillins

30

Buccal cellulitis

NOw uncommon, unilateral bluish cheek if non-immunized, HIB- positive blood cultures
H. flu directed ABX- 2nd/3rd gen chepahlo like cefuroximine/cefotaxime
High rate of concomitant bacteremia/meningits, do an LP

31

Perianal cellulitis

Well demarcated red around anus, also constipation
GABHS, visual inspection/rectal swab
Oral abx- cephalexin/dicloxacillin

32

Nec fasc

Potntially fatal, deep cellulitis
Pain/sstemic sx OOP to findings
INfection beyond fascia to muscle
Crepitus/hemorraghic bullae, polymicrobial
IV abx = surgical debridement

33

SSSS

S. aureus w/ exfoliative toxin
Fever, tender skin, bullae, sheets of skin slough off
Nikolsky sign w/ extension of bullae w/ pressure
Good wound care + IV abx

34

Scarlet fever

Toxin-med bacterial illness w/ skin rash
GABHS strains making erythrogenic toxin
Winter/spring/respiratory droplets/nasal secretions
Clin fx- during any GABHS infection (impetigo, cellulitis, stre), first fever, chill, malaise, exudative phar)
Exanthem- starts on trunk, moves periph, red skin + tiny skin colored papules, SANDPAPER, blanches, pastia's lines in skin creases, desquam dry skin
Dx- positive throat culture/strep test
MGMT- STOP rheumatic fever w/ appropro abx, oral penicillin VK, iv benzathin pen, erythrom/macrolids
Compx= post strep glomneph and post strep arthritis (abx no prevent), rheum fever and PANDAS (ped autoimmune neuropsych disorder)- OCD/tic!

35

TSS

Toxin mediated, shock, desquam, multiorgan dysfn
Staph aureus, GABHS-assoc increasing
Dx criteria- 5 outta 6 probable, 6/6 confirmed- fever > 11, hypotn, diffuse macular erythroderma, desquam 14 days lata, multisystem gi vom/d/ab pain, CK level/myalgias, hyperemic mucous memb, pyuria/elevated BUM, TCP, CNS, negative cultures! (excpet maybe positive blood culture of staph)

36

Rotavirus

Most common infectious GE, winter, fecal oral
INcub 1-3 days, asx or v/d/dehydration, diarrhea 4-7 days, maybe URI
Dx- Elisa in stool, no WBC
Tx- supportive mgmt, fluid, refeed quick, maybe lactose intol transiently

37

Norwalk

RNA virus, feal oral, GE in all age groups, close pops
Clin fx- vomiting more prom, 48-72 hours only
Dx- clin fx, mgmt = supportive

38

ETEC

Major traveller's diarrhea, noninvasive, watery
Dx- no stool WBC, clin dx, confirm culture
Abx- quinolone/sulfa shorten sx, hydration

39

EPEC

Noninvasive watery diarrhea in preschoolers
Stool culture dx, no stool wbc
Oral sulfa/quinolon + hydration

40

EHEC

0157:h7 => HUS via endotoxin release
Stool WBC, culture dx
If HUS, dont give abx (may increase endotoxin release)

41

Shigella

Bloody diarrhea, maybe seizures b/c of neurotoxin
Stool WBC present, culture dx
3rd gen cephalo/fluroroquino

42

Salmonella

Bloody or nonbloody, fecale oral, poultry, milk, eggs, lizards/turtles
Sickle cell patients especially et bacteremia/osteo
Stool wbc either way, cuture dx
No tx if uncomp GE if immunocompetend and older than 3 mo b/c then carry for longer
Tx for invasive w/ third gen cephalo

43

Campylobacter jejuni

Most common bacterial bloody diarrhea
Self lim by contam food
WBC in stool if bloody, stool cultrue dx
Oral erythro indicated but often sx resolve w/out tx

44

Yersinia enterocolitica

Mesenteric adenitis mimickin acute appendicits
Stool culture/mesenteric node culture w/ organism
Abx can benefit, 3rd gen cephalo

45

C. diff

Normal gut flora overgrows post abx
Dx w/ toxin in stool, maybe pseudomembranes on endo
Oral/IV metro, Oral Vanc if resistant

46

V cholerae

Developing countries, massive water loss/diarrhea
Can culture from stool, or erologic diagnosis from CDC, but cinical
REPLACE fluids, could use abx to shorten course but unsual

47

Eval or diarrhea

Detailed h/p look for fever, rash, ab pain, vom, blood, abx, day care, travel, pets, foods, restaurant
Check hydration in kiddosLab = CBC, lytes, FOBT, WBC, ova/parasite, culture, ELISA (rota, giardia, c dif)
MGMT w/ fluids, maybe abx

48

HIV info 1

10000 kids in US, 1 mil AIDS world, 10x with HIV
Perinatal transmission = 95% pediatric HIV- in utero, intrapartum or postpartum,
Transmission rate up if high maternal viral load, advance maternal disease, primary maternal HIV infec, concomitant maternal genital infec (or chorio), preemie, PROM
Down transmission if undetect viral load, c-sec, or adherence to ART/infant PEP
Also sex/blood product/IV/tattoos
Clin fx- asx, early sx = FTT, TC, recurrent infection (OM, PNA, sinusitis), lymphadeno, parotitis, recurrent thrush, loss of developmental milestones, severe zoster

49

HIV Dx/MGMT

All babies w/ HIV mommas have transplacental maternal abs up to 24 mo, HIV specific DNA PCR @ birth + monthly till 4 mo, negative at 4 mo = uninfected
MGMT = Give zidovudine 6 weeks as PEP, bactrim for PCP prophylaxis till PCR negative, no BF, urine CMV to check for coinfec (5%)
HIV kiddos w/ ARVs (NRTIs, NNRTIs, protease), combo therapy key, prophylaxis opp infections, immunizations/well-child care critical.
Give all vaccines, unless supa compromised (no MMR). flu, pneumococc, TB skin test
Regular monitor T cell levels, do optho exam for CMV retinitis if CMV ab +

50

Complications of HIV

PCP- most common opp infec in kiddos, CD$ cell numb coreelation, fever, hypox, interstitial pulm infiltrate, mmt prophylaxis against PCP w/ TMP/SMX
MAC- fever, WL, night sweat, ab pain, bone marrow suppress, up LFT, if CD4< 50
Fungal- candidal thrush/esoph, crypto meningPNA, histo, cooccidio, asperigillosis,
Viral cmw, hsv, vzv
Parasite- toxo, cryptospor, isospora belli
Lymphoma from EBV

51

Infectious Mono

EBV = major cause, via saliva, infects B lymphocyte
Also toxo, CMV, HIV similar
Fx- young kids asx, older = fever up to 2 weeks, malaise/fatigue, pharyngitis (like GABHS), post cerv lymphadeno or diffuse, HSM, spleen big 80%, macular/scarlatin rash, sx resolve wks/months
Dx- cbc w/ atypical lympho, neutropen, tcp, elevated transam
Monospot = first line test, heterophile antibody, less sensitive in kids under 4 y b/c no relialbe antibody. CMV = majority of monospot neg mono
EBV titires to dx younger than 4, do antibodies to VCA, EA, EBNA, or elevated IgM-VCA level + no EBNA abs = acute, or PCR
Tx = supportive, compx = neurogenic, upper airway obs, AMOXICILLIN RASH (if given, maculopap), splenic rupture (no sports), malignancy (burkitt's lymphoma + nasophar carcinoma, lymphoprolif disease)

52

Measles

Rubeola/ 10-day, Paramyxovirus
Highly infectious
8-12 day incub, clinical prodrome, transient rash on muc membranes, then characteristic rash
CCCk- conjunctivits, cough, coryza, Koplik spots (prodrome)
Exanthem = neck/ears, spreads down chest/UE in 24 hours, red maculopap, covers LE by 2nd day, lasts 4-7 days, fever > 101
Compx- bacterial PNA =>death, OM, laryngotrach, encephalomyelitis (brain and SC), subacute sclerosing panencephalitis,
Dx- clin + serologic, mgmt = supportive care, vitamin A, Immunoglob post exposure

53

Rubella

German measles, 3 day measles, togavirus
Highly infectious, milkd, asx, prodrome = mild URI/low grade fever
Painful lymphadeno, suboccipital, post auricular, cervical nodes
Exanthem = nonpruritic, maculopap, confluent- face to trunk/extremities, 3-4 days, milkdish fever
Compx- meningoenceph, polyarteritis in teen girls, and Congen Rubella Syndrome (primary mat infec in first tri, fetal anomalies, blueberry baby, congen cataracts, PDA, hearing loss, MR, HTN, t1dm, autoimmune thryoid)

54

Aspergillosis

Molds! invasive - severely IC pts, like transplant pts, high-dose systemic amphotericin B and resect aspergilloma, bnb
Allergic bronchopulm aspg = wheezing, eosinophilia, pulm infiltrates, most often w/ CF, elevated igE, need corticos and maybe antifungal

55

Candidiasis

Live on ze skin, and Gi tract, overgrowth post abx, mild superficial infection
Clin fx- oral thrush, diaper dermatitis, vulvovaginal candiaisis, give topical antifungal
INvasive candidal in IC patients, fungemia, meningitis, osteo, endopthalmitis- give systemic antifungal

56

Coccidiomycosis

C.immitis in soil in SW US/Mexico
Clin fx- inhaled into lungs, usually asx/mild pneumo, AA/FIlipino, pregnant women, neonates, IC ppl, dissem disease, severe PNA/mening/osteo
MGMT - mild pulm disease, immunocompt pts, no tx! dissem disease w/ antifungal

57

Cryptococcal infection

Cryptococcus neoformans = yeast in soil
Clin fx- crypto inhale into lungs, most infec asx, CNS in immunocomp, crypto mening = AIDS defining illness
Dissem infection in bones/joints/skin/in IC hosts, rare in kids
MGMT - dissem = systemic antifung

58

Amebiasis

Etio = e histolytica, acquired ingestion of cyts in contam food/water, sx in 1-4 weeks as trophozoite emerges from cyst
Epi- highest incidence in developing nations
Clin fx- asx, or can be mild colitis to severe dysentery, young kids/pregos/IC patients more severe
sx- cramping ab pain, tenesmus, diarrhea w/ blood/mucus, WL, fever, tender hep meg, chest pain, right shoulder pain, resp distress, jaundice
Ab compx = intestine perf, hemorrhage, stricture, ameboma!
Extraintestinal amebiasis as abscee in liver (or brain/lung/organs)
Dx- ID of trophozoites/cysts in stool, colon/biolpsy or serum ab assay, u/s CT scan identify abscess
MGMT = based on site! Mtro = mainstay! DONT aspirate

59

Giardiasis

G. lamblia, fecal oral, drink-contaminated mountain water, day care center, person-to-person, or via animals
Clin fx- asx to explosive diarrhea, 1-2 weeks after cyst ingestion, 2-6 week persist,
Localize in small bowel, diarrhea volume, watery, foul smelling, fart, WL, low-grade FEVA
Dx- cysts, tropho in stool/stool ELIZA, give metro/fura

60

Malaria

Obligate intracellular plasmodium (falciparum worst)
Most impt cause morbid/mort, endemic, transmission mosquito
Clin fx- vague flu, h/a, malaise, anorexia, fever, cyclical fevers 48-72 hrs, correlate RBC rupture, parasitemia, chills, vomiting, h/a, ab pain
Hemolytic anemia, splenomeg, jaundice, hypogly, crebral, renal, shock, resp fail
Dx- thick/think giemsa-stained PBS, think smear = id which tpe
MGMT - chorlorquinines/mefloquine/doxy dep on type
Prevention- chemoprophylaxis, control mosquito

61

Toxo

t.gondii, cat feces contact, ingestion undercooked meat/fruit/veggies, contam cysts, transplacental passage, exposure to blood, org tx
Asx, sx like mono, malaise, fever, sore throat, myalgias, lymphadeno, HSM, rash,
Reactivate if immunosuppressed- more severe- enceph, focal brain, pneumonitis, dissem, HIV w/ focal seizure
Ocular toxo => most common kind of chorioretinitis
Congen toxo = triad hyroceph, intracranial cacl, chorio
Dx- serologist, PCr/amnio, CSF
MGMT- mostly no specific therapy, but if congen/prego/ic, give sulfadiazine/pyrimethamine
PREVENT- avoid the cats!

62

GEneral worm concepts

Risk = immigrants, travelers, homelss
Asx, ab sx- pain, arex, n, rectal prolapse
Dx w/ three separate stool exams, or tape test

63

Cysticercosis

Mexico, central america, 20-50% epilepsy caused in endemic, fecal oral from taenia solium eggs ingested
No sx until encysts in muscle/subq/brain
Subq nodules palpated
Neurocysticerosis- fourth ventricle most common, or parench, mening, spine, eyes- seziures, hydroceph stroke
Dx- ova/stool tes, serology, head ct
MGMT- antiparasitic if adult tape worm. Neurocyst w/ calcified lesions = old/nonviable, just give anticonvulsant

64

Enterobius vermicularis = pin worm

Most common in US, fecal oral, preschool
Anal or vulvar pruritis, insomnia, arex, anuresis, nighttime teeth grind
Mebendazole/albendazole, pyrantel, reat all close contacts

65

Ascaris lumbricoides

largest/most common roundworm, fecal oral
Loffler syndrome- transient pneumonitis as larvae go through lungs- fever/cough/wheezing/eosino, sbo
Mebend/albend or pyrantel, screen friends

66

Trichuris trichuria

Worldwide distribu, seen w/ ascaris
Asx mainly, or ab pain/tenesumus/bloody diarrhea/rectal prolapse
Mebendazole, albendazole, pyrantel pamoa

67

Necator americanus/ancylostoma duodenale- hookworm

Rural/trop/human feces in soil, digs in through food, cough up, swallow,
Rash/pruritis where penetrate, iron-def anemia/FTT, fatigu,e pallor
Mebendaazole, albend, ppa, screen, iron

68

Strongyloides stercoralis

Like hookworm life cycle- tropics, subtropics/SW US,
Pruritic papules at penetration site, pneumonitis, GI sx, eosionphilia
Ivermectin, thiabendazole, albendazole

69

Cutaneous larva migrans

Intradermal migration of dog/cat hookworms from feces- soil
Migrating serpiginous tracks on skin
Self lim, give ivermectin/thiabe/alben if severe

70

Toxocara canis- visceral larva migrans- VLM

1-4 y/o kids w/ Pica, eat eggs in soil/dog fur, larva released, migrate through tissues
VLM- fever/eosino/leukocytosis/HSM, malaise, cough, myocarditis
ocular larva migrans- retinal granulomas/endohtalmtis- albenda, mebenda, steroids

71

Rickettsial

Lyme, RMSF- rickettsia rickettsi- gram neg intracell
Southeastern US, summer/spring, school-age, less than 50% recall tick bite
Fever, petechial rash on extremities (ankles/feet to caudal/centripital), myalgias, HSM, jaundice, CNS, h/a, hypotn
TCP, hyponat, elevated transam, CSF aseptic
Dx- serologic + clinical,
MGMT = oral/IV doxy + supportive care, abx on clinical testing
Prevent w/ tick avoid

72

Ehrlichiosis-

Ehrlichia chaffeenis- tick
Same regions as RMSF- spottless! Fever, h/a, myalgia, lymphadeno- same TCP, elevated liver, hyponat, dx w/ serology/pcr
doxy + supportive care

73

Cat Scratch

Bartonella- g negative
regional lymphadeno, post scratch
Papule along line of scratch,red, warm, tender 1/3 w/ fever, 1-% w/ pus, parinaud oculoglandular syndrome, enceph, osteo, hep, PNA, hepatic/splenic lesions
Dx- demo elevated IgM
MGMT = supportive care- abx if systemic/immuno def, oral zpack, bactrim, cipro. no surgery

74

TB

Myocbacterium TB, recent contact w/ contagious pulm tb
Latent = asx w/ postive skin test, or radiograph w/ granulomas
TB disease- signs sx of TB w/out positive dx findings
Epid- high risk immigrants, homelss, jail, immunodef, kids under 12 usually NOT contagious b/c cough too small
LTBI- positive TB test do not progress to disease, infants under 1 greatest risk of getting...fever chills WL, cough, night sweat
Extrapulm = cervical scrofula, meningitis, ileitis abdomen, skin/joit, skeletal potts,
Xr- hilar/mediastinal lymphadeno, ghon complex, lobar/pleural effusion/cavitary upper lung
Dx- with PPD- read 48-72 hours later, 2012 weeks after exposure.
Induration measurement > 5 mm kids, >1 mm if under 4/chornic med condition or endemic, > 15 if over 4 w/ no risk factor
def dx= culture from gastric aspirates, AFB tain, psotive histology
MGMT- LTBI = INH for 9 mo, also give b6
TB disease give 1nh, rif, pyrazinamid,e 2 mo, then 4 mo inh + rifampin