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244 Cards in this Set
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- Back
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Shock |
State of inadequate tissue perfusion leading to hypoxia and cell death Compensated vs. Decompensated |
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Septic |
Most common Infection- Bacteremia- Sepsis- Shock Warm Extremities Response to microorganisms or invasion of sterile host tissue, bacteria in the blood stream, leading to a systemic response with T>38C; RR> 20, HR> 90, WBC>12,000 Must treat with Antibiotics ASAP |
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Hemorrhagic Shock |
massive blood loss leads to increased RR and pulse with hypotension Cool Extremities Need to lose 1.5-2 L of blood before effects are felt on blood pressure Treat with fluids and stoppage of bleeding |
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Anaphylaxis |
Type I Hypersensivity- leads to hypotension and constriction of airways. IgE dependent release of histamine from mast cells Warm Extremities Presents with urticaria, and angioedema, abdominal pain, mucoid production To- antibiotics, insect stings, food, Treat with Epi, intubate soon and give fluids/steroids to decrease inflammation |
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Neurogenic Shock |
Disruption of sympathetic outflow from spinal cord injury leads to unopposed vagal tone, hypotension, and brady Warm Extremities Treat with fluids, and pressors. Stop any more damage from occuring |
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Cardiogenic Shock |
decreased cardiac output leading to hypoperfusion, often result from MI, CHF, Myocarditis Cool Extremities Treat: ABC's with reperfusion |
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Pressors |
do not improve outcomes, but may bring back Resumption of Spontaneous Circulation (ROSC) |
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Toxic Shock Syndrome |
systemic illness with fever and hypotension from bacterial superantigen exposure. Often Staph Aureus, and Strep Pyogenes From over activation of T-Cells, leading to Cytokine storm and capillary leakage, tissue damage, organ failure and death. |
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Staphyloccocal TSS |
menstrual- retention of high absorbancy tampons, proliferation of TSST-1 non-mentstrual- post surgery, infections, abcsess, wounds. |
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Streptococcal TSS |
associated with invasive Strep infections, with severe pain at site. Risks: wound, chickenpox, NSAIDs, pregnancy Necrotizig fascitis, carbuncles, faruncles |
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Superantigen |
activate high percentage of immune cells and bypass usual steps of immune response Staph: TSST-1, Entero Toxins A-E Strep: Exotoxins Bind directly to MHC II without other subunits and activate all immune cells |
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Treatment of TSS |
IV Fluids Thorough inspection of wound Antibiotics IV Immunoglobulin Therapy |
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Endotoxemia |
endotoxins in the blood that lead to shock. synonomous with LPS (lipopolysaccharide) on Gm - Bacteria, binds to Toll Like Receptor and produces TNF leading to NO, PAF, LT, Kinins and Coagulation factors.
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Treatment of Endotoxemia |
IV Fluids Broad Spectrum Antibiotic Vasopressors |
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Neisseria Menigitidis |
Gm - aerobic, diplococci A, B, C, X, Y capsule has differing LPS residues Protects agains dessication, phagocytosis, and lysis and can be changed. SeroGroup A affects SubSaharan Africa B, C, and Y affect college age Causes hemorrhagic rash, menigismus, and impaired conciousness Treat: Penicillin or Ceftriaxone |
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Disease Manifestations of N. Menigitidis |
Shock- hypotension due to endotoxins DIC- from endothelial cell injury and decreased protein C Purpura Fulminans Neuro Change- Myocardial involvement Pneumonia Late Complications of arthritis, pleurisy, pericarditis. |
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Strict Anaerobe |
Can't Use O2 in electron acceptance chain, unable to breakdown H2O2 due to lack of catalase In O2 presence buildup of ROS leads to apoptosis Toxin Ingested (Botulinim) vs Toxin Formed (Clostridium) |
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Sites of Anaerobe Infection |
Oral Cavity- Fusobacterium, Actinomyces Skin- Propionibacterium Acnes GI- Bacterioudes, Clostridium GU- Bacterioudes, and Clostridium When displaced from normal flora to deeper sites, disease may set in. Oppotunity via trauma, compromised vascular supply, or tissue destruction. Also rely on proximity |
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Clostridia Pefringens |
Gram + Spore forming rods Contaminate wound with spores, germination, necrosis of tissue, formation of gas (gangrene) Lecithenase (alpha toxin)--- phospholipase that kills and hemolyzes RBC's, doesn't attract macs |
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Actinomyces Israelii |
Gram +, non-spore forming rod in chains form macrocolonies that can form grains of sand in abscesses and granulomatous lumpy jaw Often result of poor dental hygiene (think dental jaw issues) |
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Propionibacterium |
Gram + rods, non spore forming found on skin, causes acne and infection on prosthetics |
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Bacteroides Fragilis |
B. Fragilis- GI/GU Gram - non spore former with anti-phagocytic capsule, b-lacatmase producers Can infect many areas of the body |
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Fusobacterium Nucleatum |
human oral cavity and plays role in periodontal disease and plueral-pneumonia Gram - rod |
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Treatment of Anaerobic Infection |
remove devitalized tissue drain pus expose to oxygen leave tissue with increased perfusion Use Antibiotics: Penicillin, Carbapenems, Clindamycin, and Metronidazole |
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Abrasion |
superficial wound produced by rubbing or scrabing rough sliding motion |
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Contusion |
blunt force trauma that injures small blood vessels causing interstitial bleeding (Bruise) often due to pressure |
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Incision |
inflicted by sharp instrument, cuts vessels and leaves a relatively smooth edges |
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Laceration |
tear or disruption often have intact vessel and nerve bridging and jagged irregular edges |
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Puncture |
trauma caused by a long, narrow instrument Penetrating- when tissue is pierced Perferorating- when it creates an exit wound |
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Cause of Death |
disease or injury that begins lethal chain of events. Chained together by immediate, intermediate, and proximate causes |
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Manner of Death |
nonspecific, final common pathway: Accident- death not forseeable Homicide- known possibility of harm Suicide- self inflicted and known risk Natural- exclusive natural causes |
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Contact Range |
Muzzle touching body, everything leaving gun enters body. |
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Intermediate Range |
have stippling, bits of gunpowder cause abrasions |
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Asphyxia |
environmental- altitude, sealed space Smothering- nose or mouth blocked Chocking- internal airway block Mechanical- pressure prevents breathing |
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RUSH |
Rapid Ultrasound in Shock Evaluate: Pump, Tank, Pipes using curvillinear probe |
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Step 1 of RUSH |
Pump: Heart: for contractility, effusion, strain Parasternal View Subxiphoid View Apical View |
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Step 2 of RUSH |
Tank: Abdomen IVC (long axis): small and collapsed? eFAST (RUQ): Look for free fluid eFAST (LUQ) FAST (pelvis) Pulmonary: Pneumothorax/B lines |
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Step 3 of RUSH |
Pipes: Vessels Thoracic Aorta AAA Femoral DVT Popliteal DVT |
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Wound Infection |
1. Organizsms cultured from tissue or drained 2. Purulent Drainage 3. Abscess during invasive procedure 4. localized pain/tenderness, redness, swelling |
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Micro of War Wound |
Acinetobacter E. Coli Psuedo Enterobacter Klebsiella Proteus Mycobacteria |
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Empiric Treatment of War Wounds |
Meropenem Vancomycin Antifungals Debride thoroughly, repeat washouts, use of wound vacuums |
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Medical Examiner |
ID Body Cause of death Manner of death Autopsy Collect Evidence Document Act as expert witness |
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Fever (Definition) |
state of elevated core temparature, often part of defensive responses to invasion of micro-organisms or inanimate objects. Often a result of cytokine effect on hypothalamic center |
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Hyperthermia |
elevated core temperature that is unregulated and not caused by pyogenic cytokines |
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Definition of FUO |
temperature greater than 38.3 C on several occasions for 3 weeks or more, with uncertain diagnosis after one week diagnosis in hospital or upon outpatient evaluation |
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Pyogenic Factors |
IL-1, IL-6, TNF, IFN, CNF Interact with receptors at the hypothalamic center leading to activation of Phospho lipase A2 and PGE2 formation, activating thermosensitive neurons. |
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Hyperpyrexia |
temperature above 106 F, heat stroke and organ damage begins above this temperature. Heart rate increases and O2 consumption raises with each degree |
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Pulse Temperature Dissociated Fever |
No increase in HR with temp rise Typhoid, Brucella, Dengue, Q Fever, Lepto, Legion, RMSF, Malaria, Drug Fevers |
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Continuos Fever |
Salmonella infections |
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Intermittent Fevers |
associated with abscess, chronic malaria follow an up and down pattern |
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Saddleback Fevers |
form a saddle pattern over the course of a few days. Dengue fever |
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Pel-Ebstein Fever |
long periods of fever followed by long periods of normal temps Hodgkins Lymphoma |
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Bacillus Anthracis (Anthrax) |
Gm + (aerobic) spore forming ROD Cereus- food poisoning (rice) Anthracis- soil/animals- contact, ingestion, aeroslization Sporulation--- Germination Virulence Factors: Capsule- Poly D Glut Acid Toxins: EF- Edema Toxin- adenylate cyclase LF- Lethal Toxin- cleaves MAPKK stops signals Both need PA to enter cells |
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Cutaneous Anthrax |
Majority of disease, from exposure to animals leads to a papule with ESCHAR and necrosis often painless, with associated edema. |
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Gastrointestinal Anthrax |
rare, following ingestion of conatminated meet Ulcers at site of infection leading to regional sepsis |
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Inhalational Anthrax |
characterized by hemorrhagic mediastinitis treat with combo antibiotic therapy. Vaccine targets PA antigen to stop entry of LF/EF into cells |
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Yersinia Pestis |
Bubonic plague transmitted by fleas/rats--- goes to vesicular lesion at bite and is disseminated via lymph to form bubos and bacteremia can cause pneumonic plague if infecting lungs Gm - rod, in Mac Agar |
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Charcter of Bioagent |
Easily disseminated from person-person Results in high mortality Can cause public panic Requires special action on health care Category A, B, and C from best to less effective |
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VHF |
Viral Hemorrhagic Fevers- group of illnesses that cause systemic syndrome Arena- lassa fever, S. Amerian Hemorrhagic Bunya- CCHF, Rift Valley, Hantavirus Filovirus- Ebola, Marburg Flavivirus- Yellow Fever All enveloped RNA Viruses, geographically restricted, reservoir within animal or insect |
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Differential Diagnosis for VHF |
Bacterial- typhoid, rickettsial, leptospirosis, meninngococcemia Protoza- P. Falciprum Others, HUS E cola, heat stroke |
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VHF Patient History |
foreign travel, rural environment, contact with animal or bug bite, nosocomial exposure |
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Filovirus |
Ebola- five subtypes found in Bats Marburg Virus- central africa, introduced by monkeys enveloped ssRNA - sense, carrier state is acute, and transmitted via blood and secretion |
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CCHF |
Bunyavirus- circular RNA virus Crimean Congo Hemorrhagic Fever transmitted via tick, |
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Arenavirus |
Rodent borne disease- cause grainy ribosomal appearance (arena- sand). Transmitted in rodent feces Lassa Fever- S. American Hemorrhagic Fever- LCMV- |
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Lassa Fever |
Arenavirus- endemic in West Africa found in multimammate rat and can be passed from human to human Causes: sore throat, swelling, hearing loss. Can be alleviated with Ribavirin |
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Poxvirus |
large, complex dsDNA- replicates in the cytoplasm Smallpox- spread from secretions- dense vesicles on face arms hands and legs, involves hands and feet. VZV spares this area typically. |
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Spirochetes |
spiral shaped organisms, exhibit corkscrew movement and don't gram stain or grow Treponoma- includes syphillis Borrelia- Leptospira- |
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Borrelia Burgdorferi |
Lyme Disease- tick borne and common in Northeast. Ixodes Scapularis, only transmitted during the nymphal stage Tick inoculates human after 1-3 days--> localized infection (erythema migrans)---> disseminated infection (menigitis, carditis, arthritis) >persistent infection (arthritis, encephalopathy) Diagnosis: isolated B Burgderfori, IgM/IgG, PCR ELISA--- Western Blot Treat: Doxycycline |
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Southern Tick Associated Rash Illness |
STARI- similar rash to Lyme disease, tick borne (Amblyomma Americanum) |
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Borrelia |
Relapsing Fever: Louse Born- Recurrentis- epidemic form Tick Born- Hermsii- endemic form |
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Leptospira |
Zoonotic disease found worldwide febrile illness, with jaundice, and renal failure leads to conjunctival reddening exposure from urine in water source |
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Zoonoses |
infectino normally in non-human vertebrates--- anthrax, lyme, plague, relapsing fever, lepto Occupational risk, geography, injuries |
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Franciscella Tularensis |
Tularemia- rabbit fever From arthropod bite, skin, conjunctiva, aerosol Gm -, coccobacilli Facultative intracellular pathogen, grows in PMNs Ulceroglandular- direct contact Oculoglandular- aerosol Pneumonic- via aerosol Typhoidal- similar to typhoid Diagnose: serology, culture |
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Brucella |
Undulent Fever- intracellular parasite, shed from animals milk-- risk factors= milk, hunters, slaughterhouse workers Chronic infection leads to B symptoms, arthritis, meningitis, and endocarditis |
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Bartonella |
Henselae- cat scratch (flea) Quintana- trench fever (louse) Bacilliformis- Carrions disease (sand fly) |
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Bartonella Henselae |
Cat scratch disease- leads to inflammation at local lymph nodes, can also lead to Bacillary angiomatosis |
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Bartonella Quintana |
Trench fever passed from body louse bacteremia with fever followed by bacillary angiomatosis, endocarditis |
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Bartonella Baciliformus |
From sandfly causes biphasic disease Oroya Fever- Hemolytic anemia Veruga Peruana |
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Rickettsiaceae |
obligate intracellular, Gm - coccobacilli bacteria transmitted via arthropods Typhus, Spotted Fever, Rickettsia, Orientia visible with Giemsa stain, requires actin polymerization to move from cell to cell Spotted fever is caused by proliferation of organisms in small vessels leading to vasculitis and pettechiae. Can also cause fever and headache |
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Rickettsia Rickettsii |
Rocky Mounted Spotted Fever- from Dermacentor Variabalis endothelial cells |
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Rickettsia Akara |
causese rickettsial pox- from a mite in urban environments, leads to rash and eschar at bite site. endothelial cells |
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Rickettsia Prowazekii |
cause of epidemic typhus, from body louse often follows war endothelial cells |
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Orientia Tsutsugamsushi |
Scrub Typhus- mite born military implications endothelial cells |
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Rickettsia Typhi |
endemic or Murine typhus, worldwide and flea/rodent vectors endothelial cells |
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Anaplasmataceae |
Ehlrichia (HME)/Anaplasma- obligate intracellular bacteria that survive within cytoplasmic vacuoles of hematopoetic cells |
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Anaplasma Phagocytophillum |
infects granulocytes (neutropils) reffered to as HGE and transmitted by Ixodes Scapularis |
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Coxiella Burnetti |
Q Fever- infection through contact leads to atypical pneumonia and endocarditis |
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Ticks |
Lyme disease, HGE, HME, STARI, relapsing fever, RMSF, Tularemia, Q Fever |
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Mites |
Scrub Typhus, Ricketsialpox |
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Lice |
Trench fever, epidemic typhus, relapsing fever |
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Fleas |
endemic typhus, murine typhus, bubonic plague, cat scratch fever |
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Molluscum Contagiosum |
wart-like papular lesions on the face, back buttock spread via towels and pools self limiting and often recurring |
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Tanapox/Yabapox |
common skin infection from animals. fever headache, and papular lesions begin to occur |
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Rabies |
rhabdovirus- enveloped -ssRNA, with bullet shape Acute encephalitis and fatal if untreated Find in Negri bodies, eosiniphillic inclusion bodies |
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SARS/MERS |
Coronovirus- ssRNA + sense enveloped |
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Hendra and Nipah Virus |
Paramyxovirus, infect horses and pigs widespread vasculitis, with brain lung and spleen involvement |
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VHF |
Filovirus- ebola and marburg Arena- Lassa, S. American Bunya- CCHF, RVF, Hantavirus |
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Lassa Fever |
west africa, infection through the multimamate rat and urine/feces. Human transmission can occur |
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LCMV |
Lymphocyctic choriomeningitis virus rodent borne, enveloped that lead to ribosomal grainy and sandy appearance. presents with an aseptic meningitis, and can be biphasic febrile illness |
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Hantavirus |
rodent borne bunyavirus also enveloped, ssRNA. passed through aerosolization of rat feces fever, headache, hemorrhage, acute renal injury, or pulmonary findings |
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Viral Encephalitis |
Mosquito- Flavi- West Nile, St. Louis, Japanese Mosquito- Toga- EEE, WEE, VEE (equine enceph) Mosquito- Bunya- California, La Crosse Tick- Flavi- Powassan |
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VHF/Fevers |
Mosquito- flavi- dengue, yellow fever Tick- bunya- Tick- Reo- Colorado tick fever |
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Enveloped Arbovirus |
All except for Reovirus |
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Symptoms of Arbovirus |
Flu-like symptoms, other viral illness with fever, rash, aches, and chills Encephalitis- Diagnosis: based on serology or direct antigen tests |
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West Nile Virus |
flavivirus, from the Culex mosquito causes mengitis and fever |
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Japanese Encephatlitis |
flavivirus, from culex mosquito to pigs |
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Yellow Fever |
Flavivirus Jungle YF- primates and mosquitos Urban YF- Aedes Mosquito present with chills, headache, and fever, myalgias, and GI complaints, black vomit |
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Dengue Fever |
Flavivirus, biggest problem in the world today transmitted by the Aedes mosquito, air travel facilittates wider range of spread high fever, lymphadenopathy, myalgia, joint pains, headache, and rash |
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Togaviruses |
Equine Encephalitis (Wester/Eastern) cause sometime subclinical encephalitis that has been known to cause sever neuro damage |
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Bunyaviruses |
California Serogroup La Crosse- aedes mosquito- midwest states Jamestown Canyon |
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Reovirus |
Colorado tick virus, no envelope From wood tick, infects erythroid precursor cells and persists leading to vasculitis |
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Malaria |
parasite that infects hepatocytes and RBC's Falciprum, Vivax, Ovale, and Malariae From the anopheles mosquito Sporozites come from mosquitos saliva... enter the hepatocytes to form Schizonts and release Merozoites. Merozoites infect RBC's where they form back into schizonts and release more merozoites. Hypnozoites lay dormant in liver for Vivax and Ovale |
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Symptoms of Malaria |
Generally develop 1-2 weeks following infection and coincide with beginning of erythrocytic cycle |
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Defenses against Malaria |
Duffy Antigen Negative- stops Vivax from entering into RBC Sickle Cell Trait- infected RBC's will sickle and not pass on parasites G6PD Deficient- parasites grow poorly due to increased ROS burden |
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Clinical Malaria |
Fever, Chills, Headache Abdominal Pain and Splenomegaly |
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Uncomplicated Malaria |
Episodes of cold stage with shaking hot stage with high temperature sweating stage with resolution Recur every 2 days with Vivax, Ovale, Falcip Every 3 days with Malariae |
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Complicated Malaria |
cerebral malaria, respiratory distress, severe anemia renal failure, hypoglycemia, circulatory collapse, and acidosis often occur with P. Falciprum |
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P. Falciprum |
Most severe of all parasites because it can infect all stages of RBC's and increase parasitemia further than all others. |
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Mechanism of Tissue Hypoxia and Acidosis |
Sequestration- erythrocytes infected wil create knobs and adhese to capillaries and post capillary venules Decreased deformability of infected and non infected RBC's leading to blockage of vessels |
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Cerebral Malaria |
acute encephalopathy not attributable to other causes, decreased consciousness, delirium, seizures brain swells, due to sequestered RBC's in blood vessels of the brain |
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Diagnosis of Malaria |
Blood smear- Antigen Testing- BINAX, level of parasitemia PCR |
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P Vivax or P. Ovale |
Schuffner's Dots, enlarged cells Ovale- oval, elongated Vivax- moving ameoboid shape |
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P. Malariae |
band form, owl eye trophozites |
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P. Falciprum |
multiple ring shaped trophozites with banana shaped gametocytes |
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Rapid Diagnostic Malarial Test |
Measure the presence of one or more malaria antigens Pro: easy to perform, relatively inexpensive, available Cons: poor sensitivity in low parasitemia, should proceed with treatment even if negative |
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Microscopy of Malaria |
Giemsa stained thick and thin films Pros- inexpensive, rapid, best test for differentiating Cons- skill required, quality control is an issue |
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Malarial Molecular Assays |
PCR kit for research use only Pros- sensitive, best assay for differentiating Cons- demanding and expensive |
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P. Falciprum |
RBC's not enlarged Rings are delicate and numerous Gametocytes are banana shaped |
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P. Malariae |
RBC's not enlarged, may be smaller Band and basket forms Rings and merozites are chunky and heavy |
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P. Vivax |
RBC's are enlarged (only reticulocytes) Trophozites look vivacious All stages are present Hypnozites |
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P. OVale |
RBC enlarged Oval in shape, with fimbriated edges Hypnozites |
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Dr. Stewarts Dance |
P Falcip- I'm an egg (rings) P Malariae- I'm a ballet dancer (band) P Ovale- I'm a sloppy drunk (fimbraie) P. Vivax- I'm a kickboxer (stretching) |
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Mechanical Disease Transmission |
Pathogens by feet, hair, or mouth Requires physical transference from vector to human |
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Biological Transmission |
Propagative- pathogen multiplies within vector Cyclo-development- changes form but doesn't multiply Cyclo-propogative- pathogen changes form and multiplies within vector |
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Arhtropods |
exoskeleton, symmetrical and segmented bodies Hexapoda (insects) Arachnids (ticks, mites, spiders) |
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Culcidae (mosquito) |
wings with scales, mouthparts with probiscis immature stages rely on aquatic environment |
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Anopheles |
Mosquito, feed on mammals, rest at a 45 degree angle to the skin when biting. Larvae rest parallel Carry: Malaria, Filariasis, Arbovirus |
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Culex |
Mosquito with long respiratory siphons, and blunt distal abdomen Carry: Arbovirus, VEE, WEE, Filariasis |
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Aedes |
Mosquito, often breed in more temporary sources of water Carry: Arbovirus (Dengue, Yellow Fever), Filariasis |
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Psychodidae |
Sand Fly, long antenae with hairy body Bartonella, Leishmaniasis, Sand Fly fever |
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Simuliidae |
Black Flies Carry onchocerciasis (river blindness) |
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Glossinidae |
Tsetse Fly: feed on blood and causes trypanososmiasis (sleeping sickness) |
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Hemiptera Reduviidae |
Kissing bug or Conenoses vector of Chagas (Trypanosome Cruzii) |
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Phthiraptera |
Lice: Body, Head, Crab (Pubic) |
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Pediculus Humanus Humanus |
Body Louse- problem during situations of overcrowding, wars, famine lay on clothes Ricketssia Prowazekii, Borellia Recurentis, Bartonella Quintana |
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Siphonaptera |
Fleas- wingless parasites of mammals cause allergic reaction, plague, murine typhus, tularemia |
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Cockroach |
carry: Polio, Enatmoeba, trichomonas, Giardia, E. Coli, Staph, Shigella, nematodes Can also cause allergies in asthmatics |
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Human Bot Fly |
lay eggs within body, cause a painful boil like lesion |
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Ticks |
Ixodes- B. Burgderfori
A. Americanum- STARI |
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Dog Bites |
young boys, face, neck, hand sexually intact male, working dog, low income neighborhood and and agressive child often cause lacerations, bleeding, fracture |
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Cat Bites |
deeper puncture wounds, progress more rapidly to fulminant infection abscess formation |
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Bacteria of Cat/Dog Bites |
Cat: Pasteurella, Strep, Staph, Moraxella; Fusobacterium, Bacteroides Dog: Fusobacterium, Bacteroides, Prophyromonas Treat with Floroquinolones for coverage |
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Pasteurella Multocida |
carried in nasopharynx of cats, incubates quickly local cellulitis, low grade fever sensitive to B-lactams and Azithromycin |
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Capnocytohphaga Canimorsus |
normal flora in dogs and cats, can cause fever, myalgias, rash, sepsis sensitive to b-lactams, cephalosporin |
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Management of Animal Bites |
Irrigate, Surgery, Leave wound open to delay closure elevate antibiotics (Amoxicillin-Clavulonate) |
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Eikenella Corrodens |
anaerobic small GN Bacilli, common in oral flora multi drug resistance but susceptible to Penicillin |
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Rat Bite Fever |
Streptobacilus, Spirllum Minus- causes relapsing fever, migratory polyangitis |
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Candiru |
swim up urethra |
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Mycobacterium Marinum |
fresh and salt water tanks causes granuloma- papule, pustules, and ulcers |
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Vibrio Vulnificus |
shellfish associated infection leading to death give doxy and ceftriaxone |
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Rabies |
1st- Flu like illness, discomfort at wound site 2nd- anxiety confusion, agitation, delerium HYDROphobia 3rd- Coma, Death PCR Saliva, Neck biopsy, serum, CSF to rule out rabies |
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Tetanus |
Clostridium Tetani- found in soild, dust, manure Spores enter wound and disseminate toxin to CNS, neurotransmitter release and unnoposed muscle contraction occurs Give Tetanus Ig, Toxoid booster, antibiotics |
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Treatment Take-aways for Animal Bites |
Pasteurella- needs more than Clindamycin Rat Bite- PCN, doxycycline Herpes B- Valacyclovir Prophylax rabies and tetanus |
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Acute Chagas Disease |
myocarditis, meningoencephalitis, extremes of age at greatest risk Romana's Sign- unilateral painless, periorbital edema Find parasite in blood, PCR |
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Chronic Chagas |
Leads to heart findings- arrythmias, conduction disorders, cardiomyopathy, thromboembolism T. Cruzi antibody (IgG) |
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Chagas Treatmetn |
Benznidazole- nitroimidazole derivitave Nifurtimox- inhibits pyruvic synthesis |
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African Trypanosmiasis |
Sleeping Sickness (sub-saharan)- from tsetse fly T. Gambiense- West africa--- slower T. Rhodesiense- East Africa--- fast progression chancre at bite, haemo-lymphatic stage- Meningoencephilitic stage |
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Diagnosis of HAT |
Wet Prep/Giemsa Stain
CATT- for Gambiense only |
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Leishmaniasis |
Number 2 parasitic killer behind malaria, many species and multiple disease Zoonotic, with protozoan life cycle- in both humans and sand fly vectors Cell mediated immunity controls infection Apparent immunity to reinfection Can cause Cutaneous, Mucocutaneous, or Visceral |
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Amastigote |
rounded, or oval, nucleus, and kinetoplast, found in RE cells |
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Promastigote |
single flagellu, motile, nucleus found in sand fly and culture |
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Mucocutaneous Leishmaniasis |
mononuclear cell infiltrate, lymphocytes predominate few amastigotes, PCR diagnosis is key Treat with Pentavalent Antimony, amphotericin, |
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Old World v. New World |
Visceral: L. Donovani v. L. Infantum Cutaneous: Tropica vs. Mexicana Mucosal: only New World: Braziliensis/Guyanesis |
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Visceral Leishmaniasis |
Donovani, Infantum (Chagasi) more common in traveler causes wasting from TNF, IL-2 secretion by macrophages can progress to Kala Azar- Fever, Weight loss, hepatosplenism, pancytopenia, hypergammaglobulinemia can use serology, tissue biopsy to find Anti-leishmanial antibody Use- liposomal amphotericin for immunocompetent hosts |
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CBRN Weaposn |
Chemical, Biological, Radiation, Nuclear 1. Against soldiers 2. Against economy 3. Against the public |
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Filariae |
threadlike, tissue invasive roundworms that can be transmitted via insect vector Include: W. Bancrofti, Brugia Spp., Onchocerca Volvulus, and Loa Loa |
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Lymphocytic Filariasis |
W. Bancrofti, Brugia Malayi, Brugi Timori From mosquitos and becomes blood borne post infection, adult worms then settle in the lymphatics Microfilariae peak at midnight typically Cause retrograde lypmhangitis (elephantitis), hydrocele, chyluria If in lungs can cause a pulmonary eosiniphilia leading to nocturnal asthma with infiltrates |
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Onchocerciasis |
Onchocerca Volvulus, chronic and progressive disease with eye, skin and lymph involvement Transmitted via Blackflies, microfilariae are skin dwelling Skin- nodules, pruritis, rash, depigmentation, lichenification Eye- keratitis, chorioretinitis Lymphatic Obstruction- hydrocele, elephantiasis Biopsy skin nodule |
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Ivermectin |
Avermectin drug, antiparasitic activity. Actinomcycete that has antihelminth effects Opens chloride gated channels in helminths causing an influx in Cl, hyperpolarization, and paralysis only kills microfilarae |
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Doxycycline |
can kill bacteria within the GI tube of helminths leading to death of the helminth. Wolbachia endobacteria |
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Loiasis |
from Loa Loa carrying deerfly blood borne microfilariae leading to subcutaneous tissue involvement Peak in circulation at Noon Can cause fatigue, urticaria, arthralgias, Calabar swelling, eyeworm Diagnosis: adult worm in conjunctiva Treat with DEC |
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Angiostrongylus Cantonensis |
Rat Lungworm (SE Asia) most common cause of eosiniphilic meningitis caused by ingestion of snail or paranteric hosts leads to headache, mengismsus, paresthesis Supportive therapy |
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Trichinellosis |
T. Spiralis, T. Nelsoni- from contaminated meat eat meat with cysts, cysts released in stomach, invade stomach lining, and encysts in muscle Eosiniphilia, leukocytosis Rx: natural recovery, prednisone |
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Toxocariasis |
T. Canis (dog) T. Catis (cat) from eggs in feces larvae hatch in intestine and migrate to liver spleen, eye, lung, or brain self limiting but can treat with albendazole and steroids |
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Anisakis Simplex |
inhabits stomach of final hosts, from raw or undercooked seafood tries to penetrate gastric mucosa but will die eventually leads to abscess formation or allergic reaction |
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Blood microfilaria at night |
lymphatic filariasis |
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Subcutaneous Nodules Skin Microfilaria |
Onchocerca Volvulus |
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Blood microfilaria day |
Loa Loa |
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Muscle Pain and Eosiniphilia |
Trichinella |
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Eosiniphilic Meningitis |
angiostrongylus |
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Abdominal pain from sushi |
Anisakis |
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Eosiniphilia + F + Liver enzymes |
visceral larva migrans |
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FUO Definition |
Old: temp >101 on several times, > 3 wks duration of illness or failure to reach diagnosis in 1 week Current: 3 outpatient visits or 3 days in hospital or 1 week of intelligent investigation |
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Fever = What? |
Inflammatory response from:
Endogenous: IL-1, 6, TNF, IFNs, (Infection, Cancer, Immune disease) Exogenous pyrogens: mostly infection, toxins (endotoxin) Disorders of Autoregulation (CNS disorder, poisoning, drug reaction) ` |
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Duration of Symptoms (FUO) |
Infection: rapid onset/resolution/death, chronic inflammation is an exception (Tb, lyme, syph/viral, parasite) Malignancy: declare themselves within weeks Rheum/Immuno:long histories of months to years |
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Lab Evals (First Tier) |
Inflammatory Markers: WBC, platelet count, shift to PMN's, ESR, CRP U/A, BUN, Cr, Bilirubin- renal, liver Amylase- pancreas LDH, Uric Acid- cancer |
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Lab Evals (Second Tier) |
Specific Serology (HBV, EBV, HIV, Bacteria (Lyme, syph, bartonella,) Protozoa Autoantibodies (dsDNA, ANA, RF) CT, MRI, U/S |
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Chloroquine |
concentrates in acidic parasite vesicles raising pH and inhibiting Heme Polymerase, leads to build up of toxic metabolites from host RBC. used to treat radical and acute cases, can be use prophylactically but does not harm exoerythrocitics Adverse outcomes in those with G6PD and P. Falciprum resistance |
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Primaquine |
often combined with chloroquine to kill hypnozoites in Vivax and Ovale can cause intravascular hemolysis in AA or darker skinned individuals |
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Quinine/Quinidine |
active against erythrocytic stage, good against chloroquine resistant P. Falciprum in combo with Doxycycline |
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Mefloquine |
prophylaxis and treatment of chloroquine resistant falciprum, can be used with artesunate to combat latency. contraindicated in patients with psych disorders or seizures |
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Atovaquone |
inhibits elctron transport to reduce membrane potential in mitcohcondria also called Malarone good prophylaxis of P. Falciprum |
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Pyrimethamine |
prodrug proguanil, inhibits dihydrofolate reducatse in plasmodia at concentrations at concentrations that are not harmful to host cells, also can cause megaloblastic anemia as a result of folate deficiency |
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Sulfonamides/Sulfones |
effective for prophylaxis of chloroquine resistant malaria. |
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Artemisinins |
Artensuate/Artemether can be used in conjunction with other meds to stop P. Falcip |
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Severe Malaria Treatment |
Give Artemisinin and Quinine IV STAT |
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Prophylaxis of Malaria |
Causal: Atoquavo-praguinal Suppressive: chloroquine, doxycycline, mefloquine (last resort) |
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Hygeine Hypothesis |
Increased hygeine has contributed to increased rates of allergy and autoimmune disease possibly due to the decrease in chronic parasitic worm infections (Ascaris being hightest rate) |
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Immune Response to Helminths |
1. Elevated IgE levels 2. Eosiniphilia 3. T-Cell production of IL-4, IL-5, IL-13 |
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Allergy Reactions |
Although children tested for allergen, they had little to no reaction. Chronic helminth infection may have raised threshold of basophils and mast cells to release granules |
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Autoimmune Reaction |
helminth protection against autoimmunity is due to Th2 responses surpressing Th1 responses Upregulates regulatory mechanisms of the immune system making it less likely to have cross-reactive cells |
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Measles |
coryza, conjunctivitis, fever and koplik spots with maculopapular rash on trunk and proximal extremities See multinucleated cells due to Factor F transmitted via respiratory droplets to respirtory epithelium. Controlled by T cells which lead to hypersensitivy and rash. |
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Mumps |
parotitis, orchitis, keratitis, pancreatitis, and pediatric deafness |
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Entamoeba Histolytica |
protozoan parasite that causes dysntery , bloody diarrhea, and can lead to abscess in the liver Leads to a flask shaped ulceration of mucosa Have a chitin wall that make them resistant to gastric acids, colonize gastric mucosa and trophozoites grow in anaerobic fashion Treat with metronidazole |
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Syphillis |
Spirochete, Treponoma Pallidum primary- painless chancre secondary- maculopapular rash on hands and feet tertiary- chronic infection, cardio/neuro involvement |
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Clostridium Infections |
gram - anaerobic spore formers C. Dificile in the presence of antibiotics will grow disproportionately (Toxin A and B lead to pseudomembrane) C. Tetani- puncture wound and tetanospasmin block release of NT and cause spastic paralysis C. Botulinim-prevents release of AcH and leads to flaccid paralysis C. Perfringens- gas gangrene, from Alpha-toxin |
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Rocky Mounted Spotted Fever |
From Ixodid tick- Rickettsia Ricketsii an obligate intracellular where they invade endothelial cells spreading to the body. Causes increased vascular permeability and edema Renal failure can be precipitated, microinfarcts of the brain |
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Ancient History |
spiritual, religious, agrarian, medicinal Drugs: opiates, tobacco, alcohol Potency: fermented |
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19th Century |
Urbanization, industrialized, child labor, Spanish American war Drugs: Narcotics, alcohol, tobacco |
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Early 20th Century |
WWI, Prohibition Drugs: alcohol, narcotics, tobacco Potency: black market distillation Harissons Narcotics Act: 1914 |
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Mid 20th Century |
WWII, Cold War, Vietnam, Baby Boomer, Psychos Drugs: alcohol, narcs, psychedelics, marijuana Anti-Drug Abuse Acts 1986 |
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Late 20th Century |
Persian gulf war, prescription drugs for children and elderly Synthetics and manufactured drugs Increased incarceration and mandated treatment |
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21st Century |
Internet Alcohol, caffeine, nicotine, performance enhancing drugs, marijuana, MDMA, designer drugs |
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DSM Critieria for Substance Dependance |
1. Tolerance 2. Withdrawal 3. Lack of control 4. Persistent desire 5. Reduced capacity to continue normal life |
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Risks for SA Disorders |
Adolescents: gang involvement, poor performance Adult: genetic factor, non-married, psychiatric disorders Sex: Men over women |
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Tolerance |
standard dose of drug produces diminished effects over long term use and frequency |
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Physical Dependance |
sustained and repeated administration of drug lead to condition in which normal physiologic function is dependent on drug |
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Cocaine |
stimulant- leads to increased HR, BP
Mechanism: blockades reuptake of NE, DA, and 5-HT, short acting on the nucleus accumbens Damage: Cardiovascular, nasal septum from constriction, and psychosis |
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Amphetamine |
Stimulant of CNS, give increased alertness, happiness, elation and euphoria
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Marijuana |
Causes increased HR, BP, euphoria, impairs short term memory and causes hunger mechanism: Receptors for THC are CB1 and 2 they inhibit adenylyl cyclase and are near areas of memory, and motor function. |
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LSD |
synthetic drug that causes dizziness, pupillary dilation, blurred vision, altered awareness, elation, and detachment. Mechanism: partial agonist of 5-HT |
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Anticholinergics |
Atropine, high does can lead to hallucinations |
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Phenycidine (PCP) |
synthetic, analgesic, amnesia, dysphoria, and violence Mechanism: blocks NMDA receptor |
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Alcohols |
Completely absorbed by GI goes to liver where it is oxidized by alcohol dehydrogenase to become acetylaldehyde. Acetylaldehyde is then changed to acetic acid by acetlyaldehyde dehydrogenase Brain: disinhibits DA receptors and causes feelings of euphoria |
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Opiates (Heroin) |
Mu Opiod R- Disinhibition |
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Cannabinoids |
CA-1 CA-2, disinhibition of DA |
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LSD |
5HT Receptor increases efflux |
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Caffeine |
blocks Adenosine R Increased arousal |
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Nicotine |
nACHnR disinhibits DA |
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Benzodiazepenes |
GABA-R Allosteric action |
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Alcohol |
GABA R allosteric blocks NMDA-R stoping Glu |
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Cocaine |
blocks DAT, NET, SERT Increasing concentrations in the synapse |
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Amphetamines |
blocks VMAT displacing DA leads to depletion of DA |
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MDMA |
blocks SERT, leads to serotonin depletion |
