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61 Cards in this Set
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A 27 yo female presents with a hx of fever of 40 C, chills, hematuria and CVA tenderness. She has spina bifida and an indwelling urinary catheter.What is a likely diagnosis? What is a possible organism?
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Pyelonephritis probably due to the indwelling catheter. If she has had several of these in the past she is at risk for resistant organisms, reflux kidney damage and chronic pyelonephritis
A gram - organism • This is a complicated UTI. They results due to stones, catheter,renal problems, renal transplant, anatonic disorder, increased post void residual urine. • Types of organism: E. Coli,Klebseilla, Serratia, Proteus, Providencia, Also but less common, Gram + cocci such as group B strep and enterococci |
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A 24 yo female presents with a c/o dysuria, frequency, urgency and hematuria. No fever, chills or flank pain
What is a likely diagnosis? |
Acute Hemorrhagic Cystitis
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Treatment of UTI
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3 day course of antibiotic such as • TMP- SMX • Quinilone • E. Coli most likely organism |
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Fever of Unknown Origin
• Temperature > 38.3 C ( 101.0 F) for 3 weeks and unable to diagnose even with 1 week in the hospital. |
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Causes: – Classic – Nosocomial – Neutropenic – HIV associated – Drug induced |
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Carbuncle:
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A network of furuncles connected by sinus tracts
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Cellulitis:
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Cellulitis: Painful, erythematous infection of deep skin with poorly demarcated borders
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Erysipelas:
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Fiery red, painful infection of superficial skin with sharply demarcated borders
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Folliculitis:
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Papular or pustular inflammation of hair follicles
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Furuncle:
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Painful, firm or fluctuant abscess originating from a hair follicle
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most likely organism in dog or cat bite
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pasturella multicida
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most likely organism in human bite
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eikenella corrodens
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most likely organism in inpetigo
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s. aureus
s. pyogenes |
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Treatment of of MRSA
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Community Acquired • Sulfa, tetracycline, clindamycin – Hospital Acquired • Vancomycin |
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Erysipelas
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also known as St. Anthony's fire • Presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking • Common sites are the legs and face • caused almost exclusively by beta- hemolytic streptococcus |
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Sepsis
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Systemic inflammatory response to infection • Can lead to hypotension and organ failure • Hypotension means systolic BP < 90 or a decrease by 40 mm Hg • Main need vasopressors to maintain perfusion of organs • + blood cultures are essential for dx of sepsis often associate with elevated WBC and left shift • Broad spectrum antibiotics started until |
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Osteomyelitis 3 types
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3 types
• Acute hematogenous spread • Due to contiguous spread as from an ulcer/fracture • Associated with vascular disease (PVD, DM) |
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Necrotizing Fasciitis
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AKA: gas gangrene • Polymicrobial and include both anaerobic and aerobic bacteria esp. Group A Strep • An ID emergency that refers to widespread destruction of deep subcutaneous tissue and fascia – spares muscle and skin • Can lead to multiorgan failure • 25% morbidity • X-ray can show gas in soft tissue • Tx aggressive debridement and antibiotic and hemodynamic stabilization |
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Infectious Endocarditis
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Infectious endocarditis
• Fever • Pathologic murmur ( holosystolic or diastolic) • Evidence of embolic disease such as splinter hemorrhages in the nail • Petechiae/ecchymosis- conjunctivae,palate, extremities • Roth spots on the fundi |
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Myocarditis / Pericarditis
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Caused by numerous Viruses, bacteria, fungi, parasites, Rickettsia and chlamydia • Myocarditis: damage to the myocardium by direct microbial action or action by toxin – Fever, arthralgias, myalgia and chest pain • Pericarditis infection of the pericardium – Fever, chest pain, weight loss,night sweats and cough |
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A 24 yo podiatry student has a 3 days hx of a hacking cough productive of white mucus. He also has malaise, fever, body aches. On exam the patient has a fever of 102.2F and you hear scattered rales in the left lung base.
• What is a likely diagnosis? |
Mycoplasm Pneumonia
• Classic symptoms with occasional rash, serous otitis media and joint aches. • Common in young people in colleges and universities • Treatment with Macrolides and Quinilones |
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Question
• A 55 yo female develops a productive cough of rust colored sputum, congestion, fever and chills. She also has pleuritic chest pain. On exam she is tachypneic at a rate of 40 / minute. CXR infiltration in the RLL. • What is the diagnosis? |
Pneumonia
• Strep Pneumoniae • Community Acquired • The elderly or debilitated patient willl have an atypical presentation |
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Tinea Versicolor
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caused by the yeast- Malassezia furfur • Generally oval or irregularly-shaped spots of 1/4 to 1 inch in diameter • Dark tan or pink in color – may be hypopigmented • Treatment with antifungal medication – Selsun blue for the hair is also helpful in conjunction |
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Herpes Simplex I
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Oral lesion • Transmission by direct contact • Antiviral agents control outbreaks and decrease shedding |
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Herpes Zoster
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Infection along the dermatome • Associated with previous chicken pox • Vaccine now available – 60% protection |
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Lyme Disease
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Lyme Disease
• Multisystem infection cause by spirochete: Borrelia burgdorferi • Spread by the deer tick ( ixodes) • Early localized – erythema chronicum migrans with myalgias for 3 to 32 days • Early treatment: Doxycycline or Amoxicillin • Early diagnosis may be |
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oxoplasmosis
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caused by the protozoa Toxoplasma gondii, – one of the most common zoonoses. T – the parasite undergoes sexual reproduction in cats and is excreted as an unsporulated oocyst. After two to three days, the oocysts develop spores that are infective. – Risk factors:direct contact with cat feces (e.g., cleaning the litter box, gardening in feces-contaminated soil), and consumption of undercooked meat. – asymptomatic, but patients may develop cervical lymphadenopathy and a mononucleosis-like illness that is generally self-limited. Rarely, acute infection in pregnant women, especially during the first trimester, – can cause serious congenital infection. I – it can also cause severe disease in immunocompromised persons. |
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Campylobacteriosis and Salmonellosis
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Most common bacterial infections associated • Many animals, including cats and dogs • Salmonella is also common in cats, dogs, chicks, ducklings, and reptiles, such as turtles and iguanas. Pet rodents also • cause more than 200,000 cases of gastroenteritis per year.. |
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Cat-Scratch Disease
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.Exposure to young cats or cats with fleas is a risk factor for infection • Bartonella henselae • The clinical manifestations of infection are an inoculation lesion at the point of injury and inflammation of nearby lymph nodes several weeks later |
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Psittacosis
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also known as parrot fever • caused by Chlamydophila (formerly Chlamydia) psittaci • most resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws. • Exposure to feces or nasal secretions of infected birds can result in human infection • it can progress to a significant pneumonia that usually responds to doxycycline (Vibramycin) or macrolides |
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Meningitis
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Inflammation of the meninges • Triad of symtoms:Fever, Nuchal Rigidity and Mental Status Changes but occurs in < 50% • Occasionally with a purpuric rash • A medical emergency – associated with bacteremia • Lumbar puncture should be performed. • May be caused by many agests- most common S. pnmeumoniae, Neisseria meningitis, H. influenza – all with polysaccharide capsule which protects against complement mediated cell lysis • Treatment with antibiotics and dexamethasone to decrease IC pressure |
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Sinusitis
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Acute sinusitis is defined pathologically by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than four weeks. • Associated with sinus tenderness and congestion often >7 to 10 days • Viral or bacterial - 50 percent of people with a clinical diagnosis of acute sinusitis have bacterial sinus infection • Treatment is supportive with nasal decongestant. Nasal steroids are beneficial. Antibiotics are used sparingly in severe conditions |
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Pharyngitis/tonsillitis
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Inflammation of the pharynx or tonsils • Approximately 30 to 65 percent of pharyngitis cases are idiopathic, and 30 to 60 percent have a viral etiology (rhinovirus, adenovirus and many others). • Bacteria are responsible for approximately 5 to 10 percent of pharyngitis cases, with group A beta- hemolytic streptococci being the most common bacterial etiology • Other bacteria that occasionally cause pharyngitis include groups C and G streptococci, Neisseria gonorrhoeae, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus |
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Strep Pharyngitis
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spread by direct person-to-person contact, through droplets of saliva or nasal secretions
• a temperature higher than 38.5°C (101.3°F) • specificity of throat culture :99 %, 76 to 99% percent in office settings • Rapid strep:specificity >95 %,sensitivity of only 76 to 87 % • penicillin -the drug of choice for the treatment • persist for up to 15 days on unrinsed toothbrushes and removable orthodontic appliances |
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Complications of Group A Beta-Hemolytic Streptococcal Pharyngitis
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Nonsuppurative complications: – Rheumatic fever – Poststreptococcal glomerulonephritis • Suppurative complications – Cervical Lymphadenitis – Peritonsillar or retropharyngeal abscess – sinusitis – Mastoiditis – Otitis media – Meningitis – Bacteremia – Endocarditis – Pneumonia |
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Otitis Media
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Fluid in the middle ear associated with infection • Most commonly in young children – peak 6 to 36 months. • Common bacteria: – Strep pneumoniae – H. Influenza – M. catarrhalis • Tx: antibiotics on occasion myringotomy tubes are indicated. Antibiotic use is controversial • When amoxicillin is used, the dose should be 80–90 mg/kg/day |
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Pathophysiology
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Usually following viral URI • Secrtions and inflammation -occlusion of the eustachian tubes. • negative pressure is generated and causes a serous effusion. • Effusion causes bacterial growth • Can cause perforation of the tympanic membrane or extension into the adjacent mastoid air cells |
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Otitis Externa
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Inflammation or infection of the external auditory canal • 50 % percent of bacterial cases involve Pseudomonas aeruginosa, followed in incidence by Staphylococcus aureus and then various aerobic and anaerobic bacteria • Types: – Diffuse Otitis External – swimmer’s ear – Necrotizing Otitis Externa • Can spread to the bone • Tx: neosporin otic or quinolone otic but necrotizing OE requires PO antibiotic such as quinolone |
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Infectious Mononucleosis
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Caused by the Epstein Barr virus • Infection in adolescents associated with fever, pharyngitis and lymphadenopathy. Also with hepatomegally and spleenomegally • highest rates in persons 10 to 19 years of age • Clinical symptoms occur in 50% of cases • 90 to 97% of adults seroconverted at an earlier stage in life |
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Pneumonias
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Symptoms: fever, cough, dyspnea, chest discomfort
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Pneumonias Tx
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Tx with oral antibiotics, rest and fluid
• May require oxygen • Can cause pulmonary abscess or empyemia |
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Gastroenteritis
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Inflammation of the GI tract • Refers to an enteric infection associated with vomiting with or without diarrhea • May be viral or food poisoning • Norwalk virus – 40% of cases |
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Treatment of Diarrhea
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Fluid and electrolyte Replacement • Antimotility agents • Loperamide- imodium • Not with high fever or bloody stool- may delay clearance of bacteria • Antibiotics generally not given |
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C. Diff
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Pseudomembranous Colitis • Often associate with antibiotic use • Classic symptoms – fever, leukocytosis, crampy abdominal pain, watery diarrhea • ELISA and latex agglutination tests are most commonly used to detect toxin • Fecal leukocytes • Tx with Metronidazole or vancomycin • Easily spreads through the hospital – hand washing imperative |
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Giardia lamblia
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Most frequently isolated intestional parasite in the US • Transmission through contaminated water and person to person • Testing: Giardia antigen stool assay or microscopic evaluation • Tx: Metronidazole |
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Syphillis
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T. pallidum – a spirochete • Decline in cases since 1991 • Incubation period 10 to 90 days • Primary causes chancres and adenopathy • Secondary – disseminated throughout the body and associated with a rash • Latent- silent • Latent or Tertiary- 30% of patients neuro symptoms i.e dementia posterior column disease • TX: Penicillin DOC |
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Chlamydia
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C.trachomatis • PID in women and urethritis in men • Men may have a clear discharge with dysuria while women may have no symptoms at all • May lead to infertility • Treatment with azithromycin or doxycycline |
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Gonorrhea
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Gram negative diplococcus • Causes greenish discharge in men and PI D. women may be asymptomatic in women. • Can also cause exudative pharyngitis • Treat with Ceftriaxone 250 mg Im but also treat for chlamydia and treat partner. |
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Herpes Simplex 2
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Causes Genital viral infection 70 to 95% of the time • Resembles Herpes 1 • Associated with skin to skin contact • 20% of young adults infected • Recurrent infections usually with a prodrome of fever, itch, tingling • Regional lymphadenopathy • Tx with antiviral medication |
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Prostatitis
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90% of men with symptoms of prostatitis have nonbacterial conditions • When bacteria are present – Febrile – Pyuria and bacteruria – Dysuria – Swollen prostate – EXTREAMLY tender • Treatment with antibiotics: Bactrim • May be difficult to eradicate causing chronic prostatitis |
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Cystitis
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Bladder infection • dysuria, frequency, urgency • Bacteria, RBC and WBC found after clean catch urine. Occasionally nitrites also found. • E.coli most common organism • Others: Klebseilla, Proteus mirabilis, enterobacter • Tx with antibiotics |
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Pyelonephritis
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Bacterial infection of the kidney and renal pelvis • Associated with fever, flank pain and pyuria • Risk: female, sexual intercourse, Hx of UTI, Diaphram contraceptive,postmenopausal state, catheters, pregnancy • 80% E. Coli also Klebsiella and Proteus • Tx with antibiotics |
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Parasites of the Alimentary Tract
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Types – Nematoda or Roundworms: Ascaris, Pin Worms, Whipworm – Platyhelminths or Flatworms : • Tapeworms • Blood Flukes: Schistosoma types • Intestinal Flukes • Liver Flukes • Most people asymptomatic or non specific complaints |
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Leishmaniasis
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Leishmania donovani Kala- azar – a systemic illness – Spread by the bite of the sandfly – Phlebotomus – Leads to glomerulonephritis – Fever, chills, weight loss and organomegally • Other types of Leishmania cause cutaneous and mucocutaneous problems |
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Malaria
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Flu like illness caused by 4 species of the protozoan genus Plasmodium – P. falciparum – P. vivax – P. ovale – P. malaria • Spread by the anopheles mosquito • Prevention – Mosquito avoidance – DEET in concentrations of 15 to 35 % – Medication |
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West Nile Virus
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Spread by the bite of the mosquito – they bite and infect birds and so other mosquitos become infected when they bite the birds • female Culex pipiens mosquitoes and it can be transmitted from mother to child • Virus- belong to the genus Flavivirus within the family Flaviviridae. • Infection may be asymptomatic or lead to meningits / encephalitis • Best prevention- mosquito control |
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Rabies
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Most deadly disease transmitted from animal to humans • Rhabdoviridae family • Fatal • Pre exposure vaccine for animal handlers such as vets and spelunkers • Unprovoked attacks suggest rabies. • Treatment with Rabies immunglobulin |
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A 32 yo female presents with c/o fever, headache, malaise, fever and lymphadenopathy. She admits to having unprotected sex with a bisexual male
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Acute Retroviral syndrome and the symptoms above are most common. May also have rash, nausea and vomiting. Up to 50% of patients have a sever headache and signs similar to meningitis. The best test to do is an HIV RNA test because the HIV EIA and western blot may be negative.
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Prevention of Perinatal Transmission of HIV
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Treatment
• Oral Zidovudine initiated at 14 to 34 weeks of gestation to end of pregnancy • IV Zidovudine during labor and delivery • Oral for first 6 weeks of newborn’s life |
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PCP Pneumonia
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Pneumocystis pneumonia • DOE, non productive cough, weight loss and fever, LAB: low LDH • Treatment: • Bactrim, dapsone, Pentamidine, Atovaquone • Steroids if hypoxic • 40% have a second episodes within 18 months • Prophylaxis: CD4 < 200 or episodes or oral candida, or episode of PCP |
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Toxoplasma gondii
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Can cause single or multiple lesions in the brain • A protozoan pathogen • Most common cause of brain lesions • CD4 is usually < 100 • Treatment: pyrimethamine, sulfadiazine,folinic acid • Single lesion may be lymphoma so a biopsy is indicated. This has a poor prognosis |
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It is January and a 73 yo males presents with sudden onset of headache,fever, chills, and body aches. He also has sore throat, cough, congestion and malaise. On exam he is ill with a fever, tachpnea and tachycardia. He has scattered rhonchi in the lungs. He has no hx of any vaccines in recent years.
• What is a likely diagnosis? |
This appears to be influenza A
• Headache is a common symptom |