Infectious Diseases Flashcards
(205 cards)
1
Q
What is an epidemic?
A
An increase, often sudden, in the number of cases of a disease above what is normally expected in a pop.
2
Q
What is an outbreak?
A
Carries the same definition as epidemic but is often used for a more limited geographic area
3
Q
What is a cluster?
A
Aggregation of cases grouped in place and time that are greater than the number expected
4
Q
What is an endemic?
A
The amount of a particular disease usually present in a community
5
Q
What is a pandemic?
A
An epidemic that has spread over several countries or continents, affecting a large number of people
6
Q
What are the requirements for an infectious disease case to be considered suspected?
A
Epidemiological exposure + 2 or more symptoms
7
Q
What are the requirements for an infectious disease case to be considered Probable?
A
Relevant epidemiological exposure + no disease symptoms + positive IgM
8
Q
What are the requirements for an infectious disease case to be considered confirmed?
A
Lab confirmation by viral RNA or antigen, IgM antibody and PRNT (plaque reduction neutralization test)
9
Q
What are the direct laboratory methods for diagnosing an infectious disease?
A
Virus Isolation
Genome detection
Antigen detection
10
Q
What are the indirect methods used to diagnose an infectious disease?
A
Serology IgM
Serology IgG
11
Q
What agent causes Zika?
A
Flavivirus = a single stranded RNA virus
12
Q
What carries the Zika Virus?
A
Aedes aegypti
Aedes albopictus
Both are types of mosquitos that live in tropical climates and are daytime and twilight feeders; they breed in standing water
13
Q
How is Zika virus transmitted?
A
Patient it bit by an infected mosquito = primary
Maternal-fetal
Sex
Blood transfusions
Organ transplants
Lab exposure
14
Q
In what bodily fluids has Zika virus been found?
A
Blood
Semen
Saliva
Female genitalia tract secretions
CSF
Amniotic fluid
Breast milk
15
Q
What are the clinical manifestations of Zika?
A
Acute onset of low grade fever
Priorities rash
Arthralgia
Conjunctivitis
16
Q
When will patients start to see symptoms of Zika?
A
2-14 days after being bit
17
Q
How long does it take for symptoms of Zika to resolve?
A
2-7 days
18
Q
What requirements are given in order to clinically diagnose a patient with Zika?
A
If they have 2 or more of the following symptoms:
Maculopapular pruritic rash
Arthralgia in small joints of hand and feet
Non-purulent conjunctivitis
Acute onset of low-grade fever
19
Q
What is the complication/concern to patients with Zika?
A
In women who are pregnant, Zika causes the following symptoms to the unborn fetus:
Fetal loss Microencephaly Gillian-Barre Syndrome Brain Ischemia Myelitis Meningoencephalitis
20
Q
If the patient is presenting to you < 14 days after onset of symptoms, what diagnostic test should you order for Zika?
A
Serum or urine sample to test for Zika Virus RNA = rRT-PCR
21
Q
If the patient is presenting to you > 14 days after onset of symptoms of Zika, what diagnostic testing should you order?
A
Serum sample to test for Zika virus IgM and PRNT (antibodies and title)
22
Q
How do you treat Zika?
A
Supportive care:
Rest
Hydrate
Acetaminophen
23
Q
What should you avoid prescribing to patients with Zika?
A
NSAIDS until Dengue is ruled out completely
Aspirin in children due to Reyes Syndrome
24
Q
How do you prevent Zika?
A
Limit travel to certain areas
Remove standing water
Mosquito repellant
Long sleeves and pants should be worn
Environmental control
Protected intercourse
25
What is the recommendation for women who are planning to get pregnant but have been diagnosed with Zika?
They should wait 3-6 months before trying to conceive
26
What is the Zika virus considered?
A Nationally notifiable disease
27
What is the causative agent of Chikungunya?
Alphavirus = single stranded RNA virus
28
What is Chikungunya carried by?
Aedes aegypti
Aedes albopictus
Day feeder mosquitos
29
How is Chikungunya transmitted?
Through infected mosquito bites
A patient can be infected with the virus and then travel to another part of the world; however, unless there are the specific mosquitos present in that new area that can carry the disease, there is no way for it to be spread
30
Where is Chikungunya endemic to?
West Africa
31
When do outbreaks of Chikungunya usually occur?
During the rainy season
32
What are the clinical manifestations of Chikungunya?
Abrupt, high grade fever ( 104 F)
Polyarthralgia of multiple joints (hands, wrists, ankles); bilateral and symmetrical
Intense and disabling pain
Macular or maculopapular rash
Pruritis
Non specific lab findings:
Lymphopenia
Thrombocytopenia
33
What is the incubation period for Chikungunya?
3-7 days
34
When is the acute phase of Chikungunya usually seen?
7-10 days after exposure
35
How long does the high grade fever seen with Chikungunya usually last?
3-5 days
36
When does the Polyarthralgia seen in Chikungunya usually occur?
2-5 days after onset of fever
37
What are the complications typically seen with patients who have Chikungunya?
Death in patients over 65 and with comorbidities
Persistent debilitating and immobilizing arthritis
Respiratory, renal, and cardiovascular failure
Some patients have persistent or relapsing disease for up to 3 years after infection
38
How do we diagnose Chikungunya?
Blood sample:
Virus RNA present 1-7 days after infection = use RT-PCR
IgM antibodies present > 8 days after infection = ELISA
39
When will IgM antibodies for Chikungunya be seen?
5 days after onset of symptoms and up to 3 months after
40
When will IgG antibodies for Chikungunya been seen?
2 weeks after onset of symptoms and persist for years
41
What is the treatment for Chikungunya?
Supportive care
NSAIDS
Steroids
Methotrexate
Immune modulating agents
42
How do we prevent Chikungunya?
Minimize mosquito exposure
Mosquito repellents
Bed nets
43
What is the causative agent of Dengue?
Single stranded RNA virus in the Genus Flavivirus
44
How many types of Dengue are there?
Four:
DENV 1-4
All types cause full disease
45
How many strains of Dengue are there?
47
46
What is Dengue carried by?
Aedes Aegypti
Aedes albopictus
47
How is Dengue transmitted?
Bite from infected mosquito
There is evidence of maternal-fetal transmission
48
What is the leading cause of death in the tropics and subtropics?
Dengue
49
When does Dengue usually transmit?
Late summer and early fall
50
What is the death to case ratio for Dengue?
Low = those that get this disease usually make a full recovery
51
What are the three classifications of Dengue?
Dengue without warning signs
Dengue with warning signs
Severe Dengue
52
What are the requirements in order for a patient to be diagnosed with Dengue without warning signs?
Fever + two of the following:
```
N/V
Rash
Aches
Pains
Leukopenia
Positive tourniquet sign
```
53
What are the clinical manifestations associated with Dengue without warning signs?
N/V
Rash
Headache
Eye pain
Muscle ache
Joint pain
Leukopenia
Positive tourniquet sign
54
What are the clinical manifestations associated with Dengue with warning signs?
Abdominal pain and tenderness
Persistent vomiting
Clinical fluid accumulation
Mucosal bleeding
Lethargy or restlessness
Hepatosplenomegaly > 2cm
Increase in hematocrit with decrease in platelets
55
What are the clinical manifestations associated with Severe Dengue?
Severe plasma leakage leading to shock and fluid accumulation with respiratory distress
Severe bleeding
Severe organ failure —> AST or ALT > 100
Impaired consciousness
56
What are the three phases of Dengue infection?
Febrile
Critical
Convalescent
57
When can you see the febrile phase of Dengue infection?
IN dengue with or without warning signs
58
What is the febrile phase of Dengue characterized by?
Sudden onset of high grade fever = > 101.3 F or 38.5 C
59
How long does the febrile phase of Dengue infection last?
3-7 days
60
What will you see upon physical exam of a patient in the febrile phase of Dengue infection?
Conjunctival injection
Pharyngeal erythema
Lymphadenopathy
Hepatomegaly
Facial puffiness
Petechiae
Leukopenia
Thrombocytopenia
Elevated liver enzymes
61
What are the outcomes for a patient in the febrile phase of Dengue infection?
Recovery/Convalescent phase
Critical phase
62
What is the critical phase of Dengue infection characterized by?
```
Systemic vascular leak Syndrome:
Plasma leak
Bleeding
Shock
Organ failure
```
Moderate to severe thrombocytopenia
63
When will the critical phase of Dengue infection occur?
3-7 days after infection
64
How long does the critical phase of Dengue infection last?
24-48 hours
65
What is the outcome of a patient in the critical phase of Dengue infection?
These patients typically will not recover
66
What is the Convalescent phase of Dengue infection?
Recovery phase
Plasma leakage and hemorrhage resolve
Vital signs stabilize
Profound fatigue
67
How long does the convalescent phase of Dengue infection last?
Usually 2-4 days but can take weeks to months
68
How do we diagnose a patient with Dengue infection?
If its the first week of illness:
RT-PCR and viral antigen nonstructured protein test
ELISA test about 4 days after illness for IgM
69
How do we treat Dengue?
Supportive care
Fever management:
Acetaminophen
NO NSAIDS!!!
Bleeding management:
Blood replacement
Plasma leakage:
Volume replacement —> IV fluids
Shock treatment
70
How do we prevent Dengue?
Mosquito control
Vaccination outside of the US and is only given to those that test positive for Dengue antibodies or hav e a history of Dengue
Limit travel
Improve community participation
71
Out of the three mosquito/arthropod borne illnesses, which one will manifest conjunctivitis?
Zika
72
Out of the three mosquito/arthropod borne illnesses, which one will manifest Hemorrhage and Shock?
Dengue
73
Out of the three mosquito/arthropod borne illnesses, which one will manifest arthralgia?
Chikungunya
74
What is the causative agent for Ebola?
Filoviridae family = non-segmented, single stranded RNA virus
75
What are the 5 species of Ebola?
```
Zaire
Sudan
Tai Forest
Bundibugyo
Reston
```
76
Which species of Ebola CANNOT infect humans?
Reston
77
What other disease does Ebola resemble?
Rabies
Measles
Mumps
78
How is Ebola transmitted?
Direct contact with infected body fluid of infected animal or human
79
How long can the virus live on surfaces for?
Hours to days
80
What are the clinical manifestations of Ebola?
Fever
Chills
Malaise
Diffuse Maculopapular rash
```
GI:
Watery diarrhea
Nausea
VOmiting
Abdominal pain
```
Blood in stool
Petechiae
Mucosal bleeding
81
What symptoms cause severe cases of Ebola?
VOmiting and Diarrhea which cause severe volume loss
82
How long is the incubation period for Ebola?
6-12 days post exposure
83
What are the phases associated with Ebola?
Early phase
GI phase
Shock phase
Recovery phase
Convalescence phase
84
What are the defining characteristics of the early phase of Ebola?
Occurs within 1-3 days
Fever
Malaise
Symptoms are vague
85
What are the characteristics of the GI phase of Ebola?
Occurs 3-10 days
Nausea
Vomiting
Diarrhea
86
What are the characteristics of the Shock phase of Ebola?
Occurs 7-12 days
With or without major hemorrhage
87
What are the characteristics of the recovery phase of Ebola?
Occurs within 7-12 days
Resolution of symptoms
88
What are the characteristics associated with the Convalescent phase of Ebola?
Up to 2 years after infection
Prolonged symptoms of arthralgia, weakness, fatigue, and insomnia
89
When do symptoms of Ebola usually start to resolve?
Within 2 weeks of illness
90
What diagnostic test is used for Ebola?
ReEbov:
| Rapid immunoassay test that gives results within 15 minutes
91
What are some non specific lab studies that can be done that diagnose Ebola?
Leukopenia
Thrombocytopenia
Hematocrit increase or decrease
Transaminase elevations
Coagulation abnormalities
Renal abnormalities —> proteinuria or renal insufficiency
Electrolyte abnormalities —> Hyponatremia or Hypokalemia
92
What is the treatment for Ebola?
Supportive Care to prevent volume depletion
Aggressive fluid and electrolyte resuscitation —> be careful not to do too much
Anti-emetics
Antipyretic
Blood products —> FFP, PRBC, platelets
TPN = total parenteral nutrition
Antiviral
Compassionate use medications
93
What are some of the Compassionate Use medications given to patients with Ebola?
Favipiravir
Artesunate-amodiaquine = antimalarial
Zmapp
G-S-5734
TKM-Ebola
BCX4430
94
What are the factors that determine prognosis for a patient with Ebola?
Age —> young survive
Gender —> higher fatality in males
GI disease —> Higher rate of mortality with diarrhea
Viral load —> HIgher virus load in the blood increases the likelihood of death
95
How do we prevent Ebola?
Strict infection control
Proper use of PPE
Effective communication between the government and healthcare workers
No vaccination yet
96
What is Ebola considered but the CDC?
A Category A bioterror agent
97
What is bacteremia?
A bacterial pathogen enters the blood stream
98
What bacteria is the most common cause of COMMUNITY and HOSPITAL acquired bacteremia?
Staph aureus
99
What bacteria is most common in the setting of skin and soft tissue infection?
Group A Strep
100
What other bacteria are associated with Bacteremia?
E. Coli
Klebsiella
Enterobacter
Pseudomonas
101
How does bacteremia get transmitted?
Seeding of the blood from different sources
102
What are the clinical manifestations of Bacteremia?
Fever
Chills
Malaise
SIRS = Systemic Inflammatory Response Syndrome
Hypotension
Tachycardia
103
How do we diagnose Bacteremia?
Diagnostic Evaluation:
ID consult if necessary
TEE echo imaging
Lab values:
Leukocytosis with left shift (increased neutrophils)
Positive blood cultures will determine the type of bacteria
104
What organisms found in a blood culture mean that the blood culture is contaminated?
Coagulase Negative Staph
Corynebacterium
Viridans
105
What is the treatment for Bacteremia?
Empiric IV with use of:
Vanco
Daptomycin
Cefazolin (MSSA)
Pen G
106
What is Sepsis?
Life threatening organ dysfunction by dysregulated host response to an infection
107
What is the Continuum of Severity of Sepsis?
Infection —> Bacteremia —> Sepsis —> Septic shock —> MODS —> death
108
When is sepsis more common?
Winter
109
What commonly causes sepsis?
Gram + bacteria
110
What are the clinical manifestations of Sepsis?
Hypotension with SBP < 90
Tachycardia
Tachypnea > 22
Fever > 100.9
111
What lab values correlate with Sepsis?
Leukocytosis > 12
Leukopenia < 4
Hyperglycemia > 140
Elevated C-reactive proteins
Elevated Cr
Coag abnormalities
Thrombocytopenia < 100
Elevated Serum lactate
112
What are the clinical requirements for a patient to be diagnosed with SIRS (Systemic Inflammatory Response Syndrome)?
Presence of two or more of the following:
Temp > 38C or < 36 C
Heart rate > 90 bpm
RR > 20 breaths/min
PaCO2 < 32 mm Hg
WBC > 12000 cell/mm3 or > 10% immature (band) forms
113
What are the risk factors for Sepsis?
ICU admission
Bacteremia
Advanced age
Immunosuppression
Diabetes and cancer
Community acquired pneumonia
Previous hospitalization
114
What is septic shock?
Sepsis with circulatory, cellular, and metabolic abnormalities
115
What are the clinical manifestations of septic shock?
Cool skin
Cyanosis
Oliguria
Altered Mentation
Elevated lactate
116
What is Vasodilator or distributary shock?
Circulatory, cellular, and metabolic abnormalities with greater risk for mortality than just sepsis
117
What is MODS (Multi-organ Dysfunction Syndrome)?
Progressive organ dysfunction
Severe end of severe illness
Can be primary or secondary
No universally accepted criteria
118
If a patient with HIV has blood cultures that do not detect the virus, what are their chances of spreading HIV?
0%
119
What are the CDC Defined Stages of HIV infection?
Early Infection
Clinical Latency
AIDS
120
What are the characteristics of an early infection of HIV?
Virus is present in large numbers
Patient is highly contagious
121
What is characteristics about the clinical latency period of HIV?
No or subtle symptoms in patient
122
What are the two criteria for a patient to be diagnosed with AIDS?
CD4 count must be below 200, regardless of symptoms
Patient develops an AIDS defining condition regardless of CD4 count
123
What are the lab tests that we can take on a patient to diagnose HIV?
```
Viral Load
CD4 count
HIV genotype
TB test
Hep B or C test
Other STDs
```
124
If an HIV patient has a PPD test for TB, what is considered a postive result for this patient?
A bump greater than 5mm
125
What is the 90/90/90 COntinuum of Care Goal?
90% of people with HIV have been tested
90% of those patients who have been tested are steadily on treatment
90% of those patients steadily on treatment have viral loads less than 200 copies/mL
126
What are the top two routes of transmission for HIV?
MSM --> Men
Heterosexual contact --> Women
127
What age range has the highest rates of HIV diagnosis?
24-34 years
128
What races are most commonly infected with HIV?
Minorities esepically African american men and women
129
How can HIV be transmitted?
Sex
Blood
Birth
130
What are the risk factors for HIV?
```
Viral Load > 200
Lack of Circumcision
Greater number of sexual partners
More likely to get HIV if receiving anal sex
Increased risk with active STDs
Genetics
```
131
What are the clinical manifestations of Acute HIV infection?
```
Fevere
Lymphadenopathy
Pharyngitis
Rash
Myalgia/arthralgia
Headache
Oral or Genital ulcers
N/V
Diarrhea
```
Patient will feel like they have a virus
132
What is the screening test for HIV?
4th Generation Antibody/Antigen test
133
If patients screening test comes back positive for HIV, what is the next course of action?
Order a viral load test to see where in the course of their HIV infection they are
134
If a patient comes into your office and appears to have mono, what should you do?
Do a viral load test for HIV
135
When would a viral load for HIV become detectable?
5-20 days after infection
136
What are the differential diagnoses for HIV?
```
EBV (mono)
CMV
Toxoplasmosis
Rubella
Syphillis
Hepatitis
Disseminated GC
Any viral infection
```
137
What are the B conditions that may occur in early syptomatic HIV infection?
Thrush
Vaginal candidiasis that is persistent, frequent, or difficult to manage
Oral hairy leukopenia
Herpes Zoster involving two episodes or more than one dermatome
Peripheral Neuropathy
Bacillary Dysplasia
Cervical dysplasia
Cervical carcinoma in situ
Constitutional symptoms such as fever or diarrhea for more than one month
Idiopathic Thrombocytopenic purpura
Pelvic inflammatory disease, espeically if complicated by a tuboovarian abscess
Listeriosis
138
What disease does the CDC consider AIDS-defining conditions?
Bacterial infections that are multiple or recurrent
Candidiasis of bronchi, trachea, lungs, or esophagus
INvasive Cervical Cancer
Disseminated or extrapulmonary Coccidioidomycosis
Extrapulmonary Cryptococcosis
Chronic intestinal (> 1 month) Cryptosporidiosis
CMV and CMV retinitis
Encephalopathy
Herpes simplex that has chronic ulcers or bronchitis, pneumonitis, or esophagitis
Disseminated or extrapulmonary Histoplasmosis
Chronic intestinal Isopsoriasis
Kaposi Sarcoma that occurs sporadically
Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
Burkitt, immunoblastic, or Primary brain lymphoma
Mycobacterium avium complex or disseminated or extrapulmonary Mycobacterium kansasii
Mycobacterium tuberculosis of any site that is pulmonary, disseminated, or extrapulmonary
General Mycobacterium species infection
Pneumocystitis jirovecii pneumonia
Recurrent Pneumonia
Progressive multifocal leukoencephalopathy
Recurrent Salmonella septicemia
Toxoplasmosis of the brain
Wasting syndrome
TB of any site + HIV positive
139
What is the primary prophylaxis if a patient has a CD4 count less than 200 or 14%?
Bactrim or alternative for Pneumonitis jirovecii
140
What is the primary prophylaxis if a patient has a CD4 count less than 100 and Toxoplasmosis IgG serology is positive?
Bactrim
141
What is the primary prophylaxis if a patient has a CD4 count less than 50?
Azithromycin or other for MAC
142
What immunizations should an HIV positive patient have?
Flu vaccine yearly but not the live strain
Strep pneumo
Hep B if not immune
Hep A if in risk group
Routine Td
143
How many new diagnoses of HIV occur yearly in the US?
44000
144
How many deaths due to HIV are there per year in the US?
10000
145
Who do you treat for HIV?
EVERYONE that has HIV
Exception is for practical and psychosocial reasons
146
Why do we treat everyone who has HIV?
It helps the individual and helps to prevent transmission to others
147
What must you do before prescribing treatment for HIV?
Obtain a genotype study
148
What drug class is the backbone of HIV treatment?
nRTIs
149
What side effect can all nRTIs have?
Metabolic acidosis early in use
The patient will feel really sick
150
What are the 4 nRTIs commonly used to treat HIV?
Tenofovir (TDF or TALA)
Lamivudine (3TC) or Emtricitabine (FTC)
Abacavir
Zidovudine (AZT)
151
What is special about the drug Abacavir?
You must check the patient to make sure they are NOT HLA B*5701 positive before using
152
What are the nnRTIs that are commonly used to treat HIV?
Efavirenz (Sustiva)
Etravirine
Rilpivirine
Doravarine
153
What are the side effects of Efavirenz?
Transient Rash
Vivid dreams
CNS effects
154
When should you not prescribe Rilpivirine?
If the patients viral load is >100,000 or CD <200
155
What medications should you use with Protease Inhibitors in order to metabolically boost them?
low-dose Ritonavir or Cobicistat
156
What are the protease Inhibitors?
Atazanavir
| Darunavir
157
What is the side effect of Atazanavir?
Increase in unconjugated bilirubin causing patient to become jaundice
158
When are protease inhibitors typically used?
In alternative regimens
159
What are the Integrase Inhibitor drugs?
Raltegravir
Elvitegravir
Dolutegravir
Bictegravir
160
Which integrase inhibitor can you not use in pregnancy due to risk of neural tube defects?
Dolutegravir
161
Which integrase inhibitor needs Cobicistat for a metabolic boost?
Elvitegravir
162
What are the two Entry inhibitors?
Maraviroc
| Monoclonal anti-CD4 injection
163
What is the recommended starting regimen for HIV treatment?
INSTI (integrase inhibitors) + 2 Nukes
164
If a patient is considered to pre-exposed to HIV, what can they take for prophylaxis?
Truvade (TNF) + Emtricitabine
PrEP
165
Who are at risk of getting opportunistic infections?
Patients on chemotherapy, chronic steroid use (> 21 days), and the elderly
166
What are opportunistic infections associated with?
T cell immunosuppression
167
What are the fungal opportunistic infections?
Cryptococcus
Histoplasma
Candida
Pneumocystis
168
What is the viral opportunistic infection?
Cytomegalovirus (CMV)
169
What is the parasite opportunistic infection?
Toxoplasma
170
What factors increase the risk of getting fungal infections?
Severity of impairment of cell-mediated immunity
Recent or current use of antifungal medication
Risk of exposure such as where the patient work and use of steroids
Neutropenia
171
What is Criptococcus caused by?
C. neoformans
| C. gotii
172
How is Criptococcus transmitted?
Air droplets
Bird droppings
Spores are inhaled, become lodged into the lung alveoli, then disseminate hematogenously and cause infection
173
What are the clinical manifestations of Criptococcus?
```
Meningitis
Meningoencephalitis
Malaise
Fever above 38.4C
Papilledema
Meningeal Signs
Headache
N/V
Cough/SOB
Altered Mental Status
```
174
How do we diagnose Criptococcus?
Cryptococcal antigen in CSF
175
What is the treatment for Criptococcus?
Amphotericin B
Fluconazole
Drainage of CSF if opening pressure during LP is >20; this will relieve symptoms but not get rid of the fungus
176
How is Histoplasmosis transmitted?
Inhalation
177
When do symptoms of Histoplasmosis start to appear?
1-3 months after exposure
178
What are the clinical Manifestations of Histoplasmosis?
Weight loss
Hepatosplenomegaly
Fever
Skin Ulcers
Lymphadenopathy
Dyspnea on exertion
179
What tests do we use to diagnose Histoplasmosis?
Urine sample --> H. capsulatim antigen
CBC --> Pancytopenia and LFT abnormalities seen
Chest xray --> Bilateral diffuse reticulonodular infiltrates
Lymph node biopsy --> Budding yeasts
180
How do we treat Histoplasmosis?
Amphotericin B
Itraconazole
12 weeks
181
When is oropharyngeal candidiasis most common?
when the patients' CD4 count is below 200
182
When is esophagitis most common?
When the patients' CD4 count is below 100
183
What are the four types of Candidiasis?
Erythematous
Hyperplastic
Angular Cheilitis
Pseudomembranous
184
What are the clinical manifestations of Candidiasis?
Mild burning sensation in mouth
Pt. will describe that it feels like there is food stuck in their esophagus but there isn't
Erythema must occur around the spots
185
What is the treatment for Candidiasis?
Itraconazole 200mg/day for 14 days
Fluconazole 100mg/day for 14 days*DOC*
If patient cannot swallow, use IV meds
AVOID topical treamtents like swish and spit
186
What is the most common cause of dysphagia and odynophagia in AIDS?
Esophageal candidiasis
187
What test do we use to see if a patient has Candidiasis?
Endoscopy
188
How long does it take for the patient to feel better once starting treatment?
2 days
189
What is Pneumocystisi caused by?
Environmental exposure to the fungus
190
What damage does Pneumocystis jirovecii do to the lung?
Inflammation
Interstitial Edema
Diffuse Alveolar damage
191
What are the clinical manifestations of Pneumocystis jirovecii?
Gradual onset and progression of fever
Dry Cough
Dyspnea/SOB gradually gets worse
Symptoms occur about 1 month after exposure
192
What imaging test should we order for a patient we suspect has Pneumocystis jirovecii?
HRCT chest
193
What lab test should we order for a patient we suspect has Pneumocystis jirovecii?
BAL+ immunofluorescence
194
What is the treatment for Pneumocystis jirovecii?
Bactrim (TMT-SMX)
IV 15-20 mg/kg/day for 21 days
PO 2 DS tablets every 8 hours for 21 days
195
What is a differential diagnosis of Pneumocystis jirovecii?
TB
196
If a patient comes in with a CD4 count <50 and presents with an eye problem, what must we automatically consider them to have until proven otherwise?
Cytomegalovirus
197
Where does CMV usually effect?
Retina
CNS
GI tract
198
What are the clinical menifestations of CMV?
CMV Retinitis:
No pain but floaters, blurry vision, decreased peripheral vision
LIght flashes or sudden vision loss
Starts in one eye but can become both
If left untreated, patient will become blind due to retinal detachment 2-6 months after infection
199
How do we diagnose CMV?
Perivascular, fluffy, yellow-white retinal infiltrates +/- hemorrhage
200
What is the treatment for CMV?
IV Ganciclovir, lifelong
201
What is Toxoplasmosis caused by?
T. gondii
202
What are the clinical manifestations of Toxoplasmosis?
Seizures
Headache
Confusion
Fevere
Lethargy
Focal sign
Altered Mental Status
Psychomotor retardation
Meningissmus
No increased CSF pressure
Aggressive
Patient can have strokes
203
What imaging test should we order if we suspect Toxoplasmosis?
Brain MRI --> will show more than 1 lesion present
204
What is the differential diagnosis for Toxoplasmosis?
CNS lymphoma
205
How do we treat Toxoplasmosis?
Pyrimethamine + Sulfadiazine + Leucovorin
Brain biopsy
