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CMN 572 Module 5 > Infectious Diseases - Turnham Zoom > Flashcards

Infectious Diseases - Turnham Zoom Flashcards

1
Q

Scarlet Fever

Appearance

A
  • Enlarged tonsils
  • Sandpaper-like Papules
  • Circumoral Pallor (white around mouth)
  • Blanching (Pastia lines - skin fold lines don’t blanch)
  • Increase density of rash on neck, axilla, groin
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2
Q

Scarlet Fever

Dx Feature

A
  • Petechiae on soft palate
  • STRAWBERRY TONGUE
    • Strep test
  • Group A beta hemolytic strep is cause
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3
Q

Scarlet Fever

Treatment

A
  • PCN 10-14 days
  • If PCN allergy, use Erythromycin or Clindamycin
  • Should improve w/in 48 hours
  • Goals: prevent acute rheumatic fever, decrease spread of disease, prevent glomerulonephritis
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4
Q

Streptococcal Perianal Cellulitis

Characteristics

A
  • Perianal erythema, tenderness
  • Afebrile; otherwise well
  • Heavy growth of group A strep (GAS) on culture
  • Scant rectal bleeding with defecation possibly
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5
Q

Enteroviruses

A
  • Any RNA virus that occurs in GI tract, but can spread to other areas (including Hep A and Polio)
  • Commonly spread through respiratory secretions
  • More than 90% of these viruses are non-distinctive
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6
Q

Enterovirus Examples

A
  • Herpangia
  • Acute lyphonodular pharyngitis
  • Hand-Foot-Mouth Disease
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7
Q

Hand-Foot-Mouth Disease
(Coxsackievirus Type A 5, 10, 16)

Rash Types

A
  • Rash
    • Macular (lesions flat and level with surrounding skin)
    • Maculopapular (lesions flat and raised)
    • Urticarial (raised, itchy skin, aka hives)
    • Scarlatinaform (diffuse redness with small papules)
    • Petechia (pinpoint round spots)
    • Vesicular (happens near vesicles)
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8
Q

Hand-Foot-Mouth Disease
(Coxsackievirus Type A 5, 10, 16)

Characteristics

A
  • Lesions found on tongue, oral mucosa, hands, and feet

- Associated with fever, sore throat, malaise

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9
Q

Mononucleosis

Transmission

A
  • Exposure to EBV
  • Transmitted through intimate contact - direct salivary transfer (kissing disease)
  • After exposure, EBV remains in host for life
  • Incubation is 1-2 months after exposure
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10
Q

Mononucleosis

Characteristics

A
  • Prolonged fever
  • Exudative pharyngitis
  • Generalized adenopathy
  • Hepatosplenomegaly
  • Atypical lyphocytes
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11
Q

Mononucleosis

Presentation

A
  • Incubation period 1-2 months
  • 2-3 days prodrome of malaise leading to febrile illness
  • Major complaint is pharyngitis
  • Splenomegaly present 50-75% of the time
  • Hepatomegaly present 30% of the time (LFTs elevated)
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12
Q

Mononucleosis

Diagnosis

A
  • Heterophile Antibodies
    • More sensitive in pt over 5 yo
    • May not be detectable until 2nd week of illness
    • Monospot positive if titer is significant but this is NOT TOTALLY DIAGNOSTIC
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13
Q

Mononucleosis

Treatment

A
  • Avoid contact sports for 6-8 weeks
  • Analgesics/Antipyretics if needed
  • Drink plenty of fluids
  • Bed rest
  • F/U labs and US IF:
    • Splenomegaly
    • Elevated LFTs
    • Abnormal CBC (lymphocytosis)
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14
Q

Mononucleosis
Immunity

VCA IgG
VCA IgM
EBNA IgG

A
  • No previous exposure = all 3 -
  • Recent Infection = both VCA +
  • Previous Infection = both IgG +
  • Exposure in past = VCA IgG +
  • Post Infection = + for all
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15
Q 
Erythema Infectiosum (Fifth Disease)
Characteristics
A
  • Caused by a parvovirus (B19)
  • Spread by respiratory secretions
  • Late Winter-Early Spring
  • Starts with fever
  • Rash on the face “slapped cheek”
  • Symmetrical, full body reticulated (lacy) rash
  • Patches usually have circumscribed macular borders that are non-tender (how to differentiate from cellulitis)
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16
Q

Erythema Infectiosum (Fifth Disease)

A
  • Rash appears 4-14 days post exposure
    • Infectious prior to rash appearing
  • Rash will fade in several days to weeks, but may reappear with local inflammation, heat, sunlight, stress
  • Pregnant women may develop fetal infection (hydrops fetalis - accumulation of fluid in 2 or more fetal compartments)
    • Increased risk for fetal demise
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17
Q

Roseola

Characteristics

A
  • Infants 6-36 months
  • Late fall-Early spring
  • Human herpes virus 6 or 7
  • Transmitted through respiratory secretions
  • Incubation period about 9 days
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18
Q

Roseola

Presentation

A
  • Abrupt onset of fever (102-105 for 3-8 days)
  • Fever abruptly subsides, then faint pink spots that blanch appear on neck, upper arms, and trunk (sometimes face/legs)
  • Benign illness (self-limiting)
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19
Q

Rubeola (Measles)

Characteristics

A
  • Incubation 9-14 days
  • Fever, cough, conjunctivitis, and coryza (inflammation of nasal mucosa)
  • KOPLIK SPOTS (red/white patches in oral mucosa): 1-2 days prior to and after onset of rash
  • Maculopapular rash spreads down face to trunk over 3 days, then merges
  • Leukopenia
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20
Q

Rubella
“3 Day” German Measles
Characteristics

A
  • No hx of rubella vaccine
  • Incubation 14-21 days (most infectious 1-5 days after rash appears)
  • Respiratory symptoms
  • Low-grade fever
  • Conjunctivitis
  • Adenopathy behind ears and sub-occipital
  • Rash starts on face @ hairline, then trunk/extremities as it fades from face
  • Gone by 4th day
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21
Q

Congential Rubella Syndrome

A
  • Woman who gets rubella early in pregnancy has a 90% chance of giving birth to deformed baby
  • Most are deaf or blind
  • Many are mentally retarded
  • May have damaged heart or unusually small brain
  • Miscarriages also common
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22
Q

Mumps

Characteristics

A
  • Acute and self-limiting
  • Swelling of one or more salivary glands
  • Parotid gland enlargement typical
  • Rubulavirus can be found in urine, respiratory secretions, CSF
    • May be inactivated by heat, chemical agents (chloroform, formalin), or UV light
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23
Q

Mumps

Exposure to Symptoms

A
  • Transmitted through respiratory droplets
  • Incubation 16-18 days, however some may develop in 12-25 days post exposure
  • Prodromal complaints (last 3-5 days)
    • Low-grade fever (< 101)
    • HA
    • Malaise/myalgias
    • Loss of appetite
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24
Q

Mumps

Symptoms

A
  • Majority of pts have parotitis (parotid gland)
  • One or both sides may be affected
  • May have associated (same side) earache
  • Parotid enlargement typically starts on one side then becomes bilateral
    • Up to 80% of cases have bilateral enlargement
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25
Q

Mumps

Other areas that may be affected

A
  • CNS
    • Most common location after parotid gland
    • True aseptic meningitis
  • GI
    • Acute pancreatitis
  • GU
    • Unilateral orchitis (inflammation of testicle)
    • Approx 10% of males
    • High fever, severe testicular pain, erythema of scrotum
    • Sterility is rare with orchitis
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26
Q

Mumps

Treatment

A
  • Educate pt/fam to isolate for 5 days after dx to lessen risk of transmission
  • Warm/cold packs to affected areas
  • NSAIDs/Tylenol
  • Rest/Fluids
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27
Q

Varicella Virus

Characteristics

A
  • Incubation 10-21 days
  • Contagious from 1-2 days before rash appears until lesions crust over (usually 5-6 days after onset)
  • Spread by droplet precautions and direct contact with lesions
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28
Q

Varicella Virus

Symptoms

A
  • Variable fever
  • Non-specific symptoms including malaise/fatigue, HA
  • Rash begins on the head/face then mostly on face/trunk
  • Widely scattered red macules and papules followed rapidly by vesicles, pustules, then crusting over 5-6 days
  • New crops stop after 5-7 days
  • Pruritis usually intense
  • No longer contagious when crusting begins
29
Q

Varicella Virus

Treatment

A
  • Varicella Vaccine (Varivax)
    • Ages 12 months and booster @ 5 yo.
    • Slight chance of outbreak in people who have been vaccinated
    • May receive vaccine w/in 72 hours of exposure to prevent/diminish severity of illness
  • Antiviral drugs
    • Acyclovir, age 12 +
    • Given in pts with COPD, on LT salicylate therapy, or on Corticosteroids (suppressed immunity)
    • Must be started w/in 24 hours of onset of rash
30
Q 
Herpes Zoster (Shingles)
Info
A
  • 1 in 5 Americans
  • Associated with normal aging, certain meds, cancers, or infections
  • Involves single dermatome (truncal or cranial)
  • May have prodrome of neuropathic pain or itching in same area
31
Q 
Herpes Zoster (Shingles)
Characteristics
A
  • Vesicles often coalesce (come together to form one mass)
  • Crusting occurs in 7-10 days
  • Common in HIV infected/Immunocompromised pts
  • Complications include bacterial infection, CN paralysis, Meningitis, Encephalitis, and Keratitis
32
Q 
Herpes Zoster (Shingles)
Treatment
A
  • Acyclovir = Preferred
    • But…you know Dr. Turnham says that compliance is often better with fewer pills to swallow
    • Ensure pt can pay for pills, or it won’t matter
33
Q 
Herpes Zoster (Shingles)
Cranial
A
  • REFER TO OPTHAMOLOGY IF THERE IS A LESION ANYWHERE ON HEAD
34
Q

Salmonella Gastroenteritis

Info

A
  • Infects domestic and wild animals
    • Fowls and reptiles have higher carriage rate
  • Contaminated foods; fecal/oral route
  • Highest attack rates in children < 6 yo with a peak 6 mos-2 yo
  • Stools are watery, may have mucus, sometimes blood (suggests shigellosis)
35
Q

Salmonella Gastroenteritis

Symptoms

A
  • N/V
  • HA
  • Fever
  • Abd pain
  • Diarrhea = frequently associated with bacteremia especially in newborn/infants
36
Q

Salmonella Gastroenteritis

Dx

A
  • Stool culture for C&S
  • May culture blood, urine, CSF, or pus from a lesion in acutely ill pt
  • Reportable to health dept
37
Q

Salmonella

Differentials

A
  • Staphylococcal Food Poisoning
    • Shorter incubation (2-4 hrs), vomiting main symptom, no fever
  • Shigellosis
    • Bloody diarrhea, high fever, pus/blood in stool microscopically
    • Incubation 2-4 days
  • Campylobacter
    • Resembles salmonella, but culture of stool differentiates the two
38
Q

Salmonella

Treatment

A
  • Abx in infants < 3 mos, SSD, Immunosuppressed, severely ill children
  • 3rd gen Cephalosporin recommended
    • Fluoroquinolones for adults
  • Abx does not shorten course of illness, may prolong convalescent carriage of organism
  • Dr. Turnham’s soapbox:
    • Use Probiotics with abx to reduce C-diff
    • PLEASE
39
Q

Salmonella

Follow-up

A
  • 50% of pts have + stool culture after 4 wks
  • Infants tend to remain carriers for up to 1 yr
  • Food handlers and child care workers should have 3 negative cultures before resuming work
  • Asymptomatic children do not need exclusion
  • Infants, pts > 65yo, sepsis, and any pt requiring hospitalization should be considered for abx
40
Q

Traveler’s Diarrhea

A
  • Benign, self-limiting
  • Prophylaxis - only if comorbid disease (Inflammatory Bowel, HIV, etc.)
  • Single-dose Fluoroquinolone is usually effective
  • Test for Ova/Parasite in stool and do C&S to differentiate with parasitic infection
41
Q

Traveler’s Diarrhea

Symptoms

A
  • Fever (rare)
  • > 10 watery stools/day
  • Occasional vomiting
  • Abd cramping that accompanies loose stool
42
Q

Fever of Unknown Origin
(FUO)
Information

A
  • Min. 3 week duration
  • Fever > 38.3 C (100.9 F)on several occasions
  • Dx has not been made after 3 outpatient visits or 3 days of hospitalization
43
Q

Fever of Unknown Origin
(FUO)
Causes

A
  • Adults: infections 25-40%, Cancer 25-40%
  • Children: infections 30-50%, Cancer 5-10%
  • Latent TB infection
  • Opportunistic infection in immunocompromised pt
  • Potential drug toxicity/drug interactions
44
Q

Fever of Unknown Origin
(FUO)
Treatment

A
  • Refer to Infectious disease specialist will interpret/coordinate specialized testing with CDC
45
Q

Animal and Human Bites

A
  • Most fatalities are d/t dog bites (mauling)
  • Human and cat bites are majority of infected bite wounds
  • Hand bites have higher risk of closed-space infection
  • Abx prophylaxis - non-infected bites of hand
  • Hospitalization required for infected hand bite
  • Infected wound needs culture to direct therapy
46
Q

Dog Bites

A
  • Treat like any other wound: irrigate with NS, debridement of devitalized tissue, remove any foreign matter
  • Td or TdaP
  • Rabies vaccine?
  • Suture with CAUTION
  • Prophylactic abx???
  • If bite involves joint, periosteum - prompt referral to ortho for sx consult
  • Tx: Broad spectrum coverage with Augmentin or Cephalexin
47
Q

Human Bite

A
  • Treat prophylactically with abx

- Only suture severe lacerations to face

48
Q

Cat Bites

A
  • Increased risk of infection
  • Prophylactic PCN + Cephalexin OR Augmentin
  • May result in cat scratch disease:
    • Papule or pustule at site
    • Fatigue
    • Fever
    • HA
    • Adenopathy near site
    • May have splenomegaly
  • Consider admission and IV abx for infection
49
Q

All Bites

Tx

A
  • Augmentin is tx of choice
50
Q

Lyme Disease

Info

A
  • Caused by Borrelia Burgdorferi, a spirochete that is gram negative
  • Tick usually active for 36-48 hours for transmission of Lyme Disease
  • Black legged tick or deer tick
    • NE
    • Mid-Atlantic
    • North Central
    • Upper MW
  • Western Black legged tick
    • Pacific Coast
51
Q

Lyme Disease

Stage 1

A
  • Early Localized infection
  • Erythema migrans (bulls eye) - flat or slightly raised with central clearing
  • Incubation 3-30 days, but usually 7-10 days
  • Lesion expands over several days, concomitant viral-like illness w/myalgia, arthralgia, HA, and fatigue; may or may not have fever
  • Resolves in 3-4 weeks even w/o tx
52
Q

Lyme Disease
Stage 1
Differentials

A
  • Chemical reactions
  • Tick/Spider bites
  • Drug Eruptions
  • Urticaria
  • Staph and Strep Cellulitis
  • Tinea Corporis
53
Q

Erythema Migrans

A
  • Bulls-Eye: Flat or slightly raised lesion with central clearing
  • Ex: Ringworm
  • Common Sites:
    • Thigh
    • Groin
    • Armpits
    • Trunk
54
Q

Lyme Disease

Stage 2

A
  • Early disseminated infection
  • 50-60% of pts w/erythema migrans are bacteremic; secondary skin lesions develop in 50% of pts
  • Malaise, fatigue, fever, HA, neck pain, generalized achiness are common
  • Fatigue may last months
  • Organism may sequester in certain areas and produce focal symptoms such as cardiac/neuro manifestations
55
Q

Lyme Disease

Stage 3

A
  • Late persistent infection
  • Months to years after initial infection and manifests as musculoskeletal, neurologic, and skin disease(s)
  • Monoarticular (one joint) or Oligoarticular (few joints) arthritis
    • Mostly in knees or other large weight bearing joints
56
Q

Lyme Disease

Testing/Diagnosis

A
  • Serologic testing based on a 2-test approach:
    • First test: Enzyme Immunoassay (EIA) OR Immunofluorescence Assay (IFA)
    • If neg, consider alternative dx
    • If + and s/s < 30 days -> check IgM, IgG/Western Blot
    • If + and s/s > 30 days -> IgG/Western Blot only
57
Q

Lyme Disease

Treatment

A
  • Prophylactic: Doxycycline 200mg x 1 dose
  • Tx is 14-21 days in early stages of disease with:
    • Doxycycline > 8 yo or Amox for all ages or pregnancy
    • Cefuroxime axetil - costly - IM/IV doseage
    • Erythromycin - less effective, not 1st line
  • Most pts respond with prompt resolution of s/s w/in 4 weeks
  • Referral to infectious disease specialist recommended for atypical/prolonged cases
58
Q

Zika Virus Infection

Info

A
  • Spread mostly by bite of infected Aedes species mosquito
  • Can be passed from pregnant woman to fetus. Infection during pregnancy can cause birth defects
  • No vaccine or medicine to treat Zika
  • Zika transmission has been reported in the U.S.
59
Q

5 things to know about Zika

A

1 - Spreads through infected mosquitos, can also get through sex
2 - Best prevention of Zika is to prevent mosquito bites
3 - Zika is linked to birth defects
4 - Pregnant women should not travel to areas with Zika
5 - Travelers infected with Zika returning home can spread virus through mosquito bites

60
Q

Coronavirus
COVID-19
Info

A
  • Large family of viruses commonly exchanged between humans and animals
  • Spread through respiratory droplets, may linger in air and on surfaces for up to…? (2020 info, no longer accurate)
61
Q

Coronavirus
COVID-19
Diagnosis

A
  • Test anyone with:
    • Fever
    • Dry cough
    • Known exposure + s/s
    • Over 65 yo
    • Healthcare workers
    • Immunocompromised or has comorbidities
    • Hospitalized with resp s/s
62
Q

Coronavirus
COVID-19
Treatment

A
  • WHO currently endorsing systemic steroids in critically ill/severe cases of COVID-19
  • Remdesevir is only CDC approved tx for COVID
  • Blood thinner post-COVID for risk of clots
  • CDC no longer recommends Azithromycin + Hydroxychloroquinne
63
Q

COVID-19 Treatment
FOR TEST PURPOSES
Non-Hospitalized Pt

A
  • Insufficient data to recommend for/against antiviral or antibody therapy
64
Q

COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized, but no supplemental O2 needed

A
  • Dexamethasone or other corticosteroids

- Insufficient data to recommend for/against Remdesivir.

65
Q

COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed (but not through high-flow device/Noninvasive ventilation)

A
  • Remdesivir (e.g. for pts who require minimal supplemental O2)
  • Dexamethasone + Remdesivir (for pts requiring increasing amounts of supp O2)
  • Dexamethasone (when combo therapy with Remdesivir cannot be used/not available)
66
Q

COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed (+ high-flow device/Noninvasive ventilation)

A
  • Dexamethasone OR Dexamethasone + Remdesivir
67
Q

COVID-19 Treatment
FOR TEST PURPOSES
Hospitalized + supplemental O2 needed using INVASIVE MECHANICAL VENTILATION

A
  • Dexamethasone
68
Q

COVID-19 Treatment

Antibody and Plasma Tx

A
  • Monoclonal antibodies
    • HIV, RSV, Influenza, MERS, Ebola, Zika, and COVID all have monoclonal antibodies
  • Convalescent plasma
    • Cytokine storm syndrome: hyper response of the body’s immune system. In COVID it is more of an inflammatory response and not enough anti-inflammatory cytokines.
69
Q

COVID-19 Treatment

Monoclonal Antibody Guidelines

A
  • Must meet at least 1 of the following:
  • BMI > or = 35
  • CKD
  • DM
  • Immunosuppressive disease
  • Currently receiving immunosuppressive tx
  • > or = 65yo
    or = 55yo AND have CV disease, HTN, OR COPD/respiratory disease
  • Age 12-17 AND have BMI . or = 85th% for their age
    • OR have sickle cell disease
    • OR congenital heart disease
    • OR neurodevelopmental disorders (cerebral palsy)
    • OR medical-related technological dependence (trach, gastrostomy, + pressure ventilation)
    • OR asthma, reactive airway, or other respiratory condition that requires daily medication for control

CMN 572 Module 5 (2 decks)

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