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Misc 2 Flashcards

1
Q

Yellow Fever Vaccine Complications

A
  • vaccine-associated encephalitis
    • inversely a/w with age
  • yellow fever vaccine-assoc neuro disease
    • 4-23 days post vaccine
    • HA, F ⇒ confusion, focal deficits, GBS, coma
    • complete recovery expected
  • yellow fever vaccine-assoc viscerotropic disease
    • 2-7 days post vaccine
    • fever, MOF
    • death >60% of cases
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2
Q

Malaria ppx

A

For ALL malaria spp in ALL malaria areas: atovaquone/proguanil

alt (all spp): mefloquine, doxy

Chloroquine in sensitive malaria areas

**chloroquine and proguanil are safe in pregnancy

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3
Q

Returning traveler with:

linear, pruritic serpiginous skin lesions that slowly advance

A

cutaneous larva migrans (Ancylostoma spp)

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4
Q

Returning traveler with:

urticarial linear lesions moving faster

A

cutaneous migration of Strongyloides filariform larvae (larva currens)

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5
Q

Returning traveler with:

fever w/ maculopapular rash

A

consider:

  • arbovirus (dengue, chik)
  • measles, rubella
  • parvo
  • EBV, CMV
  • HIV, syphilis
  • VHF
  • rickettsial infection
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6
Q

Returning traveler with:

nodular migratory panniculitis (SE Asia, Africa, occ Latin America)

A

think gnathostomiasis

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7
Q

Returning traveler with:

painful boil-like lesions (Africa, S Am)

A

myiasis

Africa - cordylobia

Latin - Dermatobia hominis

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8
Q

Returning traveler with:

generalized pruritic papular dermatitis

Sub-Saharan Africa

A

onchocerciasis

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9
Q

Returning traveler with:

destructive ulcer w/ undermining edges

A

buruli ulcer (Mycobacterium ulcerans)

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10
Q

Returning traveler with:

necrotic ulcer surrounded by edema

A

anthrax

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11
Q

Returning traveler with:

itchy, painful, red/purple nodule (2-5cm) which ulcerates

w/ surrounding edema and assoc LAD

(often after a fly bite)

A

trypanosoma brucei rhodesiense

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12
Q

Returning traveler with:

chronic, painless ulcer (unless superinfected)

heaped-up margins on exposued skin surfaces

L America, Mediterranean, Middle East, Asia, Africa

A

cutaneous leishmaniasis

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13
Q

Returning traveler with:

eschar/dark, scabbed lesion at site of insect bite

A

Rickettsial infection (e.g. African tick-bite fever, scrub typhus)

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14
Q

papule develops at site of inoculation w/ fever onset

becomes vesicular/pustular, then ulcerates

tender, a/w painful LAD

A

ulceroglandular tularemia

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15
Q

Returning traveler + eos

+ fever/respiratory symptoms

A
  • acute schisto
  • cocci/paracocci
  • loeffler’s syndrome (ascaris, hookworms, strongy)
  • paragonimiasis
  • tropical pul eosinophilia (Wuchereria bancrofti, Brugia malayi)
  • visceral larva migrans
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16
Q

Returning traveler + eos

GI sx

A
  • ascariasis
  • hookworms (ancylostoma duodenale, necator americanus)
  • schisto
  • strongy
  • tapeworms (T solium, T saginata)
  • trichinellosis
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17
Q

Returning traveler + eos

RUQ pain

A
  • fascioliasis
  • liver flukes (Clonorchis sinensis, Opisthorchis)
  • liver hydatid disease
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18
Q

Returning traveler + eos

neuro sx

A
  • cocci (chronic meningitis in IS pts)
  • eosinophilic meningitis (angiostrongy, gnathostoma)
  • neurocysticercosis
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19
Q

Returning traveler + eos

  • intermittent pruritic edematous SQ swellings
  • calabar swellings
  • lymphadenitis and edema
  • diffuse pruritic dermatitis
  • larva currens
A
  • gnathostomiasis
  • loiasis
  • lymphatic filariasis
  • onchocerciasis
  • strongy
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20
Q

Abx frequently a/w CDI

A
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21
Q

S pneumoniae PCN breakpoints

A

Meningeal (unchanged) _<_6

Non-meningeal in image

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22
Q

New tetracyclines (review table)

23
Q

Alt abx options for MRSA PNA (if unable to use vanc)

A
  • linezolid/tedizolid
  • clinda
  • ceftarloine
  • omadacycline
  • delafloxacin (meh)
24
Q

Big important SE of linezolid

A
  • Serotonin syndrome (beware of use with MAOIs)
  • Also lactic acidosis
  • peripheral/optic neuritis
25
Cephalosporin toxicities
* hypersensitivity reactions * GI upset - (CRO = GB sludge, pseudocholecystitis) * Heme: eos, hemolytic anemia (+Coombs) * Hepatotoxicity * Nephro: interstitial nephritis * Neurotoxicity (worse w/ renal failure)
26
lobsterman (or any sort of fish worker) GPR, catalase-negative erythema, warmth, pain in hand
erysipelothrix rhusiopathiae
27
vanc MIC that demonstrates resistance with Enterococcus (usually faecium)
_\>_ 32 vanA or vanB mediated
28
what to think about with macrolide resistance
if arises from alteration in ribosomal target: co-resistance to clinda - constitutive or inducible D-test looks for inducible clinda resistance
29
Tests for carbapenemase production
carba NP test --\> B-lactam ring hydrolyzed by carbapenemase --\> dec pH (color change from red to yellow)
30
Typical susc pattern of ESBL-producer
**R to cephalosporins** **Susc to carbapenems**
31
Typical susc pattern of KPC-producer
32
which organisms may not have the best sensitivity on meningitis/encephalitis panel
* HSV * crypto (CRAg \> PCR from panel)
33
which organisms are typically not on GI path panel
* aeromonas (O&P may be helpful) * microsporidia
34
**Strongy** ## Footnote feces placed on plate and detection of migrating larvae with trail of bacterial colonies
35
Causes of sporotrichoid lesions 1. gardening, soil, splinters, animal bites/scratches 2. gardening, soil, splinters in IC hosts 3. aquarium, fish handling, water exposure 4. living/traveling in endemic regions
1. sporothrix 2. nocardia brasiliensis 3. M marinum 4. Leishmaniasis
36
lesions in both lung and brain
* actinomyces * aspergillus * endemic mycoses * MTB * nocardia * infectious emboli * Lemierre syndrome (Fusobacterium) * toxo (and T cruzi) * tumors
37
sulfur granules, filamentous anaerobe dental procedures, aspiration, IUD erosive mass, ignores tissue planes
actinomyces
38
SE Asia soil/water exposure (rainy season, post-tsunami) PNA + severe sepsis/shock or multiple abscesses can be yrs after exposure safety pin on Gram stain
**melioidosis** ## Footnote trans via inhalation/incolutation
39
Dx and Tx melioidosis
_Dx_: cx _Tx_: * mild - IV mero or ceftaz x2wks, followed by eradication via PO TMP/SMX x3-6mos
40
PNA/sepsis-shock in SE Asia or N Australia (can look like TB presentation) can see skin ulcers/abscess RF: DM, EtOH, chronic renal/lung disease
Melioidosis
41
What organism? What else can look like this?
**Y pestis** **_Safety pin appearance_** * vibrio * B mallei, pseudomallei * Hameophilus ducreyi (chancroid) * Kleb granulomatous (granuloma inguinale)
42
Facultative intracellular GNR oxidase positive safety pin on bipolar staining S and SE Asia, N Australia, China (esp NE Thailand and N Australia)
Melioidosis (Burkholderia pseudomallei)
43
short GP rod (coccobacillus) cavitary PNA (hemoptysis) salmon pink colonies advanced HIV, SOT horse/manure exposure
rhodococcus
44
Dx and tx of rhodococcus
_Dx_: Blood culture (+ in \>25%). Tissue - gram stain shows necrotizing granulomatous reaction, microabscesses _Tx_: 2-3 rx: vanc + imi/mero + fluoroquinolone or rifampin x2-3wks, then --\> PO FQ + azithro/clari or rifampin
45
**indolent** PNA in **IC** host fever, cough, **hemoptysis** nodules, thick-walled cavities farm, soil, manure, or horse exposure aerobic GP, coccobacillary, **salmon-pink colonies** weakly acid-fast
**Rhodococcus** *(mistaken for Nocardia, but no branching)*
46
*(The B's)* Beaded Branching Brain + lung Bactrim
nocardia
47
tx of nocardia
**TMP/SMX = mainstay (skin = monotx)** ## Footnote **Empiric**: amikacin + imi/mero + TMP/SMX **alt**: CRP, linezolid based of susc testing
48
**NOCARDIA** * small lung nodules, small R pleural effusion * subcarinal LAD * solitary RLL mass - single focus of cavitation w/ surrounding GGO
49
dx of nocardia
* suggestive rads - nodules, cavities, GGO, consolidations/effusions. MRI brain - single/multiple abscesses * Blood, BAL culture or bx * MALDI ID
50
nocardia
51
clinical features of nocardia
* seen in IC pts (esp SOT) * mos-yrs post-tx * slowly progressive PNA - cough, dyspnea, F * can disseminate to any organ * co-infections w/ aspergillus do occur * 10% w/ skin manifestations from direct inoculation (tropical region, gardens/walks barefoot) - sporotrichoid lesions * mycetomas - chronic, progressive, LEs. Draining sinuses
52
**nocardia** * beaded, branching, GP * partially acid-fast
53
Immunocompromised patient LLL nodular consolidation w/ central cavitation GP filamentous organism (beaded, branching), partially acid-fast
Nocardia

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